ABSTRACT
The COVID-19 pandemic had a significant impact on the management of chronic diseases such as cancer. Comprehensive care, from preventive strategies to palliative care for cancer patients, has been strongly affected by multiple factors associated with the pandemic. The hampering of early detection, timely diagnosis, as well as recommended treatment and follow-up are side effects of SARS-CoV-2 infection worldwide that will undoubtedly produce changes in the prognosis and survival of oncologic patients. Through this narrative review, we report global and local figures of these effects, as a first approach to tackle the challenge of updating cancer care.
ABSTRACT
El síndrome respiratorio agudo severo por coronavirus (SARS-CoV-2) ha generado una pandemia que ha requerido ajustes significativos en los sistemas de salud mundiales, tanto a nivel hospitalario como ambulatorio. Para patologías crónicas no transmisibles, como las oncológicas, esta pandemia ha tenido repercusiones importantes especialmente a nivel primario de atención. Se ha afectado el manejo oncológico integral, desde la detección precoz, el tratamiento, los exámenes de control y el seguimiento de los pacientes. Entre ellos destaca la disminución, a nivel mundial, del número de procedimientos diagnósticos digestivos, de imágenes, citológicos, quirúrgicos, de tratamiento sistémico, consultas e interconsultas oncológicas. Diversas organizaciones han recopilado cifras de ello y han proyectado cifras de como la disminución de diagnóstico oportuno o el retraso y/o interrupción del tratamiento repercutirán en un aumento de la morbimortalidad. Por ello, han elaborado guías de recomendaciones para minimizar el riesgo de contagio por coronavirus, para retomar a la brevedad el nivel de atención. Esta revisión ejemplifica el impacto de la pandemia de COVID-19 en el manejo habitual de los pacientes con patologías oncológicas, lo que permitirá dimensionar su efecto, así como delinear un plan multidisciplinario de recuperación y puesta al día en el manejo integral de los pacientes oncológicos. (AU)
Subject(s)
Humans , COVID-19/epidemiology , Neoplasms/diagnosis , Neoplasms/therapy , Neoplasms/epidemiology , Comorbidity , Time-to-Treatment , SARS-CoV-2ABSTRACT
Background: Atrial fibrillation is associated to a high risk of systemic embolism and to hypercoagulability. Aim: To evaluate the activation of the coagulation cascade through determinations of the thrombin-antithrombin complex in patients with atrial fibrillation and to correlate this data with the clinical and echocardiographic risk factors for systemic embolism. Patients and Methods: In 53 patients with atrial fibrillation plasma levels of the thrombin-antithrombin complex were determined on admission to a coronary care unit and 30 days later. Using a univariate and multiple regression analysis, the association basal thrombin-antithrombin with the duration of the arrhythmia, age over 70 years, previous use of antiplatelet agents, history of hypertension, mitral valve disease, diabetes, heart failure, previous systemic embolism, left atrial diameter and the presence of spontaneous contrast echo or thrombus in the left atrial appendage, was studied. Results: Basal thrombin-antithrombin values were 40.1ñ69 mg/L (Median 8.34 [3.0-47.5]) compared to 2.7ñ3.3 mg/L in healthy controls (p <0.001). No significant correlation was found between activation of the coagulation cascade and risk factors for systemic embolism. There were no significant differences in thrombin-antithrombin values between patients with chronic or paroxysmal atrial fibrillation (29.5ñ43 mg/L and 49.4ñ83 mg/L respectively). Mean thrombin-antithrombin values in patients under antiplatelet agents were lower than in those without treatment (17.3ñ43 vs 66.8ñ127 mg/L; p=0.018). Conclusions: The activation of the coagulation cascade in patients with atrial fibrillation was confirmed. However, no association of this activation with well known clinical and echocardiographic risk factors for systemic embolism, was found. Previous antiplatelet treatment prevented a higher activation of the coagulation cascade
Subject(s)
Humans , Male , Female , Thrombophilia , Atrial Fibrillation/complications , Thromboembolism , Echocardiography , Case-Control Studies , Risk Factors , Hemostasis , Platelet Aggregation Inhibitors/therapeutic use , Coagulation Protein Disorders/diagnosisABSTRACT
Se analizan los mecanismos que interfieren en la producción del dolor, su efecto fisiopatológico y los factores que interfieren en su manejo. Se presenta una revisión bibliográfica actualizada de la farmacología y farmacocinética del Ketorolaco analizando sus propiedades analgésicas, anti-inflamatorias y antipiréticas así como sus efectos a nivel sistémico con especial énfasis en los que produce efectos adversos severos: gastrointestinales, renal y hematológico. Se resume su uso terapéutico en niños y adultos incluyendo efectos detectados en el embarazo y parto. Se desarrolla el proceso de enfermería a través de diagnósticos de los principales riesgos potenciales de su uso a nivel de atención primaria y secundaria