Safety of mRNA-COVID-19 Vaccines in Patients With Thoracic Cancers.

BACKGROUND: Pivotal trials of COVID-19 vaccines did not include cancer patients with questions remaining in this population. Particularly in patients with thoracic malignancies receiving anticancer treatments, the safety of these vaccines has so far been little investigated. METHODS: This is a prospective trial of patients with thoracic cancer receiving anticancer treatments and COVID-19 vaccines at the Division of Thoracic Oncology of European Institute of Oncology between February and September 2021. RESULTS: A total 207 patients affected by thoracic cancers (199 lung cancers and 8 mesotheliomas) had received Covid-19 vaccines (206 mRNA vaccines and 1 virus-vectored vaccine). The majority of patients had at least one comorbidity (76.3%). They were concomitantly treating with targeted therapy (TT) (45.9%), immunotherapy (IO) (22.7%), and chemotherapy (CT) (14%). A total of 64 AEs (15.6%) were observed after administration of Sars-Cov-2 vaccine. The majority of AEs were grade 1 [G1] (6.3%) and G2 (8.8%), only two events were G3 (0.5%). The median follow-up was 9 months (range 1-22 months), during this follow-up 21 patients (10.1%) had a positive nasal swab, most of the patients were asymptomatic (67%) and the symptomatic ones (33%) had mild symptoms and fewer complications and hospitalizations. CONCLUSIONS: COVID-19 m-RNA vaccines appear to be safe in the cohort of patients with thoracic malignances in active treatment, including those receiving immunotherapy. Considering the high morbidity and mortality associated with COVID-19 in patients with lung cancer receiving active treatments, our study supports the current vaccine prioritization, third and/or fourth dose, of all cancer patients with active treatment.

Should temozolomide be used on the basis of O6-methylguanine DNA methyltransferase status in patients with advanced neuroendocrine tumors? A systematic review and meta-analysis.

BACKGROUND: Temozolomide (TEM) is an active treatment in metastatic neuroendocrine tumors (NETs). Patients affected by glioblastoma multiforme or advanced melanoma treated with TEM who have deficiency of O6-methylguanine DNA methyltransferase (MGMT) have a better responses and survival. However, the predictive role of MGMT in patients with NETs treated with TEM is still debated. METHODS: We conducted a systematic review of the literature and meta-analysis, based on PRISMA methodology, searching in the main databases (PubMed, Embase, Scopus, Web of Science, Cochrane Library and clinical trial.gov) and the proceedings of the main international congresses, until April 26, 2021. RESULTS: Twelve out of 616 articles were selected for our analysis, regarding a total of 858 NET patients treated with TEM-based chemotherapy. The status of MGMT had been tested in 513 (60%) patients, using various methods. The pooled overall response rate (ORR) was higher in MGMT-deficient compared with MGMT-proficient NETs, with a risk difference of 0.31 (95% confidence interval, CI: 0.13-0.50; p < 0.001; I2: 73%) and risk ratio of 2.29 (95% CI: 1.34-3.91; p < 0.001; I2: 55%). The pooled progression free survival (PFS) (hazard ratio, HR = 0.56; 95% CI: 0.43-0.74; p < 0.001) and overall survival (OS) (HR = 0.41; 95% CI: 0.20-0.62; p = 0.011) were longer in MGMT-deficient versus MGMT-proficient NETs. CONCLUSIONS: Our meta-analysis suggested that MGMT status may be predictive of TEM efficacy. However, due to the high heterogeneity of the evaluated studies the risk of biases should be considered. On this hypothesis future homogeneous prospective studies are warranted.

Psychological autopsy study comparing suicide decedents, suicide ideators, and propensity score matched controls: results from the study to assess risk and resilience in service members (Army STARRS).

BACKGROUND: The suicide rate has increased significantly among US Army soldiers over the past decade. Here we report the first results from a large psychological autopsy study using two control groups designed to reveal risk factors for suicide death among soldiers beyond known sociodemographic factors and the presence of suicide ideation. METHODS: Informants were next-of-kin and Army supervisors for: 135 suicide cases, 137 control soldiers propensity-score-matched on known sociodemographic risk factors for suicide and Army history variables, and 118 control soldiers who reported suicide ideation in the past year. RESULTS: Results revealed that most (79.3%) soldiers who died by suicide have a prior mental disorder; mental disorders in the prior 30-days were especially strong risk factors for suicide death. Approximately half of suicide decedents tell someone that they are considering suicide. Virtually all of the risk factors identified in this study differed between suicide cases and propensity-score-matched controls, but did not significantly differ between suicide cases and suicide ideators. The most striking difference between suicides and ideators was the presence in the former of an internalizing disorder (especially depression) and multi-morbidity (i.e. 3+ disorders) in the past 30 days. CONCLUSIONS: Most soldiers who die by suicide have identifiable mental disorders shortly before their death and tell others about their suicidal thinking, suggesting that there are opportunities for prevention and intervention. However, few risk factors distinguish between suicide ideators and decedents, pointing to an important direction for future research.

Violencia hacia la mujer: un problema de todos / Violence towards the woman: a problem of all

Se analizan conceptos, definiciones y prevalencia de la Violencia hacia la Mujer, así como, consecuencias en la salud física, psicológica y sexual de las mujeres, haciendo referencia a los costos sociales y económicos y llamando a la comunidad médica a la visibilización de este problema.

Descenso nocturno de la presión arterial: factores determinantes y relación con daño orgánico secundario a hipertensión / Night-time drop in blood pressure: determining factors and relationship with organic damage as a side-effect of hypertension

Objetivos. Evaluar el descenso nocturno de la presión arterial en los pacientes con hipertensión ligera y determinar su posible relación con la presencia de daño en órganos diana. Diseño. Estudio transversal. Emplazamiento. Ocho centros de salud urbanos. Pacientes. Cuatrocientos dieciocho pacientes adultos con hipertensión arterial ligera-moderada. Intervenciones. a) Lectura de la presión arterial en 3 visitas; b) monitorización ambulatoria de la presión durante 24 horas; c) ecocardiografía (en 219 pacientes), y d) determinación de albuminuria (en 134 pacientes). Se definió como descenso nocturno de presión arterial la diferencia entre las presiones ambulatorias diurna y nocturna, y como descenso relativo al porcentaje de descenso de la presión nocturna respecto de la diurna. Resultados. El descenso nocturno de las presiones sistólica y diastólica fue de 13,6 (10,7) y 12,1 (8,6) mmHg, respectivamente. Los factores predictores del descenso nocturno de PA (por ciento) fueron, en sentido directo, la presión arterial ambulatoria diurna (p < 0,05) y el sexo femenino (p < 0,05) y, en sentido inverso, la edad (p < 0,05). No se observó asociación entre el descenso nocturno de presión arterial y la masa del ventrículo izquierdo. Solamente en mujeres se observó una relación independiente, en sentido inverso, entre el descenso nocturno de presión arterial y la excreción urinaria de albúmina (p < 0,05). Conclusiones. El descenso nocturno relativo ( por ciento) de la presión arterial es mayor en las mujeres que en los varones, disminuye con la edad y depende de la presión ambulatoria diurna. En las mujeres, un menor descenso nocturno de la presión arterial se asocia a mayor daño orgánico (AU)

[Nocturnal drop of arterial blood pressure: determinant factors and relationship with organic damage secondary to hypertension]. / Descenso nocturno de la presión arterial: factores determinantes y relación con daño orgánico secundario a hipertensión.

OBJECTIVES: To evaluate the night-time drop in blood pressure in patients with light hypertension and to determine its possible relationship with damage in key organs. DESIGN: Cross-sectional study. SETTING: Eight urban health centres. PATIENTS: Four hundred and eighteen adults with light-moderate hypertension. INTERVENTIONS: a) Blood pressure reading on three visits; b) ambulatory monitoring of pressure for 24 hours; c) echocardiograph (in 219 patients); d) albuminuria determination (in 134 patients). A night-time drop in blood pressure was defined as the difference between day and night ambulatory pressures; and relative drop, as the night-time pressure drop as a percentage of the day-time pressure. RESULTS: Night-time drop in systolic and diastolic pressures was 13.6 (10.7) and 12.1 (8.6) mmHg, respectively. The predictive factors of night-time drop in blood pressure were, directly, daily ambulatory blood pressure (p < 0.05) and female gender (p < 0.05) and, inversely, age (p < 0.05). No association was observed between night-time drop in blood pressure and left ventricular mass. Only in women was an independent relationship found, inversely, between night-time drop in blood pressure and urinary excretion of albumin (p < 0.05). CONCLUSIONS: Relative night-time drop in blood pressure is greater in women than in men, diminishes with age and depends on the day-time ambulatory pressure. In women a minor night-time drop in blood pressure is associated with greater organic damage.

Disfunciones sexuales: asistencia clínica y factores asociados en ginecología / Sexual dysfunctions: clinical assistance and associated factors in gynecology

La salud sexual es parte significativa de la salud integral de la mujer y su deterioro obedece a numerosos factores biopsicosociales. Las consecuencias de este deterioro son múltiples y una de ellas es la disfunción sexual, cuya prevalencia en mujeres es de alrededor del 50 por ciento. Con el fin de responder a esta necesidad, se implementa un equipo interdisciplinario en el Departamento de Obstetricia y Ginecología del Hospital Clínico de la Universidad de Chile. Se describe la experiencia clínico-asistencial de la Unidad de sexualidad humana durante un período de 8 años en base a 182 pacientes atendidas. Los principales motivos de consulta son el deseo sexual hipoactivo (38 por ciento), vaginismo y dispareunia (16,5 por ciento) y anorgasmia (10 por ciento). La presencia de factores asociados es alta, tanto en el ámbito psicológico (66,5 por ciento) como en el orgánico (23 por ciento) y se manifiestan de manera interdependiente, situación que corrobora la implementación de un trabajo en equipo interdisciplinario. Además, se detectan necesidades en salud mental (28 por ciento) que exceden el ámbito sexual y que requieren atención específica

Caso inusual de cáncer de ovario avanzado / Unusual case of advanced ovarian cancer

El cáncer de ovario, es una patología de diagnóstico tardío y de alta mortalidad en sus estadios avanzados. Se presenta el caso de una paciente de 51 años, portadora de un cáncer de ovario (Cistoadenocarcinoma seroso papilar ovárico bilateral) estadio IIIb, con 13 años de sobrevida post tratamiento. Se analiza tanto su historia clínica, estudio, tratamiento y su evolución en el tiempo

¿Y la sexualidad qué?: visión desde la perspectiva de un hospital universitario / What about sexuality?: perspective from a universitary hospital

Se analizan los fundamentos y campo de acción de una Unidad de Sexualidad Humana en el ámbito de la ginecología, desde una perspectiva multidisciplinaria, abarcando las áreas propias del quehacer de un hospital universitario

[Retroperitoneal tumor arising from neural crest: ganglioneuroma+]. / Tumor retroperitoneal derivado de la cresta neural: ganglioneroma.

OBJECTIVES: This study shows the contribution of the different imaging methods in the diagnosis of retroperitoneal ganglineuroma. METHODS: A retroperitoneal mass was incidentally detected in a young male patient. Patient evaluation included plain abdominal radiography, intravenous urography, ultrasound and computed tomography. RESULTS: Ultrasound and computed tomography provide information on tumor characteristics and extent, although it has no diagnostic specifity and does not permit distinguishing ganglioneuroma from other neural crest tumors.

[Occupational exposure to hepatitis B virus in hospital personnel at the Naval Medical Center "Cirujano Mayor Santiago Távara"]. / Exposición ocupacional al virus de la hepatitis B del personal hospitalario del Centro Médico Naval "Cirujano Mayor Santiago Távara".

Four hundred apparently healthy workers from different service areas of the Naval Medical Center "Cirujano Mayor Santiago Távara" constituted the basis for this epidemiological assessment for hepatitis B. Determination of serologic markers was done with an enzyme linked immunoabsorbent assay (ELISA). We evaluated hepatitis B surface antigen (HBsAg), total antibodies against hepatitis B core antigen IgG type (anti-HBc-IgG) and antibodies against hepatitis B core antigen IgM type (anti-HBc-IgM). Results showed that 11.75% of the samples studied had antibodies against the core antigen. Negative results were obtained for HBsAg and anti-HBc-IgM. We found correlation between blood contact and the prevalence of the total antibodies against hepatitis B core antigen IgG type in medical personnel. The total antibodies against hepatitis B core antigen IgG type was positive in function of previous history of hepatitis, time of occupation, and age. The results obtained in the present study confirm the increased risk of hepatitis B infection in health care personnel compared to general population. This seroepidemiological survey shows that hospital personnel of the Naval Medical Center has a lower prevalence of HBV infection that the prevalence found by other authors in the personnel of other hospitals in Perú.

Fístula genitourinaria y dispositivo intrauterino / Genitourinary fistula and intrauterine device

Se presenta un caso de incontinencia urinaria producida por una fístula vesico-uterina, causada por un dispositivo intrauterino ectópico

Herpes simplex virus and cytomegalovirus in pregnant Chilean university students.

Virus isolation tests were performed during the first, second, and third trimesters of pregnancy on a group of 163 students who received prenatal care at the University of Chile's Student Medical and Dental Service to determine the possible existence of genital herpes or cytomegalovirus infections. Vaginal secretion samples tested for herpes simplex virus (HSV) and urine samples tested for cytomegalovirus (CMV) were inoculated onto cell cultures and examined by immunofluorescent procedures using monoclonal antibodies. HSV was detected in five subjects, only one of whom had herpetic lesions, and was identified as type 2 in all cases. Cytomegalovirus was detected in seven subjects.

[Herpes simplex virus and cytomegalovirus in pregnant Chilean university students]. / Virus del herpes simple y citomegalovirus en universitarias chilenas embarazadas.

Virus isolation tests were performed on a group of 163 students who received prenatal care at the Student Medical and Dental Service at the University of Chile (Santiago) during the 1st, 2nd, and 3rd trimesters of pregnancy to determine the possible existence of genital herpes infection (isolation from vaginal secretions) or cytomegalovirus infection (isolation from urine). The samples were inoculated on cell cultures and were then studied using immunofluorescence with monoclonal antibodies. The herpes simplex virus (HSV) was detected in the vaginal secretions of 5 pregnant women, only one of whom had herpes lesions; in all these cases, the virus isolated was HSV type 2. Cytomegalovirus was detected in 7 of the pregnant women.

[A prospective study of programmed nursing consultation in an urban health center]. / Estudio prospectivo de la consulta programada de enfermería en un centro de salud urbano.

A study of the programmed nurse clinic in a health center was carried out to evaluate its different health care activities, the time consumed in them, the type of patients cared for, and the mechanism of organization of the clinic. A remarkable finding was a high number of daily appointments (11.8 persons), with an excellent rate of compliance with the appointment (89.3%). It was found that most of the diseases cared for in the nurse clinic were those most commonly managed with a protocol design in primary care: hypertension (34.1%), diabetes (6.9%), hyperlipoproteinemia (9%) and obesity (12.8%). Other parameters were evaluated, such as mean time per visit, which was predominantly between five and ten minutes, or activities during the visits, with a clear predominance of the clinical protocols. There was a remarkably high efficiency of the nursing staff, with a low rate of referral to the medical clinic (6.9%). We conclude that nurse clinics play an important role in the health centers, as the only possible mechanism to guarantee the correct fulfillment of the different programs. This requires a definite constant physical space for a given minimal period of time of about 2 hours per day.