ABSTRACT
PURPOSE: This study aimed to describe the demographic and clinical characteristics of cancer patients with COVID-19, exploring factors associated with adverse outcomes. PATIENTS AND METHODS: This retrospective cohort study methodically extracted and curated data from electronic medical records (EMRs) of numerous healthcare institutions on cancer patients diagnosed with a confirmed SARS-CoV-2 infection between May 2020 and August 2021, to identify risk factors linked to extended hospitalization and mortality. The retrieved information encompassed the patients' demographic and clinical characteristics, including the incidence of prolonged hospitalization, acute complications, and COVID-19-related mortality. RESULTS: A total of 1446 cancer patients with COVID-19 were identified (mean [Standard deviation] age, 59.2 [14.3] years). Most patients were female (913 [63.1%]), non-white (646 [44.7%]), with non-metastatic (818 [56.6%]) solid tumors (1318 [91.1%]), and undergoing chemotherapy (647 [44.7%]). The rate of extended hospitalization due to COVID-19 was 46% (n = 665), which was significantly impacted by age (p = 0.012), sex (p = 0.003), race and ethnicity (p = 0.049), the presence of two or more comorbidities (p = 0.006), hematologic malignancies (p = 0.013), metastatic disease (p = 0.002), and a performance status ≥ 2 (p = 0.001). The COVID-19-related mortality rate was 18.9% (n = 273), and metastatic disease (<0.001), performance status ≥2 (<0.001), extended hospitalization (p = 0.028), renal failure (p = 0.029), respiratory failure (p < 0.001), sepsis (p = 0.004), and shock (p = 0.040) significantly and negatively influenced survival. CONCLUSION: The rate of extended hospitalization and COVID-19-specific death in cancer patients was notably high and could be influenced by comorbidities, cancer treatment status, and clinical fragility. These observations may aid in developing risk counseling strategies regarding COVID-19 in individuals diagnosed with cancer.
Subject(s)
COVID-19 , Neoplasms , Humans , Female , Middle Aged , Male , COVID-19/epidemiology , SARS-CoV-2 , Retrospective Studies , Brazil/epidemiology , Comorbidity , Neoplasms/complications , Neoplasms/epidemiology , Risk Factors , HospitalizationABSTRACT
INTRODUÇÃO: Os cuidados com as preservações dos nervos laríngeos recorrentes e das glândulas paratireóides, nas tireoidectomias, continuam desafiando os cirurgiões em razão das graves complicações que podem ocorrer quando são manipulados inadequadamente. O trabalho teve como objetivo, no curso das tireoidectomias totais e parciais, estabelecer protocolo anatômico-cirúrgico das relações anatômicas entre os nervos laríngeos recorrentes com as artérias tireóideas inferiores, identificar-preservar esses nervos e as glândulas partireóides. MÉTODO: Os registros fotográficos durante os trans-operatórios foram obtidos de 79 pacientes submetidos às tireoidectomias totais e parciais (lobectomia total direita ou esquerda e istmectomia), respectivamente, com as identificações dos nervos e artérias bi ou unilateralmente, propondo expor as relações anatômicas entre essas estruturas, operados entre janeiro de 2005 e julho de 2006. RESULTADOS: Os registros fotográficos foram adaptados aos desenhos esquemáticos para estabelecer os principais pontos de referências anatômicas dos nervos laríngeos recorrentes em relação às artérias tireóideas inferiores, totalizando 116 nervos laríngeos recorrentes. CONCLUSÃO: A íntima relação dos nervos laríngeos recorrentes e as artérias tireóideas inferiores podem se apresentar de diversas formas, incluindo as anomalias congênitas, como a do laríngeo não recorrente, as duplicações e triplicações pré-laríngeas do nervo, sem dúvida, algumas vezes, dificultando a identificação dessas estruturas. São imperativas as claras identificações dessas estruturas e das glândulas paratireóides para preservá-las, no curso das tireoidectomias totais e parciais, a fim de evitar as complicações pós-operatórias.
BACKGROUND: Care in preserving the recurrent laryngeal nerves and the parathyroids glands, during thyroidectomies, continue to challenge surgeons because of the serious complications, which can occur when they are inadequately handled. The work aimed at establishing a surgical-anatomical protocol of the relations between the recurrent laryngeal nerves with the lower thyroidal arteries and identify and preserve the nerves and the parathyroids glands, in the course of total and partial thyroidectomies. METHODS: The photographic records during the surgery have been obtained from 79 patients who were submitted to total and partial thyroidectomies (total right or left lobectomy and istmectomy) respectively, with identification of the nerves and arteries, both unilateral and bilateral, proposing to expose the anatomical relations between these structures, operated on between January 2005 and July 2006. RESULTS: The photographic records were adapted to the schematic drawings so as to establish the major anatomical points of reference of the recurrent laryngeal nerves vis-à-vis the inferior thyroidal arteries were completed in a total of 116 recurrent laryngeal nerves. CONCLUSION: The intrinsic relation of the nerves with the arteries can occur in different forms, including the congenital abnormalities, as that of the non-recurrent laryngeal, the prelaryngeal duplications and triplications of the nerve, undoubtedly hindering the identification of such structures. Even under the protection of the anatomic and surgical difficulties, a clear identification of the nerve, artery and the parathyroid glands is imperative to preserve them in the course of total and partial thyroidectomies in order to avoid post-surgical complications.
