Diagnóstico y tratamiento de los tumores de la unión esofagogástrica. Experiencia en el Instituto Nacional de Cancerología / Diagnosis and treatment of esophagogastric junction tumors. Experience at the National Cancer Institute

Introducción. El diagnóstico adecuado de los tumores de la unión esofagogástrica es esencial para el tratamiento de estos pacientes. La clasificación propuesta por Siewert-Stein define las características propias, factores de riesgo y estrategias quirúrgicas según la localización. El objetivo de este estudio fue describir las características de los pacientes con adenocarcinoma de la unión esofagogástrica tratados en nuestra institución. Métodos. Estudio retrospectivo, descriptivo, de corte longitudinal, que incluyó los pacientes con diagnóstico de adenocarcinoma de la unión esofagogástrica intervenidos quirúrgicamente en el Instituto Nacional de Cancerología, Bogotá, D.C., Colombia, entre enero de 2012 y mayo de 2017. Resultados. Se operaron 59 pacientes (84,7 % hombres), con una edad media de 62,5 años. En su orden de frecuencia los tumores fueron tipo II (57,6 %), tipo III (30,7 %) y tipo I (11,9 %). El 74,6 % recibieron neoadyuvancia y se realizó gastrectomía total en el 73 % de los pacientes. La concordancia diagnóstica moderada con índice Kappa fue de 0,56, difiriendo con la endoscópica en 33,9 %. El 10,2 % de los pacientes presentó algún tipo de complicación intraoperatoria. La supervivencia a tres años en los tumores tipo II fue del 89,6 % y del 100 % en aquellos con respuesta patológica completa. Conclusión. Es necesario el uso de diferentes estrategias para un proceso diagnóstico adecuado en los tumores de la unión esofagogástrica. En esta serie, los pacientes Siewert II, aquellos que recibieron neoadyuvancia y los que obtuvieron una respuesta patológica completa, tuvieron una mejor supervivencia a tres años

Introduction: Proper diagnosis of gastroesophageal junction tumors is essential for the treatment of these patients. The classification proposed by Siewert-Stein defines its own characteristics, risk factors and surgical strategies according to the location. This study describes the characteristics of patients with adenocarcinoma of the esophagogastric junction treated at our institution. Methods. Retrospective, descriptive, longitudinal study, which includes patients diagnosed with adenocarcinoma of the esophagogastric junction who underwent surgery at the National Cancer Institute in Bogotá, Colombia, between January 2012 and May 2017. Results. Fifty-nine patients (84.7% men) were operated on, with a mean age of 62.5 years. In their order of frequency, the tumors were type II (57.6%), type III (30.7%) and type I (11.9%). 74.6% received neoadjuvant therapy and total gastrectomy was performed in 73% of the cases. The moderate diagnostic concordance with the Kappa index was 0.56, differing from the endoscopic one in 33.9%. 10.2% of the patients presented some type of intraoperative complication. Three-year survival in type II tumors was 89.6% and 100% in those with complete pathologic response. Conclusion. The use of different strategies is necessary for an adequate diagnostic process in tumors of the esophagogastric junction. In this series, Siewert II patients, those who received neoadjuvant therapy, and those who obtained a complete pathological response had a better three-year survival

Ventajas de la secuenciación de próxima generación sobre la hibridación fluorescente in situ para detectar la codeleción 1p/19q en oligodendrogliomas / Advantages of next generation sequencing over fluorescent in situ hybridization to detect 1p/19q codeletion in oligodendroglioma / Vantagens do sequenciamento de próxima geração sobre a hibridização fluorescente in situ para detectar codeleção 1p/19q em oligodendrogliomas

El perfil molecular de los gliomas permite garantizar la precisión del diagnóstico, informar el pronóstico e identificar opciones de tratamiento. Esta revisión tiene como objetivo exponer que con la secuenciación de próxima generación (NSG) el diagnóstico de los pacientes con oligodendrogliomas puede ser más exacto. Además, con un dispositivo de diagnóstico in vitro, basado en la NSG (F1CDx), en el que se utilizan los bloques de parafina de gliomas para analizar hasta 395 genes relacionados con cáncer (incluido IDH 1 y 2), se puede también informar la pérdida de la totalidad del brazo corto del cromosoma 1 y del brazo largo del cromosoma 19 (codeleción 1p/19q), a diferencia de la hibridación fluorescente in situ (FISH) que detecta desde la más mínima deleción, lo cual los hace sensibles pero no específicos ya que el FISH es incapaz de distinguir entre la pérdida de la totalidad del brazo del cromosoma y una deleción focal. Esta distinción es importante ya que la sobrevida es inferior en tumores con deleción parcial en rela­ción con los oligodendrogliomas, que tienen por definición la pérdida total de ambos cromosomas. Se hace también alusión a otras plataformas genómicas como GlioSeq y GLIO-DNA panel, que pueden cumplir la misma función. En conclusión, la F1CDx puede determinar con precisión 1p/19q con una concordancia del 96.7% frente a FISH. Los casos en que el FISH dio positivo y no concordaban con F1CDx, era porque no se trataba de oligodendrogliomas. F1CDx también analiza todos los genes que permiten la aproximación más exacta al diagnóstico de oligodendroglioma.

Molecular profiling of gliomas helps ensure diagnostic accuracy, inform prognosis, and identify treatment options. This review aims to show that with next generation sequencing (NGS) the diagnosis of patients with oligodendrogliomas can be more accurate. In addition, with an in vitro diagnostic device, based on NSG (F1CDx), in which glioma paraffin blocks are used to analyze up to 395 cancer-related genes (including IDH 1 and 2), it is also possible to report the loss of the entire short arm of chromosome 1 and the long arm of chromosome 19 (1p/19q codeletion), unlike fluorescence in situ hybridization (FISH) that detects even the slightest deletion, making them sensitive but not specific, as FISH is unable to distinguish between the loss of the entire arm of the chromosome and a focal deletion. This distinction is important since survival is lower in tumors with partial deletion compared to oligodendrogliomas, which by definition have the total loss of both chromosomes. Reference is also made to other genomic platforms such as GlioSeq and GLIO-DNA panel, which can fulfill the same function. In conclusion, the F1CDx can accurately determine 1p/19q with a concordance of 96.7% against FISH. The cases in which the FISH was positive and did not agree with F1CDx, it was because they were not oligodendrogliomas. F1CDx also analyzes all the genes that allow the most accurate approach to the diagnosis of oligodendroglioma.

O perfil molecular de gliomas ajuda a garantir a precisão do diagnóstico, informar o prognóstico e identificar as opções de tratamento. Esta revisão tem como objetivo mostrar que com o sequenciamento de próxima geração (NSG) o diagnóstico de pacientes com oligodendrogliomas pode ser mais preciso. Além disso, com um dispositivo de diagnóstico in vitro baseado em NSG (F1CDx), no qual blocos de parafina de glioma são usados para analisar até 395 genes relacionados ao câncer (incluindo IDH 1 e 2), também é possível relatar a perda do todo o braço curto do cromossomo 1 e o braço longo do cromossomo 19 (codeleção 1p/19q), ao contrário da hibridização fluorescente in situ(FISH) que detecta desde a menor deleção, o que os torna sensíveis, mas não específicos, pois o FISH é incapaz de distinguir entre a perda de todo o braço do cromossomo e uma deleção focal. Essa distinção é importante, pois a sobrevida é menor nos tumores com deleção parcial em relação aos oligodendrogliomas, que por definição apresentam a perda total de ambos os cromossomos. Também é feita referência a outras plataformas genômicas, como GlioSeq e painel GLIO-DNA, que podem cumprir a mesma função. Em conclusão, o F1CDx pode determinar com precisão 1p/19q com uma concordância de 96,7% versus FISH. Os casos em que FISH foi positivo e não concordaram com F1CDx, foi porque não eram oligodendrogliomas. O F1CDx também analisa todos os genes que permitem a abordagem mais precisa para o diagnóstico de oligodendroglioma.

Sobrevida en población pediátrica con leucemia linfoblástica aguda tratada con protocolo ALLIC-BFM de quimioterapia. Revisión sistemática / Survival of pediatric population with acute lymphoblastic leukemia treated with ALLIC-BFM chemotherapy protocol. Systematic review

La leucemia linfoblástica aguda constituye la neoplasia infantil más frecuente. Los tratamientos actuales posibilitan más del 80% de supervivencia libre de enfermedad por cinco años. En el 2000, se probó un protocolo de quimioterapia llamado leucemia linfoblástica intercontinental Berlín-Frankfurt-Münster (ALLIC BFM). El proceso investigativo se realizó mediante la metodología PRISMA, con el propósito de sistematizar la información acerca de la supervivencia de los pacientes pediátricos con leucemia linfoblástica aguda tratados con el uso del protocolo de quimioterapia ALLIC BFM en sus versiones de 2002 o 2009. La supervivencia global en pacientes donde se utilizó el protocolo de 2002 fue del 52% al 91,7% y la libre de enfermedad fue del 45% a 83,3%; mientras que, con el uso del protocolo 2009 se reportó una supervivencia global del 71,1% al 90% y la libre de enfermedad fue del 69,4% al 90,3%. Los principales factores que afectaron la supervivencia fueron las complicaciones relacionadas con el tratamiento, los pacientes de alto riesgo y la medicación insuficiente.

Acute lymphoblastic leukemia is the most common childhood neoplasia. Current treatments allow more than 80% disease-free survival for five years. In 2000, a chemotherapy protocol called Berlin-Frankfurt-Münster intercontinental lymphoblastic leukemia (ALLIC BFM) was tested. The investigative process was carried out using the PRISMA methodology. This study aimed to systematize the information about the survival of pediatric patients with acute lympho-blastic leukemia treated with the ALLIC BFM chemotherapy protocol in its 2002 or 2009 versions. 52% to 91.7% of patients showed an overall survival in patients where the 2002 proto-col was used, and disease-free was from 45% to 83.3%; while, with the use of the 2009 protocol, an overall survival of 71.1% to 90% was reported, and disease-free survival was 69.4% to 90.3%. The main factors affecting survival were treatment-related complications, high-risk patients, and insufficient medication.

Prise en charge du cancer du col utérin métastatique au CHU de Treichville et résultas/ / Management of metastatic cervical cancer at the University Hospital of Treichville and results

la prise en charge du cancer col métastatique s'est enrichie depuis 2017 par la disponibilité des thérapies ciblées dans notre pays. Cette étude avait pour objectifs de déterminer les caractéristiques épidémiologiques, cliniques et thérapeutiques des patientes prises en charge pour cancer du col métastatique dans notre structure. Methodes. il s'agit d'une étude rétrospective à visé descriptive menée dans les services de gynécologie et d'oncologie du CHUT, du janvier 2018 ­ octobre 2021. Elle a concerné les dossiers de patientes traitées pour un cancer du col de l'utérus métastatique confi rmé. Ont été inclus les dossiers des patientes qui ont reçu au moins 06 cures de chimiothérapie associées ou non à la thérapie ciblée, et dont la dernière cure a été réalisée 24 mois avant la fi n de l'étude. Resultats. Nous avons colligé 47 dossiers dont les patientes avaient un âge moyen de 54 ans. Elles avaient toutes déjà accouché, et étaient sans activités dans 57% des cas. La tumeur initiale était un carcinome épidermoïde dans la majorité des cas (87%). Les sites métastatiques les plus fréquents étaient lespoumons (39%), le foie (26%), les os (15%). Elles ont toutes bénéfi cié de la combinaison PaclitaxelCisplatine ­Bévacizumab comme traitement spécifi que. La survie globale a été de 52 % à 24 mois, et était meilleur chez les patientes qui ont reçu le Bévacizumab dans leur traitement.

Experiencia de downstaging versus criterios de Milán para trasplante hepático por carcinoma hepatocelular en una cohorte prospectiva / Experience with downstaging versus Milan criteria for liver transplantation in patients with hepatocellular carcinoma in a prospective cohort

Introducción. El acceso al trasplante hepático (TH) en pacientes con carcinoma hepatocelular (CHC) se basa en la aplicación de criterios morfológicos rigurosos estipulados desde 1996, co-nocidos como criterios de Milán. Una de las estrategias descritas para expandir estos criterios se conoce como downstaging (reducción del estadiaje tumoral mediante terapias locorregionales). El objetivo de este estudio fue describir el comportamiento postrasplante de pacientes con CHC que ingresaron dentro de los parámetros de Milán, comparado con el de aquellos pacientes llevados a terapia de downstaging en un centro colombiano. Metodología. Se incluyeron pacientes adultos con cirrosis hepática (CH) y CHC que fueron llevados a TH en el Hospital Pablo Tobón Uribe, entre julio de 2012 a septiembre de 2021. Como desenlace principal se definió recurrencia y tiempo de recurrencia de la enfermedad tumoral, muerte por todas las causas y tiempo al fallecimiento. Se evaluaron las características sociodemográficas y clínicas de cada grupo. Se incluyeron scores pronósticos de recurrencia de la enfermedad tumoral. Resultados. Se trasplantaron 68 pacientes con CH y CHC, 50 (73,5 %) eran hombres y la edad promedio fue 59 años; 51 pacientes (75 %) cumplían con los criterios de Milán y 17 (25 %) fueron llevados a terapia de downstaging previo al TH. No hubo diferencias significativas en la supervivencia global y supervivencia libre de trasplante entre los dos grupos evaluados, p=0,479 y p=0,385, respectivamente. Tampoco hubo diferencia significativa en la recurrencia de la enfermedad tumoral entre ambos grupos (p=0,81). En total hubo 7 casos de recurrencia tumoral (10,2 %) y 11 casos de muerte (16,2 %). Conclusiones. No se encontraron diferencias significativas en recurrencia y mortalidad entre los pacientes que cumplían los criterios de Milán y los trasplantados luego de la terapia de downstaging, en un tiempo de se-guimiento de 53 meses hasta el último control posterior al trasplante hepático. Esta sería la primera evaluación prospectiva de un protocolo de downstaging para CHC en Colombia.

Introduction. Access to liver transplantation (LT) in patients with hepatocellular carcinoma (HCC) is based on the application of rigorous morphological criteria stipulated since 1996, known as the Milan criteria. One of the strategies described to expand these criteria is known as downstaging (tu-mor staging reduction through locoregional therapies). The objective of this study was to describe the post-transplant performance of patients with HCC who were admitted within the Milan parameters, compared with those of patients taken to downstaging therapy, in a Colombian center. Methodolo-gy. Adult patients with cirrhosis and HCC that received LT between July 2012 and September 2021 at the Pablo Tobón Uribe Hospital were included. The main outcome was defined as recurrence and time to recurrence of the tumor disease, death from all causes, and time to death. The socio-demographic and clinical characteristics of each group were evaluated. Tumor disease recurrence prognostic scores were included. Results. Sixty-eight patients with cirrhosis and HCC received LT in the time frame, 50 (73.5%) were men and the mean age was 59 years. Fifty-one patients were trans-planted (75%) fulfilling Milan criteria, and 17 (25%) patients received downstaging therapies before LT. There were no significant differences in overall survival and transplant-free survival between the two groups, p=0.479 and p=0.385, respectively. There was also no significant difference in the recurrence of the tumor disease between both groups (p=0.81). In total there were 7 tumoral recurrences (10.2%) and 11 deaths (16.2%). Conclusions. There were no differences in recurrence and survival between patients transplanted fulfilling Milan criteria and those receiving downstaging therapies, following a mean time of 53 months after LT. This is the first prospective evaluation of the downstaging protocol in Colombia.

Desafios do HIV/AIDS em país de baixa renda: sobrevida e retenção de pacientes em TARV nos cuidados de HIV na 'Era' de "Testar e Iniciar" o tratamento no Município de Maputo, Moçambique / HIV/AIDS challenges in low-income country: survival and retention of patients on ART in the 'Era' of "Test and Treat" treatment in Maputo Municipality, Mozambique

Introdução: Considerando as evidências segundo as quais o início precoce do TARV, independentemente da contagem do CD4 ou do estágio clínico da OMS, aumenta a sobrevida e a retenção de pacientes em TARV; diminui a morbidade e mortalidade; e reduz a incidência do HIV, a OMS propôs a ETI para países de baixa renda fortemente afetados por HIV/AIDS, no entanto, estudos que avaliam o seu efeito sobre indicadores clínicos e programáticos ainda são escassos em Moçambique. Objetivos: (i) Estimar taxas de mortalidade e de perda no seguimento clínico e psicossocial nas coortes de pacientes submetidos à ETI (DTI) e não submetidos à estratégia (ATI), respectivamente, e compará-las; (ii) Estimar as medianas do tempo e as probabilidades de sobrevida e de retenção nos cuidados de HIV nas duas coortes (ATI e DTI) e compará-las; (iii) Analisar a influência da ETI na sobrevida e na retenção de pacientes em TARV nos cuidados de HIV, após ajuste para potenciais confundidores. Método: Estudo de coorte retrospectivo de pacientes em TARV, com idades entre 15 e 49 anos, inscritos nos serviços públicos de saúde do município de Maputo, Moçambique. As variáveis estudadas foram sociodemográficas (sexo, idade, escolaridade, região de residência); clínicas (data do diagnóstico de HIV; óbito; estádio clínico da OMS; contagem de CD4; carga viral; data de início do TARV; perda no seguimento; regime de tratamento; co-infecção HIV/TB; indice de massa corporal); programáticas (serviço de diagnóstico/testagem de HIV; participação nos grupos de apoio para a adesão comunitária; exposição à ETI) e os desfechos de interesse foram óbito e perda no seguimento clínico e psicossocial. Utilizou-se o estimador produto limite de Kaplan-Meier, o modelo de riscos proporcionais de Cox e as estimativas das razões de "Hazard" (HR), com respectivos intervalos de confiança a 95%. Estimou-se a FAP para a exposição à ETI, como medida de impacto da estratégia na população. Resultados: A taxa média de mortalidade na coorte ATI foi de 28,1/1000 pessoas-ano, enquanto na coorte DTI foi de 24,5/1000 pessoas-ano. A taxa média de perdas no seguimento clínico e psicossocial na coorte ATI foi de 17,3/1000 pessoas-ano e na coorte DTI de 15,0/1000 pessoas-ano. A MTS na coorte ATI foi de 43,1 meses e na coorte DTI de 50,6 meses. A MTR na coorte ATI foi de 39,8 meses e na coorte DTI de 49,0 meses. Mostraram-se associadas ao tempo de sobrevida, independentemente das demais covariáveis: pertencer à faixa etária de 25-39 (HR=1,52; IC 95% 1,37 - 1,69) e 40-49 (HR=2,16; IC 95% 1,94 - 2,41); ser residente de região suburbana (HR=1,45; IC 95% 1,36 - 1,54); ser do sexo masculino (HR=1,41; IC 95% 1,33 - 1,49); estar em TARV com a II linha (HR=1,19; IC 95% 1,13 - 1,26); estar co-infectado HIV/TB (HR=1,16; IC 95% 1,10 - 1,23); pertencer ao estágio clínico IV da OMS (HR=1,93; IC 95% 1,70 - 2,17), ter IMC <18,5 Kg/m2 (HR=1,18; IC 95% 1,07 - 1,29); não estar exposto à ETI (HR=1,16; IC 95% 1,10 - 1,22). Mostraram-se associadas ao tempo de retenção nos cuidados, independentemente das outras covariáveis: estar em regime de TARV da II linha (HR = 1,48; IC 95% 1,40 - 1,56); pertencer ao estágio III (HR = 1,28; IC 95% 1,19 - 1,36) e IV (HR = 3,51; IC 95% 3,17 - 3,88) da OMS; não estar exposto à ETI (HR = 1,75; IC 95% 1,65 - 1,85); estar co-infectado HIV/TB (HR = 1,18; IC 95% 11,11 - 1,24); ser do sexo masculino (HR = 1,17; IC 95% 1,11 - 1,24); pertencer aos GAAC (HR = 1,21; IC 95% 1,12 - 1,30). A fração atribuível na população para o grupo exposto à ETI (DTI) foi de 6,4% em relação à sobrevida e 20,0% para a retenção nos cuidados de HIV. Conclusões: No contexto de um país de baixa renda fortemente afetado por HIV/AIDS e situado na região Austral de África, a ETI mostrou impacto relevante no aumento da sobrevida e a retenção de pacientes em TARV nos cuidados de HIV, bem como na redução da mortalidade e das perdas no seguimento clínico e psicossocial. O estudo também confirmou o papel de fatores associados aos dois desfechos, também identificados em outras regiões da África Subsaariana e do mundo. Estes resultados fortalecem a importância da ETI para países de baixa e média renda fortemente afetados pelo HIV, para acelerar a resposta local e global do HIV/AIDS por via de intervenções nacionais.

Background: Considering the evidence that early initiation of ART, regardless of CD4 count or WHO clinical stage, increases survival and retention of patients on ART, decreases morbidity and mortality, and reduces HIV incidence, WHO proposed the test-and-treat strategy for low-income countries with a high burden of HIV/AIDS, however, studies evaluating the effect of this strategy on survival and retention of patients on ART are still scarce in Mozambique. Objectives: (i) Estimate the mean rates of mortality and loss in clinical and psychosocial follow-up among the cohorts, respectively, of patients submitted to the strategy (DTI) and not submitted to the strategy (ATI) and compare them; (ii) Estimate the median time and probabilities of survival and retention in HIV care in the two cohorts (ATI and DTI) and compare them; (iii) Analyze the influence of the test-and-start strategy on survival and retention of patients on ART in HIV care, after adjusting for potential confounders. Method: Retrospective cohort study of patients on ART, aged between 15 and 49 years old, enrolled in public health services of Maputo municipality. Variables studied were: sociodemographic (gender, age, education, region of residence); clinical (date of HIV diagnosis; death; WHO clinical stage; CD4 count; viral load; ART initiation date; loss to follow-up; treatment regimen; HIV/TB co-infection; body mass index); programmatic (HIV diagnosis/testing service; participation in support groups for community adherence; exposure to the "test and treat" strategy) and the outcomes of interest were death and loss of clinical and psychosocial follow-up. Kaplan-Meier estimator, Cox proportional hazards model and Hazard ratio (HR) estimates were used, with 95% confidence intervals. Attributable fraction in the population for the exposure to the "test and treat" strategy was estimated as a measure of the strategy's impact on the population. Results: Mean mortality rate in ATI cohort was 28.1/1000 person-years, while in DTI cohort it was 24.5/1000 person-years. Mean rate of loss to clinical and psychosocial follow-up in ATI cohort was 17.3/1000 person-years and in DTI cohort was 15.0/1000 person-years. Median survival time (MTS) in ATI cohort was 43.1 months and in DTI cohort was 50.6 months. Median retention time (MTR) in ATI cohort was 39.8 months and in DTI cohort was 49.0 months. Regardless of the other covariates, the predictors of death were the following: belonging to the age group 25-39 (HR=1.52; CI 95% 1.37 - 1.69) and 40-49 (HR=2.16; CI 95% 1.94 - 2.41); be resident of a suburban region (HR=1.45; 95%CI 1.36 - 1.54); be male (HR=1.41; 95% CI 1.33 - 1.49); be on second-line ART regime (HR=1.19; 95% CI 1.13 - 1.26); be co-infected HIV/TB (HR=1.16; 95% CI 1.10 - 1.23); belonging to WHO clinical stage IV (HR=1.93; 95% CI 1.70 - 2.17), having a BMI <18.5 Kg/m2 (HR=1.18; 95% CI 1.07 - 1 ,29); not being exposed to the test-and-treat strategy (HR=1.16; 95% CI 1.10 - 1.22). Regardless of the other covariates, the predictors of the loss in clinical and psychosocial follow-up were: be on second-line ART regime (HR = 1.48; 95% CI 1.40 - 1.56); belonging to WHO stage III (HR = 1.28; 95% CI 1.19 - 1.36) and IV (HR = 3.51; 95% CI 3.17 - 3.88); not being exposed to the test-and-start strategy (HR = 1.75; 95% CI 1.65 - 1.85); be co-infected with HIV/TB (HR = 1.18; 95% CI 11.11 - 1.24); be male (HR = 1.17; 95% CI 1.11 - 1.24); belonging to the GAAC (HR = 1.21; 95% CI 1.12 - 1.30). Population attributable fraction for the group exposed to the test-and-treat (DTI) strategy was 6.4% for survival and 20.0% for retention in HIV care. Conclusions: In the context of a low-income country strongly affected by HIV/AIDS and located at southern Africa region, the test-and-treat strategy showed a relevant impact on increasing survival and retention time of patients on ART in HIV care, as well as on reducing of mortality and losses in clinical and psychosocial follow-up. The study confirmed, as well, the role of factors associated with the two studied outcomes, also identified in other regions of sub-Saharan Africa and worldwide. These results strengthen the importance of the test-and-treat strategy for low- and middle-income countries heavily affected by HIV, to accelerate local and global HIV/AIDS response through national interventions.

Perfil de morbidade no primeiro ano de vida entre recém-nascidos de alto risco / Morbidity profile in the first year of life among high-risk newborns

Os cuidados destinados aos recém-nascidos prematuros extremos têm propiciado importantes resultados na sobrevida dessas crianças. Objetivo: Caracterizar o perfil de morbidade no primeiro ano de vida entre recémnascidos de alto risco. Materiais e Métodos: Trata-se de uma pesquisa exploratória realizada no ambulatório de seguimento de recém-nascidos de alto risco do norte de Minas Gerais. A coleta de dados foi referente às admissões no período de março de 2014 a abril de 2015. O instrumento contemplava características: demográficas, sociais, condições de gestação e parto, intercorrências no pós-parto e condições de saúde das crianças acompanhadas ao longo do primeiro ano de vida. Realizou-se a análise estatística descritiva e o teste Qui-Quadrado, assumindo-se um nível de significância de 5% para comparação da distribuição das morbidades por faixas de peso. Resultados: Participaram deste estudo 282 recém-nascidos, sendo 53,9% do sexo masculino. Entre as mães, 58,2% era multípara e 35,8% hipertensas. Em relação ao peso de nascimento, 59,6% dos recém-nascidos acompanhados pesaram menos de 1500 gramas. As principais morbidades identificadas no primeiro ano de vida foram atraso do desenvolvimento neuro-psicomotor, infecções de vias aéreas superiores, as alterações neurológicas e as afecções respiratórias crônicas. Foram registradas diferenças estatisticamente significantes para o atraso do desenvolvimento neuro-psico-motor (p<0,001), intercorrências neurológicas (p=0,008) e episódios de diarreia (p=0,047), entre as faixas de peso de nascimento. Conclusão: A assistência ambulatorial para o recém-nascido prematuro de alto risco contribui para a identificação e a prevenção de doenças recorrentes nessa população(AU)

Introduction: Care for extremely premature newborns has provided important results in the survival of these children. Objective: To characterize the morbidity profile in the first year of life among high-risk newborns. Materials and Method: This is an exploratory research carried out at the follow-up clinic for high-risk newborns in the north of Minas Gerais. Data collection referred to admissions in the period from March 2014 to April 2015. The instrument included characteristics: demographic, social, pregnancy and delivery conditions, postpartum complications and health conditions of children monitored during the first year of life. Descriptive statistical analysis and the chisquare test were performed, assuming a significance level of 5% to compare the distribution of morbidities by weight range. Results: A total of 282 newborns participated in this study, 53.9% of whom were male. Among the mothers, 58.2% were multiparous and 35.8% were hypertensive. Regarding birth weight, 59.6% of newborns monitored weighed less than 1500 grams. The main morbidities identified in the first year of life were delayed neuro-psycho-motor development, upper airway infections, neurological disorders and chronic respiratory conditions. Statistically significant differences were recorded for delayed neuro-psycho-motor development (p<0.001), neurological complications (p=0.008) and episodes of diarrhea (p=0.047), between birth weight ranges. Conclusion: Outpatient care for high-risk premature newborns contributes to the identification and prevention of recurrent diseases in this population(AU)

Overall survival in Chilean patients with lymphoma and human immunodeficiency virus: A retrospective cohort study

ABSTRACT Introduction: People living with human immunodeficiency virus (PLWH) still face high morbidity and mortality resulting from lymphoma. Aim: To describe a population of PLWH and lymphoma in a Chilean public hospital and compare the overall survival (OS) with a previously reported cohort from the same institution. Methods: Retrospective single-center cohort study. All the patients diagnosed between 2010 and 2017 were included. Demographic and clinical variables were obtained from medical records. The overall survival (OS) was estimated in treated patients from diagnosis until death or October 2020. The OS was then compared with a cohort of patients diagnosed between 1992 and 2008. Main Results: Eighty-four patients were included. The most common histological types were Burkitt's lymphoma (BL), diffuse large B-cell lymphoma (DLBCL), Hodgkin's lymphoma (HL) and plasmablastic lymphoma (PBL) at 31%, 27%, 21% and 14%, respectively. The three-year OS for the whole cohort of BL, DLBCL, HL and PBL was 58.9%, 65.2%, 47.4%, 76.4% and 50%, respectively. Compared to the cohort of 1992 to 2008, a global increase in the OS was found after excluding HL and adjusting for age and clinical stage (HR 0.38, p = 0.002). However, when the main types were analyzed individually, the increase in the OS was statistically significant only in DLBCL (HR 0.29, p = 0.007). Most patients with DLBCL received CHOP chemotherapy, as in the previous cohort. Conclusion: The OS has improved in this population, despite no major changes in chemotherapy regimens, mainly due to the universal access to antiretroviral therapy.

Hepatocellular carcinoma: A real-life experience in a specialized center in Bogotá, Colombia / Hepatocarcinoma: experiencia de la vida real en un centro especializado de Bogotá, Colombia

Abstract Introduction: Hepatocellular carcinoma (HCC) is the most frequent malignant primary liver tumor globally. In 2018, it ranked sixth and represented the fourth cause of death from cancer; the five-year overall survival is 18 %. Most cases of HCC develop in patients with cirrhosis of any etiology, especially because of hepatitis B and C viruses, alcohol, and recently nonalcoholic steatohepatitis (NASH). Aim: To analyze the clinical characteristics, diagnostic methods, treatments, prognostic variables, and survival. Materials and methods: This retrospective descriptive study was conducted on a cohort of patients diagnosed with cirrhosis and treated between January 2011 and December 2020 at a health care center in Bogotá. The diagnosis of HCC was confirmed radiologically or by biopsy. We analyzed the information descriptively with absolute frequency measures in the case of categorical variables. For continuous variables, the information was summarized with measures of central tendency (mean or median) and their relevant measures of dispersion. Results: We included 152 patients diagnosed with HCC, with a mean age of 69.4 years; 51.3 % were men. The leading cause of HCC was nonalcoholic fatty liver disease (NAFLD), which accounted for almost a third of cases (32 %); other causes were alcohol (15 %) and hepatitis C virus (14 %). The median manifestation of the tumor was two nodules with a size close to 4 cm. Besides, 35 % of patients had a BCLC (Barcelona Clinic Liver Cancer) stage with curative options, and 25 % received curative treatment options. The first-line systemic therapy used in this cohort was sorafenib®, used in 35 patients (33.7 %). Survival curves showed that women, Child-Pugh class A, and BCLC stage 0 had higher median survival. Multivariate analysis showed a higher risk of death for males (hazard ratio [HR]: 2.16; confidence interval [CI]: 1.24-3.76), Child-Pugh class B (HR: 2.14; CI 1.16-3.95), and Child-Pugh class C (HR: 7.52; CI 2.88-19.57). Conclusions: NAFLD is the leading cause of HCC in this cohort. A third of patients are diagnosed in early BCLC stages with a curative treatment option, and 25 % are treated with curative therapies. Sorafenib was the first-line therapy in advanced HCC. Overall survival after diagnosis of HCC remains low, being necessary to join forces in the follow-up of patients with cirrhosis to improve these outcomes.

Resumen Introducción: el hepatocarcinoma (HCC) es el tumor hepático primario maligno más frecuente en el mundo: en 2018 ocupó la sexta posición y representó la cuarta causa de muerte por cáncer; la supervivencia global a 5 años es del 18 %. La mayoría de los casos de HCC se desarrolla en pacientes con cirrosis de cualquier etiología, especialmente por virus de la hepatitis B y C, alcohol y, recientemente, por la esteatohepatitis no alcohólica (NASH). Objetivo: analizar las características clínicas, métodos de diagnóstico, tratamientos, variables pronósticas y supervivencia. Metodología: estudio descriptivo retrospectivo de una cohorte de pacientes con diagnóstico de cirrosis atendidos entre enero de 2011 y diciembre de 2020 en un centro de atención médica de Bogotá, con diagnóstico de HCC confirmado radiológicamente o por biopsia. La información se analizó de forma descriptiva con medidas de frecuencia absoluta en el caso de las variables categóricas; para las variables continuas se resumió la información con medidas de tendencia central (media o medianas) y su respectiva medida de dispersión. Resultados: se incluyeron 152 pacientes diagnosticados con HCC, con edad promedio de 69,4 años, 51,3 % eran hombres. La principal causa de HCC fue el hígado graso no alcohólico (NAFLD), que representó casi una tercera parte de los casos (32 %); otras causas fueron el alcohol (15 %) y el virus de la hepatitis C (14 %). La mediana de presentación del tumor fue de 2 nódulos con un tamaño cercano a 4 cm. El 35 % de los pacientes tenía un estadio BCLC (Barcelona Clinic Liver Cancer) con opciones curativas y el 25 % de los pacientes recibió opciones curativas de tratamiento. La terapia sistémica de primera línea utilizada en esta cohorte fue el sorafenib®, que se utilizó en 35 pacientes (33,7 %). Las curvas de supervivencia mostraron que las mujeres, el estadio Child-Pugh A y el estadio BCLC 0 presentaron mayores medianas de supervivencia. El análisis multivariado evidenció un mayor riesgo de muerte al ser hombre (Hazard ratio [HR]: 2,16; intervalo de confianza [IC]: 1,24 a 3,76), estar en los estadios Child-Pugh B (HR: 2,14; IC: 1,16 a 3,95) y Child-Pugh C (HR: 7,52; IC: 2,88 a 19,57). Conclusiones: el NAFLD es la principal causa de HCC en la presente cohorte, una tercera parte de los pacientes se diagnostica en estadios BCLC tempranos con opción curativa de tratamiento, y un 25 % se trata con terapias curativas. El sorafenib fue la terapia de primera línea en HCC avanzado. La supervivencia global luego del diagnóstico de HCC sigue siendo baja, y es necesario aunar esfuerzos en el seguimiento de los pacientes con cirrosis para mejorar estos resultados.

Sobrevida de pacientes en hemodiálisis crónica versus diálisis peritoneal crónica / Survival of patients on chronic hemodialysis versus chronic peritoneal dialysis

RESUMEN Objetivo. Comparar la supervivencia de pacientes con enfermedad renal crónica (ERC) en hemodiálisis (HD) versus diálisis peritoneal (DP). Materiales y métodos. Se realizó un análisis de supervivencia de una cohorte retrospectiva de pacientes ≥ 18 años que iniciaron HD versus DP en el Hospital Víctor Lazarte Echegaray del 2015 al 2019. Se analizaron las covariables: edad, sexo, diabetes mellitus con causa de ERC, catéter venoso central temporal (CVC) como acceso vascular inicial y tasa de filtración glomerular. Se calculó la supervivencia con curvas de Kaplan-Meier para la cohorte global y para edad ≥ 60 años, diabetes mellitus como causa de ERC y CVC. Se estimó el riesgo de fallecer mediante Hazard Ratio (HR) según el modelo de riesgos proporcionales de Cox para cada covariable ajustada a la modalidad de diálisis en un análisis bivariado y multivariado considerando diferencia significativa si el valor de p < 0,05. Resultados. Se incluyeron 368 pacientes en HD de los cuales fallecieron 129 (35,1%) y 172 pacientes en DP de los cuales fallecieron 66 (38,4%) (p=0,455). La probabilidad acumulada de supervivencia a los 60 meses para HD fue de 30% y para DP fue de 37% con curvas de supervivencia similares (p=0,719). La mediana del tiempo de sobrevida en HD fue de 32 meses (RIC: 20-53) y en DP fue de 32,5 meses (RIC: 18-57) (p=0,999). Se determinó que las covariables asociadas con una mayor mortalidad ajustadas a la modalidad de diálisis fueron edad ≥60 años (HR 1,77; p<0,001) y diabetes mellitus como causa de ERC (HR 1,63; p=0,002). Conclusiones. La supervivencia de los pacientes con enfermedad renal crónica en HD y DP fue similar.

ABSTRACT Objective. To compare the survival of patients with chronic kidney disease (CKD) on hemodialysis (HD) versus peritoneal dialysis (PD). Materials and methods. Survival analysis of a retrospective cohort of patients ≥ 18 years who started HD versus PD at the Victor Lazarte Echegaray Hospital from 2015 to 2019. We analyzed the following covariates: age, sex, diabetes mellitus as cause of CKD, temporary central venous catheter (CVC) as initial vascular access and glomerular filtration rate. Survival was calculated with Kaplan-Meier curves for the overall cohort and for age ≥ 60 years, diabetes mellitus as a cause of CKD and CVC. The risk of death was estimated by Hazard Ratio (HR) according to the Cox proportional hazards model for each covariate adjusted for dialysis type in a bivariate and multivariate analysis considering significant difference if the p-value < 0.05. Results. We included 368 patients on HD of whom 129 (35.1%) died, and 172 patients on PD of whom 66 (38.4%) died (p=0.455). The cumulative probability of survival at 60 months for HD was 30% and for PD was 37% with similar survival curves (p=0.719). The median survival time for HD was 32 months (IQR: 20-53) and for PD was 32.5 months (IQR: 18-57) (p=0.999). The covariates associated with higher mortality adjusted for dialysis type were age ≥60 years (HR 1.77; p<0.001) and diabetes mellitus as a cause of CKD (HR 1.63; p=0.002). Conclusions. Survival of patients with CKD on HD and PD was similar.

Infiltración linfocitaria tumoral como factor de buen pronóstico de supervivencia en pacientes con cáncer gástrico localmente avanzado / Tumor lymphocytic infiltration as a good prognostic factor for survival in patients with locally advanced gastric cancer

Introducción: La relación entre supervivencia e infiltración linfocitaria en el cáncer gástrico se ha determinado como factor pronóstico beneficioso, este estudio local tiene como objetivo determinar la probabilidad de supervivencia en los pacientes con cáncer gástrico estadios IB al IIIC de acuerdo con el porcentaje de infiltración linfocitaria tumoral. Metodología: El presente estudio longitudinal se realizó en el Hospital Oncológico Solón Espinosa Ayala Solca-Núcleo de Quito. El período de estudio de enero del 2013 a enero del 2016, el tiempo de seguimiento terminó en diciembre del 2018. El cálculo de la muestral fue no probabilístico en donde se incluyeron casos de pacientes mayores a 18 años con diagnóstico de cáncer gástrico con estadios clínicos IB al IIIC, que contaron con una muestra histopatológica de gastrectomías. Se usó la variable: "Porcentaje de infiltración" para el análisis la muestra y se dividió en 3 grupos: G1: infiltración linfocitaria leve, G2: moderada y G3: intensa. Las estimaciones de supervivencia se calcularon utilizando el método de Kaplan-Meier y la comparación entre los grupos con la prueba de rango logarítmico. Resultados: 173 pacientes con cáncer gástrico con estadios clínicos IB al IIIC, seguidos a 72 meses, el 60 % son hombres y el 40 % mujeres. Según el porcentaje de infiltración linfocitaria, el 52 % reportaron un porcentaje de infiltración leve, el 21 % moderada y el 27 % intensa. A los 72 meses de seguimiento la supervivencia en G1 fue del 31 %, en G2 fue del 48 %, y en G3 fue del 77 % (P= 0.001). Conclusión: Se encontró que el grado de infiltración linfocitaria intensa en los pacientes con cáncer gástrico estuvo asociado a una mejor supervivencia en el seguimiento a 72 meses.

Introduction: The relationship between survival and lymphocytic infiltration in gastric cancer has been determined to be a beneficial prognostic factor. This local study aims to assess the probability of survival in patients with gastric cancer stages IB to IIIC according to the percentage of lymphocytic infiltration. Methodology: This longitudinal study was conducted at the Solón Espinosa Ayala Solca-Núcleo Cancer Hospital in Quito. The study period was from January 2013 to January 2016; the follow-up time ended in December 2018. The sample calculation was nonprobabilistic and included cases of patients older than 18 diagnosed with gastric cancer with clinical stages IB at IIIC, which had a histo-pathological sample of gastrectomies. The variable "percentage of infiltration" was used to analyze the sample, and it was divided into three groups: G1: mild lymphocytic infiltration, G2: moderate, and G3: intense. Survival estimates were calculated using the Kaplan­Meier method and compared groups with the log-rank test. Results: A total of 173 patients with gastric cancer with clinical stages IB to IIIC were followed up for 72 months; 60% were men, and 40% were women. According to the percentage of lymphocytic infil-tration, 52% reported a rate of mild infiltration, 21% moderate, and 27% intense. At 72 months of follow-up, survival was 31% in G1, 48% in G2, and 77% in G3 (P= 0.001). Conclusion: The degree of intense lymphocytic infiltration in gastric cancer patients was associated with better survival at the 72-month follow-up.

Sedación paliativa en enfermedad terminal / Palliative sedation in terminal desease

Resumen Algunos pacientes con enfermedad terminal que están cerca del final de la vida pueden experimentar un sufrimiento intolerable dado por síntomas refractarios a las terapias paliativas específicas. La Sedación Paliativa (SP) se considera una modalidad de tratamiento eficaz para el manejo de estos síntomas refractarios cuando los esfuerzos agresivos no proporcionan alivio. La SP consiste en el uso de medicamentos que inducen sedación y disminución del nivel de conciencia con el objetivo de aliviar el sufrimiento intolerable en los últimos días de la vida. Los síntomas físicos refractarios más frecuentes son el dolor, delirium y disnea, sin embargo, la SP también se indica para tratar el sufrimiento existencial o la angustia psicológica, que es un problema extremadamente difícil y delicado. La SP ha sido ampliamente debatida por las obvias implicaciones éticas, socioculturales y de toma de decisiones. Se ha reportado que la SP se administra en una proporción que va del 2% al 52% de los pacientes con enfermedades terminales. Los estudios han sugerido que la SP es exitosa en el manejo de los síntomas intratables al final de la vida, no genera efectos perjudiciales sobre la supervivencia y es satisfactoria para los familiares.

Abstract Palliative sedation (PS) is frequently applied in some patients with terminal illness, who are near the end of life, to ameliorate unendurable and refractory distress; it is considered an effective treatment modality for the management of refractory symptoms when aggressive efforts do not provide relief. PS consists of the use of medications that induce sedation and decrease the level of consciousness with the aim of relieving intolerable suffering in the last days of life. The most frequent physical refractory symptoms are pain, delirium, and dyspnea, but PS is also indicated to treat existential suffering or psychological distress, which is an extremely difficult and delicate problem. PS has been widely debated given its obvious ethical, sociocultural, and decision-making implications. It has been reported that PS is given to 2-52% of patients with terminal illness; studies have suggested that PS is successful in managing intractable symptoms at the end of life, satisfactory for family members, and does not have detrimental effects on survival.

Survival in Patients with Cirrhosis According to Etiology. Retrospective Cohort / Sobrevida en pacientes con cirrosis de acuerdo con su etiología. Cohorte retrospectiva

Abstract Introduction: Cirrhosis is the final stage of chronically progressive liver diseases of various etiologies. It is a common disease, with a variable prevalence in each country. Its peak incidence occurs between 40 and 50 years of age, predominantly in men. Aims: To compare a cohort of patients diagnosed with cirrhosis, evaluate their complications and survival according to etiology, describe clinical and laboratory aspects, and determine the role of a fatty liver. Materials and methods: A retrospective cohort study was carried out with patients who held a specialized hepatology consultation in the center of liver and digestive diseases (CEHYD) in Bogotá, Colombia, between January 2010 and June 2019. Results: We reviewed a total of 1,200 medical records (56.8 % women). There were no statistically significant differences in median survival between groups by etiology, sex, presence or absence of complications, or Child. We noted that the older the age at the diagnosis of cirrhosis, the higher the risk of death; HR 1.04 (95 % CI 1.02-1.075). For each month that follow-up increases, the risk of death decreases by 90 %; HR 0.1 (95 % CI 0.03-0.29). For each month that the follow-up of complications increases, the risk of death is reduced by 2 %; HR 0.98 (95 % CI 0.97-0.99). Conclusions: Survival by etiology was similar in the different groups. Nonalcoholic steatohepatitis (NASH) was the leading cause of cirrhosis in this cohort. Efforts should focus on its diagnosis and management in the early stages.

Resumen Introducción: la cirrosis es el estadio final de enfermedades hepáticas crónicamente progresivas de diferentes etiologías. Es una enfermedad frecuente, con una prevalencia variable en cada país. Su pico de incidencia se presenta entre los 40 y 50 años, predominantemente en hombres. Objetivos: comparar una cohorte de pacientes con diagnóstico de cirrosis, evaluar sus complicaciones y sobrevida de acuerdo con su etiología, describir los aspectos clínicos y de laboratorio, y determinar el papel del hígado graso. Materiales y métodos: se realizó un estudio de cohorte retrospectiva, en donde se incluyeron pacientes que asistieron a consulta especializada de hepatología en el centro de enfermedades hepáticas y digestivas (CEHYD), en la ciudad de Bogotá, durante enero de 2010 y junio de 2019. Resultados: se revisaron un total de 1200 historias clínicas (56,8 % mujeres). No se evidenció diferencias estadísticamente significativas en las medianas de sobrevida entre los grupos por etiologías, sexo, presencia o no de complicaciones, o Child. Se evidenció que entre mayor edad en el diagnóstico de cirrosis, el riesgo de muerte es mayor; HR 1,04 (IC 95 % 1,02-1,075). Por cada mes que aumenta el seguimiento se reduce el riesgo de muerte en 90 %; HR 0,1 (IC 95 % 0,03-0,29). Por cada mes que aumenta el seguimiento de las complicaciones se reduce el riesgo de muerte en 2 %; HR 0,98 (IC 95 % 0,97-0,99). Conclusiones: La sobrevida por etiología fue similar en los diferentes grupos. La esteatohepatitis no alcohólica (NASH) fue la principal causa de cirrosis en esta cohorte. Se deben orientar esfuerzos a su diagnóstico y manejo en fases tempranas.

Morbilidad y mortalidad de 599 pacientes con drepanocitosis en el Instituto de Hematología e Inmunología / Morbidity and mortality of 599 sickle cell disease patients in the Institute of Hematology and Immunology

Introducción: La drepanocitosis es la anemia hemolítica congénita más común del mundo. Entre el 5 y 15 por ciento de la población mundial es portadora de la hemoglobina S y en Cuba, la frecuencia es de 3,08 por ciento, lo que representa un problema de salud pública. Objetivo: Caracterizar el cuadro clínico, el perfil hematológico y la probabilidad de supervivencia de los pacientes con drepanocitosis en el Instituto de Hematología e Inmunología. Método: Se realizó estudio descriptivo, longitudinal y retrospectivo, que incluyó todos los enfermos seguidos, al menos dos años, en la institución, entre enero de 1973 y diciembre del 2009. Resultados: Se incluyeron 599 pacientes (285 masculinos), 439 SS/Sβ0tal y 160 SC/Sβ+tal. El seguimiento medio fue de 17,6±9,5 años. Predominaron los pacientes entre 20 y 59 años. Los eventos clínicos más frecuentes fueron las crisis vasoclusivas dolorosas, las infecciones, el síndrome torácico agudo y las complicaciones hepáticas. Los valores de reticulocitos, plaquetas, leucocitos y hemoglobina fetal fueron significativamente mayores en los pacientes SS/Sβ0tal; no así la hemoglobina total que fue mayor en los SC/Sβ+tal. La probabilidad de supervivencia global de los pacientes a los 45 años fue de 69 por ciento. Los accidentes vasculares encefálicos (17,5 por ciento), las complicaciones hepáticas (17,5 por ciento) y las cardíacas (14,28 por ciento) fueron las principales causas de muerte. Conclusiones: La distribución demográfica y por hemoglobinopatías, el cuadro clínico, y el perfil hematológico fueron similares a los encontrados en pacientes de otras regiones geográficas, excepto la frecuencia de complicaciones hepáticas que fue mayor. La probabilidad de supervivencia fue similar con los mejores centros de atención en el mundo(AU)

Introduction: Sickle cell disease is the most common congenital hemolytic anemia in the world. Between 5 to 15 percent of the world population is a carrier of hemoglobin S and in Cuba, the frequency is 3.08 percent, which represents a public health problem. Objective: To characterize the clinical picture, the hematological profile, and the probability of survival of patients with sickle cell disease at the Institute of Hematology and Immunology. Method: A descriptive, longitudinal and retrospective study was carried out, which included all patients followed up for at least two years at the institution between January 1973 and December 2009. Results: 599 patients (285 male), 439 SS/Sβ0tal and 160 SC/Sβ+tal, were included. The mean follow-up was 17.6±9.5 years. Patients between 20 and 59 years old predominated. The most frequent clinical events were painful vasocclusive crises, infections, acute chest syndrome, and liver complications. The reticulocytes, platelets, leukocytes and fetal hemoglobin values ​​were significantly higher in the SS/Sβ0tal patients, but not the total hemoglobin, which was higher in the SC/Sβ+tal. The overall survival probability of patients at 45 years was 70 percent. Stroke (17.5 percent), liver complications (17.5 percent), and cardiac complications (14.28 percent) were the main causes of death. Conclusions: The demographic distribution and by hemoglobinopathies, the clinical events, and the hematological profile were similar to those found in patients from other geographic regions, except the frequency of liver complications, which was higher. The probability of survival was comparable with the best care centers in the world(AU)

Sobrevida en pacientes internados en unidades de cuidados intensivos por COVID-19 en la provincia de Buenos Aires, Argentina / Survival in patients admitted to intensive care units due to COVID-19 in the province of Buenos Aires, Argentina

INTRODUCCIÓN: Uno de los problemas que ha enfrentado el sistema de salud de los diferentes países debido a la pandemia de COVID-19 es la disponibilidad de servicios y atención médica en unidades de cuidados intensivos (UCI). El objetivo fue evaluar la sobrevida en pacientes internados por COVID-19 en UCI entre enero y abril de 2021 en la provincia de Buenos Aires, Argentina. MÉTODOS: Se consideró a los pacientes que, incluidos en el sistema de vigilancia, tuvieran su correlato de información del porcentaje ocupacional de camas de la UCI desde el sistema general. Con esta información se realizó un análisis de sobrevida, considerando tablas de vida, Kaplan-Meier y regresión de Cox. El evento fue el óbito, el tiempo de seguimiento a 96 días y las fechas de internación, defunción y egreso dentro de la UCI como períodos individuales de cada paciente. La capacidad operativa de las UCI fue medida a través del porcentaje de ocupación de camas al momento del ingreso. RESULTADOS: Las UCI con un porcentaje ocupacional mayor al 80% mostraron pacientes con menor curva de sobrevida que sus pares por debajo de esas cifras al momento de ingresar a la internación. DISCUSIÓN: Las diferencias en promedios de sobrevida son estadísticamente diferentes, y muestran dos curvas distintas de supervivencia en el momento en que la segunda ola de COVID-19 afectaba a la Argentina.

Perinatal Outcomes after Fetal Endoscopic Tracheal Occlusion for Isolated Congenital Diaphragmatic Hernia: Rapid Review / Resultados perinatais após oclusão traqueal endoscópica fetal por hérnia diafragmática congênita isolada: Revisão rápida

Abstract Objective To compare the perinatal outcomes of fetuses with isolated congenital diaphragmatic hernia after fetal endoscopic tracheal occlusion (FETO) and antenatal expectant management. Data sources In this rapid review, searches were conducted in the MEDLINE, PMC, EMBASE and CENTRAL databases between August 10th and September 4th, 2020. Randomized controlled trials (RCTs), quasi-RCTs or cluster-RCTs published in English in the past ten years were included. Study selection We retrieved 203 publications; 180 studies were screened by abstract. Full-text selection was performed for eight studies, and 1 single center RCTmet the inclusion criteria (41 randomized women; 20 in the FETO group, and 21 in the control group). Data collection Data collection was performed independently, by both authors, in two steps (title and abstract and full-text reading). Data synthesis There were no cases of maternal mortality. The mean gestational age at delivery was of 35.6±2.4 weeks in the intervention group, and of 37.4±1.9 weeks among the controls (p<0.01). Survival until 6 months of age was reported in 50% of the intervention group, and in 5.8% of the controls (p<0.01; relative risk: 10.5; 95% confidence interval [95%CI]: 1.5-74.7). Severe postnatal pulmonary hypertension was found in 50% of the infants in the intervention group, and in 85.7% of controls (p=0.02; relative risk: 0.6; 95%CI: 0.4-0.9). An analysis of the study indicated some concerns of risk of bias. The quality of evidence was considered moderate to low. Conclusion Current evidence is limited but suggests that FETO may be an effective intervention to improve perinatal outcomes.

Resumo Objetivo Comparar os resultados perinatais de fetos com hérnia diafragmática congênita após oclusão traqueal endoscópica fetal (OTEF) e conduta expectante pré-natal. Fontes dos dados Nesta revisão rápida, pesquisas foram conduzidas nas bases de dados MEDLINE, PMC, EMBASE e CENTRAL entre 10 de agosto de 2020 e 4 de setembro de 2020. Ensaios clínicos randomizados (ECRs), quase-ECRs e ECRs em cluster publicados em inglês nos últimos dez anos foram incluídos. Seleção dos estudos Foram recuperadas 203 publicações; 180 destas foram triadas pelo resumo. Fez-se a leitura do texto completo de 8 estudos, e 1 ECR cumpriu os critérios de inclusão (41 mulheres aleatorizadas; 20 no grupo OTEF e 21 no grupo de controle). Coleta de dados A coleta de dados realizada independentemente pelos dois autores, em duas etapas (título e resumo, e leitura do texto completo). Síntese dos dados Não houve casos de mortematerna. A idade gestacionalmédia no parto foi de 35,6±2,4 semanas no grupo de intervenção, e de 37,4±1,9 semanas entre os controles (p<0,01). A sobrevida até 6 meses de idade foi relatada em 50% do grupo de intervenção, e em 5,8% dos controles (p<0,01; risco relativo: 10,5; intervalo de confiança de 95% [IC95%]: 1,5-74,7). Hipertensão pulmonar grave ocorreu em 50% dos lactentes do grupo de intervenção, e em 85,7% dos controles (p = 0.02; risco relativo: 0,6; IC95%: 0,4-0,9). Uma análise do estudo indicou algumas preocupações quanto ao risco de viés. A qualidade da evidência foi considerada de moderada a baixa. Conclusão As evidências atuais são limitadas,mas sugeremque a OTEF pode ser uma intervenção eficaz para melhorar resultados perinatais.

Survival of patients with advanced cancer in Enteral Nutritional Therapy: a comparison between caloric estimates / Sobrevida de pacientes com câncer avançado em Terapia Nutricional Enteral: um comparativo entre estimativas calóricas

ABSTRACT Objective To assess factors related to the achievement of the caloric estimates of enteral nutritional therapy and the survival of patients with advanced cancer in exclusively palliative care. Methods Retrospective study, where patients using enteral nutrition admitted from March 2019 to February 2020 were divided into two groups: Group 1 included patients who reached 75% of the estimated caloric goals, and Group 2 included those who did not. The data were extracted from the patients' electronic medical records. Logistic regression analyzes were performed to assess associations between the studied sociodemographic, clinical, and nutritional variables, and the Kaplan-Meier curve and Cox regression were used to assess the survival of the groups. Results A total of 158 patients participated in the study, with a median age of 63 (IIQ: 55-70) years. 57% reached the caloric goal (Group 1). In the logistic regression, the functional capacity (OR: 5.82; CI: 2.28-14.84; p<0.001) and symptoms of nausea or vomiting (OR: 0.050; CI: 0.005-0.455; p=0.008) were independent variables for achieving the caloric goal. Cox regression showed Karnofsky Performance Status as an independent predictor for survival (HR: 1.85; CI: 1.13-3.04). Conclusion Patients with better functionality have longer survival and are potential candidates for reaching the caloric goals proposed by national and international guidelines for cancer patients.

RESUMO Objetivo Avaliar os fatores relacionados ao alcance das estimativas calóricas da terapia nutricional enteral e a sobrevida dos pacientes com câncer avançado em cuidados paliativos exclusivos. Métodos Estudo retrospectivo no qual pacientes em uso de nutrição enteral internados no período de março de 2019 a fevereiro de 2020 foram divididos em dois grupos: Grupo 1, composto por pacientes que atingiram 75% das metas calóricas estimadas, e Grupo 2, composto por aqueles que não atingiram. Os dados foram extraídos do prontuário eletrônico dos pacientes. Análises de regressão logística foram realizadas para avaliar associações entre as variáveis sociodemográficas, clínicas e nutricionais estudadas, e a curva de Kaplan-Meier e regressão de Cox foram usadas para avaliar a sobrevida dos grupos. Resultados Participaram do estudo 158 pacientes, com mediana de idade de 63 (IIQ:55-70) anos. Cinquenta e sete por cento dos pacientes atingiram a meta calórica (Grupo 1). Na regressão logística, a capacidade funcional (OR:5,82; IC: 2,28-14,84; p<0,001) e os sintomas náuseas ou vômitos (OR:0,050; IC:0,005-0,455; p=0,008) se mostraram variáveis independentes para o alcance da meta calórica. A regressão de Cox mostrou o Karnofsky Performance Status como preditor independente para sobrevida (HR: 1,85; IC: 1,13-3,04) Conclusão Pacientes com melhor funcionalidade possuem sobrevida maior e são potenciais candidatos ao alcance das metas calóricas propostas por diretrizes nacionais e internacionais para pacientes com câncer em terapia nutricional enteral.

Nutritional factors and metabolic biomarkers: impact in risk and survival of women with breast cancer / Fatores nutricionais e biomarcadores metabólicos: impacto no risco e sobrevida de mulheres com câncer de mama

Breast cancer (BC) is the most common cause of cancer and the leading cause of death in women. BC is a complex disease and distributes in distinct molecular subtypes regarding the expression of estrogen receptor (ER), progesterone receptor (PR), receptor tyrosine-protein kinase erbB-2 (HER2), and Ki67 protein status. Although BC is multifactorial evidence indicates that nutritional factors are relevant during steps of carcinogenesis, recurrence, and survival. We aim to assess the role of nutrition status and metabolic biomarkers in women with BC. This is a case-control study between May 2011 and August 2012. In the case group, there was a follow-up until April 2019, characterizing a cohort study. From these groups, different manuscripts were structured with different study designs according to each hypothesis. Manuscript 1 - cohort based on the follow-up of the BC group, Manuscript 2 - a cross-sectional study with women with Luminal A BC (ER positive, PR positive/negative, HER2 negative, Ki67 low) and Manuscript 3 - a cross-sectional case-control study. Data were obtained by medical records, interviews and anthropometric parameters with electrical impedance. Blood samples were collected after 12-hour fasting to analyze serum glucose, glycated hemoglobin, insulin growth factor 1 (IGF-1), insulin growth factor binding protein (IGFBP-3), insulin and adipokines, thiobarbituric acid reactive substances (TBARS), non-esterified fatty acids (NEFA), DNA oxidative damage (8-OH-dG) and lipoproteins (total cholesterol - TC, Low-density lipoprotein cholesterol - LDL-c, high-density lipoprotein cholesterol - HDL-c and triacylglycerols) and fatty acid profile of erythrocyte membrane. All statistical tests were performed using Statistical Package for Social Sciences® (SPSS), version 21.0. Statistical significance was set at p < 0.050. The main results of the study showed that premenopausal women with BC and clinical staging (CS) between II and III had a more atherogenic lipid profile characterized by the decrease in HDL-c, increase in LDL-c, non-HDL-C and apolipoprotein B (Apo B). We highlight that women with BC and high LDL-c and non-HDL-c had increase odd of having larger tumor size whereas HDL-c was associated with a decreased risk. Premenopausal women with BC had an increased level of TBARS and NEFA at diagnosis and had a lower survival probability. Additionally, women with Luminal A BC had higher serum levels of glucose, IGF-1, IGFBP-3, IL1ß, IL6, and lower IL10 compared to its matching controls. Also, women with increased serum levels of TBARS, glucose, and insulin increased risk of Luminal A BC, and higher levels of adiponectin decrease the risk of developing Luminal A BC when controlled by menopause status and BMI. Women with BC presented impaired IGF-1/insulin axis, sustained by overweight/obesity and higher central adiposity. Increased levels of serum glucose, insulin, and IGF-1 showed higher odds to developing BC. In conclusion, our results demonstrate the relevant impact of metabolic biomarkers on risk of developing BC and in survival outcomes. This study reinforces the relevance to increase prevention strategies regarding lifestyle and nutrition to decrease incidence and improve outcome of BC.

Câncer de mama (CM) é a causa mais comum de câncer no mundo e a principal causa de morte em mulheres. O CM é uma doença complexa e é classificada em tipos moleculares de acordo com a expressão do receptor de estrogênio (RE), receptor de progesterona (RP), receptor tyrosine-protein kinase erbB-2 (HER2) e proteína Ki67. Embora o CM seja multifatorial, há evidências científicas que indicam que componentes nutricionais podem ser relevantes durante as diversas etapas da carcinogênese, recidiva e sobrevivência. O objetivo deste estudo foi avaliar o papel do estado nutricional e marcadores metabólicos em mulheres com CM. Trata-se de um estudo caso-controle realizado entre maio 2011 e agosto 2012. O grupo caso foi acompanhado até abril 2019, caracterizando um estudo de coorte. A partir destes grupos foram estruturados diversos manuscritos com delineamentos diferentes, segundo cada hipótese levantada, a saber: Manuscrito 1 - Coorte baseada no seguimento do grupo CM, Manuscrito 2 - Estudo transversal baseado em mulheres com CM Luminal A (RE positivo, RP positivo/negativo, HER2 negativo, Ki67 baixo) e; Manuscrito 3 - estudo transversal do tipo caso-controle. Os dados foram obtidos através de prontuários médicos, entrevista e avaliação antropométrica com uso de bioimpedância elétrica. As amostras de sangue foram coletadas após jejum de 12 horas e a partir dessas foram analisadas glicemia, hemoglobina glicada (HbA1c), insulina, fator de crescimento semelhante à insulina 1 (IGF-1), proteína 3 de ligação ao fator de crescimento semelhante a insulina (IGFBP-3), substâncias reativas ao ácido tiobarbitúrico (TBARS), ácidos graxos não esterificados (NEFA), dano oxidativo ao DNA (8-OH-dG), perfil lipídico (colesterol total - CT, colesterol associado à lipoproteína de baixa densidade - LDL-c, colesterol associado à lipoproteína de alta densidade - HDL-c e triacilgliceróis) e perfil de ácidos graxos incorporados às membranas eritrocitárias. Todos os testes estatísticos foram realizados no programa Statistical Package for Social Sciences® (SPSS), versão 21.0. Significância estatística foi considerada em p < 0,050. Os principais resultados do estudo mostram que mulheres com CM na pré-menopausa e com estadiamento clínico II e III tiveram um perfil lipídico mais aterogênico caracterizado pela diminuição do HDL-c, aumento do LDL-c, nãoHDL-c e apolipoproteína B (Apo B). Destaca-se que mulheres com CM e LDL-c e nãoHDL-c aumentados apresentaram maior chance de tumores maiores, enquanto mulheres com CM com maior HDL-c apresentaram menor risco. Mulheres com CM na pré-menopausa que apresentaram maior conteúdo de TBARS e NEFA no momento do diagnóstico tiveram menor sobrevida. Adicionalmente, mulheres com CM e tumores do tipo Luminal A tiveram maiores concentrações de glicose, IGF-1, IGFBP-3, IL1ß, IL6 e menores de IL10 comparadas com o grupo controle. Mulheres com com concentrações mais elevadas de TBARS, glicose e insulina apresentaram maior risco de CM Luminal A, enquanto aquelas com concentrações mais elevadas de adiponectina apresentaram menor risco de desenvolver CM Luminal A, mesmo quando controlados pelo estado de menopausa e IMC. Mulheres com CM apresentaram alterações no eixo IGF-1/insulina que foi sustentada no sobrepeso/obesidade e no aumento da adiposidade central. Observou-se que mulheres com concentrações mais elevadas de glicose, insulina e IGF-1 tiveram maior chance de desenvolver CM. Em conclusão, os resultados demonstram o relevante impacto dos marcadores metabólicos no risco de desenvolver CM e o seu impacto na sobrevida. Este estudo reforça a relevância das estratégias de prevenção relacionadas ao estilo de vida e nutrição a fim de diminuir incidência e melhorar a sobrevida de mulheres com CM.

Disgerminoma ovariano na gestação: relato de caso / Ovarian dysgerminoma in pregnancy: a case report

Os disgerminomas são tumores malignos de células germinativas ovarianas, são raros, geralmente acometem mulheres em idade fértil e têm bom prognóstico e sobrevida elevada. Paciente de 20 anos, primigesta com 26 semanas de gestação, foi admitida no centro obstétrico da Fundação Hospitalar Santo Antônio em Blumenau- SC com quadro de dor abdominal intensa refratária à analgesia e desconforto respiratório. Ressonância magnética demonstrou derrame pleural, moderada ascite e volumosa lesão expansiva de aspecto sólido-cístico em anexo direito. Foram realizadas salpingo-oforectomia à direita e omentectomia parcial e coletado lavado peritoneal. Anatomopatológico evidenciou disgerminoma. A paciente seguiu acompanhamento gestacional nos serviços de pré-natal de alto risco e oncologia. Devido à imaturidade fetal, manteve-se conduta expectante e, após o parto normal com 37 semanas, foi realizado estadiamento e iniciada quimioterapia adjuvante. Devido à baixa incidência e à raridade de tumores de células malignas ovarianas, relatos de casos como este são importantes para discutir as melhores estratégias de manejo clínico.(AU)

Dysgerminomas are rare malignant ovarian germ cell tumors that generally affect adolescence and early adulthood, have a good prognosis and high survival. Patient 20 years old, gestation 1, at 26 weeks of gestation, was hospitalized at the obstetric center of Fundação Hospitalar Santo Antônio in Blumenau-SC, with severe abdominal pain refractory to analgesia and respiratory discomfort. Magnetic resonance showed pleural effusion, moderate ascites and a massive expansive lesion with a solid cystic aspect in the right ovary. Right salpingoophorectomy, partial omentectomy and peritoneal lavage were collected. Anatomopathological evidence showed dysgerminoma. Patient followed gestational follow-up at high-risk prenatal and oncology services. Due to fetal immaturity, expectant management was maintained and after vaginal delivery at 37 weeks, staging was performed and adjuvant chemotherapy was started. Due to the low incidence and rarity of ovarian malignant cell tumors, case reports such as this one are important to discuss the best clinical management strategies.(AU)

Supervivencia del paciente trasplantado y del injerto renal en una cohorte retrospectiva en México / Transplant patient and kidney graft survival in a retrospective cohort in Mexico

Introducción: el conocimiento de la funcionalidad del injerto y la supervivencia del paciente es fundamental para valorar el éxito del trasplante renal. Objetivo: determinar la supervivencia de los pacientes trasplantados por tipo de donante y la funcionalidad de los injertos renales en una cohorte en México. Material y métodos: cohorte de trasplante renal de 2013 a 2017 en México. Se analizaron 790 pacientes seguidos por un año para valorar la supervivencia de los pacientes trasplantados por tipo de donante y la funcionalidad de los injertos renales. Para ello se usaron medidas de tendencia central y dispersión, así como tablas de supervivencia de Kaplan-Meier con SPSS, versión 25. Resultados: de los 790 pacientes, 518 fueron de donante vivo (65.56%) con supervivencia del paciente de 97.88% y de funcionalidad del injerto de 93.24% a 12 meses de seguimiento; 272 pacientes recibieron el injerto de donante fallecido con supervivencia del paciente de 91.18% y funcionalidad del injerto renal de 84.19%. Conclusiones: aún existe una diferencia de casi 5% en la supervivencia del paciente receptor de un donante vivo en referencia con un donante fallecido. Para la funcionalidad del injerto renal esta diferencia es > 7%. La donación cadavérica ha aumentado; sin embargo, incluso en cifras bajas es de aproximadamente el 35% en México

Background: Knowledge of the functionality of the graft and patient survival is essential to assess the success of kidney transplantation. Objective: To determine the survival of transplanted patients by type of donor and the functionality of kidney grafts in a cohort in Mexico. Material and methods: Kidney transplant cohort from 2013 to 2017 in Mexico. 790 patients followed up for one year were analyzed to assess the survival of transplanted patients by type of donor and the functionality of kidney grafts. For this, measures of central tendency and dispersion were used, as well as Kaplan-Meier survival tables with SPSS, version 25. Results: Out of the 790 patients, 518 were from living donors (65.56%) with patient survival of 97.88% and graft function of 93.24% at 12 months of follow-up; 272 patients received the graft from a deceased donor with patient survival of 91.18% and renal graft function of 84.19%. Conclusions: There is still a difference of almost 5% in the survival of the recipient patient from a living donor compared to a deceased donor. For the functionality of the kidney graft, this difference is > 7%. Cadaveric donation has increased; however, even at low figures is of approximately 35% in Mexico