ABSTRACT
The Breast Cancer Revealed initiative was designed and conducted to know the status of breast cancer at each point of breast cancer care, through i) prevention, ii) detection, iii) diagnosis, iv) treatment, and iv) the capacity of our health systems. The expert panel from 11 Latin American countries identified several strategies and proposed high impact priorities, including implementation of prevention policies, improve primary healthcare capacity for breast cancer screening, have adequate infrastructure to make effective and timely diagnoses, have a multidisciplinary team in the treatment process, access to a variety of treatments for all types of patients, have a coordinated and articulated system from primary care to specialized hospital. In a region with limited resources, prioritization in high-impact strategies for breast cancer control could lead to improved clinical outcomes and quality of life for our patients.
Subject(s)
Breast Neoplasms , Humans , Female , Breast Neoplasms/diagnosis , Breast Neoplasms/epidemiology , Breast Neoplasms/therapy , Latin America/epidemiology , Quality of Life , Delivery of Health Care , Early Detection of CancerABSTRACT
Background: A third of people with juvenile myoclonic epilepsy (JME) are drug-resistant. Three-quarters have a seizure relapse when attempting to withdraw anti-seizure medication (ASM) after achieving seizure-freedom. It is currently impossible to predict who is likely to become drug-resistant and safely withdraw treatment. We aimed to identify predictors of drug resistance and seizure recurrence to allow for individualised prediction of treatment outcomes in people with JME. Methods: We performed an individual participant data (IPD) meta-analysis based on a systematic search in EMBASE and PubMed - last updated on March 11, 2021 - including prospective and retrospective observational studies reporting on treatment outcomes of people diagnosed with JME and available seizure outcome data after a minimum one-year follow-up. We invited authors to share standardised IPD to identify predictors of drug resistance using multivariable logistic regression. We excluded pseudo-resistant individuals. A subset who attempted to withdraw ASM was included in a multivariable proportional hazards analysis on seizure recurrence after ASM withdrawal. The study was registered at the Open Science Framework (OSF; https://osf.io/b9zjc/). Findings: Our search yielded 1641 articles; 53 were eligible, of which the authors of 24 studies agreed to collaborate by sharing IPD. Using data from 2518 people with JME, we found nine independent predictors of drug resistance: three seizure types, psychiatric comorbidities, catamenial epilepsy, epileptiform focality, ethnicity, history of CAE, family history of epilepsy, status epilepticus, and febrile seizures. Internal-external cross-validation of our multivariable model showed an area under the receiver operating characteristic curve of 0·70 (95%CI 0·68-0·72). Recurrence of seizures after ASM withdrawal (n = 368) was predicted by an earlier age at the start of withdrawal, shorter seizure-free interval and more currently used ASMs, resulting in an average internal-external cross-validation concordance-statistic of 0·70 (95%CI 0·68-0·73). Interpretation: We were able to predict and validate clinically relevant personalised treatment outcomes for people with JME. Individualised predictions are accessible as nomograms and web-based tools. Funding: MING fonds.
ABSTRACT
The COVID-19 pandemic led to the development and emergency approval of an array of effective vaccines against SARS-CoV-2. Given the relatively small number of patients included in vaccine trials, postapproval epidemiological surveillance is crucial to detect infrequent vaccine-related adverse events. We conducted a nationwide retrospective descriptive study evaluating the incidence of seizures among recipients of SARS-CoV-2 vaccines in Mexico from December 24, 2020 (date of administration of first doses nationwide) to October 29, 2021. Among 81 916 351 doses of any vaccine that were administered, we documented seizures in 53 patients, of which 31 (60%) were new onset seizures. The incidence rate of seizures per million doses was highest for mRNA-1273 (Moderna) with 2.73 per million, followed by BNT162b2 (Pfizer-BioNTech) with 1.02 per million, and Ad5-nCoV (CanSino) with 1.01 per million. Thus, we found that seizures following SARS-CoV-2 vaccination are exceedingly rare events.
Subject(s)
COVID-19 , Vaccines , BNT162 Vaccine , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Humans , Mexico/epidemiology , Pandemics , Retrospective Studies , SARS-CoV-2 , Seizures/chemically induced , Seizures/etiology , Vaccination/adverse effects , Vaccines/adverse effectsABSTRACT
El Síndrome coronario agudo es la manifestación más severa de la Cardiopatía isquémica, el cual abarca 3 entidades, Angina Inestable, Infarto agudo al miocardio sin elevación del ST, y con elevación del segmento ST. La enfermedad trivascular corresponde a una estenosis de más del 50% en 3 o más arterias epicárdicas principales. Con este estudio se buscó ofrecer información actualizada, obtenida del servicio de Terapia Endovascular, del único centro de Intervencionismo coronario a nivel Nacional que atiende pacientes con enfermedad arterial coronaria del Instituto Salvadoreño del Seguro Social (ISSS), ubicado en el Hospital Médico Quirúrgico y Oncológico (HMQyO), para determinar la concordancia entre la elevación del segmento ST en la derivación aVR en pacientes con síndrome coronario agudo sin elevación del ST, y la enfermedad trivascular diagnosticada por medio de cateterismo cardíaco, del ISSS, año 2018. Este fue un estudio de tipo correlacional, analítico, y transversal de concordancia, llevado a cabo desde enero a diciembre del año 2018. Con un Universo de 102 pacientes sometidos a cateterismo cardíaco debido a síndrome coronario agudo que acudieron al ISSS, Unidad de Hemodinámica HMQyO, y una muestra con un nivel de confianza del 95%, y una precisión de error estándar de 0.05, de 82 pacientes. Dentro de los resultados significativos podemos mencionar que la enfermedad trivascular en contexto de síndrome coronario agudo sin elevación del ST, es más frecuente en pacientes de sexo masculino, área urbana, y mayores de 55 años. El factor de riesgo principal fue la Hipertensión arterial. El hallazgo de elevación del segmento ST en la derivación aVR como predictor de Enfermedad coronaria trivascular, en pacientes con síndrome coronario agudo sin elevación del ST, tuvo una concordancia según índice Kappa de Cohen Moderada de 0.52, sensibilidad 71.4%, especificidad 88.8%, valor predictivo positivo 93.75%
Subject(s)
Acute Coronary Syndrome , ST Elevation Myocardial Infarction , Internal MedicineABSTRACT
NEW RECORDS OF PONTARACHNID MITES (ACARI: Hydrachnidia) from the Caribbean island of Puerto Rico are presented. Litarachna lopezae sp. n., from substrata collected from Bajo de Sico, a mesophotic coral reef ecosystem in Mona Passage off Puerto Rico, is described as new to science. The new species was collected from nearly 70 m depth, the greatest depth from which pontarachnid mites have been found until now. In addition, a Litarachna sp. was also found in association with the tube of the polychaete Sabellastarte magnifica (Shaw, 1800) at the shallow waters of north Puerto Rico.
ABSTRACT
Objective. To compare the clinical profiles in newborns of adolescent and non-adolescent mothers. Materials and Methods. Comparative cross-sectional study. Newborns selected by cluster sampling registered in the hospital. Two groups were formed according to the mother's age: adolescent and non-adolescent. The clinical profile was evaluated with: weight, length, Apgar score, gestational age, and presence of neonatal pathology. For the comparison between proportions, we used chi-squared test and student´s t-test between the mean. Results. Of the 2,155 clinical profiles of newborns analyzed, 819 (38%) were newborns of adolescent mothers and 1,336 (62%) of non-adolescent mothers. Differences between birth weight groups 2,859 ± 459 vs. 3,265 ± 486 grams (p = 0.000), male gender 518 (63%) vs. 725 (54%) female (p = 0.000); intrauterine growth restriction in full-term newborns 62 (7.5%) vs. 66 (4.9%) (p = 0.012); prematurity 171 (21%) vs. 213 (16%) (p = 0.003). Factors that favor the alteration of clinical profiles in newborns: adolescent mother OR: 1.58 (1.99-2.99), male gender OR: 1.80 (1.50-2.17), neonatal pathology OR: 3.73 (2.50-5.30), association of low birth weight in newborns of adolescent mothers OR: 2.4 (1.72-3.42). Conclusion. We found a high frequency of observing in newborns of adolescent mothers greater risk of prematurity, intrauterine growth restriction, and neonatal pathology. No differences were seen in length and Apgar score.
ABSTRACT
Con el objetivo de describir la incidencia de infecciones intrahospitalarias asociadas a dispositivos invasivos en unidades de cuidados intensivos (UCI) del Hospital Nacional Cayetano Heredia se realizó un estudio observacional retrospectivo utilizando datos de la Oficina de Epidemiología y Salud Ambiental durante los años 2010 al 2012. Se notificó un total de 222 infecciones intrahospitalarias, la UCI de Medicina tuvo la incidencia por 1000 días de uso del dispositivo más alta para neumonía asociada a ventilador mecánico (28,6); infección del torrente sanguíneo asociado a catéter venoso central (11,9), e infección del tracto urinario asociado a catéter (8,1). Los principales agentes infecciosos aislados fueron Pseudomona sp. (32,3%) en la UCI de emergencia, Staphylococcus coagulasa negativo (36%) en la UCI de medicina y Candida sp (69,2%) en la UCI de cirugía. Las tasas de infecciones asociadas a dispositivos invasivos se reportaron altas semejantes a otros hospitales nacionales con limitados recursos e infraestructura.
In order to describe the incidence of nosocomial infections associated to invasive devices in intensive care units (UCI) of the National Hospital Cayetano Heredia, a retrospective observational study was conducted using the data from the Office of Epidemiology and Environmental Health from 2010 to 2012. A total number of 222 nosocomial infections were reported; the general medicine UCI reported the highest incidence of pneumonia cases associated to a mechanical ventilator in 1000 days of use of the device (28.6); infection of the blood stream associated to central venous catheter (11.9), and infection of the urinary tract associated to a catheter (8,1). The main infectious agents isolated were Pseudomona sp. (32.3%) in the emergency UCI, negative Staphylococcus coagulasa (36%) in the general medicine UCI and Candida sp (69.2%) in the Surgery UCI. The rates of infections associated to invasive devices were high as in other national hospitals with limited resources and infrastructure.
Subject(s)
Male , Female , Humans , Critical Care , Incidence , Cross Infection , Epidemiology, Descriptive , Observational Study , Retrospective Studies , PeruABSTRACT
Pseudoleptocheliajuliae n. sp. is described from Puerto Rican waters in depths from 1 to 28 m. The new species and P. fairgo from western Australia are the only members of the genus as defined in this revision that have a distinct process on the posterior margin of the cheliped carpus. The male of P. juliae is distinguished from that of P. fairgo by this process being sub-acute and having a distinctly narrower propodus. Lang's generic diagnosis for the female of Pseudoleptochelia is incorrect, which has led to confusion. Based in examination of Mediterranean specimens attributed to the type species P. anomala (Sars), Pseudoleptochelia is rediagnosed to contain seven species; P. anomala; P. fairgo; . juliae; P. magna; P. mortenseni; P. occiporta; and P. straddi., The genus is reviewed and discussed and the taxonomic status for the remaining nine species previously assigned to the genus is re-evaluated. Pseudoleptochelia shares similarities with the more recently described Pacific genera Konarus and Parakonarus and to a lesser extent to the highly derived genus Makraleptochelia.
Subject(s)
Crustacea/classification , Animal Distribution , Animal Structures/anatomy & histology , Animal Structures/growth & development , Animals , Body Size , Crustacea/anatomy & histology , Crustacea/growth & development , Female , Male , Organ SizeABSTRACT
Metastasis to the breast from extramammary tumors are uncommon and metastatic colon carcinoma (MCC) to the breast is extremely rare. A case history is presented of a 42 year-old woman with a finding of a breast lump. One year before,she had undergone an anterior colon resection for a rectal carcinoma. Mammographic examination revealed a high density, well demarcated, 3 cm lesion located in the upper outer quadrant of left breast, along with smaller multiple bilateral nodules. Following breast biopsy, the final diagnosis of MCC was based on the absence of any precursor lesion within the breast (no surrounding ductal carcinoma in situ) and of the expression of cytokeratin 20 and ß-catenin on immunohistochemistry.The treatment strategy for metastatic breast disease is based on a proper assessment of such cases by surgeons,radiologists and pathologists.
Subject(s)
Adenocarcinoma/secondary , Breast Neoplasms/secondary , Colonic Neoplasms/pathology , Adult , Female , HumansABSTRACT
A 35-year-old woman presented with abdominal pain and weight loss. Pelvic computed tomography showed a 15 cm mass in the left ovary. Grossly, the removed ovary was completely replaced by a solid tumor mass. On histological analysis (100 sections), the lesion showed the typical morphological features of dysgerminoma (20%) admixed with a major (80%) fibrosarcoma component. Tumors did not have well-demarcated boundaries with a close intermingling of both cell types. Despite surgery and combination chemotherapy, the disease progressed rapidly and the patient died of disease 18 months after diagnosis. Review of the literature showed that soft tissue sarcomas of several types may occasionally be associated with gonadal and extragonadal mixed germ-cell tumors or with spermatocytic seminoma of the testis. However, no previously published report of an ovarian fibrosarcoma associated with a pure dysgerminoma was found in the literature.
Subject(s)
Dysgerminoma/pathology , Fibrosarcoma/pathology , Neoplasms, Multiple Primary/pathology , Ovarian Neoplasms/pathology , Adult , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Combined Modality Therapy , Dysgerminoma/drug therapy , Dysgerminoma/surgery , Fatal Outcome , Female , Fibrosarcoma/drug therapy , Fibrosarcoma/surgery , Humans , Neoplasms, Multiple Primary/drug therapy , Neoplasms, Multiple Primary/surgery , Ovarian Neoplasms/drug therapy , Ovarian Neoplasms/surgeryABSTRACT
El objetivo del estudio fue identificar las características clínico-epidemiológicas, el tratamiento y la evolución de 90 casos con el diagnóstico de piomiositis tropical (PT). Se revisaron las historias clínicas de los pacientes atendidos en el Hospital de Apoyo Banda de Shilcayo, San Martín, entre enero de 1999 y junio del 2001, identificándose 90 casos de PT. Los pacientes tuvieron de 2 a 40 años, 57 fueron varones y 33 mujeres. La sintomatología más común fue fiebre, mialgia y signos inflamatorios en los sitios de lesión. Generalmente había una sola lesión, siendo la ubicación más frecuente los miembros inferiores y la pelvis. La desnutrición y la lesión, siendo la ubicación más frecuente los miembros inferiores y la pelvis. La desnutrición y la anemia estuvieron presentes en más de la mitad de los menores de 10 años. El diagnóstico se basó en los hallazgos clínicos y ecográficos. Los antimicrobianos más utilizados fueron oxacilina, clindamicina, aminoglucósidos y dicloxacilina. Dieciséis pacientes presentaron complicaciones (neumonía, sepsis, shock séptico, etc). La letalidad fue 2.2 por ciento.
