From dyspnea to diagnosis, unmasking undifferentiated cardiac sarcoma: a case report.

BACKGROUND: Sarcomas are the most common type of cardiac malignancy, but they are extremely rare. Within this group, angiosarcomas have the highest frequency, followed by undifferentiated sarcomas. This type of tumor has a poor prognosis and a high recurrence rate. Information about these tumors is limited, relying mainly on case reports and autopsy series. The purpose of this case report is to detail the multifaceted approach to diagnosing and managing an undifferentiated cardiac sarcoma and contribute to the literature. CASE PRESENTATION: A 28-year-old man presented with dyspnea and chest pain, which had developed progressively over several weeks. Physical examination revealed low blood pressure, elevated heart rate, and diminished heart sounds. Imaging, including a CT scan, identified a hypodense mass in the right ventricle. Further evaluation through echocardiograms and contrast angiotomography confirmed a mass causing right ventricular obstruction. Part of the tumor was surgically removed and diagnosed  as cardiac sarcoma.  Histopathological analysis of the mass showed an undifferentiated cardiac sarcoma. CONCLUSION: This case underscores the significance of including cardiac tumors as a potential cause when diagnosing cardiac masses. It also demonstrates the poor prognosis and tendency for recurrence, while revealing the absence of established management guidelines.

Statistical characteristics of analytical studies published in Peruvian medical journals from 2021 to 2022: A methodological study.

OBJECTIVE: While statistical analysis plays a crucial role in medical science, some published studies might have utilized suboptimal analysis methods, potentially undermining the credibility of their findings. Critically appraising analytical approaches can help elevate the standard of evidence and ensure clinicians and other stakeholders have trustworthy results on which to base decisions. The aim of the present study was to examine the statistical characteristics of original articles published in Peruvian medical journals in 2021-2022. DESIGN AND SETTING: We performed a methodological study of articles published between 2021 and 2022 from nine medical journals indexed in SciELO-Peru, Scopus, and Medline. We included original articles that conducted analytical analyses (i.e., association between variables). The statistical variables assessed were: statistical software used for analysis, sample size, and statistical methods employed (measures of effect), controlling for confounders, and the method employed for confounder control or epidemiological approaches. RESULTS: We included 313 articles (ranging from 11 to 77 across journals), of which 67.7% were cross-sectional studies. While 90.7% of articles specified the statistical software used, 78.3% omitted details on sample size calculation. Descriptive and bivariate statistics were commonly employed, whereas measures of association were less common. Only 13.4% of articles (ranging from 0% to 39% across journals) presented measures of effect controlling for confounding and explained the criteria for selecting such confounders. CONCLUSION: This study revealed important statistical deficiencies within analytical studies published in Peruvian journals, including inadequate reporting of sample sizes, absence of measures of association and confounding control, and suboptimal explanations regarding the methodologies employed for adjusted analyses. These findings highlight the need for better statistical reporting and researcher-editor collaboration to improve the quality of research production and dissemination in Peruvian journals.

Role of fecal microbiota transplant in management of hepatic encephalopathy: Current trends and future directions.

Fecal microbiota transplantation (FMT) offers a potential treatment avenue for hepatic encephalopathy (HE) by leveraging beneficial bacterial displacement to restore a balanced gut microbiome. The prevalence of HE varies with liver disease severity and comorbidities. HE pathogenesis involves ammonia toxicity, gut-brain communication disruption, and inflammation. FMT aims to restore gut microbiota balance, addressing these factors. FMT's efficacy has been explored in various conditions, including HE. Studies suggest that FMT can modulate gut microbiota, reduce ammonia levels, and alleviate inflammation. FMT has shown promise in alcohol-associated, hepatitis B and C-associated, and non-alcoholic fatty liver disease. Benefits include improved liver function, cognitive function, and the slowing of disease progression. However, larger, controlled studies are needed to validate its effectiveness in these contexts. Studies have shown cognitive improvements through FMT, with potential benefits in cirrhotic patients. Notably, trials have demonstrated reduced serious adverse events and cognitive enhancements in FMT arms compared to the standard of care. Although evidence is promising, challenges remain: Limited patient numbers, varied dosages, administration routes, and donor profiles. Further large-scale, controlled trials are essential to establish standardized guidelines and ensure FMT's clinical applications and efficacy. While FMT holds potential for HE management, ongoing research is needed to address these challenges, optimize protocols, and expand its availability as a therapeutic option for diverse hepatic conditions.

Emergence of Rhino-Orbito-Cerebral Mucormycosis in Peru: Impact of the COVID-19 Pandemic.

Introduction Mucormycosis is an invasive fungal infection caused by Mucorales that has been increasingly recognized over the years, particularly during the COVID-19 pandemic. Nevertheless, in Peru, there has been limited research on this disease. This study seeks to provide insights into the demographics, clinical presentations, treatment, and outcomes of patients with mucormycosis, before and during the COVID-19 pandemic. Materials and methods We conducted a retrospective case series by reviewing the medical records of Peruvian patients hospitalized at a referral medical center between 2017 and 2021. The selection criteria included patients aged 18 years or older with clinical features of rhino-orbito-cerebral mucormycosis supported by radiological imaging. We extracted data related to risk factors for mucormycosis infection, clinical presentation, management, and hospitalization. Data analysis was performed using Stata software (StataCorp LLC, College Station, Texas, USA) to compare patient groups before and during the COVID-19 pandemic. Results Nineteen cases met our selection criteria: 11 men and eight women with an average age of 57.6 ± 10.6 years. All 19 patients had type 2 diabetes mellitus as comorbidity, with 13 cases exhibiting uncontrolled diabetes. Six patients presented before the COVID-19 pandemic, while 13 during its course. Within the group of patients diagnosed during the pandemic, nine were diagnosed with SARS-CoV-2 infection. Regarding the site of mucormycosis infection, the paranasal sinuses were predominantly involved. Survival analysis indicated that patients who developed mucormycosis during the COVID-19 pandemic, those with uncontrolled diabetes, or those who did not undergo surgery had lower probabilities of survival. Conclusion Mucormycosis is a rare infection associated with high mortality and morbidity with increased frequency during the COVID-19 pandemic. Early diagnosis, timely administration of antifungal treatment, surgery, and effective management of comorbidities can have life-saving implications. Unfortunately, despite the availability of various diagnostic tests and less toxic antifungal options such as liposomal amphotericin-B, such resources are not accessible in Peru's national hospitals.

Liver transplant in primary sclerosing cholangitis: Current trends and future directions.

Primary sclerosing cholangitis (PSC) is a chronic and progressive immune-mediated cholangiopathy causing biliary tree inflammation and scarring, leading to liver cirrhosis and end-stage liver disease. Diagnosis of PSC is challenging due to its nonspecific symptoms and overlap with other liver diseases. Despite the rising incidence of PSC, there is no proven medical therapy that can alter the natural history of the disease. While liver transplantation (LT) is the most effective approach for managing advanced liver disease caused by PSC, post-transplantation recurrence of PSC remains a challenge. Therefore, ongoing research aims to develop better therapies for PSC, and continued efforts are necessary to improve outcomes for patients with PSC. This article provides an overview of PSC's pathogenesis, clinical presentation, and management options, including LT trends and future aspects. It also highlights the need for improved therapeutic options and ethical considerations in providing equitable access to LT for patients with PSC. Additionally, the impact of liver transplant on the quality of life and psychological outcomes of patients with PSC is discussed. Ongoing research into PSC's pathogenesis and post-transplant recurrence is crucial for improved understanding of the disease and more effective treatment options.

Difficult diagnosis in the clinical evaluation of a patient with squamous cell carcinoma of the sigmoid colon: a case report.

BACKGROUND: Squamous cell carcinoma (SCC) of the sigmoid colon is an exceedingly rare subtype of colorectal cancer (CRC) associated with chronic inflammatory conditions. Due to its variable clinical presentation ranging from subclinical to fully symptomatic and limited available information, it poses a diagnostic challenge. We aim to provide a review of the current literature and raise awareness about the importance of a thorough clinical analysis for an early diagnosis. CASE PRESENTATION: We describe the case of a 59-year-old Peruvian woman with a medical history of diverticular disease and irritable bowel syndrome. The patient presented with nonspecific symptoms such as abdominal discomfort, constipation, and bloating. Diagnostic tests and biopsy revealed a rare case of squamous cell carcinoma of the sigmoid colon. The patient underwent surgical resection and adjuvant chemotherapy. CONCLUSION: Despite the rarity of this type of cancer in the colon, the patient's clinical course highlights the importance of considering it as a potential diagnosis in patients with nonspecific symptoms and a history of gastrointestinal disorders. Surgical treatment followed by radiotherapy is the preferred management. Factors such as lack of postoperative complications and the stage of the neoplasia can augur a positive. PROGNOSIS: A prompt diagnosis is crucial, as detecting a neoplasia in its early stages can make surgery more effective.