ABSTRACT
Background: Multiple myeloma (MM) is one of the most common malignancies found in hematology. Aim: To describe the features of patients with MM and perform a survival analysis according to the different treatment protocols used between 2000 and 2016. Material and Methods: Analysis of the database of the Chilean national anti-neoplastic drug program. Information was obtained from 1,103 patients, with a median age of 64.5 years (range 27-95) and a male to female ratio of 1:1.2. Results: The mean overall survival (OS) of patients receiving or not receiving Thalidomide was 46 and 30 months, respectively (p < 0.01). The mean OS of patients treated before 2007 (treated with melphalan and prednisone) and between 2007 and 2012 (treated with thalidomide and dexamethasone) was 36 and 48 months respectively. In the group starting in 2013 (treated with cyclophosphamide, thalidomide and dexamethasone) the median survival had not been reached at 20 months of follow up (p = 0.01 for all comparisons). Autologous transplantation (AT) was carried out in only 18% of the eligible patients. The median OS of the patients who receive an AT had not been reached at 48 month compared with 36 month among those who did not received the procedure (p < 0.01). Conclusions: Even though overall survival has improved with time, new drugs must be introduced in our protocols to obtain similar results to those obtained worldwide.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Multiple Myeloma/drug therapy , Antineoplastic Combined Chemotherapy Protocols/classification , Survival Analysis , Chile/epidemiology , Retrospective Studies , Disease-Free Survival , Multiple Myeloma/mortalityABSTRACT
ABSTRACT Purpose: The aim of this study was to introduce a reproducible algorithm for the surgical management of late-onset (>2 months) bleb complications after trabeculectomy with mitomycin C. Methods: We performed a retrospective review of eyes treated using a reproducible algorithm approach by a single surgeon for the surgical management of late-onset bleb complications from July 2006 to April 2014. Exclusion criteria were bleb revision with less than 3 months of follow-up or bleb revision combined with other glaucoma procedures at the time of surgery. Success was evaluated using the Kaplan-Meier survival method and defined as achieving all of the following criteria: primary surgery indication resolved, no additional surgery required for decreasing the intraocular pressure (IOP), and IOP of ≥6 mmHg and ≤18 mmHg. Results: Twenty-three eyes from 20 patients were evaluated. Indications for bleb revision were hypotonic maculopathy (47.8%), bleb leak (30.4%), and dysesthetic bleb (21.7%). The overall primary outcome success rate calculated using the Kaplan-Meier survival method was 65.2% at 48 months. When the IOP target was changed to ≤15 mmHg, the bleb survival rate was 47.8% at 48 months. At the most recent postoperative visit, 95.7% of eyes had an IOP of ≤15 mmHg and 56.5% were being treated with an average of one medication per eye. One eye (4.3%) required a second bleb revision for persistent hypotony and two eyes required glaucoma surgery to reduce IOP during follow-up. Conclusions: An algorithm approach for the surgical management of late-onset bleb complications with a success rate similar to those reported in specialized literature is proposed. Randomized trials are needed to confirm the best surgical approach.
RESUMO Objetivo: Descrever um algoritmo reprodutível para o tratamento cirúrgico das complicações da bolha de início tardio (>2 meses) após trabeculectomia com mitomicina-C. Métodos: Revisão retrospectiva de olhos que foram submetidos a um algoritmo reprodutível para o tratamento cirúrgico das complicações da bolha de início tardio por um único cirurgião, de julho de 2006 a abril de 2014. Os critérios de exclusão foram revisão de bolha com menos de 3 meses de seguimento ou revisão de bolha combinado com outro procedimento antiglaucomatoso no momento da cirurgia. O sucesso foi avaliado pelo método de sobrevida de Kaplan-Meier e definidos como ter atingido todos os seguintes critérios: indicação de cirurgia primária resolvido, nenhuma cirurgia adicional necessária para diminuir a pressão intraocular (IOP), IOP ≥6 mmHg e ≤18 mmHg. Resultados: Vinte e três olhos de 20 pacientes foram incluídos. Indicações para revisão bolha foram maculopatia hipotônica (47,8%), extravasamento da bolha (30,4%) e bolha elevada (21,7%). A taxa de sucesso do resultado primário global calculada pelo método de sobrevivência de Kaplan-Meier foi de 65,2% aos 48 meses. Quando a IOP foi diminuída para ≤15mmHg, a taxa de sobrevivência bolha foi de 47,8% em 48 meses. Na visita pós-operatória mais recente, 95,7% dos olhos apresentavam PIO ≤15mmHg e 56,5% estavam sob tratamento com uma média de um medicamento por olho. Um olho (4,3%) necessitou de uma segunda revisão da bolha para hipotonia persistente e dois olhos necessitaram cirurgia de antiglaucomatosa para reduzir a IOP durante o seguimento. Conclusões: Um algoritmo de abordagem para o tratamento cirúrgico das complicações tardias da bolha com uma taxa de sucesso semelhante aos relatados na literatura especializada é proposto. Ensaios clínicos randomizados são necessários para confirmar a melhor abordagem cirúrgica.
Subject(s)
Humans , Male , Female , Middle Aged , Postoperative Complications/surgery , Reoperation , Algorithms , Trabeculectomy/adverse effects , Glaucoma/surgery , Blister/surgery , Postoperative Complications/drug therapy , Ocular Hypotension/surgery , Ocular Hypotension/etiology , Retrospective Studies , Follow-Up Studies , Blister/etiology , Mitomycin/therapeutic use , Cross-Linking Reagents/therapeutic use , Kaplan-Meier Estimate , Intraocular PressureABSTRACT
BACKGROUND: Tear desiccation on a glass surface followed by transmitted-light microscopy has served as diagnostic test for dry eye. Four distinctive morphological domains (zones I, II, III and transition band) have been recently recognized in tear microdesiccates. Physicochemical dissimilarities among those domains hamper comprehensive microscopic examination of tear microdesiccates. Optimal observation conditions of entire tear microdesiccates are now investigated. One-µl aliquots of tear collected from individual healthy eyes were dried at ambient conditions on microscope slides. Tear microdesiccates were examined by combining low-magnification objective lenses with transmitted-light microscopy (brightfield, phase contrasts Ph1,2,3 and darkfield. RESULTS: Fern-like structures (zones II and III) were visible with all illumination methods excepting brightfield. Zone I was the microdesiccate domain displaying the most noticeable illumination-dependent variations, namely transparent band delimited by an outer rim (Ph1, Ph2), homogeneous compactly built structure (brightfield) or invisible domain (darkfield, Ph3). Intermediate positions of the condenser (BF/Ph1, Ph1/Ph2) showed a structured roughly cylindrical zone I. The transition band also varied from invisibility (brightfield) to a well-defined domain comprising interwoven filamentous elements (phase contrasts, darkfield. CONCLUSIONS: Imaging of entire tear microdesiccates by transmitted-light microscopy depends upon illumination. A more comprehensive description of tear microdesiccates can be achieved by combining illumination methods.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , Tears/diagnostic imaging , Dry Eye Syndromes/diagnostic imaging , Microscopy, Phase-Contrast/methods , Desiccation/methods , Reference Values , Surface Properties , Tears/metabolism , Lighting , Reproducibility of Results , LightABSTRACT
El presente estudio es de tipo exploratorio y aborda la asociación entre las dimensiones del modelo de estrés laboral (Effort Reward Imbalance, DER), y el modelo de salud mental (General Health Questionnaire, GHQ-28). Se basa en entrevistas y encuestas realizadas a 68 trabajadores del sector salud en 3 lugares de Santiago, Chile (un hospital privado, un hospital público y un consultorio de atención primaria). Los participantes incluyen auxiliares de enfermería, técnicos paramédicos y personal administrativo de varios departamentos. Se encontró asociaciones positivas entre el mal estado de salud mental y la presencia de estrés laboral.
This study explored the association between dimensions of a job-stress model, Effort-Reward Imbalance (ERI), and a mental health model, the General Health Questionnaire (GHQ-28). The exploratory study was based on interviews and self-response questionnaires given to 68 health care workers at three worksites in Santiago, Chile (a large public hospital, a large private hospital, and a primary care clinic). The participants included nursing assistants, technicians, and administrative staff from various departments. Positive associations were found between bad mental health and job stress.
Subject(s)
Humans , Male , Female , Burnout, Professional , Health Workforce , Psychosocial Impact , Health Services , ChileABSTRACT
Several single-nucleotide polymorphisms have been identified in the human TNF gene promoter. The polymorphism at position-308 (TNF-308), which involves substituting G for A and designing the TNF2 allele, leads to a higher rate of TNF gene transcription than the wild-type TNF1 allele in in vitro expression studies. It has also been linked to increased susceptibility to a variety of illnesses. Using PCR-RFLP analysis we detected significant differences in the TNF-308 genotypes of Chilean and other populations. We conclude that there is a gradient in the distribution of the TNF2 allele according to ethnicity; we have also hypothesized that populations bearing a higher proportion of the TNF2 allele may have an increased predisposition toward or incidence of several chronic metabolic, degenerative, inflammatory and autoimmune diseases.
Subject(s)
Humans , Alleles , Gene Frequency , Genetic Predisposition to Disease , Polymorphism, Genetic , Promoter Regions, Genetic , Tumor Necrosis Factor-alpha , Chile , Genetic Predisposition to Disease , Genotype , Polymerase Chain Reaction , Polymorphism, Restriction Fragment LengthABSTRACT
El objetivo de este trabajo es presentar las alteraciones del habla en la histeria de conversión. La histeria de conversión es una enfermedad que produce alteraciones del habla con bastante frecuencia y en forma muy atípica y abigarrada. Se presenta una casuística de 136 pacientes con histeria de conversión en un período comprendido entre 1962 y 1993 en el Servicio de Neurología, Hospital del Salvador. Se trata de 54 hombres y 82 mujeres, en total 136 pacientes, de los cuales 10 hombres y 25 mujeres, en total 35 pacientes, presentaron alteraciones del habla. Las alteraciones del habla más frecuentes fueron afonía en 17 pacientes (5 hombres y 12 mujeres), mutismo en 6 pacientes (2 hombres y 4 mujeres), pedolalia en 5 pacientes (1 hombre y 5 mujeres), habla como extranjero 4 pacientes (1 hombre y 3 mujeres), inversión de palabras en 3 pacientes (1 hombre y 2 mujeres). Se observa en estos pacientes una utilización del habla claramente distorsionada la cual es caprichosa por su fugacidad y variabilidad, pero dentro de una manifestación clínica consecuente y unitaria y hecho importante que compromete todas las funciones del habla; respiración, fonación, articulación, entonación y resonancia. Se destaca que las alteraciones del habla en la histeria de conversión son importantes de buscar como signo semiológico propio de la enfermedad y así afirmar el diagnóstico positivo de ellas
Subject(s)
Humans , Male , Female , Speech Disorders/classification , Conversion Disorder/physiopathology , Aphonia , Audiology , Language Disorders , Mutism , Speech Disorders/therapy , Speech TherapyABSTRACT
Se analizan 126 casos de hidatidosis pleuropulmonar y quistes abdominales complicados del toráx, tratados durante los últimos dieciocho años. Se propone una clasificación anátomo-patológica del estado de los mismos en el momento de realizar la cirugía y las situaciones más comunes con que debe enfrentarse el cirujano; se valoran los elementos diagnósticos al ingreso, el tratamiento realizado (técnicas conservadoras y de exéresis), complicaciones intra y postoperatorias, morbilidad y mortalidad. Se evalúan los resultados obtenidos con la conducta instituída