ABSTRACT
Introducción: La pandemia por COVID-19 es un problema de salud mundial. Habitualmente cursa con sintomatología leve y 5% de los afectados evoluciona a cuadros graves que requieren de cuidados intensivos. Objetivo: Determinar el perfil clínico, la mortalidad y factores asociados a la misma en pacientes con COVID-19 ingresados al Departamento de Cuidados Intensivos de Adultos, del Hospital de Clínicas de la Facultad de Ciencias Médicas, Universidad Nacional de Asunción, Paraguay, entre agosto de 2020 a agosto de 2021. Pacientes y Método: Se realizó un estudio observacional analítico de corte transverso. Los datos se obtuvieron a partir de las historias clínicas de los pacientes. Resultados: Se incluyeron 214 pacientes críticos entre 21 y 85 años de edad (mediana 54 años), 57,9% del sexo masculino, 85% provenientes del Departamento Central y Asunción. La mortalidad global fue de 38,3%. Se asociaron significativamente con la mortalidad una edad ≥ 60 años, las comorbilidades (diabetes mellitus, cardiopatía, enfermedad renal crónica), los índices de gravedad (APACHE II, SOFA, inicial), procalcitonina elevada, utilización de vasopresor, asistencia respiratoria mecánica y utilización del decúbito prono; así como la presencia de SDRA y el requerimiento de depuración extrarenal. En el análisis multivariado (por regresión logística) los factores de riesgo de mortalidad independientes fueron: la edad mayor de 60 años, la utilización de noradrenalina y depuración extra-renal durante la hospitalización. Conclusión: Nuestra mortalidad es similar a la reportada internacionalmente. Los factores de riesgo de mortalidad identificados muestran una población con mayores posibilidades de un desenlace desfavorable.
Background: The COVID-19 pandemic is a world health issue. Generally, it is with mild and around 5% evolves to a severe disease that requires intensive care. Aim: To determine the clinical profile, mortality and associated factors in COVID-19 patients admitted at the Adult Intensive Care Department at the Hospital de Clinicas, between August 2020 and August 2021. Methods: Cross-section observational analytic study. Data was obtained from clinical charts. Results: 214 patients were included, with an average age of 54 years, 57.9% male. Overall mortality was 38.3%. Factors associated significantly with mortality were: ≥60 years of age, comorbidity (diabetes mellitus, heart disease, chronic renal disease), severity index (APACHE II, initial SOFA), high procalcitonin, use of vasopressor, mechanical respiratory assistance and prone decubitus; as well as the presence of acute respiratory distress syndrome and hemodialysis. Multi varied analysis identified as mortality risk factors: ≥60 years of age, noradrenaline use and hemodialysis. Conclusion: Mortality rate is similar to that reported worldwide. Mortality risk factors identified show a population with higher possibilities for unfavorable outcome.
ABSTRACT
ABSTRACT Background Papillary cystadenoma is a rare benign neoplasm of the epididymis. It may occur sporadically or in association with von Hippel-Lindau disease (VHLD). Papillary cystadenoma of the epididymis (PCE) is a benign mimic of metastatic clear cell renal cell carcinoma (CCRCC) given their histologic similarities. Case presentation Herein, we present the case of a 40-year-old man with a four-year history of microhematuria and a recently detected right paratesticular mass. A testicular sonogram revealed a hypoechoic, hypervascular solid mass in the right epididymal head treated by surgical excision. Histopathological examination demonstrated a 1.1 cm papillary cystadenoma of the epididymis. Genetic testing performed later showed no signs of VHLD. However, heterozygous mutations in three genes - CASR, POT1, and RAD51D - were found which have never been reported in PCE before. Conclusions Papillary cystadenoma of the epididymis should always be considered in the differential diagnosis of epididymal lesions, especially those that are cystic. The mainstay of treatment remains surgical excision, which provides an excellent prognosis.
ABSTRACT
Background Predominantly intraosseous meningiomas are rare entities that include true primary intraosseous meningiomas (PIM), as well as meningiomas that may show extensive bone involvement, such as en plaque meningiomas. Different hypotheses have been proposed to decipher the origin of PIMs, such as ectopic arachnoid cap cell entrapment during birth or after trauma. Surgical resection is the treatment of choice of such lesions. Case presentation We present a case of a 65-year-old man with an enlarging mass in the parieto-occipital region that grew slowly and progressively over 13 years, following head trauma during a motor vehicle accident. One year prior to presentation, he started experiencing daily holocranial headaches and blurry vision. CT and MRI studies revealed a permeative midline calvarial lesion measuring 14 cm in greatest dimension with extensive periosteal reaction, extension into the subcutaneous soft tissues, subjacent dural thickening and intracranial extension with invasion of the superior sagittal sinus. The favored pre-operative clinical diagnosis was osteosarcoma. The abnormal calvarium was excised and histopathological examination confirmed the diagnosis of a predominantly intraosseous calvarial meningioma, WHO grade I. Conclusions The present case highlights the importance of histopathologic diagnosis in guiding therapeutic decisions and reiterates the necessity of considering PIM or meningiomas with extensive intraosseous component in the differential diagnosis of calvarial masses, even when imaging suggests a neoplasm with aggressive behavior, such as osteosarcoma.
Subject(s)
Humans , Male , Aged , Bone Neoplasms/complications , Meningioma/complications , Osteosarcoma/complications , Diagnosis, Differential , Craniocerebral Trauma/complicationsABSTRACT
El objetivo del presente trabajo fue determinar la expresión de diversos biomarcadores moleculares en liquen plano oral para ayudar a comprender su conducta biológica. Materiales y métodos: Se realizó un estudio inmunohistoquímico en 40 casos de liquen plano oral contra BAX, BCL-2, CD-138, Histona 3, Ki-67, MCM3 y p53, en el Área de Patología Molecular Estomatológica de la Facultad de Odontología, UDELAR, Uruguay. Resultados: Se observó mayor expresión de BAX en contraposición con BCL-2, sugiriendo un comportamiento proapoptótico, respaldado a su vez por la ausencia de expresión de p53. La expresión de los marcadores de proliferación celular fue en todo el tejido lesional observado, sugiriendo así alteraciones de la proliferación. CD-138 se expresó de manera intensa y uniforme, determinando una baja alteración de las uniones intercelulares para estos casos. Conclusiones: La alteración en la expresión de las proteínas estudiadas sugiere un trastorno en los mecanismos proliferativos y apoptóticos, los cuales se asocian con una conducta patológica de la mucosa oral.
This study aims to establish an association of the expression of specific biomarkers in oral lichen planus to understandits biological behavior. Materials and methods: An immunohistochemistry study was conducted in 40 cases of oral lichen planus against BAX, BCL-2, CD138, Histone 3, Ki-67, MCM3 and p53 at the Molecular Pathology Area of the School of Dentistry, UDELAR, Uruguay. Results: A greater expression of BAX was detected compared to BCL-2, suggesting a pro-apoptotic behavior, supported by the absence of p53 expression. MCM3 expression was more sensitive than Ki-67, considering proliferation alterations. CD-138 had a more intense and uniform expression, determining fewer intercellular adhesion alterations. Conclusions: The expression of the proteins studied suggests an alteration in proliferative and apoptotic mechanisms, associated with a pathological behavior of the oral mucosa.
O objetivo deste trabalho foi determinar a expressão de vários biomarcadores moleculares no líquen plano oral para ajudar a compreender seu comportamento biológico. Materiais emétodos: Foi realizado um estudo imunohistoquímico em 40 casos de líquen plano oral contra BAX, BCL-2, CD-138, Histona 3, Ki-67, MCM3 e p53, na área de Patologia Molecular Estomatológica da Faculdade de Odontologia , UDELAR, Uruguai. Resultados: Observou-se aumento da expressão de BAX em contraste com BCL-2, sugerindo um comportamento proapoptótico, apoiado por sua vez pela ausência da expressão de p53. A expressão de marcadores de proliferação celular foi observada em todo o tecido da lesão, sugerindo alterações na proliferação. CD-138 foi expressado de maneira intensa e uniforme, determinando uma baixa alteração das junções intercelulares para esses casos. Conclusões: A alteração na expressão das proteínas estudadas sugere um distúrbio nos mecanismos proliferativos e apoptóticos, os quais estão associados a um comportamento patológico da mucosa oral.
Subject(s)
Humans , Lichen Planus, Oral , BiomarkersABSTRACT
Se reporta el caso de un recién nacido con características del síndrome de Smith-Lemli-Opitz, con genitales femeninos y cariotipo 46, XY, el cual presenta además signos del llamado síndrome de Bandas Amnioticas (ADAM), constituye el primer caso reportado de esta asociación, se revisa la literatura y se hace la correlación entre el grado de compromiso genital y la severidad de la expresión fenotípica