ABSTRACT
Background: The COVID-19 pandemic in 2020 profoundly impacted healthcare worldwide, and Peru was particularly affected, experiencing the highest COVID-19 case fatality rate globally. Methods: We conducted a retrospective comparative study of patients presenting with aneurysmal subarachnoid hemorrhage (SAH) at a public Peruvian national referral center specializing in cerebrovascular diseases. Two study periods were considered, one during the first wave of the COVID-19 pandemic and a second identical period in 2019. Variables included patient demographics, comorbidities, COVID-19 infection status, clinical presentation, treatment approaches, and hospital outcomes. Results: We analyzed 114 patients with aneurysmal SAH, 65 (57.0%) treated in 2019 and 49 (43.0%) in 2020. The mean time from emergency admission to the day of definitive treatment during 2019 and 2020 was 2.72 and 1.93 days, respectively. Likewise, the mean time from symptom onset to the date of definitive treatment was 6.71 and 7.70 days, respectively. We identified significant associations between complications such as sepsis, respiratory failure, acute kidney failure, and hospital mortality. The proportion of fatalities was significantly higher in 2020 compared to 2019 (36.7% vs. 15.4%, respectively). Interestingly, there was no statistically significant association between COVID-19 infection status and mortality during the 2020 period. Conclusion: Patients with aneurysmal SAH treated during the pandemic had a higher proportion of sepsis, respiratory failure, acute kidney failure, and mortality compared to the pre-pandemic period. Reallocating healthcare resources to prioritize COVID-19 patients may have inadvertently neglected or delayed care for patients with other emergency conditions, such as aneurysmal SAH. This highlights the importance of maintaining adequate care for non-infectious emergencies during a pandemic.
ABSTRACT
INTRODUCCION: Los astrocitomas son los tumores más frecuentes del SNC y constituyen el 40 a 50 por ciento de todos los tumores cerebrales. La sobrevida depende de varios factores clínicos y de tratamiento, y varía en diferentes estudios internacionales, sin embargo no se conoce la sobrevida real de los pacientes operados de astrocitoma en nuestro medio. El presente estudio tiene como objetivo determinar el impacto de la cirugía y la radioterapia complementaria en la sobrevida y el resultado funcional de pacientes con astrocitomas operados en el Hospital Nacional Guillermo Almenara entre los años 2003 y 2009. MATERIALES y METODOS: Se realizó un estudio retrospectivo, observacional y longitudinal de 124 pacientes operados de astrocitoma en el Hospital Guillermo Almenara entre 2003 y el 2009. Los datos fueron recolectados de historias clínicas, reportes operatorios y entrevistas telefónicas. Se clasificó a los pacientes según el tipo histológico de astrocitoma y se analizaron las variables: Grupo de riesgo pronóstico, tipo de tratamiento y extensión de la cirugía, utilizando para el análisis el programa SPSS 15.0. RESULTADOS: De los 124 pacientes, la mayoría 36.3 por ciento (45/124) tuvieron el diagnóstico de astrocitoma grado IV, seguido por el de grado II 30.6 por ciento (38/124), el grado III 28.2 por ciento (35/124) y sólo el 4.8 por ciento (6/124) grado I. La mayor sobrevida se presentó en el grado I (68 meses), seguido por el grado II (56.7 meses), el grado III (34.8 meses) y el grado IV con 11.3 meses. El resultado funcional fue ligeramente mejor en el grupo de resección total radical (90 por ciento con Karnosfky >70) según tipo de tratamiento, y en el grupo de astrocitomas grado II (85 por ciento con Karnosfky >70) según tipo histológico. Según grupo pronóstico, la sobrevida en los grupos de bajo, mediano y alto riesgo fue 74.8, 46.0 y 31 meses respecto para el astrocitoma grado II, de 46.7, 28.1 y 8.5 meses para los astrocitomas grado III...
INTRODUCTION: Astrocytomas are the most common tumors of the CNS and constitute 40-50 per cent of all brain tumors. Survival depends on several clinical factors and treatment, and prognostic is known in different international studies, however, it does not know the actual survival of astrocytoma patients operated in our area. The present study aims to determine the impact of surgery and adjuvant radiotherapy on survival and functional outcome of patients with astrocytomas operated in the Hospital Guillermo Almenara between 2003 and 2009. MATERIALS AND METHODS: A retrospective, observational, longitudinal study of 124 patients operated astrocytoma in the Guillermo Almenara Hospital between 2003 and 2009 was performed. Data were collected from medical records, operative reports, and telephone interviews. Patients were classified according to the histological type of astrocytoma and variables were analyzed: prognostic risk group, treatment type and extent of surgery, using SPSS 15.0. RESULTS: Of the 124 patients, the majority 36.3 per cent (45/124) were diagnosed with astrocytoma grade IV, followed by astrocytoma grade II 30.6 per cent (38/124), grade III 28.2 per cent (35/124) and only 4.8 per cent (6/124) was grade I. The greatest survival occurred in the grade (68 months), followed by grade II (56.7 months), grade In (34.8 months) and 11.3 months with grade IV. Functional outcome was slightly better in the group of patients with total radical resection (90 per cent with Karnosfky >70) according to type of treatment, and in the group of grade II astrocytomas (85 per cent with Karnosfky >70) according to histological type. According prognostic group, survival in the groups of low, medium and high risk was 74.8, 46.0 and 31 months respectively for astrocytoma grade II, 46.7, 28.1 and 8.5 months for grade III astrocytomas; and 12.3, 12.3 and 6.1 months for grade IV. Regarding the type of treatment, longer survival was obtained in the group of surgery plus...
Subject(s)
Male , Female , Humans , Young Adult , Adult , Middle Aged , Astrocytoma/surgery , Astrocytoma/radiotherapy , Clinical Evolution , Prognosis , Survival , Longitudinal Studies , Observational Studies as Topic , Retrospective StudiesABSTRACT
El objetivo en la cirugía de un tumor cerebral es la máxima resección tumoral con el menor déficit postoperatorio sin embargo ello no siempre es posible principalmente en el caso de lesiones cercanas a áreas funcionales. A pesar de uso de numerosas técnicas de imágenes en el preoperatorio e intraoperatorio, el resultado funcional no es conocido sino hasta después de la cirugía cuando el déficit es irreversible. La cirugía con el paciente despierto es una técnica segura y que permite evaluar el estado neurológico durante el acto quirúrgico y detectar precozmente cualquier deficit en la función logrando optimizar los resultados de la resección tumoral. Presentamos el primer reporte de caso en el Perú de Cirugía con el Paciente Despierto para la resección de Gliomas de bajo Grado, realizada en el Hospital Nacional Guillermo Almenara Irigoyen en febrero del 2008.
The aim in the surgery of a cerebral tumor is the maximum tumor resection with the minor neurological postoperative deficit nevertheless it not always is possible principally in case of injuries near to functional areas. In spite results is not known but after surgery when the deficit is irreversible. The awake patient surgery is a safe technique and that it allows to evaluate the neurological state during the surgical act and to defect prematury any deficit in the function, obtaining to optimize the results of the tumor resection. We presented the firts report of case in Peru of Awake Patient Surgery for low grade glioma resection, realized in the National Hospital Guillermo Almenara Irigoyen in February 2008.