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Int. braz. j. urol ; 47(2): 359-373, Mar.-Apr. 2021. tab
Article in English | LILACS | ID: biblio-1154467


ABSTRACT Background: Non-metastatic castration resistant prostate cancer (M0 CRPC) has seen important developments in drugs and diagnostic tools in the last two years. New hormonal agents have demonstrated improvement in metastasis free survival in M0 CRPC patients and have been approved by regulatory agencies in Brazil. Additionally, newer and more sensitive imaging tools are able to detect metastasis earlier than before, which will impact the percentage of patients staged as M0 CRPC. Based on the available international guidelines, a group of Brazilian urology and medical oncology experts developed and completed a survey on the diagnosis and treatment of M0 CRPC in Brazil. These results are reviewed and summarized and associated recommendations are provided. Objective: To present survey results on management of M0 CRPC in Brazil. Design, setting, and participants: A panel of six Brazilian prostate cancer experts determined 64 questions concerning the main areas of interest: 1) staging tools, 2) treatments, 3) side effects of systemic treatment/s, and 4) osteoclast-targeted therapy. A larger panel of 28 Brazilian prostate cancer experts answered these questions in order to create country-specific recommendations discussed in this manuscript. Outcome measurements and statistical analysis: The panel voted publicly but anonymously on the predefined questions. These answers are the panelists' opinions, not a literature review or meta-analysis. Therapies not yet approved in Brazil were excluded from answer options. Each question had five to seven relevant answers including two non-answers. Results were tabulated in real time. Conclusions: The results and recommendations presented can be used by Brazilian physicians to support the management of M0 CRPC patients. Individual clinical decision making should be supported by available data, however, for Brazil, guidelines for diagnosis and management of M0 CRPC patients have not been developed. This document will serve as a point of reference when confronting this disease stage.

Humans , Male , Physicians , Prostatic Neoplasms, Castration-Resistant/diagnosis , Prostatic Neoplasms, Castration-Resistant/drug therapy , Perception , Brazil , Treatment Outcome , Patient Selection , Consensus
Artrosc. (B. Aires) ; 28(2): 134-139, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1282678


Introducción: el objetivo de este trabajo es reportar y analizar los resultados con un mínimo de dos años de seguimiento en pacientes no deportistas tratados por lesión SLAP. Secundariamente, analizar las variables: tipo se lesión, score ASES y antecedente de trauma y su relación con el retorno a las actividades habituales.Materiales y métodos: se evaluaron veintinueve pacientes tratados por lesiones de SLAP con seguimiento mínimo de veinticuatro meses, operados por dolor, sin inestabilidad evidente, 82.76% fueron hombres. La edad promedio fue 36.82 años. Se evaluó la función en el preoperatorio y en el último seguimiento con el score de ASES, movilidad y retorno a las actividades previas. Se analizaron los resultados y los factores de riesgo para impedir este retorno.Resultados: catorce pacientes (48.28%) asociaron un trauma. Fueron ocho (27.59%) SLAP tipo I, diecisiete (58.62%) tipo II y cuatro pacientes (13.79) tipo V. Retornaron a su actividad previa veintiuno de ellos (72.41%). Se repararon las lesiones SLAP tipo II y V y se realizó desbridamiento en aquellas tipo I. Se obtuvo una diferencia estadísticamente significativa entre los valores pre y postoperatorios con mejoría de la movilidad en flexión anterior de 163.96 a 173.4°, rotación interna de 58.27 a 71.72°, rotación externa de 61.55 a 76.89° (p <0.05) y en el score ASES preoperatorio 56.51 a 90.24 (p <0.05). No así en el subgrupo que no retornó a su actividad previa. La complejidad de la lesión SLAP influyó negativamente en dicho retorno.Conclusión: los resultados con la reparación o desbridamiento artroscópico son funcionales, con alta tasa de retorno a la actividad previa. Los peores resultados se relacionaron a las lesiones SLAP de mayor severidad

Introduction: The objective of this work will be to report and analyze the results with a minimum of two years of follow-up in non-athlete patients treated for SLAP lesion and to analyze the following variables: type of SLAP, ASES score and history of trauma with the return to normal activities. Materials and methods: twenty-nine patients treated for SLAP lesions with a minimum follow-up of twenty-four months, operated due to pain, without evident instability were evaluated, 82.76% were male. The average age was 36.82. The function was evaluated in the preoperative period, and in the last follow-up with the ASES score and mobility. The results and risk factors for not returning to their previous activity were analyzed as well. Results: fourteen patients (48.28%) had associated trauma. There were eight (27.59%) SLAPS type I, seventeen (58.62) type II and four (13.79) type V. Twenty-one (72.4%) patients returned to their previous activity. SLAP type II and V were repaired and type I were debrided. A statistically significant difference was obtained between the preoperative and final evaluation of anterior flexion (163.96 to 173.4°), internal rotation (58.27 to 71.72°), external rotation (61.55 to 76.89°) ( p <0.05) and ASES score (56.51 to 90.24) (p <0.05). Instead, this does not occur in the subgroup that did not return to its previous activities. The complexity of the SLAP lesion influenced this return. Conclusions: the results of SLAP lesion arthroscopic reconstruction are functional with a high rate of return to the patient previous activity. The worst results are related to greater slap severity

Adult , Arthroscopy , Treatment Outcome , Patient Selection , Shoulder Injuries
Rev. bras. ortop ; 55(6): 715-721, Nov.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1156207


Abstract Objective To evaluate the functional outcomes of patients diagnosed with femoroacetabular impingement (FAI) older than 60 years, compared with those of patients of age 40 years or younger. Methods This was a retrospective review of patients with FAI who underwent hip arthroscopy between 2010 and 2015. The patients were adults aged over 60 years with Tönnis ≤ 1 matched in a 1:1 ratio with adults aged 40 years or younger, according to the type of deformity (cam, pincer, or mixed), sex, and the date when the surgery was performed. Results Thirty-four patients were included in each group. The mean age was 30.6 ± 6.9 years and 65.6 ± 4.6 years in the control and case groups, respectively. There were no significant differences between the groups at 1-year follow-up (p > 0.05). In the group with older patients (case group), we observed a change in the total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score from 46.3 to 22.0 in the 1st postoperative year, while the control cases improved in the WOMAC score from 38.1 to 7.2 in relation to the preoperative stage. Conclusion In the group of patients ≤ 40 years old, a considerable change was observed in the WOMAC score without a statistical significance compared with the > 60 years group. This observation suggests that hip arthroscopy is beneficial when there is an appropriate selection of patients with FAI, regardless the age of the patient.

Resumo Objetivo Avaliar os resultados funcionais de pacientes diagnosticados com impacto femoroacetabular (IFA) e com mais de 60 anos de idade em comparação aos resultados de pacientes com até 40 anos de idade. Métodos Esta é uma revisão retrospectiva de pacientes com IFA submetidos à artroscopia do quadril entre 2010 e 2015. Os pacientes eram adultos com mais de 60 anos de idade e Tönnis ≤ 1, alocados na proporção de 1:1 com adultos de até 40 anos de idade, de acordo com o tipo de deformidade (came, pincer, ou misto), sexo e data de realização da cirurgia. Resultados Trinta e quatro pacientes foram incluídos em cada grupo. A idade média foi de 30,6 ± 6,9 anos e 65,6 ± 4,6 anos nos grupos controle e de casos, respectivamente. Não houve diferenças significativas entre os grupos no acompanhamento de 1 ano (p > 0.05). No primeiro ano após a cirurgia, a pontuação Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) passou de 46,3 para 22,0 no grupo de pacientes mais velhos (casos) e de 38,1 para 7,2 no grupo controle em comparação ao estágio pré-operatório. Conclusão O grupo de pacientes com até 40 anos de idade apresentou uma mudança considerável na pontuação WOMAC, mas sem significado estatístico em comparação ao grupo de pacientes acima de 60 anos. Essa observação sugere que a artroscopia do quadril é benéfica quando a seleção de pacientes com IFA é apropriada, independentemente da idade dos indivíduos.

Humans , Male , Female , Adult , Middle Aged , Osteoarthritis , Arthroscopy , General Surgery , Congenital Abnormalities , Training Support , Control Groups , Patient Selection , Femoracetabular Impingement , Health Facility Moving , Hip
Medwave ; 20(9): e8051, 30-10-2020.
Article in English, Spanish | LILACS | ID: biblio-1141139


Introducción La infección por SARS CoV-2 fue declarada pandemia el 11 de marzo de 2020. Desde entonces, se han propuesto e iniciado numerosos estudios, cuyo propósito incluye prevención, diagnóstico, manejo y tratamiento de esta nueva enfermedad. Objetivo Identificar y categorizar los estudios intervencionales hasta mayo de 20202 relacionados con la infección por SARS-CoV-2, de acuerdo con población y ubicación geográfica (con énfasis en Latinoamérica) y comprobar si existe correlación según el propósito, fase y estado de reclutamiento de los mismos. Metodología Se seleccionaron 1672 de los 1705 estudios disponibles en la plataforma de ensayos clínicos de la Organización Mundial de la Salud (OMS) relacionados con COVID-19. Se utilizaron las herramientas Jupyter y Python para el procesamiento y depuración de datos. Resultados Se encontraron 1672 estudios de tipo intervencional relacionados con la infección por SARS-CoV-2. China, Estados Unidos, Irán, Francia y España son los países que participan en mayor cantidad de estudios, mientras que solamente 4,1% proviene de América Latina (mayoritaria-mente brasileños). Las investigaciones que se centran únicamente en adultos mayores son 28, y solamente 10 estudios se basan exclusivamente en población menor de 19 años. Conclusión El interés mundial por esta nueva enfermedad se ve reflejado en la cantidad creciente de estudios intervencionales que se han realizado hasta la fecha. Sin embargo, los estudios analizados no abarcan proporcionalmente los grupos etarios más vulnerables, y no cuentan con una participa-ción equitativa de los países del orbe. En el caso de América Latina se agudiza esta problemática debido a las limitaciones sociales, económicas y políticas de la región. Debido a que es una enfermedad emergente, aún no existe suficiente información para poder establecer correlaciones contundentes entre las variables estudiadas. La estandarización definitiva de protocolos resulta prematura, ya que la mayoría de los estudios se encuentran en curso.

Introduction The World Health Organization declared the disease caused by the novel coronavirus (SARS-CoV-2), a pandemic on March 11, 2020. Several studies have been proposed and started since then, mainly covering prevention, diagnosis, management, and treatment. Objective To identify and categorize all intervention studies up to the end of May related to SARS-CoV-2 infection, according to population and geo-graphical location (emphasis in Latin America) and to verify if there is any correlation according to purpose, phase, and recruitment status. Methods One thousand six hundred seventy-two trials were selected from 1705 until May 24 on the World Health Organization clinical trials platform related to COVID-19. Jupyter and Python tools were used for data processing and cleaning. Results One thousand six hundred seventy-two intervention studies related to SARS-CoV-2 infection were found. China, The United States, Iran, France, and Spain are the countries participating in the largest number of studies, while only 4,1% are from Latin America (mostly Brazilian). 28 studies are focusing only on older adults, and ten studies are based exclusively on populations under 19 years of age. Conclusion The worldwide interest in this new disease is reflected in the increasing number of intervention studies that are being carried out to date. How-ever, the studies analyzed do not cover the most vulnerable age groups proportionally and do not have equitable participation of all the coun-tries. In Latin America, this problem is exacerbated by the region's social, economic, and political limitations. Because it is an emerging disease, there is still not enough information to establish strong correlations between the analyzed variables, and the standardization of protocols is not yet definite because most of the studies are in progress.

Humans , Clinical Trials as Topic/statistics & numerical data , SARS-CoV-2/isolation & purification , COVID-19/therapy , Patient Selection , Pandemics/prevention & control , COVID-19/diagnosis , COVID-19/prevention & control
Rev. chil. obstet. ginecol. (En línea) ; 85(supl.1): S122-S130, set. 2020. graf
Article in Spanish | LILACS | ID: biblio-1138657


La pandemia de SARS-CoV-2 es una emergencia sanitaria sin precedentes, que ha implicado un reordenamiento en la priorización de procedimientos médicos electivos, frente a un potencial colapso del sistema de salud a nivel mundial y riesgo de contagio del personal y pacientes. Al igual que en el resto del mundo, en Chile la mayoría de los centros de medicina reproductiva han debido suspender sus diferentes terapias de reproducción asistida (TRA). Sin embargo, a raiz de la disminución del número de contagios y mayor evidencia científica disponible, la Sociedad Europea de Reproducción Humana y Embriología (ESHRE) ha recomendado reiniciar los ciclos de medicina reproductiva de forma gradual, a través de sistemas de triage, priorizando pacientes por medio de la generación de distintos escenarios. Considerando esta recomendación, se realizó una revisión sobre la evidencia existente respecto a SARS-CoV-2 / COVID-19 en medicina reproductiva recopilando diferentes directrices de las principales sociedades internacionales, con el objetivo de generar una recomendación ajustada a la realidad nacional.

SARS-CoV-2 pandemic is an unprecedented health emergency, which involves a reorganization of elective procedures, facing a potential global health system collapse. In Chile, as in the rest of the world. most reproductive medicine centers have suspended their different assisted reproduction therapies (ART). However, due to the decrease in the number of infections and due to a greater collection of scientific evidence, the European Society for Human Reproduction and Embryology (ESHRE) have recommended restarting cycles gradually through triage systems, prioritizing patients through the generation of different scenarios. With this in mind, we carried out a review of the existing evidence so far regarding SARS-CoV-2 and reproductive medicine, and we tried to compile the different guidelines of the main international societies, to generate a recommendation adjusted to our local scenario.

Humans , Female , Pneumonia, Viral/prevention & control , Coronavirus Infections/prevention & control , Reproductive Medicine/standards , Reproductive Techniques, Assisted/standards , Betacoronavirus , Ovulation Induction , Fertilization in Vitro , Triage , Practice Guidelines as Topic , Patient Selection , Embryo Transfer , Pandemics/prevention & control
Rev. chil. pediatr ; 91(4): 631-641, ago. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1138682


Resumen: En los últimos años, la obesidad severa en adolescentes ha aumentado a nivel mundial y Chile no es la excepción a este fenómeno. Es conocido que esta condición aumenta exponencialmente los riesgos para la salud y se asocia a mortalidad prematura. Desde el año 2008, diversas guías de tratamiento de obesidad pediátrica han incluido a la cirugía bariátrica como una estrategia de tratamiento para adolescentes obesos severos seleccionados. Estos procedimientos han mostrado ser seguros y eficaces en adultos. Un cuerpo emergente de evidencia demuestra que, en centros especializados, en el corto y mediano plazo se obtendrían resultados similares en adolescentes. Sin embargo, en este grupo de pacientes, la cirugía bariátrica tiene implícitos otros riesgos inherentes a la etapa de desarrollo en que se encuentran, y los resultados y complicaciones especialmente de largo plazo en gran medida son aún desconocidos. Por lo anterior y para el logro de los resultados esperados, es muy importante que la selección de pacientes, la cirugía y el seguimiento, sean realizados por equipos multidisciplinarios calificados, en centros hospitalarios que cuenten con la infraestructura adecuada, siendo imprescin dible la adherencia de por vida al seguimiento médico y nutricional. El objetivo de este documento es presentar la postura de la Rama de Nutrición de la Sociedad Chilena de Pediatría (SOCHIPE) frente a las diversas aristas a considerar para la adecuada indicación de estos procedimientos en adolescentes obesos severos.

Abstract: In recent years, severe obesity in adolescents has been rising worldwide, and Chile is no exception to this phenomenon. This condition exponentially increases health risks and it is associated with prema ture mortality. Since 2008, several guidelines on pediatric obesity treatment have included bariatric surgery as a treatment strategy for certain severely obese adolescents. These procedures have proven to be safe and efficient in adults. Recent evidence shows that, when done in specialized centers, the re sults would be similar in adolescents in the short and medium term. Nonetheless, in this group of pa tients, bariatric surgery has risks related to their stage of development, and data on long-term results and complications are still lacking. Therefore, to achieve the expected results, the patient selection, surgery, and follow-up must be carried out by qualified multidisciplinary teams, in hospitals centers that have the appropriate infrastructure, It is essential for the patients a life-long adherence to medi cal and nutritional monitoring. The objective of this document is to present the position statement of the Nutrition Branch of the Chilean Society of Pediatrics on the different issues to be considered for the adequate indication of these procedures in severely obese adolescents.

Humans , Adolescent , Obesity, Morbid/surgery , Bariatric Surgery/methods , Pediatric Obesity/surgery , Pediatrics , Postoperative Complications/diagnosis , Postoperative Complications/therapy , Obesity, Morbid/complications , Chile , Treatment Outcome , Patient Selection , Bariatric Surgery/standards , Pediatric Obesity/complications
Rev. otorrinolaringol. cir. cabeza cuello ; 80(2): 184-192, jun. 2020.
Article in Spanish | LILACS | ID: biblio-1115834


La recurrencia de carcinoma de células escamosas orofaríngeo (CCEOF) se asocia a mal pronóstico, particularmente en recurrencias en etapa avanzada. La cirugía en el contexto de rescate es más complicada por el tratamiento oncológico del tumor primario, por lo tanto, tiene un mayor riesgo de complicaciones y estadía hospitalaria. Sin embargo, la cirugía de rescate es la mejor oportunidad del paciente como tratamiento curativo y para supervivencia a largo plazo. La población de pacientes que reciben tratamiento para CCEOF ha cambiado en la última década, se ha reconocido que la incidencia de virus papiloma humano (VPH) asociado a CCEOF ha generado el gran aumento de CCEOF y el cambio asociado en las características de la población de pacientes, ahora los pacientes son más jóvenes y tienen menos comorbilidades. Con el aumento exponencial en la incidencia de CCEOF, la necesidad de cirugía de rescate en CCEOF podría verse en aumento. En vista del aumento de la incidencia de casos con carcinoma escamoso de orofaringe y su importante relación con el VPH, esta revisión se enfoca en la supervivencia tras cirugía de rescate con intención curativa y evaluar si con los avances en su tratamiento ha mejorado su pronóstico.

Recurrence of oropharyngeal squamous cell carcinoma (OPSCC) is associated with poor prognosis, particularly in advanced stage recurrences. Salvage surgery is complicated by previous oncological treatment of the primary tumor, therefore, it has a higher risk of complications and hospital stay. However, salvage surgery is the patient's best opportunity as a curative treatment and for long-term survival. The population of patients receiving treatment for OPSCC has changed in the last decade, it has been recognized that the incidence of human papilloma virus (HPV) associated OPSCC has generated an increase of OPSCC and changes in the epidemiology of the patient population, with younger patients and with less comorbidities. With the exponential increase in the incidence of OPSCC, the need for salvage surgery in OPSCC could increase in the future. In view of the increase in the incidence of cases with squamous oropharyngeal carcinoma and its relationship with HPV, this review focuses on survival after salvage surgery with curative intent and assessing whether the progress in its treatment has improved its prognosis.

Humans , Otorhinolaryngologic Surgical Procedures/methods , Carcinoma, Squamous Cell/surgery , Head and Neck Neoplasms/surgery , Neoplasm Recurrence, Local , Papillomaviridae , Postoperative Complications , Prognosis , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/virology , Survival Rate , Salvage Therapy , Patient Selection , Medical Futility , Head and Neck Neoplasms/mortality , Head and Neck Neoplasms/virology
Rev. chil. obstet. ginecol. (En línea) ; 85(3): 236-244, jun. 2020. tab
Article in Spanish | LILACS | ID: biblio-1126158


OBJETIVO: Describir y analizar la experiencia clínica, resultados y complicaciones según Clavien-Dindo de las histeroscopías quirúrgicas realizadas en pabellón. MÉTODOS: Estudio descriptivo retrospectivo de las histeroscopías quirúrgicas realizadas entre el 1 de enero de 2012 y 1 de enero de 2018 en el Hospital Clínico de la Universidad de Chile. RESULTADOS: Hubo 613 histeroscopías quirúrgicas en el período analizado, de las cuales 593 cumplieron con los requisitos para incluirse en este estudio. Las indicaciones para realizar el procedimiento fueron: pólipo endometrial (56,3%), miomas uterinos (22,1%), sangrado uterino anormal (4,3%) y otras (17,7%). Hubo un 89,2% de concordancia entre el diagnóstico intraoperatorio y el estudio histopatológico. Se pesquisaron 11 hiperplasias endometriales sin atipías, 3 con atipías y 10 neoplasias malignas. Cabe destacar que, del total de pólipos resecados, hubo 8 casos (2,5%) con potencial malignidad (atipías o neoplasia maligna). Según la clasificación Clavien Dindo, hubo 22 complicaciones intraoperatorias (3,7%) grado I o II, cuyo diagnóstico fue realizado en el acto quirúrgico. No hubo complicaciones grado III o más (severas, con reintervención). CONCLUSIÓN: La tasa de éxito, correlación histeroscópica - anatomopatológica final y complicaciones fue similar a lo publicado en la literatura disponible. El diagnóstico intraoperatorio de la lesión y su reparación en el mismo acto quirúrgico, disminuye el riesgo de morbimortalidad de las pacientes, haciéndolo similar al de una paciente sin complicación. Utilizar la clasificación Clavien Dindo para evaluar las complicaciones nos permitirá en adelante, objetivar, mejorar aspectos del procedimiento quirúrgico y plantear estrategias de prevención y manejo de dichos eventos adversos.

OBJECTIVE: To describe and analyze the clinical experience, results and complications according to Clavien-Dindo of surgical hysteroscopies performed in the ward. METHODS: Retrospective descriptive study of surgical hysteroscopies performed between January 1, 2012 and January 1, 2018 at the Hospital Clinico of the University of Chile. RESULTS: There were 613 surgical hysteroscopies in the analyzed period of which 593 fulfilled the requirements to be included in this study. The indications to perform the procedure were: endometrial polyp (56.3%), uterine fibroids (22.1%), abnormal uterine bleeding (4.3%) and others (17.7%). There was an 89.2% agreement between the intraoperative diagnosis and the histopathological study. Eleven endometrial hyperplasias without atypia, 3 with atypia and 10 malignant neoplasms were investigated. It should be noted that, of the total of resected polyps, there were 8 cases (2.5%) with potential malignancy (atypia or malignant neoplasm). According to the Clavien Dindo classification, there were 22 intraoperative complications (3.7%) grade I or II, the diagnosis of which was made during surgery. There were no grade III or more complications (severe, with reoperation). CONCLUSION: The success rate, final hysteroscopic-pathological correlation and complications was similar to that published in the available literature. The intraoperative diagnosis of the lesion and its repair in the same surgical act, reduces the risk of morbidity and mortality of the patients, making it similar to that of a patient without complication. Using the Clavien Dindo classification to assess complications will henceforth allow us to objectify, improve aspects of the surgical procedure and propose strategies for the prevention and management of such adverse events.

Humans , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Hysteroscopy/statistics & numerical data , Genital Diseases, Female/surgery , Postoperative Complications/classification , Severity of Illness Index , Hysteroscopy/adverse effects , Epidemiology, Descriptive , Retrospective Studies , Treatment Outcome , Patient Selection , Genital Diseases, Female/pathology , Length of Stay
Neumol. pediátr. (En línea) ; 15(1): 251-256, Mar. 2020. tab
Article in Spanish | LILACS | ID: biblio-1088092


Home cardio-respiratory monitoring began over 40 years ago with the aim of preventing sudden infant death. Although it has been shown that monitoring does not meet this objective, its prescription has been maintained in various clinical situations and with very different criteria. Consensus on the subject has not been able to define precisely the type of monitoring or the time required for different diseases. Among the diseases that still consider the indication of cardio-respiratory monitoring at home are: persistent apnea of prematurity, high-risk BRUE (Brief Resolved Unexplained Events), neurological or metabolic diseases with compromise of the respiratory center, convulsive cough, pathologic gastroesophageal reflux and technology-dependent patients (high flow nasal cannula (CNAF), noninvasive ventilation (NIV), invasive mechanical ventilation (IMV) to tracheostomy, and others). A review is presented on the development of cardio-respiratory monitoring at home, highlighting the true usefulness of this technology with a general proposal, which must be evaluated on a case-by-case basis and always taking into account the conditions that must be met to perform adequate monitoring and useful.

La monitorización cardio-respiratoria en domicilio se inició hace más de 40 años con el objetivo de prevenir la muerte súbita del lactante. Aun cuando se ha demostrado que la monitorización no cumple este objetivo, se ha mantenido su prescripción en diversas situaciones clínicas y con criterios muy diversos. Consensos acerca del tema no han llegado a definir con precisión el tipo de monitorización ni el tiempo requerido para distintas enfermedades. Dentro de las enfermedades que todavía consideran la indicación de monitorización cardio-respiratoria en domicilio se encuentran: apnea persistente del prematuro, BRUE (episodio breve resuelto inexplicado) de alto riesgo, enfermedades neurológicas o metabólicas con compromiso del centro respiratorio, tos convulsiva, reflujo gastroesofágico patológico y pacientes dependientes de tecnología (cánula nasal de alto flujo (CNAF), ventilación no invasiva (VNI), ventilación mecánica invasiva (VMI) a traqueostomía, y otros). Se presenta una revisión sobre el desarrollo de la monitorización cardio-respiratoria en domicilio, resaltando la verdadera utilidad que tendría esta tecnología con una propuesta general, que debe evaluarse caso a caso y siempre teniendo en cuenta las condiciones que deben cumplirse para realizar una monitorización adecuada y útil.

Humans , Infant , Apnea/physiopathology , Respiratory Rate/physiology , Heart Rate/physiology , Monitoring, Physiologic/methods , Risk Assessment , Patient Selection , Home Care Services
Einstein (Säo Paulo) ; 18: eAO4858, 2020. tab, graf
Article in English | LILACS | ID: biblio-1056075


ABSTRACT Objective To develop and validate the content of a tool aimed to select patients with hypertension for pharmaceutical care, based on identification of individuals in greater need of attention. Methods The tool was developed and assessed for face and content validity, which was carried out in three stages. Phase I consisted of comprehensive literature review, which prompted the development of the first version of the tool. Phase II consisted of validation by an expert panel. Phase III consisted of a pilot study with hypertensive patients and preparation of the final version of the instrument. Results Literature review yielded 30 studies, out of which 13 factors associated with hypertension and cardiovascular disease control and complications were selected. Once the initial version of the tool named INSAF-HAS was obtained, four expert meetings were held, each leading to instrument improvement until a final consensus was reached. In the pilot study, INSAF-HAS was applied to 30 patients with a diagnosis of hypertension for applicability pretest; adjustments were made and the final version of INSAF-HAS obtained. Conclusion The INSAF-HAS tool developed in this study has face and content validity, and may contribute to the selection of patients with hypertension in greater need of pharmaceutical care services.

RESUMO Objetivo Desenvolver e realizar a validação de conteúdo de uma ferramenta para seleção de pacientes com hipertensão arterial sistêmica a serem atendidos em serviços de cuidado farmacêutico, com base na identificação daqueles com maior necessidade dessa assistência. Métodos O instrumento foi desenvolvido e avaliado por validação de face e conteúdo, subdividida em três fases. A fase I abordou ampla revisão bibliográfica, que originou a versão inicial da ferramenta. Na fase II, realizou-se a validação com a análise de um painel de experts . A fase III foi composta por estudo piloto realizado com pacientes com hipertensão, tendo sido definida a versão final do instrumento. Resultados A partir da revisão bibliográfica, 30 estudos foram consultados, e foram selecionados 13 fatores associados ao controle e à ocorrência de complicações, relacionados à hipertensão arterial sistêmica e a doenças cardiovasculares. Por conseguinte, mediante a versão inicial da ferramenta intitulada INSAF-HAS, realizaram-se quatro reuniões com especialistas, para obtenção de consenso final. A cada encontro, o instrumento foi aprimorado. No estudo piloto, 30 pacientes com diagnóstico de hipertensão arterial sistêmica foram abordados para o pré-teste de avaliação da aplicabilidade e, após as adequações, obteve-se a versão final do INSAF-HAS. Conclusão A ferramenta elaborada INSAF-HAS apresenta validade de face e conteúdo. Ela deve contribuir para a seleção de pacientes portadores de hipertensão arterial sistêmica e com maior necessidade de participação em serviços de cuidado farmacêutico.

Humans , Male , Female , Pharmaceutical Services/standards , Surveys and Questionnaires/standards , Patient Selection , Hypertension/drug therapy , Antihypertensive Agents/therapeutic use , Cardiovascular Diseases/etiology , Pilot Projects , Reproducibility of Results , Risk Factors , Disease Progression , Hypertension/complications
Immune Network ; : 10-2020.
Article in English | WPRIM | ID: wpr-811172


Immune checkpoint inhibitors (ICIs) have shown remarkable benefit in the treatment of patients with non-small-cell lung cancer (NSCLC) and have emerged as an effective treatment option even in the first-line setting. ICIs can block inhibitory pathways that restrain the immune response against cancer, restoring and sustaining antitumor immunity. Currently, there are 4 PD-1/PD-L1 blocking agents available in clinics, and immunotherapy-based regimen alone or in combination with chemotherapy is now preferred option. Combination trials assessing combination of ICIs with chemotherapy, targeted therapy and other immunotherapy are ongoing. Controversies remain regarding the use of ICIs in targetable oncogene-addicted subpopulations, but their initial treatment recommendations remained unchanged, with specific tyrosine kinase inhibitors as the choice. For the majority of patients without targetable driver oncogenes, deciding between therapeutic options can be difficult due to lack of direct cross-comparison studies. There are continuous efforts to find predictive biomarkers to find those who respond better to ICIs. PD-L1 protein expressions by immunohistochemistry and tumor mutational burden have emerged as most well-validated biomarkers in multiple clinical trials. However, there still is a need to improve patient selection, and to establish the most effective concurrent or sequential combination therapies in different NSCLC clinical settings. In this review, we will introduce currently used ICIs in NSCLC and analyze most recent trials, and finally discuss how, when and for whom ICIs can be used to provide promising avenues for lung cancer treatment.

Biomarkers , Carcinoma, Non-Small-Cell Lung , Drug Therapy , Humans , Immunohistochemistry , Immunotherapy , Lung Neoplasms , Oncogenes , Patient Selection , Protein-Tyrosine Kinases
Rev. chil. enferm. respir ; 35(4): 308-309, dic. 2019.
Article in Spanish | LILACS | ID: biblio-1092712


El trasplante pulmonar representa una opción terapéutica en pacientes con fibrosis pulmonar avanzada que presentan un curso progresivo a pesar de tratamiento médico, mejorando su sobrevida y calidad de vida. Es de vital importancia que el neumólogo conozca cuando referir a un paciente y estar familiarizado con los requisitos necesarios y contraindicaciones para enviar un paciente a un centro de trasplante. La derivación oportuna permite realizar un completo estudio, además de identificar las contraindicaciones y condiciones clínicas susceptibles de modificar y/o corregir antes de un trasplante.

Pulmonary transplantation represents a therapeutic option in patients with advanced pulmonary fibrosis who have a progressive course despite medical treatment, improving their survival and quality of life. It is vital that the pulmonologist knows when to refer a patient and be familiar with the requirements and contraindications. Timely referral grants the necessary time for a complete study, in addition to identifying contraindications and clinical conditions that could be modified and / or corrected before a transplant.

Humans , Lung Transplantation/methods , Idiopathic Pulmonary Fibrosis/surgery , Referral and Consultation , Lung Transplantation/standards , Patient Selection
Salud pública Méx ; 61(5): 601-608, sep.-oct. 2019.
Article in English | LILACS | ID: biblio-1127323


Abstract: Objective: To describe the rationale and the methodology of a multicenter project to study the etiology of breast cancer in young Latin American women. Materials and methods: The International Agency for Research on Cancer has established an international collaborative population-based case-control study in four countries in Latin America: Chile, Colombia, Costa Rica, and Mexico (the PRECAMA study). Standardized methodologies were developed to collect information on reproductive variables, lifestyle, anthropometry, diet, clinical and pathological data, and biological specimens. The study will be extended to other countries in the region. Conclusion: PRECAMA is unique in its multidisciplinary approach that combines genetics, genomics, and metabolomics with lifestyle factors. The data generated through this project will be instrumental to identify major risk factors for molecular subtypes of breast cancer in young women, which will be important for prevention and targeted screening programs in Latin America.

Resumen: Objetivo: Describir la justificación y la metodología para el establecimiento de un proyecto multicéntrico sobre el cáncer de mama en mujeres jóvenes de América Latina. Material y métodos: La Agencia Internacional para la Investigación del Cáncer (IARC) ha establecido un estudio colaborativo internacional de casos y controles con base poblacional en cuatro países de América Latina: Chile, Colombia, Costa Rica y México (el estudio PRECAMA). Se han desarrollado metodologías estandarizadas para recolectar información sobre variables reproductivas, estilos de vida, antropometría y dieta, datos clínicos y patológicos y muestras biológicas. Conclusión: PRECAMA es único en su enfoque multidisciplinario. Los datos generados a través de este proyecto serán fundamentales para identificar los principales factores de riesgo del cáncer de mama en mujeres jóvenes. Los hallazgos serán relevantes para la prevención y los programas de detección oportuna en América Latina, con beneficios clínicos inmediatos.

Humans , Female , Adult , Young Adult , Breast Neoplasms/etiology , Specimen Handling/methods , Breast/pathology , Breast Neoplasms/genetics , Breast Neoplasms/pathology , Exercise , Case-Control Studies , Chile , Risk Factors , Colombia , Patient Selection , Costa Rica , Eating , Informed Consent , Latin America , Life Style , Mexico
Neumol. pediátr. (En línea) ; 14(3): 159-163, sept. 2019. tab
Article in Spanish | LILACS | ID: biblio-1087676


Tracheostomy in children is an extremely delicate procedure, which consists in the creation of a stoma between the trachea and the skin. Among the most frequent indications are neurological disorders, obstruction of the upper airway or prolonged mechanical ventilation. Pediatric versus adult airway differences should be considered during surgery. In the postoperative period, hemorrhage, pneumothorax, pneumomediatin can occur. In the late postoperative period, accidental decannulation, false pathway, infection of the tracheostomy, and later formation of periostomal or endotracheal granulomas may occur. The care of the tracheostomy in the clinical unit must be with trained personnel and the family environment must be prepared for home care. As long as the tracheostomy persists, control of the airway superior and inferior to the tracheostomy must be maintained by fiber optic. Patients with neurological compromise or cardiopulmonary damage have a lower decannulation rate and a longer hospital stay.

La traqueostomía en niños es un procedimiento extremadamente delicado, que consiste en la creación de un ostoma entre la tráquea y la piel. Entre las indicaciones más frecuentes se encuentran trastornos neurológicos, obstrucción de la vía aérea superior o ventilación mecánica prolongada. Consideraciones a las diferencias de la vía aérea pediátrica versus del adulto deben tenerse en cuenta durante la cirugía. En el postoperatorio se puede presentar hemorragia, neumotórax y neumomediastino. En el postoperatorio tardío puede ocurrir decanulación accidental, falsa vía, infección de la traqueostomía, y más tardíamente formación de granulomas periostomales o endotraqueales. El cuidado de la traqueostomía en la unidad clínica debe ser con personal capacitado y se debe preparar el entorno familiar para el cuidado en el domicilio. Mientras persista la traqueostomía se debe mantener control por fibra óptica de la vía aérea superior e inferior a la traqueostomía. Los pacientes con compromiso neurológico o daño cardiopulmonar tienen menor tasa de decanulación y mayor tiempo en el hospital.

Humans , Child , Tracheostomy/adverse effects , Tracheostomy/methods , Patient Selection , Device Removal
Rev. cuba. hematol. inmunol. hemoter ; 35(3): e1014, jul.-set. 2019. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1093280


Introducción: El rituximab, anticuerpo quimérico que reconoce la molécula CD20 humana, se ha utilizado en el tratamiento de diversos trastornos linfoproliferativos de células B. Para la selección de los potenciales beneficiarios del tratamiento con rituximab se han desarrollado técnicas que, mediante el uso de anticuerpos monoclonales, detectan la presencia del CD20 en los linfocitos de estos pacientes. Objetivo: Obtener y caracterizar un anticuerpo recombinante IgG1 de ratón específico para la molécula CD20 humana, que contenga las regiones variables del anticuerpo rituximab. Métodos: Para la expresión estable del anticuerpo recombinante se empleó la transducción lentiviral de células de embrión de riñón humano (HEK293). La caracterización inmunoquímica del anticuerpo se realizó por la técnica de Western Blot y su capacidad de reconocimiento de la molécula CD20 humana se evaluó por citometría de flujo e inmunohistoquímica. Resultados: Se obtuvo el anticuerpo 1F5 que reconoce, por citometría de flujo, la molécula CD20 en líneas celulares humanas de origen linfoide, así como en células de sangre periférica de humanos sanos y pacientes con trstornos linfoproliferativos de células B. Sin embargo, la técnica de inmunohistoquímica solo permitió detectar con este anticuerpo la molécula CD20 en tejidos frescos, no así en los embebidos en parafina. Conclusiones: Este trabajo sugiere las potencialidades del uso del anticuerpo 1F5 para las mediciones de la expresión de CD20 por citometría de flujo en pacientes con leucemias B o linfomas B avanzados en fase de leucemización. Esto complementaría los estudios para la selección apropiada de pacientes para el tratamiento con el rituximab(AU)

Introduction: Rituximab, chimeric antibody specific for human CD20 molecule, has been widely used in the treatment of several B-cell linfoproliferative disorders. For the selection of patients with the greatest potential to benefit from the therapy with rituximab, a number of techniques using monoclonal antibodies have been developed to detect the CD20 molecule. Objective: To obtain and to characterize a mouse IgG1 recombinant antibody, specific for human CD20, that contains the variable regions of rituximab. Methods: The lentiviral transduction of human embryonic kidney cells (HEK293) was used for the stable expression of the recombinant antibody. The immunochemical characterization of the antibody was performed by Western Blot and the recognition of CD20 was evaluated by immunohistochemistry and flow cytometry. Results: We generated the antibody 1F5, able to recognize by flow cytometry the CD20 molecule expressed on lymphoid human cell lines, as well as peripheral blood mononuclear cells from healthy donors and patients with B-cell lymphoproliferative disorders. However, 1F5 antibody detected the CD20 molecule on fresh tissues, but not on formalin-fixed paraffin embedded tissues,by immunohistochemistry. Conclusions: This work suggests the potential use of 1F5 antibody for the measurement of CD20 expression by flow cytometry in patients with B-cell leukemias or B-cell lymphomas in phase of leukemization. This could complement the studies to ensure the appropriate selection of patients for the treatment with rituximab(AU)

Humans , Male , Female , Immunoglobulin G/analysis , Patient Selection/ethics , Rituximab/therapeutic use , Antineoplastic Agents, Immunological/therapeutic use , Antibodies/therapeutic use , Antibody Formation , Blotting, Western/methods , Antigens, CD20/analysis
Prensa méd. argent ; 105(7): 399-404, agosto 2019. tab
Article in English | LILACS, BINACIS | ID: biblio-1022114


PCOS is known now as an endocrine, metabolic, and chronic inflamatory disorder, with hyperandrogenemia, insulin resistance and obesity being the key factors that influence the expression and symptoms of the condition. Objective: To assess the level of alpha fetoprotein in PCOS women. Patients and method: A case control study conducted at Al-Elwyia. Teaching hospital when 200 women were enrolled in the study and divided into two groups: case group (100) patients with PCOS and control healthy group (100). The patient with PCOS women was diagnosed according to Roterdam criteria. Results: A total of 200 respondents and divided into 2 groups. The mean age of them (27.7 ± 2.3) years, highly significant association (P <0,001) were found between the age group especially (21-30) years in PCOS patients moreover highly significant association were found between the obese patient in PCOS than that in normal group (P<0.001). Betatrophin levels were significantly highly increases in patients than that in control group (P<0.001). Conclusion: the serum betatrophin level was significantly increased in patients with polycystic syndrome (AU)

Humans , Female , Adult , Polycystic Ovary Syndrome , alpha-Fetoproteins , Case-Control Studies , Hyperandrogenism , Patient Selection