Clinical characteristics and predictors of hospitalization among 7, 108 ambulatory patients with positive RT-PCR for SARS-CoV-2 during the acute pandemic period / Características clínicas e preditores de hospitalização entre 7. 108 pacientes ambulatoriais com RT-PCR positivo para SARS-CoV-2 durante o período de pandemia aguda

ABSTRACT Objective: To describe baseline characteristics of outpatients with a positive RT-PCR for SARS-CoV-2 and to define whether "red flags" (new-onset fever, dyspnea, and chest pain) can predict clinical worsening during the isolation period. Methods: This was an epidemiological, observational, descriptive study. Between March and September of 2020, all outpatients who tested positive for SARS-CoV-2 at a tertiary medical center located in Santiago de Chile were included. Demographic variables, comorbidities, red flags, and other symptoms were compiled using follow-up surveys at specific time points. The risk of clinical worsening (hospitalization) and adjusted hazard ratios (HRs) were calculated. Results: A total of 7,108 patients were included. The median age was 38 years (range, 0-101), and 52% were men. At baseline, 77% of the patients reported having characteristic symptoms of SARS-CoV-2 infection. The most prevalent onset symptoms were headache (53%), myalgia (47%), and fever (33%). According to the follow-up surveys, the incidence of symptoms decreased during the isolation period; however, 28% of the patients still presented with symptoms on day 14. The risk of hospitalization for patients with new-onset fever and dyspnea during the follow-up period was HR = 7.43 (95% CI, 3.85-14.3, p<0.01) and HR = 5.27 (95% CI, 1.52-18.30; p < 0.01 for both), respectively. New-onset chest pain showed no association with clinical worsening. Conclusions: In this sample of outpatients with a recent diagnosis of SARS-CoV-2 infection, a survey-based monitoring of symptoms was useful to identify those at risk of clinical worsening. New-onset fever and dyspnea during the isolation period were considered as red flags associated with clinical worsening and warrants prompt medical evaluation.

RESUMO Objetivo: Descrever as características basais de pacientes ambulatoriais com RT-PCR positivo para SARS-CoV-2 e definir se os sintomas de alerta para gravidade (febre, dispneia e dor torácica de início recente) podem prever piora clínica durante o período de isolamento. Métodos: Trata-se de um estudo epidemiológico, observacional e descritivo. Entre março e setembro de 2020, foram incluídos todos os pacientes ambulatoriais com teste positivo para SARS-CoV-2 em um centro médico terciário localizado em Santiago do Chile. Variáveis demográficas, comorbidades, sintomas de alerta para gravidade e outros sintomas foram compilados usando pesquisas de seguimento em intervalos específicos. Também foram calculados o risco de piora clínica (hospitalização) e as razões de risco (RR) ajustadas. Resultados: Foi incluído um total de 7.108 pacientes. A mediana de idade foi de 38 anos (variação: 0-101), e 52% eram homens. No início do estudo, 77% dos pacientes relataram sintomas característicos de infecção por SARS-CoV-2. Os sintomas recentes mais prevalentes foram cefaleia (53%), mialgia (47%) e febre (33%). De acordo com as pesquisas de seguimento, a incidência de sintomas diminuiu durante o período de isolamento; no entanto, 28% dos pacientes ainda apresentavam sintomas no dia 14. O risco de hospitalização para pacientes com febre e dispneia de início recente durante o período de seguimento foi RR = 7,43 (IC95%: 3,85-14,3; p < 0,01) e RR = 5,27 (IC95%: 1,52-18,30; p < 0,01 para ambos), respectivamente. A dor torácica de início recente não mostrou associação com a piora clínica. Conclusões: Nesta amostra de pacientes ambulatoriais com um diagnóstico recente de infecção por SARS-CoV-2, um monitoramento dos sintomas baseado em pesquisa foi útil para identificar aqueles com risco de piora clínica. Febre e dispneia de início recente durante o período de isolamento foram consideradas sintomas de alerta associados ao agravamento clínico e justificam avaliação médica imediata.

Caracterización de pacientes con cáncer colorrectal esporádico basado en la nueva subclasificación molecular de consenso / Characterization of patients with sporadic colorectal cancer following the new Consensus Molecular Subtypes (CMS)

Background: Colorectal cancer (CRC) is an heterogeneous disease. Three carcinogenic pathways determine its molecular profile: microsatellite instability (MSI), chromosomal instability (CIN) and CpG island methylator phenotype (CIMP). Based on the new molecular classification, four consensus CRC molecular subtypes (CMS) are established, which are related to clinical, pathological and biological characteristics of the tumor. Aim: To classify Chilean patients with sporadic CRC according to the new consensus molecular subtypes of carcinogenic pathways. Material and Methods: Prospective analytical study of 53 patients with a mean age of 70 years (55% males) with CRC, operated at a private clinic, without neoadjuvant treatment. From normal and tumor tissue DNA of each patient, CIN, MSI and CIMP were analyzed. Combining these variables, tumors were classified as CMS1/MSI-immune, CMS2/canonical, CMS3/metabolic and CMS4/mesenchymal. Results: CMS1 tumors (19%) were located in the right colon, were in early stages, had MMR complex deficiencies and 67% had an activating mutation of the BRAF oncogene. CMS2 tumors (31%) were located in the left colon, had moderate differentiation, absence of vascular invasion, lymphatic and mucin. CMS3 tumors (29%) were also left-sided, with absence of vascular and lymphatic invasion, and 29% had an activating mutation of the KRAS oncogene. CMS4 tumors (21%) showed advanced stages and presence of metastases. Conclusions: This new molecular classification contributes to understanding the heterogeneity of tumors. It is possible to differentiate molecular subgroups of a single pathological diagnosis of adenocarcinoma, opening the door to personalized medicine.