Does COVID-19 infection increase the risk of pressure injury in critically ill patients?: A narrative review.

ABSTRACT: Patients with severe COVID-19 may have endothelial dysfunction and a hypercoagulable state that can cause skin damage. In the presence of external pressure on the tissues, the local inflammatory process regulated by inflammatory cytokines can increase and prolong itself, contributing to the formation of pressure injury (PI). PI is defined as localized damage to the skin or underlying tissues. It usually occurs as a result of intense and/or prolonged pressure in combination with shear. The aim of the study is to perform a narrative review on the physiological evidence of increased risk in the development of PI in critically ill patients with COVID-19.In patients with severe COVID-19 a pattern of tissue damage consistent with complement-mediated microvascular injury was found in the lungs and skin of critically ill COVID-19 patients, suggesting sustained systemic activation of complement pathways. Theoretically, the same thrombogenic vascular changes related to COVID-19 that occur in the skin also occur in the underlying tissues, making patients less tolerant to the harmful effects of pressure and shear. Unlike the syndromes typical of acute respiratory illnesses and other pathologies that commonly lead to intensive care unit admission, COVID-19 and systemic viral spread show that local and systemic factors overlap. This fact may be justified by current epidemiological data showing that the prevalence of PI among intensive care unit patients with COVID-19 was 3 times higher than in those without COVID-19. This narrative review presents physiological evidence to suggesting an increased risk of developing PI in critically ill patients with COVID-19.

Effects of the extracorporeal shock wave therapy on the skin: an experimental study.

Extracorporeal shock wave therapy (ESWT) has been extensively studied for its multiple biological properties, and although it is widely applied in esthetical procedures, little is known about its effects on the epidermis and dermis. In this study, a histological and immunohistochemical study of the effects of ESWT was performed on rat skin. Forty-five female rats were treated with one or two sessions of ESWT and sacrificed on days 1, 7, 14, and 21 after treatment. The samples were histologically processed and then morphometric analyses were performed to assess the epidermis, dermis, and subcutaneous fat tissue thickness. Immunohistochemical reactions were also performed against the antibodies: basic fibroblastic growth factor (FGF2), its receptor (FGFR1), and α-smooth muscle actin. Slides were scanned and digitally assessed, to determine the microvessel density (MVD) and digital scoring of the immunohistochemical staining. The results showed that ESWT produced a significantly higher collagen content, MVD, and epidermis and dermis thickness than the control, non-treated group. Both in epidermis and dermis, FGF2 was overexpressed in the ESWT-treated groups, whereas FGFR1 was increased only in the group treated with two ESWT sessions at 21-days post-treatment. The ESWT-treated groups have also shown diminished thickness of subcutaneous fat tissue. In conclusion, ESWT induces neocollagenesis and neoangiogenesis, and upregulates the FGF2 expression, particularly in the groups treated with two sessions. Furthermore, it was demonstrated that overexpression of FGF2 on skins treated with ESWT seems to be a key role on its mechanism of action.

Cirugía de rescate en las recidivas locales del carcinoma de nasofaringe / Salvage surgery in the treatment of local recurrences of nasopharyngeal carcinomas

INTRODUCCIÓN Y OBJETIVOS: La quimiorradioterapia es el tratamiento de elección del carcinoma de nasofaringe. Las recurrencias locales son una de las principales causas de mortalidad en estos pacientes: el rescate quirúrgico o la reirradiación son el tratamiento de elección, según la disponibilidad. El objetivo fue evaluar y comparar los resultados de la cirugía de rescate en el tratamiento de las recidivas locales de los carcinomas nasofaríngeos mediante abordajes abiertos vs. endoscópicos. MÉTODOS: Veinte pacientes con recidivas locales de carcinomas nasofaríngeos fueron intervenidos quirúrgicamente: 12 pacientes fueron intervenidos mediante cirugía abierta y 8 mediante un abordaje endoscópico endonasal transpterigoideo. Un paciente fue estadiado como rT1; 3 como rT2; 2 como rT3 y 6 como rT4 en el grupo de abordajes abiertos; en la serie endoscópica, 2 pacientes fueron rT1, 5 fueron rT2 y uno fue rT3. RESULTADOS: En 3 de los pacientes (25%) intervenidos mediante cirugía abierta (un rT4, un rT3 y un rT2) no se logró una resección macroscópica completa). En el grupo endoscópico la resección fue completa en todos los pacientes. La tasa de complicaciones en el grupo intervenido mediante abordajes abiertos fue del 92% (5 complicaciones leves, 5 complicaciones moderadas y una complicación grave) y en el grupo intervenido mediante endoscopia fue del 100% (7 sufrieron complicaciones leves y un paciente una complicación grave). La supervivencia a los 3 y 5 años fue del 53 y del 42% en el abordaje abierto y del 100 y del 75% en el abordaje endoscópico, respectivamente. CONCLUSIONES: Los abordajes endoscópicos disminuyen la morbilidad asociada a los abordajes abiertos y permiten obtener un control oncológico favorable

INTRODUCTION AND OBJECTIVES: Chemoradiotherapy is the treatment of choice for nasopharyngeal carcinoma. Local recurrences are one of the leading causes of death in these patients, and surgical salvage the treatment of choice. Our goal was to evaluate and compare the results of salvage surgery in the treatment of local recurrence of nasopharyngeal carcinomas comparing endoscopic to open approaches. METHODS: Twenty patients with local recurrence of nasopharyngeal carcinomas underwent surgery: 12 patients underwent open surgery and 8 endoscopic endonasal transpterygoid nasopharyngectomy. One patient was classified as rT1; 3 as rT2;2 as rT3; and 6 as rT4 in the group of open approaches; in the endoscopic series, 2 patients were rT1, 5 rT2 and one rT3. RESULTS: In 3 patients (25%) operated by an open approach (one rT4, one rT3 and one rT2) a complete gross resection was not achieved. Gross total resection was achieved in patients operated by endoscopic surgery. The complication rate in the group operated by an open approach was 92% (5 minor complications, 5 moderate complications, and one serious complication) and in the group that underwent endoscopic surgery all patients had some complication (7 had minor complications and one patient developed a severe complication). Survival at 3 and 5 years was 53% and 42% with the open approach and 100% and 50% with the endoscopic approach, respectively. CONCLUSIONS: Endoscopic approaches decrease the morbidity associated with open approaches and allow for favourable oncological control

Salvage surgery in the treatment of local recurrences of nasopharyngeal carcinomas. / Cirugía de rescate en las recidivas locales del carcinoma de nasofaringe.

INTRODUCTION AND OBJECTIVES: Chemoradiotherapy is the treatment of choice for nasopharyngeal carcinoma. Local recurrences are one of the leading causes of death in these patients, and surgical salvage the treatment of choice. Our goal was to evaluate and compare the results of salvage surgery in the treatment of local recurrence of nasopharyngeal carcinomas comparing endoscopic to open approaches. METHODS: Twenty patients with local recurrence of nasopharyngeal carcinomas underwent surgery: 12 patients underwent open surgery and 8 endoscopic endonasal transpterygoid nasopharyngectomy. One patient was classified as rT1; 3 as rT2;2 as rT3; and 6 as rT4 in the group of open approaches; in the endoscopic series, 2 patients were rT1, 5 rT2 and one rT3. RESULTS: In 3 patients (25%) operated by an open approach (one rT4, one rT3 and one rT2) a complete gross resection was not achieved. Gross total resection was achieved in patients operated by endoscopic surgery. The complication rate in the group operated by an open approach was 92% (5 minor complications, 5 moderate complications, and one serious complication) and in the group that underwent endoscopic surgery all patients had some complication (7 had minor complications and one patient developed a severe complication). Survival at 3 and 5 years was 53% and 42% with the open approach and 100% and 50% with the endoscopic approach, respectively. CONCLUSIONS: Endoscopic approaches decrease the morbidity associated with open approaches and allow for favourable oncological control.

Ausencia de translocaciones cromosómicas y de expresión proteica de ALK en los adenocarcinomas nasosinusales / Absence of chromosomal translocations and protein expression of ALK in sinonasal adenocarcinomas

Introducción. Las translocaciones de la región cromosómica 2p23 causan la sobreexpresión del gen de la quinasa del linfoma anaplásico (ALK), un receptor tirosinquinasa involucrado en rutas de señalización celular que regulan la proliferación. Dicha alteración se identifica en el 5% de los adenocarcinomas de pulmón, representando una diana terapéutica en dicho subgrupo de tumores. Debido a que los adenocarcinomas nasosinusales (ACNS) tienen una histología similar a los adenocarcinomas de pulmón, el objetivo de este estudio fue evaluar si existen alteraciones en el gen ALK en los ACNS. Método. La presencia de translocaciones del gen ALK se analizó en 96 muestras de ACNS mediante fluorescence in situ hybridization usando unas sondas «break apart». Además se estudió la expresión proteica de ALK por inmunohistoquímica. Resultados. En ninguno de los casos se observó la presencia de translocaciones de ALK. Además, no se detectó expresión proteica en ninguno de los casos. Conclusiones. Los resultados obtenidos sugieren que ALK no desempeña un papel relevante en la oncogénesis de los ACNS (AU)

Introduction. Chromosomal translocations at 2p23 cause overexpression of anaplastic lymphoma kinase (ALK), a receptor tyrosine kinase involved in signalling pathways that regulate cell proliferation. This translocation occurs in 5% of lung adenocarcinoma and has been demonstrated to be useful as a therapeutic target for crizotinib. sinonasal adenocarcinomas (SNAC) are histologically similar to lung adenocarcinomas; the aim of this study was to evaluate the presence of ALK alterations in SNAC. Method. Break-apart fluorescent in-situ hybridization was used to analyse the presence of ALK translocations in 96 tumour samples. In addition, ALK protein expression was studied by immunohistochemistry. Results. The samples of SNAC did not show ALK translocation. Moreover, ALK protein expression was absent in all cases. Conclusions. These results suggest that ALK is not involved in SNAC (AU)

Absence of chromosomal translocations and protein expression of ALK in sinonasal adenocarcinomas. / Ausencia de translocaciones cromosómicas y de expresión proteica de ALK en los adenocarcinomas nasosinusales.

INTRODUCTION: Chromosomal translocations at 2p23 cause overexpression of anaplastic lymphoma kinase (ALK), a receptor tyrosine kinase involved in signalling pathways that regulate cell proliferation. This translocation occurs in 5% of lung adenocarcinoma and has been demonstrated to be useful as a therapeutic target for crizotinib. sinonasal adenocarcinomas (SNAC) are histologically similar to lung adenocarcinomas; the aim of this study was to evaluate the presence of ALK alterations in SNAC. METHOD: Break-apart fluorescent in-situ hybridization was used to analyse the presence of ALK translocations in 96 tumour samples. In addition, ALK protein expression was studied by immunohistochemistry. RESULTS: The samples of SNAC did not show ALK translocation. Moreover, ALK protein expression was absent in all cases. CONCLUSIONS: These results suggest that ALK is not involved in SNAC.

¿Es reversible el Linfedema? / ¿Is lymphedema reversible?

La elefantiasis es el estadio clínico más avanzado y dismórfico del Linfedema. El objetivo del presente estudio es relatar la reversibilidad de la elefantiasis del miembro inferior y la mantención del resultado. El caso se trata de una paciente de 24 años de edad que comenzó a presentar edema en la pierna izquierda desde los 16 años y que evolucionó a la forma más grave de esta dolencia, conocida como elefantiasis. Al examen físico se realizó perimetría que mostró 98 cm. en la zona de mayor medida, contra 32 cm. en la misma región, en su pierna contralateral. Fue propuesto un tratamiento intensivo cercano a 6-8 horas por día, que consistió en terapia linfática manual, terapia linfática mecánica y media de gorgurão, después del tratamiento intensivo. En la primera semana se logró una reducción de 4 cm/día, totalizando 20 cm. Después de la primera semana, ella continuó el tratamiento, haciendo uso de la media de gorgurão y continuó con visitas mensuales de control. Se logró una reducción total del edema con el tratamiento propuesto, en seis meses. Cerca de 10 años de seguimiento a la paciente demuestran que ha mantenido el miembro dentro de patrones de normalidad. Se concluye que es posible reducir el miembro en estadío de elefantiasis hacia patrones de normalidad y mantenerlo dentro de estos patrones.

Elephantiasis is the most advanced and disfiguring clinical stage of lymphedema. The aim of this study was to report the reversal of leg elephantiasis and maintenance of the result. We report the clinical case of a 24-year-old man who had had edema of his left leg since the age of 16 years which evolved to the most severe form of the disease, elephantiasis. Perimetry performed during the physical examination showed that the largest diameter was 98 cm compared to 32 cm in the same region of the contralateral leg. Intensive treatment (between 6and 8 hours daily) was proposed which consisted of manual lymph therapy and mechanical lymph therapy with the use of a grosgrain low-stretch stocking after the sessions. There was a reduction of about 4 cm/day totaling 20 cm during the first week. After the first week the treatment continued with the grosgrain compression stocking after the week of intensive treatment and the patient returned to the clinic for monthly check-ups. After six months of treatment the edema was reduced completely. The volume of the limb was maintained within the normal size range over a 10-year follow-up. In conclusion, it is possible to reduce edema completely and maintain the results even in patients with elephantiasis.