Perfil biosociodemográfico del cuidador principal informal del adulto mayor en una región de Ecuador / Biosociodemographic profile of the primary informal caregiver of the elderly in a region of Ecuador

La necesidad de servicios de cuidados prolongados a adultos mayores origina la actividad de ayuda no profesional y a la figura del cuidador principal informal. El objetivo de la investiga-ción fue describir el perfil del cuidador principal informal acompañante del paciente a consulta externa del Hospital de Atención Integral del Adulto Mayor en el último trimestre de 2021. Se hizo un estudio cuantitativo, observacional y descriptivo, en una población de 322 cuidadores principales informales de adultos mayores en el último trimestre de 2021, seleccionando una muestra de 190 individuos mediante un procedimiento del tipo sujetos voluntarios. El instrumento aplicado fue una guía de entrevista estructurada basada en la Encuesta de caracterización del cuidado de la díada cuidador familiar-persona con enfermedad crónica. Existió un predominio del cuidador de sexo femenino (83,2%); los hijos de los adultos mayores (57,9%); las personas casadas (48,9%); los que viven con el adulto mayor (42,6%); aquellos que ejercen esa función desde entre 1 y 6 años (57,9%) y los que dedican hasta 15 horas (58,9%). Además, el 86,3% realiza quehaceres domésticos. Se observó un deterioro de la condición de salud luego de iniciar en las funciones del cuidado y todos mencionaron padecer de alguna enfermedad; sin embargo, prevalecieron los que señalan recibir efectos emocionales positivos a partir del cuidado.

The need for long-term care services for the elderly originates the activity of non-professional help and the figure of the informal primary caregiver. This research aimed to describe the profile of the primary informal caregiver who accompanied the patient to the outpatient clinic of the Hospital de Atención Integral del Adulto Mayor in the last quarter of 2021. A quantitative, obser-vational, and descriptive study was carried out in a population of 322 primary informal caregi-vers of the elderly in the last quarter of 2021, selecting a sample of 190 individuals through a voluntary subject-type procedure. The applied instrument was a structured interview guide based on the Survey of Characterization of the Care of the Family Caregiver-person with a Chro-nic Illness Dyad. The care falls on the woman (83.2%), children (57.9%), married (48.9%), live with the elderly (42.6%), care for up to 4 family members; 17.9% who never receive help, care for between 1 and 6 years and dedicate up to 15 hours. In addition, 86.3% do housework. A dete-rioration of the health condition was observed after starting the care functions, and all of them mentioned suffering from some disease; however, those who reported receiving positive emotio-nal effects from care prevailed

A Prospective Study Evaluating Cumulative Incidence and a Specific Prediction Rule in Pulmonary Embolism in COVID-19.

Rationale: Abnormal values of hypercoagulability biomarkers, such as D-dimer, have been described in Coronavirus Disease 2019 (COVID-19), which has also been associated with disease severity and in-hospital mortality. COVID-19 patients with pneumonia are at greater risk of pulmonary embolism (PE). However, the real incidence of PE is not yet clear, since studies have been limited in size, mostly retrospective, and PE diagnostic procedures were only performed when PE was clinically suspected. Objectives: (1) To determine the incidence, clinical, radiological, and biological characteristics, and clinical outcomes of PE among patients hospitalized for COVID-19 pneumonia with D-dimer > 1,000 ng/mL. (2) To develop a prognostic model to predict PE in these patients. Methods: Single-center prospective cohort study. Consecutive confirmed cases of COVID-19 pneumonia with D-dimer > 1,000 ng/mL underwent computed tomography pulmonary angiography (CTPA). Demographic and laboratory data, comorbidities, CTPA scores, treatments administered, and clinical outcomes were analyzed and compared between patients with and without PE. A risk score was constructed from all these variables. Results: Between 6 April 2020 and 2 February 2021, 179 consecutive patients were included. The overall incidence of PE was 39.7% (71 patients) (CI 95%, 32-47%). In patients with PE, emboli were located mainly in segmental/subsegmental arteries (67%). Patients with PE did not differ from the non-PE group in sex, age, or risk factors for thromboembolic disease. Higher urea, D-Dimer, D-dimer-to-ferritin and D-dimer-to-lactate dehydrogenase (LDH) ratios, platelet distribution width (PDW), and neutrophil-to-lymphocyte ratio (NLR) values were found in patients with PE when compared to patients with non-PE. Besides, lymphocyte counts turned out to be lower in patients with PE. A score for PE prediction was constructed with excellent overall performance [area under the ROC curve-receiver operating characteristic (AUC-ROC) 0.81 (95% CI: 0.73-0.89)]. The PATCOM score stands for Pulmonary Artery Thrombosis in COVID-19 Mallorca and includes platelet count, PDW, urea concentration, and D-dimer-to-ferritin ratio. Conclusion: COVID-19 patients with pneumonia and D-dimer values > 1,000 ng/mL were presented with a very high incidence of PE, regardless of clinical suspicion. Significant differences in urea, D-dimer, PDW, NLR, and lymphocyte count were found between patients with PE and non-PE. The PATCOM score is presented in this study as a promising PE prediction rule, although validation in further studies is required.

Pseudoaneurisma recidivante a nivel de fístula arteriovenosa en brazo izquierdo / Recurrent pseudoaneurysm at the level of arteriovenous fistula in the left arm

RESUMEN El pseudoaneurisma es un daño de la pared arterial, contenido por el hematoma circundante y estructuras vecinas, con flujo sanguíneo turbulento, que mantiene comunicación con la luz del vaso afecto. El presente estudio describe un paciente masculino de 57 años, que ingresa con diagnóstico de pseudoaneurisma de fístula arteriovenosa humero cefálica izquierda. Se realiza exéresis del falso aneurisma y creación de nueva fístula con prótesis vascular. El paciente reingresa al quinto mes con masa gigante pulsátil en sitio quirúrgico. Se realiza exploración, exéresis del pseudoaneurisma recidivante y nueva fístula humero-basílica izquierda con vena safena. Evoluciona favorablemente, realizándose diálisis dos años posteriores a la última cirugía sin complicaciones.

ABSTRACT Pseudoaneurysm is damage to the arterial wall, contained by the surrounding hematoma and neighboring structures, with turbulent blood flow, which maintains communication with the lumen of the affected vessel. The present study describes a 57-year-old male patient who was admitted with a diagnosis of left cephalic humeral arteriovenous fistula pseudoaneurysm. The false aneurysm wasexcised, and a new fistula was created with a vascular prosthesis. The patient was readmitted in the fifth month with a giant pulsatile mass at the surgical site. Surgical exploration was performed, excision of the recurrent pseudoaneurysm and a new left humerus-basilic fistula with saphenous vein. He is progressing favorably, performing dialysis two years after the last surgery without complications.

Tumors associated with radiotherapy: a case series.

BACKGROUND: Breast cancer is the cancer with the highest incidence and mortality worldwide. Its treatment is multidisciplinary with surgery, systemic therapy, and radiotherapy. In Colombia, according to Globocan 2018, there is an age-standardized incidence rate of 44 per 100,000 women. Radiotherapy improves local and regional control in patients with breast cancer, and it could even improve relapse-free survival and overall survival in patients with nodal disease. The toxicity of this treatment in most cases is mild and transient, but in a low percentage of patients, radiotherapy-induced tumors may develop. CASE PRESENTATION: Seven Colombian patients treated for breast cancer at our institution developed radiotherapy-induced tumors between 2008 and 2018. The median age was 54.4 (range 35-72) years. Six patients had locally advanced tumors at the time breast cancer was diagnosed, and all of them received neoadjuvant or adjuvant chemotherapy and radiotherapy. The radiotherapy-induced tumors were five sarcomas, one of which was a well-differentiated angiosarcomatous vascular lesion with negative c-Myc (benign lesion), and the remaining patient had basal cell carcinoma associated with radiotherapy. CONCLUSIONS: Sarcomas are the most common radiotherapy-induced tumors after breast cancer treatment. These are rare, aggressive tumors and represent between 0.5% and 5.5% of all sarcomas. Basal cell carcinoma has also been associated with breast cancer treatment. The management is individualized and multimodal, including surgical resection and chemotherapy. Different studies have shown that radiation therapy is a risk factor for the development of soft tissue tumors.

Prevalence of pulmonary embolism in patients with COVID-19 pneumonia and high D-dimer values: A prospective study.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) pneumonia is associated to systemic hyper-inflammation and abnormal coagulation profile. D-dimer elevation is particularly frequent, and values higher than 1µg/mL have been associated with disease severity and in-hospital mortality. Previous retrospective studies found a high pulmonary embolism (PE) prevalence, however, it should be highlighted that diagnoses were only completed when PE was clinically suspected. MATERIAL AND METHODS: Single-center prospective cohort study. Between April 6th and April 17th 2020, consecutive confirmed cases of COVID-19 pneumonia with D-dimer >1 µg/mL underwent computed tomography pulmonary angiography (CTPA) to investigate the presence and magnitude of PE. Demographic and laboratory data, comorbidities, CTPA scores, administered treatments, and, clinical outcomes were analysed and compared between patients with and without PE. RESULTS: Thirty consecutive patients (11 women) were included. PE was diagnosed in 15 patients (50%). In patients with PE, emboli were located mainly in segmental arteries (86%) and bilaterally (60%). Patients with PE were significantly older (median age 67.0 (IQR 63.0-73.0) vs. 57.0 (IQR 48.0-69.0) years, p = .048) and did not differ in sex or risk factors for thromboembolic disease from the non-PE group. D-dimer, platelet count, and, C reactive protein values were significantly higher among PE patients. D-dimer values correlated with the radiologic magnitude of PE (p<0.001). CONCLUSIONS: Patients with COVID-19 pneumonia and D-dimer values higher than 1 µg/mL presented a high prevalence of PE, regardless of clinical suspicion. We consider that these findings could contribute to improve the prognosis of patients with COVID-19 pneumonia, by initiating anticoagulant therapy when a PE is found.

Exploratory dynamics of vocal foraging during infant-caregiver communication.

We investigated the hypothesis that infants search in an acoustic space for vocalisations that elicit adult utterances and vice versa, inspired by research on animal and human foraging. Infant-worn recorders were used to collect day-long audio recordings, and infant speech-related and adult vocalisation onsets and offsets were automatically identified. We examined vocalisation-to-vocalisation steps, focusing on inter-vocalisation time intervals and distances in an acoustic space defined by mean pitch and mean amplitude, measured from the child's perspective. Infant inter-vocalisation intervals were shorter immediately following a vocal response from an adult. Adult intervals were shorter following an infant response and adult inter-vocalisation pitch differences were smaller following the receipt of a vocal response from the infant. These findings are consistent with the hypothesis that infants and caregivers are foraging vocally for social input. Increasing infant age was associated with changes in inter-vocalisation step sizes for both infants and adults, and we found associations between response likelihood and acoustic characteristics. Future work is needed to determine the impact of different labelling methods and of automatic labelling errors on the results. The study represents a novel application of foraging theory, demonstrating how infant behaviour and infant-caregiver interaction can be characterised as foraging processes.

El estrés y el trabajo de enfermería: factores influyentes / Stress and nursing work: influential factors

Los factores estrés antes son un conjunto de situaciones que des-encadenan consecuencias físicas y mentales en el personal de salud, se generan de una circunstancia mínima y llegan a convertirse en un gran problema que va a afectar tanto a la salud de las enfermeras como a su rendimiento profesional. Objetivo: Se planteó como objetivo analizar los factores que influyen en el estrés de las enfermeras que laboran en el Hospital Básico de Esmeraldas IESS. Materiales y métodos: se realizó bajo un estudio de campo y un alcance descriptivo. La población y muestra estuvo constituida por 30 profesionales de enfermería que laboran en el área de emergencias del mencionado hospital. Se pudo obtener los datos sobre los factores que generan estrés en este profesional de salud a través de una encuesta y como instrumento un cuestionario dirigida al personal de enfermería del área de emergencia. Además, se empleó la observación Directa y como instrumento una guía de observación para analizar el ambiente laboral de las enfermeras y por último se aplicó la técnica de la entrevista con un guion de preguntas a la líder del servicio de emergencias(AU)

Stressors are a set of si-tuations that trigger physical and mental consequences on health personnel; they are generated from a minimal circum-stance and become a major problem that will affect both the health of nurses and their professional performance. Objec-tive: The objective was to analyze the factors that influence the stress of nurses who work at the Basic Hospital of Esme-raldas IESS. Materials and methods: it was carried out under a field study and a descriptive scope. The population and sample consisted of 30 nursing professio-nals who work in the emergency area of the mentioned hospital. The data on the factors that generate stress in this heal-th professional was obtained through a survey and as a tool, a questionnaire ad-dressed to nursing personnel in the emer-gency area. In addition, direct observation was used and as an instrument, an obser-vation guide to analyze the nurses' work environment and finally the interview te-chnique was applied with a script of ques-tions to the leader of the emergency ser-vice. Results: the stressors found were exhaustion, insomnia, work overload, job dissatisfaction, insufficient space; the most prevalent consequences genera-ted by stress are poor diet, insomnia and hair loss. Conclusions: stressors cause instability in nurses' health, conflicts with the health team and trigger poor care for users(AU)

Clinical Behavior of Triple Negative Breast Cancer in a Cohort of Latin American Women.

INTRODUCTION: Breast cancer is a worldwide public health problem. In Colombia, there are 13,000 new cases, having the highest incidence and mortality among cancers. This article describes the clinical behavior of patients with triple negative breast cancer (TNBC) treated at the National Cancer Institute (NCI) in Bogota, Colombia. METHODS: A historical cohort and analytical study that included elderly patients diagnosed with TNBC treated at the National Cancer Institute Functional Breast Cancer Unit (NCI-FBCU) was conducted. RESULTS: Of the 1,066 patients registered in the unit from September 1st 2013 to December 31st 2016: 146 (13.7 %) had triple negative tumors. The average age was 57.3 years; 61% of patients had locally advanced tumors. The majority of patients received neoadjuvant chemotherapy as their first treatment (69.1%), and in 41.2% of the cases platinum was added to the chemotherapy regimen. The most common surgery conducted was modified radical mastectomy in 57.8% of cases. The pathological complete response (pCR) (Chevallier 1 and 2) was reached in 22.6% and, in this group of patients, a greater overall survival (OS) was found [hazard ratio (HR) 0.08, 95% CI 0.01-0.63; p = 0.016]. Progression of the disease occurred in 36.5% of cases, being lungs the most frequent location (44.4%). The death incidence rate was 1.21 deaths per 100 patients/month. The median event-free survival (EFS) was 18.2 months. CONCLUSION: TNBC occurs in Latin American women at advanced clinical stages with aggressive clinical behavior, with lower OS rates, and higher risk of metastasis compared to other molecular subtypes.

Hyperprogression in Pediatric Melanoma Metastatic to the Breast Treated with a Checkpoint Inhibitor.

Metastatic melanomas in the pediatric population are rare, but they have been appearing more frequently. Unfortunately, little is known about the differences in the biology and therapeutic implications of pediatric metastatic melanomas when compared to those found in adults. Herein, we have presented the case of a 13-year-old girl with a stage IIID malignant melanoma arising from a congenital nevus. This patient underwent surgical management, and she received adjuvant interferon therapy; however, this treatment was incomplete due to a grade 3 transaminase elevation and the early recurrence of the disease. An isolated metastasis to the breast was documented, and a mastectomy was performed. Soon afterward, low-volume lung metastases developed, and she was treated with nivolumab. After two treatment cycles, the disease continued to develop in a hyperprogressive manner. Advances in the characterization and understanding of pediatric melanomas are needed, as well as experience in the management of new therapies in these cases, which would help clarify the extent to which we can extrapolate the data obtained from the adult population. Therapeutic interventions in melanoma cases are evolving rapidly, and the role of metastasectomies in the era of immunotherapy and BRAF and MEK-targeted therapies is largely unknown. Moreover, the identification of risk factors for the development of hyperprogression and its underlying mechanisms are also warranted.

Development of filaments for fused deposition modeling 3D printing with medical grade poly(lactic-co-glycolic acid) copolymers.

The manufacturing of custom implants and patient-tailored drug dosage forms with fused deposition modeling (FDM) three-dimensional (3D) printing is currently considered to be very promising. Most FDM printers are designed as an open filament system, for which filaments with a defined size are required. In addition to this processing requirement, the filament material must be of medical or pharmaceutical quality, in order to be suitable in these applications. In this work, filaments with nominal diameters of 1.75 mm and diameter tolerances of ±0.05 mm or lower were developed in a continuous extrusion process. The filaments were made from different medical grade poly(lactic-co-glycolic acid) (PLGA) copolymers. Thermal characterization of the material with differential scanning calorimetry (DSC) showed increased material degradation with increasing hydrophilicity. Mechanical characterization of the filaments showed tensile strengths in the range of 41-48 MPa and Young's moduli in the range of 2055-2099 MPa. Stress relaxation tests showed no irreversible change in filament diameter under processing conditions similar to the utilized 3D printer. Due to unexpected differences in processability in the 3D printer, the molecular weight of the materials was identified as an additional relevant parameter.

Evaluación del riesgo clínico, no genómico y resultados de supervivencia en el carcinoma de mama hormonosensible, HER-2 negativo, con ganglios negativos / Evaluation of non-genomic, clinical risk and survival results in endocrine-sensitive, HER-2 negative, lymph node negative breast cancer

Antecedentes y objetivos: En el cáncer de mama hormonosensible, HER-2 negativo, con ganglios negativos, la presencia de un riesgo genómico bajo permite tratar solo con hormonoterapia adyuvante, obteniendo unas excelentes tasas de supervivencia. La justificación de este estudio es demostrar que también se obtienen unas excelentes tasas de supervivencia tratando solo con hormonoterapia adyuvante mediante la evaluación del riesgo clínico. Pacientes y métodos: Estudio descriptivo, observacional y retrospectivo entre 2006 y 2016 de la cohorte de cáncer de mama hormonosensible, HER-2 negativo, con ganglios negativos, tamaño del tumor mayor de 1cm o entre 0,6 y 1cm con características desfavorables. Revisión retrospectiva de los registros de salud. Datos de mortalidad del Registro Nacional de Defunciones. Resultados: Un total de 203 pacientes fueron evaluables para la supervivencia. Ciento veintitrés (60,50%) fueron tratadas solo con hormonoterapia adyuvante, 77 (37,90%) con quimioterapia-hormonoterapia, una (0.50%) solo con quimioterapia y 2 (1%) no recibieron ningún tratamiento. La tasa de supervivencia global a los 5 años fue del 97% (intervalo de confianza [IC] del 95% 94-100). La tasa de intervalo libre de metástasis a distancia fue del 94% (IC 95% 90-98). En el subgrupo de pacientes tratadas solo con hormonoterapia la tasa de supervivencia global y del intervalo libre de metástasis a distancia a los 5 años fue del 98% (IC 95% 95-100) y 97% (IC 95% 93-100), respectivamente. Conclusiones: Las pacientes con cáncer de mama hormonosensible, HER-2-negativo, con ganglios negativos, tratadas solo con hormonoterapia según su riesgo clínico, obtienen resultados de supervivencia similares a los descritos cuando son tratadas solo con hormonoterapia según su riesgo genómico

Background and objectives: In endocrine-sensitive, HER-2 negative, node negative breast cancer, the presence of a low genomic risk allows treatment with adjuvant endocrine therapy alone, obtaining excellent survival rates. The justification for this study is to show that excellent survival rates are also obtained by treating with adjuvant hormone therapy alone, based on clinical risk assessment. Patients and methods: A descriptive, observational and retrospective study was performed between 2006 and 2016 with endocrine-sensitive, HER-2 negative, node negative breast cancer, greater than 1cm or between 0.6 and 1cm with unfavourable features. Retrospective review of health records. Mortality data of the National Registry of Deaths. Results: A total of 203 patients were evaluable for survival. One hundred and twenty-three (60.50%) were treated with adjuvant endocrine therapy alone, 77 (37.90%) with chemotherapy and endocrine therapy, one (0.50%) with chemotherapy alone and 2 (1%) were not treated. The overall survival rate at 5 years was 97% (95% confidence interval [CI] 94-100). Distant recurrence-free interval was 94% (95% CI 90-98). In the subgroup of patients treated with endocrine therapy alone, overall survival and distant recurrence-free interval rates at 5 years were 98% (95% CI 95-100) and 97% (95% CI 93-100), respectively. Conclusions: Patients with endocrine-sensitive, HER-2-negative, node negative breast cancer treated with endocrine therapy alone according to their clinical risk have similar survival outcomes as those treated with endocrine therapy according to their genomic risk

Evaluation of non-genomic, clinical risk and survival results in endocrine-sensitive, HER-2 negative, lymph node negative breast cancer. / Evaluación del riesgo clínico, no genómico y resultados de supervivencia en el carcinoma de mama hormonosensible, HER-2 negativo, con ganglios negativos.

BACKGROUND AND OBJECTIVES: In endocrine-sensitive, HER-2 negative, node negative breast cancer, the presence of a low genomic risk allows treatment with adjuvant endocrine therapy alone, obtaining excellent survival rates. The justification for this study is to show that excellent survival rates are also obtained by treating with adjuvant hormone therapy alone, based on clinical risk assessment. PATIENTS AND METHODS: A descriptive, observational and retrospective study was performed between 2006 and 2016 with endocrine-sensitive, HER-2 negative, node negative breast cancer, greater than 1cm or between 0.6 and 1cm with unfavourable features. Retrospective review of health records. Mortality data of the National Registry of Deaths. RESULTS: A total of 203 patients were evaluable for survival. One hundred and twenty-three (60.50%) were treated with adjuvant endocrine therapy alone, 77 (37.90%) with chemotherapy and endocrine therapy, one (0.50%) with chemotherapy alone and 2 (1%) were not treated. The overall survival rate at 5 years was 97% (95% confidence interval [CI] 94-100). Distant recurrence-free interval was 94% (95% CI 90-98). In the subgroup of patients treated with endocrine therapy alone, overall survival and distant recurrence-free interval rates at 5 years were 98% (95% CI 95-100) and 97% (95% CI 93-100), respectively. CONCLUSIONS: Patients with endocrine-sensitive, HER-2-negative, node negative breast cancer treated with endocrine therapy alone according to their clinical risk have similar survival outcomes as those treated with endocrine therapy according to their genomic risk.

Influencia de los factores clínicos y biográficos en el retraso en iniciar la quimioterapia adyuvante en las pacientes con cáncer de mama / Influence of clinical and biographical factors on the delay in starting adjuvant chemotherapy treatment among breast cancer patients

Background and objetive: Previous studies have related the delay in starting chemotherapy (>3 months from date of surgery) with worse survival. The study objective is to analyse the delay in the start of chemotherapy and associated biomedical, sociodemographic and cultural factors. Patients and methods: A cohort of women operated on for breast cancer, candidates for receiving adjuvant chemotherapy and participants in a clinical trial of non-pharmacological intervention, were surveyed regarding the delay in starting their chemotherapy, measured by the number of days from date of surgery. Differences in function of the clinical and biographical variables were studied. Results: In 197 women, mean delay was 42.32 (15.29) days; this was associated with tumour stage ( i , 40.06 days; ii , 44.76 days; iii , 38.7 days; P=.049), age (≤35, 37.36 days; 36-64, 41.49 days; ≥65, 52.61 days; P=.007) and occupational situation (active, 36.91 days; unemployed, 45.5 days; pensioner, 40.07 days; housewife, 43.17 days; P=.038). F r patients older than 65 years, the delay in starting adjuvant chemotherapy was longer than for those in the 2 lower age groups -less than 35 years, and between 35 and 65 years- (P=.023 and P=.009 respectively). In the multivariate analysis, the variables associated independently with the delay in starting chemotherapy were again age (P=.019), tumour stage (P=.037) and occupational situation (P=.022). Conclusion: Patients began receiving adjuvant chemotherapy within the time period (3 months from surgery) defined as appropriate, and during which no evidence exists of worse survival results. Length of delay varied according to age, tumour stage and occupational situation (AU)

Fundamento y objetivos: Estudios previos han relacionado el retraso en iniciar la quimioterapia adyuvante (>3 meses desde la cirugía) con peor supervivencia. El objetivo de este estudio es analizar el retraso en iniciar quimioterapia y la influencia de los factores biomédicos, sociodemográficos y culturales. Pacientes y método: En una cohorte de mujeres con cáncer de mama, candidatas a quimioterapia adyuvante y participantes en un ensayo clínico de intervención no farmacológica, se recogió la demora en el inicio de quimioterapia desde la cirugía. Se estudiaron las diferencias según variables clínicas y biográficas. Resultados: En 197 mujeres, la demora media (DE) entre cirugía y quimioterapia fue de 42,32 (15,29) días y estuvo asociada al estadio tumoral ( i , 40,06 días; ii , 44,76 días; iii , 38,7 días; p=0,049), la edad (≤35 años, 37,36 días; 36-64 años, 41,49 días; ≥65 años, 52,61 días; p=0,007) y la situación laboral (en activo, 36,91 días; en paro, 45,5 días; pensionistas, 40,07 días; amas de casa, 43,1 días; p=0,038). Las pacientes mayores de 65 años recibieron quimioterapia adyuvante con más demora que las menores de 35 o entre 35 y 65 años (p=0,023 y p=0,009, respectivamente). En el análisis multivariante, las variables asociadas de forma independiente con el retraso en recibir la quimioterapia continuaron siendo la edad (p=0,019), el estadio (p=0,037) y la situación laboral (p=0,022). Conclusiones: Las pacientes recibieron quimioterapia adyuvante dentro del tiempo (3 meses desde la cirugía) definido como apropiado y durante el cual no hay pruebas de peores resultados de supervivencia. El retraso varió según la edad, el estadio y la situación laboral (AU)

[Influence of clinical and biographical factors on the delay in starting adjuvant chemotherapy treatment among breast cancer patients]. / Influencia de los factores clínicos y biográficos en el retraso en iniciar la quimioterapia adyuvante en las pacientes con cáncer de mama.

BACKGROUND AND OBJECTIVE: Previous studies have related the delay in starting chemotherapy (>3 months from date of surgery) with worse survival. The study objective is to analyse the delay in the start of chemotherapy and associated biomedical, sociodemographic and cultural factors. PATIENTS AND METHODS: A cohort of women operated on for breast cancer, candidates for receiving adjuvant chemotherapy and participants in a clinical trial of non-pharmacological intervention, were surveyed regarding the delay in starting their chemotherapy, measured by the number of days from date of surgery. Differences in function of the clinical and biographical variables were studied. RESULTS: In 197 women, mean delay was 42.32 (15.29) days; this was associated with tumour stage (i, 40.06 days; ii, 44.76 days; iii, 38.7 days; P=.049), age (≤ 35, 37.36 days; 36-64, 41.49 days; ≥ 65, 52.61 days; P=.007) and occupational situation (active, 36.91 days; unemployed, 45.5 days; pensioner, 40.07 days; housewife, 43.17 days; P=.038). For patients older than 65 years, the delay in starting adjuvant chemotherapy was longer than for those in the 2 lower age groups -less than 35 years, and between 35 and 65 years- (P=.023 and P=.009 respectively). In the multivariate analysis, the variables associated independently with the delay in starting chemotherapy were again age (P=.019), tumour stage (P=.037) and occupational situation (P=.022). CONCLUSION: Patients began receiving adjuvant chemotherapy within the time period (3 months from surgery) defined as appropriate, and during which no evidence exists of worse survival results. Length of delay varied according to age, tumour stage and occupational situation.

Use of health-care services during chemotherapy for breast cancer.

AIM OF THE STUDY: The authors analyse the effect of chemotherapy on the use of additional health-care resources and report the clinical and demographic factors associated with such use. PATIENTS AND METHODS: In women with breast cancer, eligible to receive first-line (neo)-adjuvant or palliative chemotherapy, consultations with health-care practitioners (general practitioners [GPs] and specialists) and admissions to emergency department and to hospital were prospectively recorded. Differences were studied according to these clinical and demographic variables: age, tumour stage, performance status, weight, height, body mass index, surgery type, chemotherapy type, number of courses, comorbidity, marital status, educational level, social status and occupational status. RESULTS: Among 268 patients, 124 (42.2%) required one or more non-protocol health-care encounters. 180 visits were generated (GP 23.3%, specialist 35.5%, emergency department admission 21.1%, hospital admission 8.3%, others 3.3% and more than one resource 8.3%). Of total consultations 150 (83.3%) were chemotherapy-related. The number of visits was higher in the first courses. Fever and infection were the most frequent reasons for consultation in all resources. The dependent variable: 'need for non-protocol health-care encounter in any course' was statistically associated with age (p=0.002) and marital status (p=0.021); no association was found with other variables. In multivariate analysis, age (p=0.001) and marital status (p=0.009) remained statistically significant. Younger and married patients consumed less extra health resources. CONCLUDING STATEMENT: Many patients receiving chemotherapy consume health-care resources in addition to their routine visits, usually treatment-related. Patients consult less in the later courses. Older and unmarried women in particular need extra care during chemotherapy.

Tratamiento endovascular de urgencia con endoprótesis de aneurisma roto disecado de aorta torácica. A propósito de un caso / Emergency endovascular treatment with endoprosthesis of ruptured dissected aneurysm of thoracic aorta. Report of one case

Los aneurismas de aorta torácica son menos comunes que los aneurismas de aorta abdominal y pueden encontrarse en aorta ascendente, arco aórtico, aorta descendente o en una combinación de estos segmentos. De estos aneurismas el 30 porciento al 40 porciento se originan en la aorta torácica descendente. En los aneurismas de aorta torácica existe una debilidad estructural de la pared de la aorta, que conlleva una dilatación arterial progresiva con eventual ruptura o disección. Aproximadamente, 50 porciento de los aneurismas de aorta torácica son ateroscleróticos y ocurren como resultado de remodelado arterial y dilatación o a raíz de un metabolismo anormal del colágeno. La mayoría de los aneurismas de aorta torácica se descubren por casualidad durante la evaluación de otros problemas médicos. La meta del tratamiento de los aneurismas de aorta torácica, es prevenir la muerte debido a su ruptura. El riesgo de ruptura de los no tratados oscila entre 46 porciento a 74 porciento y la tasa de mortalidad por su ruptura es extremadamente alta. Los aneurismas de gran tamaño, en especial aquellos mayores de 6 cm, son más susceptibles de rupturas que los aneurismas de menor tamaño. El tratamiento endovascular, inicialmente desarrollado para los aneurismas de aorta abdominal, se introdujo en 1992 como una alternativa menos invasiva al tratamiento de cirugía abierta para los aneurismas de la aorta torácica descendente. En la actualidad, el injerto de stent endovascular en la aorta descendente o endoprótesis, recibe mayor atención como alternativa al reparo quirúrgico de los aneurismas de aorta torácica.

Thoracic aortic aneurysms are less common than abdominal aortic aneurysms and can be found in ascending aorta, aortic arch, descending aorta or in a combination of these segments. 30% to 40% of these aneurysms are originated in thoracic descending aorta. In thoracic aortic aneurysms there exists a structural wall weakness that leads to a progressive arterial dilation with eventual rupture or dissection. Approximately 50% of all thoracic aortic aneurysms are atherosclerotic and are the result of arterial restructure and dilation or are due to an abnormal collagen metabolism. Most thoracic aortic aneurysms are only found by chance during other medical problems evaluation. The goal of thoracic aortic aneurysms treatment is the prevention of death due to its rupture. Ruptured risk of untreated aneurysms oscillates between 46% and 74% and mortality rate due to its rupture is extremely high. Large aneurysms, especially when they are greater than 6 cm in diameter are more susceptible of ruptures than smaller aneurysms. Endovascular treatment, initially developed for abdominal aortic aneurysms, was introduced in 1992 as a less invasive alternative to open surgery treatment for descending thoracic aortic aneurysms. Endovascular stent or endoprosthesis is actually getting more attention as an alternative to surgical repair of thoracic aortic aneurysms.

Maze III modificado con pinza de crioablación reutilizable vs. Maze III clásico con corte y sutura, en pacientes con fibrilación auricular permanente y cirugía concomitante de la válvula mitral / Maze III modified with cryoablation reusable clamp vs. classic cut and suture Maze III in patients with permanent atrial fibrillation and concommitant mitral valve surgery

Introducción: el propósito del estudio fue evaluar el eficacia de la cirugía de Maze III modificada mediante una pinza de crioablación reutilizable en comparación con el Maze III clásico de corte y sutura, sólo en pacientes con fibrilación auricular permanente, y a la vez realizar cirugía mitral. Métodos: desde mayo de 1993 a abril de 2005, se realizó cirugía de Maze a 134 pacientes, de los cuales 92 presentaban fibrilación auricular permanente y además tenían cirugía de la válvula mitral. En el grupo clásico de Maze se incluyeron 71 pacientes (grupo I) y en el nuevo grupo 21 (grupo II). Se realizó un análisis multivariable para analizar estos resultados...

Introduction: the purpose of this study was to evaluate the efficacy of the modified Maze III surgery using a reusable cryoablation clamp compared with the classic cut and suture Maze III only in patients with permanent atrial fibrillation and mitral surgery. Methods: in the period between May 1993 and April 2005, 134 patients underwent Maze surgery. 92 had permanent atrial fibrillation and previous mitral surgery. 71 patients had had the classic Maze surgery (group I) and 21 the modified Maze III with reusable cryoablation clamp. A multivariable analysis is realized in order to analyze these results. Results: mean age was 48,1 years (24 to 67 years). 24 were men and 68 were women. Mean duration of atrial fibrillation was 3,8 ± 4.3 years (standard deviation 0,5-20). Mean left atrial diameter was 57 mm (26-82 mm). No significant differences were found between the two groups. Mean ischemic time of group I was 83 minutes and that of group II was 77 minutes (p = 0,4). Post-chirurgic bleeding was of 762 cc in group I and 680 cc in group II (p = 0,6). Mortality was 5,6% in group I and 0% in group II. Sinus rhythm was recovered in 87% patients in group I and in 85,7% patients in group II. Conclusions: modified Maze III surgery with cryoablator reusable clamp is as effective as classic Maze, considered as the gold standard. We found a decrease in the ischemic time as well as in the post-chirurgic bleeding, being not statistically significant. There is a difference in mortality between the two groups. This is a safe modification and can be applied by more surgeons in any institution. In developing countries, this device can be used as an alternative energy method.

Simultaneous detection of antibodies to six nonhuman-primate viruses by multiplex microbead immunoassay.

To maintain healthy nonhuman primates for use in biomedical research, animals are routinely screened for several infectious agents at most facilities. Commonly, monkey serum samples are tested by conventional immunoassays, such as enzyme-linked immunosorbent assays (ELISAs) or Western blotting, for antibodies to specific infectious agents. For testing for antibodies against multiple agents in each sample, conventional immunoassays are laborious and time-consuming. More efficient immunoassays are needed. Accordingly, we have developed a novel multiplex serodiagnostic system based on individually identifiable, fluorescent microbead sets, where each bead set is coated with antigens from a purified preparation of a specific virus. The coated bead sets are mixed to enable the detection of antibodies to multiple viruses in one serum or plasma sample. These viruses include four agents that are routinely tested for maintenance of specific-pathogen-free monkeys, namely, simian immunodeficiency virus, simian type D retrovirus, simian T-cell lymphotropic virus, and herpes B virus, as well as simian foamy virus and rhesus cytomegalovirus, both of which are commonly found in nonhuman primates. This multiplex microbead immunoassay (MMIA) enabled the simultaneous detection of antibodies to all six viruses in single serum samples as small as 1 microliter. The results obtained by MMIA analysis correlated with results of conventional ELISAs, which detect antibodies to single agents. Thus, this multiplex microbead detection system is an efficient diagnostic modality for serosurveillance of nonhuman primates.

Multiplex analysis of intracellular signaling pathways in lymphoid cells by microbead suspension arrays.

Phosphorylation analysis of signaling proteins is key for examining intracellular signaling pathways. Conventional biochemical approaches, e.g. immunoprecipitation, Western blot, and ELISA, have played a major role in elucidation of individual signaling events. However, these methods are laborious, time-consuming, and difficult to adapt for high throughput analysis. A multiplex approach to measure phosphorylation state of multiple signaling proteins simultaneously would significantly enhance the efficiency and scope of signaling pathway analysis for mechanistic studies and clinical application. This report describes a novel multiplex microbead suspension array approach to examine phosphoproteomic profiles in lymphoid cells. In the Jurkat T-cell leukemia line, the multiplex assay enabled targeted investigation of phosphorylation kinetics of signal transduction from receptor proximal events (tyrosine phosphoproteins CD3, Lck, Zap-70, and linker for T-cell activation) to cytosolic events (serine/threonine phosphoproteins Erk and Akt) to transcription factors (serine/threonine phosphorylated Rsk, cyclic AMP-response element-binding protein, and STAT3). To broaden the application of the multiplex analysis, signaling pathways were also studied in B-cell lymphoid tumor lines that included chronic lymphocytic leukemia lines. In these cell lines, multiplex suspension array enabled phosphoproteomic analysis of signaling cascade mediated by Syk, a homolog of Zap-70. Results obtained by multiplex analysis were confirmed by immunoprecipitation and Western blot methods. The examples of T-cell and B-cell signaling pathway analyses in this report demonstrate the utility of the multiplex suspension arrays to investigate phosphorylation dynamics and kinetics of several signaling proteins simultaneously in signal transduction pathways.

Simultaneous serodetection of 10 highly prevalent mouse infectious pathogens in a single reaction by multiplex analysis.

Under current practices of mouse colony maintenance, sera from mice are analyzed for antibodies against several widespread infectious pathogens by conventional immunoassays, generally enzyme-linked immunosorbent assay (ELISA). To test for multiple agents, these methods consume large volumes of mouse serum and are laborious and time-consuming. More efficient immunoassays, using small amounts of sample, are therefore needed. Accordingly, we have developed a novel multiplex diagnostic system that employs fluorescent microbeads, coated with purified antigens, for simultaneous serodetection of 10 mouse infectious agents. Individually identifiable, fluorescent microbeads were coated with antigens from Sendai virus, mouse hepatitis virus, Theiler's mouse encephalomyelitis virus/GDVII strain, mouse minute virus, mouse cytomegalovirus, respiratory enteric orphan virus (Reo-3 virus), mouse parvovirus, calf rotavirus for epizootic diarrhea virus of infant mice, vaccinia virus for ectromelia virus, and Mycoplasma pulmonis. Standard sera, singly positive for antibodies to individual infectious agents, were generated by inoculation of BALB/cj and C57BL/6j mice. Sera from these experimentally infected mice, as well as sera from naturally infected mice, were analyzed using a mixture of microbeads coated with antigens of the 10 infectious agents listed above. Results demonstrated that the multiplex assay was at least as sensitive and specific as ELISA for serodetection. Importantly, the multiplex assay required only 1 microliter of serum for simultaneous serodetection of the 10 mouse infectious agents in one reaction vessel. Thus, this multiplex microbead assay is a reliable, efficient, and cost-effective diagnostic modality that will impact serosurveillance of mice used in research.