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1.
Arch. argent. pediatr ; 119(4): 266-270, agosto 2021. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1280929

ABSTRACT

Objetivo. Describir el impacto de la pandemia por COVID-19 en el programa de cirugía cardiovascular pediátrica y estimar el tiempo para reducir la lista de espera quirúrgica. Métodos. Estudio descriptivo y retrospectivo. Se compararon resultados quirúrgicos del período preCOVID versus el período COVID. Se utilizó un modelo matemático para estimar el tiempo para reducir la lista de espera. Resultados. Entre el 23 de marzo y el 31 de agosto de 2020 se operaron 83 pacientes, que representan una reducción del 60 %, respecto al período preCOVID. La mediana de edad fue de 6 meses (rango intercuartílico [RIC]: 25-75, 1,8 meses a 2,9 años; p = 0,0023. El tiempo para eliminar la lista de espera varía entre 10 y 19 meses. Conclusiones. El programa tuvo una reducción del 60 %. El tiempo de resolución de la lista de espera puede ser al menos 10 a 19 meses


Objective. To describe the impact of the COVID-19 pandemic on a pediatric cardiovascular surgery program and estimate the necessary time to reduce the surgery waiting list. Methods. Retrospective, descriptive study. Surgical outcomes from the pre-COVID-19 period and COVID-19 period were compared. A mathematical model was used to estimate the time necessary to reduce the waiting list. Results. Between March 23rd and August 31st, 2020, 83 patients underwent surgery, accounting for a 60 % reduction compared to the pre-COVID-19 period. Their median age was 6 months (interquartile range [IQR]: 25-75, 1.8 months to 2.9 years; p = 0.0023). The time necessary to eliminate the waiting list ranges from 10 to 19 months. Conclusions. There was a 60 % reduction in the program. The time required to clear the backlog of cases may range from, at least, 10 to 19 month


Subject(s)
Humans , Infant , Child, Preschool , Child , Cardiovascular Surgical Procedures/trends , Waiting Lists , Time-to-Treatment/trends , Health Services Accessibility/trends , Hospitals, Public/trends , Argentina/epidemiology , Retrospective Studies , Pandemics , COVID-19/prevention & control , COVID-19/epidemiology , Models, Theoretical
2.
Rev. cuba. enferm ; 37(2): e3684, 2021. tab
Article in Spanish | LILACS, BDENF, CUMED | ID: biblio-1347416

ABSTRACT

Introducción: El alto índice de lesiones por presión en la Atención Primaria de Salud del municipio San José, generó la necesidad de utilizar una superficie especial de manejo de presión sustituto para su prevención. Objetivo: Evaluar la efectividad de una superficie especial de manejo de presión sustituto en la prevención de lesiones por presión. Métodos: Intervención cuasi-experimental con grupo control en pacientes encamados con lesiones por presión estadíos I y II en consultorios del Policlínico "Luis A. Turcios Lima", Mayabeque, durante 2018. Universo de 57 pacientes, se conformaron dos grupos por muestreo aleatorio simple. El grupo experimental con 27 pacientes (medidas generales de prevención y superficie especial de manejo de presión sustituto) y grupo control (medidas generales de prevención) 30 pacientes. Se calculó media aritmética y desviación estándar, se estimó Odds Ratio a través de modelo multivariado de regresión logística, con intervalo de confianza del 95 por ciento y un nivel de significancia p < 0.05. Resultados: Predominó el sexo femenino (66,67 por ciento grupo experimental, 73,33 por ciento grupo control). La edad media fue mayor en el grupo control (74,3 años), prevalecieron las lesiones estadio I (50,88 por ciento) y las regiones sacra y calcánea las más afectadas (45,61 por ciento y 24,56 por ciento, respectivamente), el tiempo de tratamiento promedio fue 10 días 8 horas. Se constató la efectividad de la superficie especial de manejo de presión sustituto en grupo experimental (92,59 por ciento), frente a la efectividad de medidas preventivas del grupo control (26,67 por ciento). Conclusiones: La utilización de una superficie especial de manejo de presión sustituto, diseñada con materiales de fácil acceso fue efectiva en la prevención de las lesiones por presión(AU)


ABSTRACT Introduction: The high rate of pressure injuries in primary health care of San José Municipality generated the need to use a special substitute pressure management surface for its prevention. Objective: To assess the effectiveness a special surrogate pressure management surface in preventing pressure injuries. Methods: Quasiexperimental intervention with a control group in bedridden patients with pressure injuries at stages I and II, carried out, during 2018, in family medical offices of Luis A. Turcios Lima Polyclinic, Mayabeque Province. The universe was 57 patients. Two groups were formed by simple random sampling. The experimental was made up of 27 patients (general preventive measures and special surrogate pressure management surface) and the control group was made up of 30 patients (general preventive measures). Arithmetic mean and standard deviation were calculated and odds ratio was estimated through multivariate logistic regression model, with a 95 percent confidence interval and a significance level of p < 0.05. Results: The female sex predominated (66.67 percent from the experimental group and 73.33 percent from the control group). The mean age was higher in the control group (74.3 years). Stage I lesions prevailed (50.88 percent), while the sacral and calcaneal regions were the most affected (45.61 percent and 24.56 percent, respectively). Average treatment time was ten days and eight hours. Effectiveness of the special surrogate pressure management surface was found in the experimental group (92.59 percent), compared to the effectiveness of preventive measures in the control group (26.67 percent). Conclusions: The use of a special surrogate pressure management surface, designed with easily accessible materials, was effective in preventing pressure injuries(AU)


Subject(s)
Humans , Female , Aged , Primary Health Care/methods , Pressure Ulcer/epidemiology , Time-to-Treatment/trends , Bedridden Persons , Controlled Before-After Studies/methods
3.
Rev. Asoc. Odontol. Argent ; 109(1): 3-8, ene.-abr. 2021. ilus, tab, graf
Article in Spanish | LILACS | ID: biblio-1255177

ABSTRACT

Objetivo: Comparar clínicamente el comportamiento, el tiempo operatorio requerido, el costo y la dificultad de diferentes técnicas de restauración en piezas primarias, empleando ionómero vítreo fotoactivado (IVF) polvo/líquido, con y sin uso de acondicionamiento dentinario, y en cápsulas, con acondicionamiento. Materiales y métodos: El diseño de este estudio fue experimental y comparativo. Se realizaron, en 18 pacientes de 7±2 años, 33 restauraciones con IVF de una o más piezas primarias vitales con lesiones amelodentinarias en 1 o 2 superficies. Según su día de concurrencia a la Cátedra de Odontología Integral Niños, se empleó: A) IVF polvo/líquido, con acondicionamiento (3M™ VitremerTM); B) IVF polvo/líquido, sin acondicionamiento (3M™ VitremerTM); y C) IVF en cápsulas, con acondicionamiento (Riva Light Cure). Las restauraciones fueron evaluadas clínicamente al inicio y a los 12 meses según los siguientes criterios: pérdida total, pérdida total con caries, requerimiento de reemplazo por pérdida parcial, requerimiento de reemplazo por caries, aceptable con deterioro, en condiciones. El grado de dificultad se analizó utilizando una planilla diseñada para tal fin. El tiempo operatorio requerido se midió sin considerar el tiempo de inserción. Resultados: El tiempo operatorio requerido fue de 2 minutos, 15 segundos en A; 1 minuto, 25 segundos en B; y 1 minuto, 10 segundos en C, sin considerar el tiempo de inserción. El costo fue 61,11% mayor para C. La dificultad fue de 3,2±0,6 para A y B, y de 1,5±0,7 para C (ANOVA; P<0,001). El comportamiento clínico no registró diferencias significativas entre los grupos (Fisher; P=0,339). Conclusión: Los ionómeros de restauración fotoactivados encapsulados utilizados en este estudio presentaron menor dificultad de manipulación, mayor costo y similar comportamiento clínico a un año que las presentaciones polvo-líquido, con o sin uso de acondicionamiento previo en piezas primarias (AU)


Aim: To assess the clinical performance, operative time required, cost and technical difficulties of different restorative techniques in primary teeth, using light cured glass ionomers (LCG), powder/liquid, with and without dentin conditioning and light cured glass ionomer in capsules with conditioning. Materials and methods: The design of this study was experimental and comparative. 33 restorations with LCG were performed in 18 patients, 7 ± 2-years-old, in one or more vital primary teeth with carious lesions involving one or more tooth surfaces. Patients were assigned to one of the three groups according to the day of the week in which they attended to the Pediatric Department of the Dental School: A) LCG powder/liquid, with conditioning (3M™ VitremerTM); B) LCG powder/liquid without conditioning (3M™ VitremerTM); and C) LCG in capsules with conditioning (Riva Light Cure). The restorations were clinically evaluated at baseline and after 12 months according to the following criteria: complete loss of the restoration, complete loss with caries, need of replacement because of partial loss, need of replacement because of caries, good condition with some wear and good condition. Technical difficulties were analyzed using a data sheet designed for that purpose. The operative time required was evaluated without considering the insertion time. Results: Time operative time required was 2 minutes 15 seconds in A, 1 minute 25 seconds in B and 1 minute 10 seconds in C. Cost was 61.11% higher for C. Difficulty was 3.2±0.6 for A and B and 1.5±0.7 for C (ANOVA; P<0.001). No significant differences were observed among the three groups in relation to the clinical performance (Fisher; P=0.339). Conclusions: In these 12 months, study in primary teeth, the light cured glass ionomers used dispensed in capsules showed to be the easiest to handle, had higher cost and similar clinical performance than the powder liquid presentations with and without dentin conditioner (AU)


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Tooth, Deciduous , Dentin-Bonding Agents , Dental Care for Children/methods , Dental Restoration, Permanent/methods , Glass Ionomer Cements/therapeutic use , Argentina , Schools, Dental , Statistical Analysis , Prospective Studies , Analysis of Variance , Clinical Trial , Costs and Cost Analysis , Light-Curing of Dental Adhesives , Time-to-Treatment
4.
Rev. colomb. cir ; 36(3): 427-437, 20210000. tab, fig
Article in Spanish | LILACS | ID: biblio-1254232

ABSTRACT

Introducción. El manejo de la herida cardiaca penetrante es un reto dado que requiere un rápido manejo quirúrgico para evitar que su desenlace sea fatal. Múltiples factores pronósticos han sido descritos, sin embargo, no ha sido documentada la relación entre el tiempo de llegada a quirófano y el uso de pledgets con la mortalidad. Métodos. Se realizó un estudio observacional retrospectivo de corte transversal, desde el año 2011 hasta el año 2018, en un hospital universitario de la ciudad de Medellín. Se evaluaron los registros de los pacientes con herida cardiaca penetrante confirmada y se realizó análisis univariado, bivariado y multivariado, así como curvas de supervivencia. Resultados. Los pacientes inestables o con taponamiento cardiaco que llegan al quirófano después del minuto 4 de haber ingresado a urgencias tienen cuatro veces más posibilidades de morir que los que llegan a quirófano antes (RR 4,1 IC95% 1,43­12,07). El uso de pledgets en el reparo de la herida cardiaca, corresponde a un factor protector para los pacientes, con un OR ajustado de 2,5 (IC95% 1,124-5,641). El tipo de traumatismo, la arritmia intraoperatoria y el índice de choque al ingreso también fueron factores pronósticos. Discusión. Se documenta el efecto del tiempo de llegada a quirófano sobre la mortalidad, lo cual permitirá en un futuro generar cambios en el manejo de estos pacientes en función de estos tiempos. La evidencia encontrada sugiere mejores desenlaces con el uso rutinario de pledgets


Introduction. The management of penetrating cardiac injury is challenging since it requires rapid surgical ma-nagement to avoid a fatal outcome. Multiple prognostic factors have been described, however, the relationship between the time of arrival to the operating room and the use of pledgets with mortality has not been documented.Methods. A cross-sectional retrospective observational study was conducted from 2011 to 2018 in a university hospital in the city of Medellín. Records of patients with confirmed penetrating cardiac injury were evaluated, and univariate, bivariate, and multivariate analyzes were performed, as well as survival curves.Results. Unstable patients or patients with cardiac tamponade who arrive to the operating room after 4 minutes after being admitted to the emergency room are four times more likely to die than those who arrive to the operating room earlier (RR 4.1 95% CI 1.43­12.07). The use of pledgets in the repair of the cardiac wound corresponds to a protective factor for patients, with an adjusted OR of 2.5 (95% CI 1.124-5.641). The type of trauma, intraoperative arrhythmia and the shock index on admission were also prognostic factors. Discussion. The effect of the time of arrival to the operating room on mortality is documented, which will allow in the future to generate changes in the management of these patients based on these times. The evidence found suggests better outcomes with the routine use of pledgets


Subject(s)
Humans , Wounds, Penetrating , Emergencies , Time-to-Treatment , Surgical Procedures, Operative , Mortality , Heart Injuries
5.
Rev. colomb. anestesiol ; 49(1): e300, Jan.-Mar. 2021.
Article in English | LILACS, COLNAL | ID: biblio-1149794

ABSTRACT

Abstract Hip fracture is one of the major public healthcare problems in elderly patients around the world, mainly because of the risk of falls and osteoporosis which are typical during this stage of life, and may be the cause for up to 36% of deaths among those affected. Its management in principle is surgical and the best results are achieved with patients undergoing surgery during the first 24 to 72 hours after the fracture. Any delays in surgery are mostly associated with decompensated personal pathological factors, delays in perioperative assessment, or in presurgical complementary tests; sometimes, the delays are the result of administrative formalities of the healthcare providers. These determining factors may affect both morbidity and mortality, and contribute to functional decline, disability, and reduced quality of life of these patients. A third party intervention is then necessary to improve the preventable factors that delay the osteosynthesis in these types of fractures, in addition to ensuring education, infrastructure, inputs, skilled human resources, and prompt referral of patients from the first level of care. Investigating this scenario and assessing the quality of life impact on these patients should be a priority.


Resumen La fractura de cadera representa uno de los problemas de salud pública más grandes en los pacientes ancianos en todo el mundo, principalmente, por el riesgo de caídas y la osteoporosis típicos en esta etapa de la vida, que puede causar la muerte de hasta el 36 % de los afectados; su manejo es en principio quirúrgico y los mejores resultados se presentan cuando se interviene en las primeras 24 a 72 horas después de la fractura. El retraso en la corrección quirúrgica está asociado principalmente a factores patológicos personales no compensados, demora en la valoración perioperatoria o en los estudios complementarios prequirúrgicos, o por trámites administrativos de las empresas prestadoras de servicios de salud. Estos determinantes pueden afectar la morbimortalidad y contribuir a un deterioro funcional, incapacidad y pérdida de la calidad de vida de estos pacientes. Se hace necesaria una intervención por parte de terceros para mejorar los factores prevenibles que retrasan la osteosíntesis de este tipo de fracturas; además, asegurar educación, infraestructura, insumos, talento humano capacitado y remisión rápida de pacientes desde el primer nivel de atención. Investigar en este escenario y evaluar los efectos en la calidad de vida de estos pacientes debería ser una prioridad.


Subject(s)
Humans , Aged , Aged, 80 and over , Surgical Procedures, Operative/methods , Time-to-Treatment , Hip Fractures , Quality of Life , Mortality , Fractures, Bone , Osteoporotic Fractures , Intraoperative Complications
6.
Cad. Saúde Pública (Online) ; 37(5): e00214919, 2021. tab, graf
Article in Portuguese | LILACS | ID: biblio-1249435

ABSTRACT

O câncer de cólon e reto apresenta alta incidência mundialmente, porém a letalidade da doença é maior em países em desenvolvimento. O objetivo deste estudo é analisar fatores sociodemográficos e clínicos associados ao atraso para o início de tratamento de câncer de cólon e reto em hospitais no Brasil. Trata-se de estudo retrospectivo com dados dos registros hospitalares de câncer no Brasil de 2006 a 2015. O desfecho analisado é o tempo para início do tratamento de câncer de cólon e reto e possíveis associações entre variáveis sociodemográficas e referentes a fatores clínicos. Observaram-se disparidades no tempo para início do tratamento de acordo com estratos sociodemográficos e regiões geográficas. Há maior chance de atraso para o início do tratamento de câncer de cólon em pacientes com idade acima de 50 anos, de raça/cor de pele preta (OR = 1,50; IC95%: 1,21-1,84) e parda (OR = 1,28; IC95%: 1,17-1,42), analfabetos (OR = 1.50; IC95%: 1,19-1,90) ou com baixa escolaridade e cujo tratamento ocorreu em um município distinto de sua residência (OR = 1,25; IC95%: 1,14-1,38). Em pacientes com câncer de reto, há maior chance de atraso para o início do tratamento entre os casos com idade acima de 50 anos, de raça/cor de pele preta (OR = 1,44; IC95%: 1,20-1,72) e parda (OR = 1,29; IC95%: 1,19-1,39), analfabetos (OR = 1,71; IC95%: 1,40-2,09) ou com baixa escolaridade e cujo tratamento ocorreu em um município distinto de sua residência (OR = 1,35; IC95%: 1,25-1,47). Como conclusão, maior atenção deve ser destinada a reduzir o tempo para iniciar o tratamento nas regiões desfavorecidas e nos estratos identificados com barreiras de acesso ao tratamento em tempo oportuno.


Colorectal cancer presents high incidence worldwide, but case-fatality is higher in developing countries. The study's objective was to analyze sociodemographic and clinical factors associated with delay in the initiation of treatment for colorectal cancer in hospitals in Brazil. This is a retrospective study of data from hospital cancer registries in Brazil from 2006 to 2015. The target variable is time to initiation of treatment for colorectal cancer and possible associations between sociodemographic variables and clinical factors. The analysis revealed disparities in time to treatment according to sociodemographic strata and geographic regions. Higher odds of treatment delay were associated with age over 50 years, black race/color (OR = 1.50; 95%CI: 1.21-1.84) and brown race/color (OR = 1.28; 95%CI: 1.17-1.42), illiteracy or low schooling (OR = 1.50; 95%CI: 1.19-1.90), and treatment in a city far from the patient's residence (OR = 1.25; 95%CI: 1.14-1.38). For rectal cancer, higher odds of treatment delay were associated with age over 50 years, black (OR = 1.44; 95%CI: 1.20-1.72) or brown race/color (OR = 1.29; 95%CI: 1.19-1.39), illiteracy or low schooling (OR = 1.71; 95%CI: 1.40-2.09), and treatment in a city far from the patient's residence (OR = 1.35; 95%CI: 1.25-1.47). In conclusion, greater attention should be given to reducing the time to initiation of treatment in underprivileged regions and in social strata identified with barriers to timely treatment access.


El cáncer de colon y recto presenta una alta incidencia mundialmente, pese a que la letalidad de la enfermedad es mayor en países en desarrollo. El objetivo de este estudio fue analizar los factores sociodemográficos y clínicos, asociados al retraso para el inicio del tratamiento de cáncer de colon y recto en hospitales en Brasil. Se trata de un estudio retrospectivo con datos de registros hospitalarios de cáncer en Brasil de 2006 a 2015. El resultado analizado es el tiempo para el inicio del tratamiento de cáncer de colon y recto, así como las posibles asociaciones entre variables sociodemográficas y las relacionadas con factores clínicos. Se observó disparidades en el tiempo para el inicio del tratamiento, según estratos sociodemográficas y regiones geográficas. Existe una mayor oportunidad de retraso para el inicio del tratamiento de cáncer de colon en pacientes con una edad por encima de 50 años, de raza/afrodescendiente (OR = 1,50; IC95%: 1,21-1,84) y mulata/mestiza (OR = 1,28; IC95%: 1,17-1,42), analfabetos (OR = 1,50; IC95%: 1,19-1,90) o con baja escolaridad, y cuyo tratamiento se produjo en un municipio distinto al de su residencia (OR = 1,25; IC95%: 1,14-1,38). En pacientes con cáncer de recto existe una mayor oportunidad de atraso para el inicio del tratamiento entre los casos con una edad por encima de 50 años, de raza/afrodescendiente (OR = 1,44; IC95%: 1,20-1,72) y mulata/mestiza (OR = 1,29; IC95%: 1,19-1,39), analfabetos (OR = 1,71; IC95%: 1,40-2,09) o con baja escolaridad, y cuyo tratamiento se produjo en un municipio distinto al de su residencia (OR = 1,35; IC95%: 1,25-1,47). Como conclusión, se debe prestar mayor atención a la reducción del tiempo para comenzar el tratamiento en las regiones desfavorecidas y en estratos identificados con barreras de acceso al tratamiento en el tiempo adecuado.


Subject(s)
Humans , Colorectal Neoplasms/therapy , Colorectal Neoplasms/epidemiology , Time-to-Treatment , Socioeconomic Factors , Brazil/epidemiology , Incidence , Retrospective Studies , Middle Aged
7.
Rev. bras. ortop ; 55(5): 637-641, Sept.-Oct. 2020. tab, graf
Article in English | LILACS | ID: biblio-1144205

ABSTRACT

Abstract Objective Congenital clubfoot (PTC) is a congenital orthopedic condition often requiring intensive treatment; little is known about the impact of such treatment on motor development. The present study assessed whether gait development is later in patients with PTC treated with the Ponseti method in comparison to a control group and analyzed possible related factors. Methods Patients born at term, < 6 months old, not submitted to previous treatment and with a minimum follow-up period of 24 months were included. The control group consisted of patients with no musculoskeletal disorders seen during the present study. Results The study group consisted of 97 patients, whereas the control group had 100 subjects. The mean age at gait start was 14.7 ± 3.2 months in the study group and 12.6 ± 1.5 months in the control group (p< 0.05). Factors related to late gait included age at beginning of treatment > 3 weeks, number of plaster cast changes > 7, recurrence and nonperformance of Achilles tenotomy. Age at beginning of treatment > 3 weeks was related to a greater number of plaster cast changes. Gender and laterality were not related to late gait development. Conclusion Congenital clubfoot patients treated with the Ponseti method show independent walking approximately 2 months later than the control group. Delayed treatment, higher number of plaster cast changes, recurrence and nonperformance of Achilles tenotomy were related to late gait.


Resumo Objetivo O pé torto congênito (PTC) é uma das alterações ortopédicas congênitas que mais frequentemente necessita tratamento intensivo, e pouco se sabe o impacto desse tratamento no desenvolvimento motor. O presente estudo buscou avaliar se pacientes portadores de PTC tratados pelo método de Ponseti desenvolvem a marcha mais tardiamente comparado a um grupo controle e analisar possíveis fatores relacionados. Métodos Incluídos pacientes nascidos a termo, com < 6 meses de idade, sem tratamento prévio e com seguimento mínimo de 24 meses. O grupo controle foi de pacientes sem alterações musculoesqueléticas, atendidos no mesmo período da realização do presente estudo. Resultados Um total de 97 pacientes formaram o grupo de estudo e 100 o grupo controle. A média de idade no início da marcha no grupo de estudo foi de 14,7 ± 3,2 meses, e 12,6 ± 1,5 meses (p< 0,05) no grupo controle. Fatores relacionados à marcha tardia foram: idade de início do tratamento > 3 semanas, número de trocas gessadas > 7, recidiva e não realização da tenotomia de Aquiles. Idade de início do tratamento > 3 semanas esteve relacionada a maior número de trocas de gessos. Gênero e lateralidade não tiveram relação com a marcha tardia. Conclusão Pacientes com PTC tratados com o método de Ponseti apresentam marcha independente aproximadamente 2 meses mais tarde do que o grupo controle. Início mais tardio do tratamento, maior número de trocas de gessos, recidiva e não realização da tenotomia de Aquiles foram relacionados com atraso da marcha.


Subject(s)
Humans , Male , Female , Infant , Clubfoot , Casts, Surgical , Control Groups , Walking , Treatment Outcome , Age of Onset , Lower Extremity Deformities, Congenital , Time-to-Treatment , Gait , Gender Identity , Functional Laterality , Manipulation, Orthopedic
8.
CorSalud ; 12(3): 348-354, jul.-set. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1154042

ABSTRACT

RESUMEN En marzo de 2020 existían 118 000 casos de COVID-19 en 114 países y más de 4000 muertes por esta enfermedad; en ese momento la Organización Mundial de la Salud la declaró como una pandemia. Aunque los síntomas respiratorios dominan usualmente las manifestaciones clínicas de la COVID-19, la infección por el SARS-CoV-2 puede también ser responsable de la presencia de alteraciones cardiovasculares. A escala mundial ha ocurrido una disminución significativa de la búsqueda de atención médica por parte de los pacientes, con padecimientos no relacionados con la COVID-19, debido a la preocupación de adquirir la enfermedad viral (COVID-19) en el medio intrahospitalario. En aras de llamar la atención sobre la importancia de la búsqueda oportuna de asistencia médica en pacientes con síntomas cardiovasculares en tiempos de una pandemia como la COVID-19, se presenta el siguiente caso, el cual constituye el primero que trata este tema en el país.


ABSTRACT In March 2020, there were 118000 cases of COVID-19 in 114 countries, and more than 4000 deaths from this disease; at that time, the World Health Organization declared it a pandemic. Although respiratory symptoms are clinically prevalent in the clinical manifestations of COVID-19, SARS-CoV-2 infection may also be responsible for the presence of cardiovascular disorders. On a global scale, there has been a significant decrease in seeking for medical attention by patients, over COVID-19-nonrelated disorders, due to the concern of acquiring the SARS-CoV-2 virus in the hospital environment. In order to draw attention to the importance of the timely search for medical assistance in patients with cardiovascular symptoms in times of such a pandemic, the following case is presented, which is the first to address this issue in Cuba.


Subject(s)
Coronavirus Infections , Medical Care , Time-to-Treatment , Myocardial Infarction
9.
Rev. colomb. obstet. ginecol ; 71(2): 87-102, abr.-jun. 2020. tab
Article in Spanish | LILACS | ID: biblio-1126321

ABSTRACT

RESUMEN Objetivo: establecer la asociación entre el retraso en el diagnóstico de cáncer de mama con un estadio clínico avanzado y explorar factores que influyen en dicho retraso. Materiales y métodos: estudio de corte transversal con mujeres mayores de 18 años con cáncer de mama que consultaron en cuatro centros oncológicos de Medellín, Colombia, en 2017. Se usó el Breast Cancer Delay Questionnaire que incluye variables sociodemográficas, clínicas y de tiempos de atención. Se estimó el odds ratio (OR) crudo y ajustado por medio de una regresión logística con el estadio clínico avanzado como desenlace y el retraso diagnóstico como exposición. Resultados: se incluyeron 242 pacientes. La mediana del tiempo entre identificar el problema y la biopsia diagnóstica fue 104,5 días; entre identificar el problema y la primera consulta médica, 20 días, y de la primera consulta a la biopsia diagnóstica fue de 53 días. El 52,1 % se diagnosticó en estadio avanzado. Hubo asociación del retraso diagnóstico con estadio clínico avanzado (OR = 2,15; IC 95 %: 1,21-3,79). Se encontró que la edad mayor a 40 años es un factor protector contra una lesión avanzada (OR = 0,35; IC 95 %: 0,14-0,83). El retraso diagnóstico se asoció con estar afiliada al régimen subsidiado por el Estado (OR = 9,67; IC 95 %: 2,76-33,9) y tener edad mayor a 40 años (OR = 2,75; IC 95 %: 1,16-6,53). Conclusión: se requieren intervenciones educativas en las pacientes para adherir a los programas de tamización temprana o la consulta oportuna al identificar un signo o síntoma, para lograr un diagnóstico en estadios tempranos de la enfermedad. Además, se requieren estudios prospectivos para determinar los factores relacionados con la demora en recibir el tratamiento una vez diagnosticado el cáncer de seno y evaluar las intervenciones destinadas a disminuir las dilaciones en la atención de este cáncer.


ABSTRACT Objective: To determine the association between delayed diagnosis and advanced clinical stage breast cancer, and to explore the factors that influence this delay. Materials and methods: Cross-sectional study of women over 18 years of age with breast cancer who attended 4 oncology centers in Medellín, Colombia, in 2017. The "Breast Cancer Delay Questionnaire" which includes sociodemographic and clinical variables as well as time intervals was used. Crude and adjusted odds ratio (OR) were estimated, using advanced clinical stage as outcome and delayed diagnosis as exposure. Results: 242 patients were included. The median time interval between the identification of the problem and the diagnostic biopsy was 104.5 days; between the identification of the problem and the first medical visit, 20 days; and between the first visit and the diagnostic biopsy, 53 days. Of all the cases, 52.1 % were diagnosed at an advanced stage. An association was found between delayed diagnosis and advanced clinical stage (OR = 2.15 95 % CI 1.21-3.79). Age above 40 was found to be a protective factor against having an advanced-stage lesion (OR = 0.35; 95 % CI: 0.14-0.83). Delayed diagnosis was associated with affiliation to the government subsidized health system (OR = 9.67; 95 % CI 2.76- 33.9) and age over 40 years (OR = 2.75; 95 % CI: 1.16-6.53). Conclusion: Patient education is required in order to ensure adherence to early screening programs or timely consultation whenever a sign or symptom is identified, thus allowing diagnosis at an early stage of the disease. Moreover, prospective studies are needed in order to identify factors associated with delays in treatment after the diagnosis of breast cancer, and to assess interventions designed to reduce delays in the care of this form of cancer.


Subject(s)
Breast Neoplasms , Delayed Diagnosis , Time-to-Treatment
10.
Braz. oral res. (Online) ; 34: e126, 2020. tab
Article in English | LILACS, BBO | ID: biblio-1142611

ABSTRACT

Abstract The coronavirus disease 2019 (COVID-19) outbreak has created unprecedent challenges for healthcare systems worldwide. Oncology services have been reorganized to decrease the risk of nosocomial acquisition of SARS-CoV-2, but changes in treatment pathways and follow-up cancer care can result in patients receiving suboptimal or delayed care. Herein, we describe a cross-sectional nested cohort study conducted to evaluate delays in care for patients with head and neck cancer (HNC) in post-treatment follow-up or palliative care during the COVID-19 pandemic in Northeast Brazil and its impact on health outcomes. Information was extracted from medical records and supplemented by telephone interviews. We compared the following health outcomes: self-perception of anxiety or sadness, fear of COVID-19 infection, cancer-related complications during social isolation, self-medication, diagnosis of COVID-19, and death between patients with and without delayed cancer care. The Mann-Whitney U test was used to compare distributions of continuous variables and the Fisher exact test was used for categorical variables. Thirty-one HNC patients were included in the study, and no case of confirmed SARS-CoV-2 was found. Delayed cancer care due to restriction in health services was reported in 58.1% of cases, and there was no report of telemedicine use during the COVID-19 outbreak. Cancer-related complications during the COVID-19 pandemic were described for most patients (67.7%) and included pain or discomfort, swelling, and dyspnea. Eight (25.8%) patients reported use of prescribed morphine or codeine to manage pain and six (19.4%) patients reported self-medication with over-the-counter (OTC) non-steroidal anti-inflammatory drugs (NSAIDs). We found an association between delayed HNC care and the use of self-medication (p = 0.028). This study indicated that patients with delayed HNC care during the COVID-19 outbreak are more likely to use self-medication with NSAIDs for pain management. Better strategies to follow HNC patients in socioeconomically disadvantaged communities need to be discussed and implemented.


Subject(s)
Humans , Time-to-Treatment , COVID-19 , Head and Neck Neoplasms/therapy , Brazil/epidemiology , Cross-Sectional Studies , Cohort Studies , Outcome Assessment, Health Care , Pandemics
11.
Epidemiol. serv. saúde ; 29(4): e2019503, 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1124754

ABSTRACT

Objetivo: Descrever o perfil clínico-epidemiológico de casos hospitalares de câncer primário de tireoide no Brasil. Métodos: Estudo descritivo dos casos informados pelos registros hospitalares de câncer que tiveram primeira consulta para tratamento no período 2000-2016 e cujo acompanhamento foi realizado pela instituição do registro informante. Resultados: Dos 52.912 casos, 83,4% eram femininos e 96,9% eram carcinomas diferenciados. Apresentaram menor tempo mediano para diagnóstico os casos anaplásicos (11 dias) e os residentes da região Sul do país (5 dias). O tratamento foi iniciado em até 60 dias em 88,8% dos casos que chegaram à instituição do registro sem diagnóstico e em 34,9% dos que chegaram com diagnóstico. Conclusão: Os achados são consistentes com a epidemiologia do câncer de tireoide, com predominância do sexo feminino e do carcinoma diferenciado. A análise do tempo para início do tratamento sugere dificuldades de acesso para aqueles que chegaram às instituições dos registros com diagnóstico.


Objetivo: Describir el perfil clínico y epidemiológico de los casos de cáncer de tiroides en Brasil. Métodos: Estudio descriptivo de casos reportados por los registros hospitalarios de cáncer que tuvieron su primera consulta de tratamiento en el período 2000-2016 y el monitoreo fue realizado por la institución del registro. Resultados: De los 52.912 casos, 83,4% eran mujeres y 96,9% era de carcinomas diferenciados. El tiempo promedio hasta el diagnóstico fue menor en los anaplásicos (11 días) y en la región Sur (5 días). El tratamiento se inició dentro de los 60 días en 88.8% de los casos que llegaron a la institución de registro sin diagnóstico y en 34.9% de los que llegaron con diagnóstico. Conclusión: Los resultados son consistentes con la epidemiología del cáncer de tiroides, con predominio del sexo femenino y carcinomas diferenciados. El análisis del tiempo de tratamiento sugiere dificultades de acceso para casos que llegaron con diagnóstico.


Objective: To describe the clinical and epidemiological profile of primary thyroid cancer hospital cases in Brazil. Methods: This is a descriptive study of cases held on hospital cancer records who had their first consultation for treatment in the period 2000-2016 and who were monitored by the hospitals providing those records. Results: Of the 52,912 cases, 83.4% were female and 96.9% were differentiated carcinoma cases. The median time to diagnosis was shorter for anaplastic cases (11 days) and for those living in Brazil's Southern region (5 days). Treatment was initiated within 60 days in 88.8% of cases that arrived at the hospitals without diagnosis and in 34.9% of those who arrived with diagnosis. Conclusion: The findings are consistent with thyroid cancer epidemiology, with a predominance of female cases and differentiated carcinomas. Analysis of time-to-treatment suggests access difficulties for those who already had diagnosis when they arrived at the hospitals.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Thyroid Neoplasms/diagnosis , Thyroid Neoplasms/epidemiology , Hospital Records/statistics & numerical data , Time-to-Treatment/trends , Health Information Systems , Thyroid Gland/physiopathology , Health Profile , Brazil , Epidemiology, Descriptive
12.
Rev. bras. epidemiol ; 23: e200020, 2020. tab
Article in Portuguese | LILACS | ID: biblio-1092600

ABSTRACT

RESUMO: Introdução: A vinculação é um passo fundamental para o cuidado contínuo da infecção pelo vírus da imunodeficiência humana (HIV/aids), sendo essencial para proporcionar o acesso à terapia antirretroviral, bem como ao cuidado integral. Metodologia: Estudo transversal, com pessoas vivendo com HIV (PVHIV), idade ≥ 18 anos, vinculadas entre janeiro e dezembro de 2015, em um serviço de referência para assistência ambulatorial e hospitalar especializada em HIV/aids em Belo Horizonte (MG). O tempo de vinculação foi definido como o tempo do diagnóstico até a vinculação ao serviço. Considerou-se vinculação oportuna quando esse tempo foi menor ou igual a 90 dias. Os dados foram coletados por meio de prontuários clínicos. Realizou-se análise de regressão logística com intervalo de confiança de 95% (IC95%). Resultados: Entre os 208 pacientes, a maioria era do sexo masculino (77,8%) com idade média de 39 anos. Cerca de 45% apresentaram condições definidoras de aids na vinculação. O tempo de vinculação apresentou média de 138 ± 397 dias, e a vinculação oportuna ocorreu para 76,9% dos pacientes. As variáveis associadas com a vinculação oportuna foram: ter idade ≥ 48 anos (odds ratio - OR = 8,50; IC95% 1,53 - 47,28), estar trabalhando (OR = 3,69; IC95% 1,33 - 10,25) no momento da vinculação e apresentar contagem de linfócitos T CD4 (LT CD4+) ≤ 200 células/mm3 no momento do diagnóstico de HIV (OR = 4,84; IC95% 1,54 - 15,18). Observou-se proporção importante de vinculação oportuna entre as PVHA, porém com diagnóstico tardio. Conclusão: Intervenções devem ser direcionadas para pessoas mais jovens e com maior contagem de LT CD4+, visando uma melhor prestação de cuidados contínuos em HIV.


ABSTRACT: Introduction: Linkage is a critical step in the ongoing care of human immunodeficiency virus (HIV/aids) infection and is essential for providing access to antiretroviral therapy, as well as comprehensive care. Methodology: Cross-sectional study on people living with HIV (PLHIV), aged ≥ 18 years old, linked between January and December 2015, in a referral service for outpatient and hospital care specialized in HIV/AIDS in Belo Horizonte, Minas Gerais. Linkage time was defined as the time from diagnosis to service linkage. Timely care linkage was considered when this time was ≤ 90 days. Data were collected through clinical records. A logistic regression analysis with a confidence interval of 95% (95%CI) was performed. Results: Among 208 patients, most of them were males (77.8%) with a mean age of 39 years. About 45% presented AIDS-defining conditions at the moment of linkage. Linkage time presented a mean of 138 ± 397 days. And timely linkage occurred for 76.9% of the patients. The variables associated with timely care linkage were: age ≥ 48 years (odds ratio - OR = 8.50; 95%CI 1.53 - 47.28), currently working (OR = 3.69; 95%CI 1.33 - 10.25) at the time of linkage, and present CD4+ T lymphocyte count (CD4+ T) ≤ 200 cells/mm3 at the time of HIV diagnosis (OR = 4.84; 95%CI 1.54 - 15.18). There was an important proportion of timely care linkage among PLHIV, but with late diagnosis. Conclusion: Interventions should be targeted at younger people with higher CD4+ T lymphocyte counts, in order to better provide continuous HIV care.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , Referral and Consultation/statistics & numerical data , HIV Infections/drug therapy , Continuity of Patient Care/statistics & numerical data , Anti-HIV Agents/therapeutic use , Time-to-Treatment/statistics & numerical data , Health Services/statistics & numerical data , Health Services Accessibility/statistics & numerical data , Time Factors , Brazil/epidemiology , HIV Infections/diagnosis , HIV Infections/epidemiology , Cross-Sectional Studies , CD4 Lymphocyte Count , Antiretroviral Therapy, Highly Active , Delayed Diagnosis , Middle Aged
13.
Rev. bras. cancerol ; 66(3): 1-12, 2020.
Article in Portuguese | LILACS | ID: biblio-1120480

ABSTRACT

Introdução: O câncer de mama é considerado um problema de saúde pública, tendo crescente incidência mundial. Diversos fatores contribuem para o diagnóstico tardio e dificultam o início do tratamento, repercutindo em um pior prognóstico. Objetivos: Analisar o intervalo de tempo entre o diagnóstico e o início do primeiro tratamento oncológico na população brasileira, além de avaliar os fatores associados aos maiores intervalos. Método: Trata-se de um estudo de coorte retrospectivo com 540.529 pacientes cadastrados no Sistema de Registros Hospitalares de Câncer (SisRHC)no período de 2000 a 2017. Utilizou-se como desfecho o intervalo de tempo entre o diagnóstico e o início do primeiro tratamento oncológico, considerando-se como atraso o intervalo maior do que 60 dias. Para análise das variáveis, foram realizadas análise descritiva e regressão logística simples (IC95%; p<0,05). Resultados: Foram analisados 204.130 casos que apresentaram média de idade de 55,8 anos (±13,24), sendo predominantemente do sexo feminino (99,1%), 55,1% eram da Região Sudeste e 71,4% residiam em cidades não capitais. A mediana do intervalo de tempo entre o diagnóstico e o início do primeiro tratamento oncológico foi de 63 dias (variação interquartil = 36-109). As variáveis sociodemográficas, clínicas e relacionadas ao tratamento mostraram impacto no intervalo de tempo, com exceção da variável sexo. Conclusão: O tempo entre o diagnóstico e o início do primeiro tratamento oncológico foi elevado. Fatores sociodemográficos, clínicos e relacionados ao tratamento influenciam nos intervalos de tempo. Identificá-los precocemente pode contribuir para o direcionamento de ações a esses grupos mais vulneráveis ao atraso.


Breast cancer is considered a public health problem with an increasing incidence worldwide. Several factors contribute to late diagnosis and hinder the initiation of the treatment, resulting in a worse prognosis. Objectives:To analyze the time interval between diagnosis and the beginning of the first oncologic treatment in the Brazilian population, in addition to assessing the factors associated with the longest time intervals. Method: Retrospective cohort study with 540,529 patients registered in the Hospital Cancer Registry System (SisRHC) from 2000 to 2017. The outcome was the time between diagnosis and the beginning of the first oncologic treatment, considering the interval greater than 60 days as delay. Descriptive analysis and simple logistic regression were performed (95% CI; p <0.05) to analyze the variables. Results: 204,130 cases were analyzed, mean age of 55.8 years (± 13.24), predominantly females (99.1%), 55.1% were from the southeast region and 71% lived in non-capital cities. The median of the time interval between diagnosis and the beginning of the first oncologic treatment was 63 days (interquartile range = 36-109). Sociodemographic, clinical and treatment-related variables affect the time interval, except the gender variable. Conclusion: The time between diagnosis and the beginning of the first oncologic treatment was high. Sociodemographic, clinical and treatment-related factors influence time intervals. Their early identification can contribute to guide the actions toward these most vulnerable groups to delay.


Introducción: El cáncer de mama se considera un problema de salud pública con una incidencia mundial creciente. Varios factores contribuyen al diagnóstico tardío y dificultan el inicio del tratamiento, resultando en un peor pronóstico. Objetivos:Analizar el intervalo de tiempo entre el diagnóstico y el comienzo del primer tratamiento oncologico en la población brasileña, además de evaluar los factores asociados con los intervalos de tiempo más largos. Método: Este es un estudio de cohorte retrospectivo con 540.529 pacientes registrados en el Hospital Cancer Registry System (SisRHC) desde 2000 hasta 2017. El resultado fue el intervalo de tiempo entre el diagnóstico y el comienzo del primer tratamiento oncologico, considerando como retraso el intervalo superior a 60 días. Para el análisis de las variables, se realizó un análisis descriptivo y una regresión logística simple (IC 95%; p <0,05). Resultados: Se analizaron 204,130 casos, con una edad media de 55,8 años (±13,24), predominantemente mujeres (99,1%), 55,1% de la región sureste y 71,4% residentes en ciudades no capitales.La mediana del intervalo de tiempo entre el diagnóstico y el comienzo del primer tratamiento contra el cáncer fue de 63 días (rango intercuartil = 36-109). Las variables sociodemográficas, clínicas y relacionadas con el tratamiento tuvieron un impacto en el intervalo de tiempo, con la excepción de la variable de género. Conclusión: El intervalo de tiempo promedio entre el diagnóstico y el comienzo del primer tratamiento oncologico fue alto. Además, se observó que los factores sociodemográficos, clínicos y relacionados con el tratamiento influyen en los intervalos de tiempo, por lo que identificarlos temprano puede contribuir a acciones directas para estos grupos más vulnerables al retraso.


Subject(s)
Humans , Female , Breast Neoplasms/diagnosis , Breast Neoplasms/therapy , Time-to-Treatment , Brazil , Hospital Records , Retrospective Studies
14.
Cad. Saúde Pública (Online) ; 36(2): e00011919, 2020. tab
Article in English | LILACS | ID: biblio-1055629

ABSTRACT

Women presenting with advanced breast cancer tumors are common in Brazil. Little is known about factors contributing to the delay in seeking care. The aim of this study was to identify factors associated with longer time intervals between the onset of breast cancer symptoms and the first medical visit in the Federal District, Brazil. The analysis included 444 symptomatic women with incident breast cancer, interviewed between September, 2012 and September, 2014, during their admission for breast cancer treatment in nine public hospitals in the Federal District. Patients with metastatic disease at diagnosis were not included in this study. The outcome was time interval between symptom onset and the first medical visit, whether > 90 (34% of patients) or ≤ 90 days. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95%CI). In the multivariate analysis, the > 90 day interval was significantly associated with patients not performing mammography and/or breast ultrasound in the two years prior to breast cancer diagnosis (OR = 1.97; 95%CI: 1.26-3.08), and with more advanced stages (OR = 1.72; 95%CI: 1.10-2.72). Furthermore, there was a lower chance of delay in patients with higher levels of education (OR = 0.95; 95%CI: 0.91-0.99). A relatively high proportion of breast cancer patients in the Brazilian Federal District experienced delay to attend the first medical consultation after the symptoms onset. Increasing breast cancer awareness, especially among women with low educational levels and those not participating in mammography screening programs could contribute to reduce this delay.


São comuns no Brasil os casos de mulheres com tumores de mama em estágio avançado ao diagnóstico inicial. Há pouca informação sobre os fatores que contribuem para a demora na busca de atendimento. O estudo teve como objetivo identificar os fatores associados a intervalos mais longos entre o início dos sintomas do câncer de mama e a primeira consulta médica no Distrito Federal, Brasil. A análise incluiu 444 mulheres sintomáticas com diagnóstico de câncer de mama, entrevistadas entre setembro de 2012 e setembro de 2014, durante a internação para o tratamento do câncer em nove hospitais públicos no Distrito Federal. As pacientes com doença metastática ao diagnóstico não foram incluídas no estudo. A variável de desfecho era o intervalo entre o início dos sintomas e a primeira consulta médica, sendo classificada como > 90 dias (34% das pacientes) ou ≤ 90 dias. Foi usada regressão logística para estimar os odds ratios (OR) e intervalos de 95% de confiança (IC95%). Na análise multivariada, o intervalo de > 90 dias mostrou associação significativa com a falta de mamografia e/ou de ultrassom mamário nos dois anos anteriores ao diagnóstico de câncer de mama (OR = 1,97; IC95%: 1,26-3,08), e com estágios mais avançados da doença (OR = 1,72; IC95%: 1,10-2,72). Além disso, houve probabilidade menor de demora em pacientes com maior escolaridade (OR = 0,95; IC95%: 0,91-0,99). Uma proporção relativamente alta de pacientes com câncer de mama no Distrito Federal sofreram demora na primeira consulta médica após o início dos sintomas. Uma maior conscientização sobre câncer de mama, principalmente entre mulheres com menores níveis de escolaridade e aquelas que não participam em programa de rastreamento com mamografia, pode contribuir para a redução dessa demora.


Las mujeres que presentan tumores avanzados de cáncer de mama son comunes en Brasil. Se sabe poco sobre los factores que contribuyen al retraso en la búsqueda de atención. El objetivo de este estudio fue identificar los factores asociados a los intervalos de tiempo más largos entre la aparición de los síntomas de cáncer de pecho y la primera visita médica en el Distrito Federal, Brasil. El análisis incluyó a 444 mujeres con síntomas de cáncer de pecho, que fueron entrevistadas entre septiembre 2012 y septiembre 2014, durante el tratamiento de cáncer de mama en nueve hospitales públicos del Distrito Federal. Pacientes con enfermedad metastásica en el diagnóstico no estuvieron incluidos en este estudio. El resultado fue el intervalo de tiempo entre la aparición de los síntomas y la primera visita médica, si > 90 (34% de pacientes) o ≤ 90 días. La regresión logística se usó para estimar odds ratios (OR) y los intervalos de 95% de confianza (IC95%). En el análisis multivariado, los > 90 días de intervalo estuvieron significativamente asociados con pacientes que no se realizaron mamografías y/o ultrasonidos en el pecho en los dos años previos al diagnóstico de cáncer de mama (OR = 1.97; 95%CI: 1.26-3.08), y en estadios más avanzados (OR = 1.72; 95%CI: 1.10-2.72). Además, hubo una probabilidad más baja de retraso en pacientes con niveles más altos de educación (OR = 0.95; 95%CI: 0.91-0.99). Una proporción relativamente alta de pacientes con cáncer de pecho en el Distrito Federal sufrieron retrasos para realizar las primeras consultas médicas tras la aparición de los síntomas. El aumento de la concienciación sobre el cáncer de mama, especialmente entre mujeres con bajo nivel educacional y quienes no participaron en programas de mamografías pudieron contribuir a la reducción de este retraso.


Subject(s)
Humans , Female , Breast Neoplasms/diagnosis , Mammography , Time-to-Treatment , Brazil , Educational Status , Early Detection of Cancer , Hospitals, Public
15.
Rev. bras. ginecol. obstet ; 41(10): 628-632, Oct. 2019. graf
Article in English | LILACS | ID: biblio-1042314

ABSTRACT

Abstract Although mature cystic teratoma (MCT) is benign, malignant transformation (MT) occurs in ~ 1% to 2% of all cases, and usually consists of squamous cell carcinoma (SCC), which accounts for ~ 80% of the cases. Spindle-cell (sarcomatoid) carcinoma (SCSC) is an uncommon type of SCC, comprising up to 3% of all cases. The lack of characteristic symptoms and specific imaging findings may lead to preoperative misdiagnosis. Moreover, the clinicopathologic characteristics, the treatment, the prognostic factors and the mechanism of MT have not yet been well understood due to the rarity of such tumors, especially in women of reproductive age. The authors present a case of a 34- year-old patient with 14 weeks of gestation who was diagnosed with an adnexal mass suggestive of ovarian teratoma. A laparoscopy salpingo-oophorectomy was performed after 6 months of delivery, and the histological exam revealed a sarcomatoid SCC in the MCT.


Resumo Embora o teratoma cístico maduro (MCT) seja benigno, a transformação maligna (MT) ocorre em cerca de 1% a 2% dos casos, e geralmente apresenta-se sob a forma de carcinoma espinocelular (CEC), responsável por cerca de 80% dos casos. O carcinoma (sarcomatoide) de células fusiformes (CSCF) é um tipo incomum de CEC, compreendendo até 3% de todos os casos. A falta de sintomas característicos e achados imagiológicos específicos pode levar a erros diagnósticos pré-operatórios. Além disso, as características clinico-patológicas, o tratamento, os fatores prognósticos e o mecanismo da MT ainda não são bem compreendidos devido à raridade de tais tumores, principalmente em mulheres em idade reprodutiva. Os autores apresentam um caso de uma paciente de 34 anos com 14 semanas de gestação que foi diagnosticada comumamassa anexial sugestiva de teratoma do ovário. A anexectomia laparoscópica foi realizada após 6 meses do parto, e o exame histológico revelou um CEC sarcomatoide tendo como origem um MCT.


Subject(s)
Humans , Female , Pregnancy , Adult , Ovarian Neoplasms/surgery , Ovarian Neoplasms/pathology , Ovarian Neoplasms/diagnostic imaging , Ovary/surgery , Ovary/pathology , Ovary/diagnostic imaging , Teratoma/surgery , Teratoma/pathology , Teratoma/diagnostic imaging , Carcinoma, Squamous Cell/surgery , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/diagnostic imaging , Fertility Preservation , Time-to-Treatment
16.
Prensa méd. argent ; 105(9 especial): 521-525, oct 2019. tab
Article in English | LILACS, BINACIS | ID: biblio-1046371

ABSTRACT

Over the last decade, the interest in using bacterial cellulose in medicine has increased. The article publishes the data about the efficiency of healing burn wounds in rabbits in experimental conditions with the use of the DermaRM wound dressing, compared to the traditionally used Panthenol ointment and the Branolind N salve dressing


Subject(s)
Animals , Rabbits , Ointments/therapeutic use , Bandages , Burns/therapy , Cellulose/therapeutic use , Treatment Outcome , Time-to-Treatment
18.
Ciênc. Saúde Colet ; 24(9): 3265-3274, set. 2019. tab
Article in Portuguese | LILACS | ID: biblio-1019671

ABSTRACT

Resumo Disparidades na atenção ao câncer de próstata têm sido reveladas e associadas a fatores sociodemográficos e clínicos, os quais determinam os tempos para diagnóstico e início do tratamento. O objetivo deste artigo é avaliar a associação de variáveis sociodemográficas e clínicas com os tempos para o início do tratamento do câncer de próstata. Estudo de coorte longitudinal prospectivo utilizando dados secundários, cuja população é de homens com câncer de próstata atendidos nos períodos de 2010-2011 e 2013-2014 no Hospital Santa Rita de Cássia, Vitória, Espírito Santo, Brasil. A população do estudo foi de 1.388 homens, do total, os com idade inferior a 70 anos (OR = 1,85; IC = 1,49-2,31), não brancos (OR = 1,30; IC = 1,00-1,70), com menos de oito anos de estudo (OR = 1,52; IC = 1,06-2,17) e encaminhados pelos serviços do Sistema Único de Saúde (OR = 2,52; IC = 1,84-3,46) apresentaram maior risco de atraso no tratamento. Da mesma forma, quanto menor o escore de Gleason (OR = 1,78; IC = 1,37-2,32) e os níveis de Antígeno Prostático Específico (OR = 2,71; IC = 2,07-3,54) maior a probabilidade de atraso para iniciar o tratamento. Portanto, as características sociodemográficas e clínicas exerceram uma forte influência no acesso ao tratamento do câncer de próstata.


Abstract Introduction: Disparities in prostate cancer care have been evidenced and associated with sociodemographic and clinical factors, which establish the time for diagnosis and initiation of treatment. Objective: To evaluate the association of sociodemographic and clinical variables with the onset of prostate cancer treatment. Methods: This is a prospective longitudinal cohort study with secondary data with a population of men with prostate cancer attended in the periods 2010-2011 and 2013-2014 at the Santa Rita de Cássia Hospital in Vitória, Espírito Santo, Brazil. Results: The study population consisted of 1,388 men. Of the total, those younger than 70 years (OR = 1.85; CI = 1.49-2.31), nonwhite (OR = 1.30; CI = 1.00-1.70), less than 8 years of schooling (OR = 1.52; CI = 1.06-2.17) and referred by the Unified Health System services (OR = 2.52; CI = 1.84-3.46) were more likely to have a delayed treatment. Similarly, the lower the Gleason score (OR = 1.78; CI = 1.37-2.32) and Prostate-Specific Antigens levels (OR = 2.71; CI = 2.07-3.54), the greater the likelihood of delay for the onset of treatment. Conclusion: Therefore, sociodemographic and clinical characteristics exerted a strong influence on the access to prostate cancer treatment.


Subject(s)
Humans , Male , Aged , Aged, 80 and over , Prostatic Neoplasms/therapy , Prostate-Specific Antigen/blood , Healthcare Disparities , Health Services Accessibility , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/pathology , Socioeconomic Factors , Brazil , Prospective Studies , Cohort Studies , Longitudinal Studies , Age Factors , Neoplasm Grading , Time-to-Treatment/statistics & numerical data , Middle Aged
19.
Int. braz. j. urol ; 45(3): 468-477, May-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1012330

ABSTRACT

ABSTRACT Introduction: To determine the impact of time from biopsy to surgery on outcomes following radical prostatectomy (RP) as the optimal interval between prostate biopsy and RP is unknown. Material and methods: We identified 7, 350 men who underwent RP at our institution between 1994 and 2012 and had a prostate biopsy within one year of surgery. Patients were grouped into five time intervals for analysis: ≤ 3 weeks, 4-6 weeks, 7-12 weeks, 12-26 weeks, and > 26 weeks. Oncologic outcomes were stratified by NCCN disease risk for comparison. The associations of time interval with clinicopathologic features and survival were evaluated using multivariate logistic and Cox regression analyses. Results: Median time from biopsy to surgery was 61 days (IQR 37, 84). Median follow-up after RP was 7.1 years (IQR 4.2, 11.7) while the overall perioperative complication rate was 19.7% (1,448/7,350). Adjusting for pre-operative variables, men waiting 12-26 weeks until RP had the highest likelihood of nerve sparing (OR: 1.45, p = 0.02) while those in the 4-6 week group had higher overall complications (OR: 1.33, p = 0.01). High risk men waiting more than 6 months had higher rates of biochemical recurrence (HR: 3.38, p = 0.05). Limitations include the retrospective design. Conclusions: Surgery in the 4-6 week time period after biopsy is associated with higher complications. There appears to be increased biochemical recurrence rates in delaying RP after biopsy, for men with both low and high risk disease.


Subject(s)
Humans , Male , Aged , Postoperative Complications/etiology , Prostatectomy/adverse effects , Prostatic Neoplasms/surgery , Prostatic Neoplasms/pathology , Time-to-Treatment , Intraoperative Complications/etiology , Prostatectomy/methods , Time Factors , Biopsy , Logistic Models , Retrospective Studies , Risk Factors , Analysis of Variance , Treatment Outcome , Prostate-Specific Antigen/blood , Risk Assessment , Disease Progression , Neoplasm Grading , Middle Aged , Neoplasm Recurrence, Local , Neoplasm Staging
20.
Rev. medica electron ; 41(3): 698-707, mayo.-jun. 2019.
Article in Spanish | LILACS | ID: biblio-1094077

ABSTRACT

RESUMEN El debate alrededor de las cifras de tensión arterial, y sobre todo las cifras a obtener mediante el tratamiento es en la actualidad un grave problema de salud. Se realizó una revisión sistemática en inglés y español de los principales artículos publicados en PubMed, Scielo y MEDLINE durante el periodo comprendido desde el año 2012 hasta 2018, acerca de la definición, evaluación y manejó de la tensión arterial. Todas las guías están de acuerdo en la toma de múltiples medidas de la tensión arterial para el diagnóstico, pero no para definir el control de la tensión, definir el control de la tensión arterial debe incluir una dimensión en el tiempo en un año por lo menos, y una proporción mínima de medidas donde debe pensar en la mitad de todas las medidas por lo menos, con medidas de tensión arterial tomadas por lo menos cada tres meses, por lo que sugerimos que un perfil anual de las cifras de tensión arterial debe ser considerado como un requisito mínimo para evaluar el control de la hipertensión arterial, este trabajo ha perfilado dos de los factores menos reconocidos: la necesidad de la intensificación del tratamiento después de la primera toma de tensión arterial por encima de las cifras deseadas, y el incremento de una nueva droga en vez de incrementar las dosis de las ya indicadas.


ABSTRACT The debate on the maintained arterial tension measure, and on the measure to obtain through the long term treatment, is currently a problem for the medical practitioner, due to the variation of arterial tension during the day at different hours because of the patients circadian cycle, and due to variations in different days according to the proper patient's situations or the environment around it, and the different seasons of the year. They make it difficult to know when arterial tension is within the parameters accepted as "controlled". The authors carried out a systematic review of documents published in PubMed, Scielo and MEDLINE in the period 2012-2018, both in English and Spanish, on the arterial tension definition, evaluation and management. The guidelines agree in taking arterial tension measures in different moments for the diagnosis, but not in defining tension control. Defining tension control should include a time dimension of at least a year, and a minimal proportion of measures within the parameters recognized as non-pathological or optimal on the basis of measures taken at least every three months. Therefore, the authors suggest that an annual profile of the arterial tension parameters should be considered as a minimal requirement to evaluate arterial hypertension control.


Subject(s)
Humans , Treatment Outcome , Practice Guidelines as Topic/standards , Symptom Assessment , Time-to-Treatment/organization & administration , Hypertension/diagnosis , Hypertension/etiology , Hypertension/prevention & control , Hypertension/drug therapy , Hypertension/epidemiology , Primary Health Care , Health Records, Personal
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