ABSTRACT
BACKGROUND: Prostate cancer (PCa) is the most common solid tumor in men in Germany. Collection of epidemiological and clinical data has been centralized for several years due to legal requirements via the state cancer registries. Thus, the reporting of diagnosis, therapy, and progression of cancer is obligatory in Germany. These data needs to be processed based on the questions of the treating physicians. OBJECTIVES: Intention of this work was to present the development of new cases, disease stages, treatment procedures and prognosis of PCa in Baden-Württemberg (BW). METHODS: For this purpose, data of the cancer registry BW regarding patients with PCa first diagnosed between 2013 and 2021 were evaluated. The evaluation was performed using descriptive statistics, Χ2 test and Kaplan-Meier analysis. RESULTS: A total of 84,347 new diagnoses of PCa were reported. Clinical stage was present in 55.3% of patients. Assignment by International Society of Urological Pathology (ISUP) groups was present in 75.7%. A steady increase in primary diagnosis was evident through 2019. The proportion of primary metastatic disease decreased (2013: 19.6% vs. 2021: 12.0%), and the proportion of localized tumors increased (2013: 65.5% vs. 2021: 77.1%). Radical prostatectomy (RP) dominated the treatment of localized tumors with a mean of 60.1%. The proportion of robot-assisted surgery increased from 23.7% (2013) to 60.8% (2021) with a decrease in the R1 rate from 34.8 to 26.2%. Progression-free survival correlated closely with tumor stage and ISUP group. CONCLUSION: An increase in PCa cases and a decrease of advanced tumors were observed. Treatment was mostly surgical in localized stages, with increasing proportion of robotic-assisted RP. Early diagnosis and treatment are critical for long-term prognosis.
Subject(s)
Prostatic Neoplasms , Registries , Male , Humans , Prostatic Neoplasms/therapy , Prostatic Neoplasms/epidemiology , Prostatic Neoplasms/pathology , Prostatic Neoplasms/diagnosis , Germany/epidemiology , Aged , Prognosis , Middle Aged , Incidence , Aged, 80 and over , Adult , ProstatectomyABSTRACT
BACKGROUND: We developed and validated a Spanish seizure screen for children based on a previously validated English seizure screen that could be administered by a trained research assistant in a 2-step process, approximating the clinical diagnostic process of a pediatric epilepsy specialist. This questionnaire was designed to study seizure prevalence in a research population of children at risk for epilepsy. METHODS: Spanish-speaking parents of children 6 months to 17 years old were recruited from the pediatric neurology clinics at Boston Medical Center and interviewed using a computerized questionnaire. A computerized algorithm of parent responses rendered a seizure classification of positive or negative. Blinded to questionnaire results, pediatric neurologists served as the diagnostic gold standard, ranking each patient event using a 4-level scale based on clinical history and examination: (1) not likely, (2) indeterminate, (3) probable, and (4) almost certain where rankings of 3 or 4 lead to a diagnosis of seizure. RESULTS: The questionnaire was completed by 163 enrolled parents. The seizure screen demonstrated a 94.2% sensitivity and 93.7% specificity for identifying seizures. The positive predictive value was 87.5%, and the negative predictive value was 97.2%. CONCLUSIONS: This pediatric seizure questionnaire was both sensitive and specific for detecting clinically confirmed seizures. This tool may be useful to clinicians and researchers in screening large populations of children, decreasing the time and cost of added neurologic assessments.
Subject(s)
Parents , Seizures/diagnosis , Surveys and Questionnaires/standards , Adolescent , Adult , Child , Female , Hispanic or Latino , Humans , Language , Male , Reproducibility of Results , Sensitivity and Specificity , TranslationsABSTRACT
An outbreak of nosocomial infections due to Streptococcus pyogenes (Group A Streptococcus; GAS) occurred in a post-surgery oncology unit and concerned more than 60 patients and lasted 20 months despite enhanced infection control and prophylaxis measures. All GAS strains were characterized (emm genotype, toxin gene profile and pulse-field gel electrophoresis subtype). Selected strains were sequenced and phylogenetic relationship established. Capacity to form biofilm and interaction with human pulmonary epithelial cells and macrophages were determined. Twenty-six GAS strains responsible for invasive infections (II) and 57 for non-II or colonization were isolated from patients (n = 66) or healthcare workers (n = 13). Seventy strains shared the same molecular markers and 69 the same PFGE pattern; 56 were sequenced. They all belonged to the emerging emm89 clade 3; all but 1 were clonal. Whole genome sequencing identified 43 genetic profiles with sporadic mutations in regulatory genes and acquired mutations in 2 structural genes. Except for two regulatory gene mutants, all strains tested had the same biofilm formation capacity and displayed similar adherence and invasion of pulmonary epithelial cells and phagocytosis and survival in human macrophages. This large outbreak of GAS infection in a post-surgery oncology unit, a setting that contains highly susceptible patients, arose from a strain of the emergent emm89 clade. No relationship between punctual or acquired mutations, invasive status, and strain phenotypic characteristics was found. Noteworthy, the phenotypic characteristics of this clone account for its emergence and its remarkable capacity to elicit outbreaks.
Subject(s)
Disease Outbreaks , Genotype , Streptococcal Infections/epidemiology , Streptococcus pyogenes/classification , Streptococcus pyogenes/isolation & purification , Surgical Wound Infection/epidemiology , Adult , Aged , Aged, 80 and over , Bacterial Toxins/analysis , Biofilms/growth & development , Electrophoresis, Gel, Pulsed-Field , Epithelial Cells/microbiology , Female , France , Genotyping Techniques , Humans , Macrophages/microbiology , Male , Middle Aged , Molecular Epidemiology , Neoplasms/surgery , Phylogeny , Sequence Analysis, DNA , Streptococcal Infections/microbiology , Streptococcus pyogenes/genetics , Streptococcus pyogenes/growth & development , Surgical Wound Infection/microbiology , Young AdultABSTRACT
Objetivo: Evaluar si el uso de malla protésica en la reparación quirúrgica de emergencia en el manejo de las hernias inguinales complicadas está asociado con un menor riesgo de complicaciones postoperatorias. Metodología: Estudio observacional, analítico-comparativo, retrospectivo. Se estudió a 126 pacientes con diagnóstico de hernia inguinal complicada, donde 88 pacientes usaron malla protésica y 38 pacientes no utilizaron malla. En el análisis descriptivo de las variables cualitativas se utilizó frecuencias absolutas y relativas, para las variables cuantitativas se estimó medidas de tendencia central y de dispersión; para relacionar las variables y determinar el factor de riesgo se usó la prueba de Chi- cuadrado y Odds ratio con un nivel de confianza del 95 por ciento. Resultados: La edad promedio de los pacientes fue 58,9±17,0 años, donde la mayoría tenían más de 60 años; asimismo, predominaba el sexo masculino (83,3 por ciento). En cuanto al tiempo de enfermedad en los pacientes eran <1 día (45,2 por ciento); asimismo el tipo de hernia complicada fue mayormente la incarcerada (80,2 por ciento). Por otro lado el 17,5 por ciento de los pacientes se les realizó resección intestinal. Respecto a las características operatorias se encontró diferencia significativa (p<0,05) con respecto al uso de la malla protésica; asimismo se observó que los pacientes de ambos grupos estuvieron en sala de operaciones entre 1 a 2 horas (59,1 por ciento vs 39,5 por ciento); además la técnica empleada en los pacientes con malla protésica fue Lichtenstein (90,9 por ciento) y en los que no utilizaron malla protésica fue la técnica Bassini (63,1 por ciento). Las comorbilidades más frecuentes en los pacientes que utilizaron la malla protésica fueron la hipertensión arterial (11,4 por ciento), la diabetes mellitus (6,8 por ciento) y la tuberculosis (5,7 por ciento); mientras que los pacientes que no usaron la malla protésica fueron la hipertensión arterial (21,1 por ciento)...
Objective: To evaluate whether the use of prosthetic mesh in emergency surgical repair in the management of complicated inguinal hernias is associated with a lower risk of postoperative complications. Methodology: An observational, analytical-comparative and retrospective study. The study inc1uded 126 patients with a diagnosis of complicated inguinal hernia, where 88 patients used prosthetic mesh and 38 patients did not use mesh. Absolute and relative frequencies were used in the descriptive analysis of qualitative variables, for quantitative variables measures of central tendency and dispersion was estimated; to relate the variables and determine the risk factor test Chi-square and odds ratio was used with a confidence level of 95 per cent. Results: The average age of patients was 58.9±17.0 years, where most were over 60 years; also, males predominated (83.3 per cent). Regarding the time of disease in patients were <1 day (45.2 per cent); also the kind of complicated hernia was mostly the incarcerated (80.2 per cent). On the other hand 17.5 per cent of patients underwent intestinal resection. Respect to the surgical characteristics significant difference (p<0.05) regarding the use of prosthetic mesh; also patients of both groups was observed between 1-2 hours in the surgery room (59.1 per cent vs. 39.5 per cent); also the technique used in patients with prosthetic mesh was the Lichtenstein (90.9 per cent) and in those who did not use prosthetic mesh was the Bassini technique (63.1 per cent). The most frequent comorbidities in patients who used prosthetic mesh were hypertension (11.4 per cent), diabetes mellitus (6.8 per cent) and tuberculosis (5.7 per cent); whereas in patients who did not use prosthetic mesh were hypertension (21.1 per cent) followed by tuberculosis (10.5 per cent). In the surgical technique used, significant difference was found regarding the type of complicated hernia (p<0.001); also be found that in the type of hernia incarcerated, the...
