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Background: Patients with thoracolumbar fractures with TLICS 4 classification are at the limit of surgical fixation with regards to conservative treatment; however, results in our environment are not known, which is why this study has innovative characteristics. Objective: To determine the quality of life in patients with TLICS 4 thoracolumbar fractures using traditional fixation with regards to no fixation in a third level hospital. Material and methods: A cohort prospective study was carried out in patients with TLICS 4 classification thoracolumbar fractures using traditional fixation with regards to no fixation in beneficiaries from the Mexican Institute for Social Security. The SF-12 instrument, which assessed quality of life, was administered; age, sex, days of hospitalization, time of spinal cord injury were searched in the patients' medical history. It was used descriptive and inferential statistics using Student's t or Mann-Whitney U. Results: 20 patients participated and 9 had traditional fixation (45%). All patients had type E spinal cord injuries according to the International Standards for Neurological Classification of Spinal Cord Injury. Mean age of non-fixation was 42.2 ± 12.9 and of fixation 44.9 ± 10.2; in non-fixation 6 (67%) were male. The quality of life score was 29.1 ± 0.9 in the conservative treatment and 28.7 ± 1.3 in the surgical treatment, p < 0.462. Conclusions: No differences in quality of life were observed in patients with TLICS 4 thoracolumbar fractures using traditional fixation with regards to no fixation.
Introducción: los pacientes con fracturas toracolumbares con clasificación TLICS 4 se encuentran en el límite de la fijación quirúrgica con respecto al tratamiento conservador; sin embargo, resultados en nuestro medio no son conocidos, por lo que este estudio tiene características innovadoras. Objetivo: determinar la calidad de vida en pacientes con fracturas toracolumbares clasificación TLICS 4, mediante fijación tradicional con respecto a no fijación en un hospital de tercer nivel. Material y métodos: estudio de cohorte prospectiva en pacientes con fracturas toracolumbares clasificación TLICS 4 mediante fijación tradicional con respecto a no fijación en población derechohabiente del Instituto Mexicano del Seguro Social (IMSS). Se aplicó el instrumento SF-12, que evaluó la calidad de vida; se buscó en los expedientes de los pacientes edad, sexo, días de hospitalización, tiempo de lesión medular. Se usó estadística descriptiva e inferencial mediante t de Student o U de Mann Whitney. Resultados: participaron 20 pacientes y 9 (45%) tuvieron fijación tradicional. Todos los pacientes pertenecían a la clase E según las Normas Internacionales para la Clasificación Neurológica de lesiones de la médula espinal. Edad media de no fijación con 42.2 ± 12.9 y de fijación 44.9 ± 10.2; en no fijación, 6 (67%) eran varones. La puntuación de calidad de vida fue en el tratamiento conservador con 29.1 ± 0.9 y quirúrgico 28.7 ± 1.3, p < 0.462. Conclusiones: no se observaron diferencias en la calidad de vida en pacientes con fracturas toracolumbares clasificación TLICS 4 mediante fijación tradicional y no fijación.
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Traumatismos da Medula Espinal , Fraturas da Coluna Vertebral , Humanos , Masculino , Feminino , Estudos Prospectivos , Qualidade de Vida , Estudos Retrospectivos , Vértebras Lombares/cirurgia , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Escala de Gravidade do Ferimento , Fraturas da Coluna Vertebral/cirurgiaRESUMO
Introducción: Las leucoplaquias laríngeas (LL) pueden corresponder a lesiones precancerosas. La aproximación diagnóstica es endoscópica y en caso de persistir, se debe estudiar con biopsia. Objetivo: Describir las características biodemográficas, clínicas, endoscópicas, histológicas y evolutivas de pacientes diagnosticados con leucoplaquias glóticas. Material y Método: Estudio prospectivo no-concurrente de pacientes diagnosticados con leucoplaquias glóticas en la Unidad de Voz del Departamento de Otorrinolaringología de la Pontificia Universidad Católica de Chile, entre 2012 y 2019. Resultados: Se incluyeron 29 pacientes, 65,5% hombres, con edad promedio de 61 años y seguimiento promedio de 21,1 meses. El principal motivo de consulta fue disfonía, en un 86,2% de los casos. El 38% presentó compromiso del pliegue vocal (PV) izquierdo, 24,1% derecho, 24,1% bilateral y 13,8% bilateral incluyendo comisura anterior. El 41,4% de las lesiones comprometían más del 50% del PV y 68% presentaba una onda mucosa alterada en la estroboscopia. Un 89,7% requirió biopsia, identificando carcinoma en 26,9%, displasia en 34,6% y otro diagnóstico en 38,5%. El 25,9% presentó recurrencias, del cual 28,6% progresó a cáncer. Se identificó asociación significativa en un análisis bivariado entre la edad (p = 0,030) y compromiso mayor al 50% del PV (p = 0,016) con displasia de alto riesgo o cáncer. En el análisis multivariado, solo la edad mostró ser significativa (p = 0,038; OR 1,27; IC 95% 1,01-1,59). Conclusión: El estudio de las LL es esencial para el diagnóstico precoz de cáncer laríngeo. La edad y el compromiso mayor al 50% del PV en la estroboscopia podría predecir un riesgo mayor de displasia de alto riesgo o cáncer.
Introduction: Laryngeal leukoplakia (LL) may correspond to precancerous lesions. The diagnostic approach is endoscopic, and if LL persist, a biopsy should be performed. Aim: To describe the biodemographic, clinical, endoscopic, histological, and developmental characteristics of patients diagnosed with glottic leucoplakia. Material and Method: Prospective non-concurrent study of patients diagnosed with glottic leukoplakia in the Voice Unit at the Otolaryngology Department of the Pontificia Universidad Catolica de Chile, between 2012 and 2019. Results: Twenty-nine patients were included, 65.5% men, with an average age of 61.7 years, and average follow-up of 21.1 months. Dysphonia was the chief complaint, present in 86.2% of the cases. The left vocal fold (VF) was involved in 38.0%, right in 24.1%, bilateral in 24.1%, and bilateral including anterior commissure in 13.8%. Only 41.4% compromised over 50% of the VF and 68.0% presented an altered mucosal wave in the videostroboscopy. A biopsy was performed in 89.7%, identifying carcinoma in 26.9%, dysplasia in 34.6% and other diagnosis in 38.5%. During follow-up 25.9% recurred, of which 28.6% progressed to cancer. A significant association was found in the bivariate analysis between age (p = 0.030) and extension over 50% of the VF (p = 0.016) with high-risk dysplasia or cancer. In the multivariate analysis only, the age was found to be significative (p = 0.038; OR 1.27; CI 95% 1.01-1.59). Conclusions: A thorough evaluation is essential in LL, favoring an early diagnosis for laryngeal cancer. Age and an involvement greater than 50% of the VF in the videostroboscopy could predict an increased possibility for high-risk dysplasia or cancer.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Prega Vocal/patologia , Neoplasias Laríngeas/diagnóstico , Leucoplasia/diagnóstico , Neoplasias Laríngeas/patologia , Leucoplasia/patologiaRESUMO
OBJECTIVES: To describe the clinical and epidemiological characteristics of inmates who were infected and died from COVID-19 in Peruvian prisons from April to October 2020. MATERIAL AND METHOD: Descriptive, cross-sectional, retrospective study with a secondary data source. All the inmates who were infected and died from COVID-19 in Peruvian prisons during the study period were considered. The information was collected through the validated data collection sheet and was analyzed with descriptive statistics applying the SPSS v26 software. RESULTS: 37,103 (42.3%) inmates were analyzed out of a prison population of 87,754. All of them reactive to the rapid test, with a mean age of 39.9 ± 12.6 years; 95.5% were male. 60.1% were IgG reactive; 36.1% were IgM/IgG reactive and 3.8% were IgM reactive. 20.1% of reactive inmates had COVID-19 symptoms at the time of testing. The most frequent symptoms were headache (55.6%), general malaise (49.7%), fever (49.0%) and cough (48.0%). Among the risk factors for COVID-19 were: age over 60 years (8.4%), high blood pressure (2.8%) and diabetes mellitus (2.4%). 445 deaths were registered. Total fatality reached 1.2% of the number of infected. The highest number of deaths was recorded in April and May (89 and 162, respectively). DISCUSSION: The study findings imply different approaches to managing epidemics in the prison context compared to the general population. The short and long term scenarios are uncertain, but the need to reorganize the prison health system, and to prioritise and modernise it are evident. The long-delayed reform of the prison system and the measures that set out to contain the spread of the COVID-19 disease in prisons are related processes in this regard.
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COVID-19 , Prisioneiros , Adulto , COVID-19/diagnóstico , COVID-19/epidemiologia , Estudos Transversais , Humanos , Imunoglobulina G , Imunoglobulina M , Masculino , Pessoa de Meia-Idade , Peru/epidemiologia , Prisões , Estudos RetrospectivosRESUMO
BACKGROUND: Hand osteoarthritis (HOA) is one of the most common causes of pain and functional disability in western countries and there is still no definitive cure. Low-dose radiation therapy (LDRT) has anti-inflammatory properties that have shown to be effective in the symptomatic relief of various degenerative musculoskeletal disorders. We designed a clinical protocol using LDRT for symptomatic HOA and present results and tolerance in the first 100 patients included. MATERIALS AND METHODS: Between April 2015 and March 2021, 100 patients with a median age of 60 were treated. Fifty-seven patients suffering from proximal/distal interphalangeal joint pain, 40 patients with thumb arthritis, 2 patients with radiocarpal joint affection and 1 patient with metacarpophalangeal joint pain were enrolled. LDRT comprised of 6 fractions of 0.5-1 Gy on every other day up to a total dose of 3-6 Gy. Clinical response was evaluated according to the visual analog scale (VAS) for pain level and the von Pannewitz score (VPS) for joint functionality. Any patients not achieving subjective adequate pain relief after 8 weeks of treatment were offered a second identical LDRT course. RESULTS: With a median follow-up of 10.5 months (range 7.55-12.45), 94% reported an improvement in the pain, with a significant reduction in the VAS level after 3, 6 and 12 months (p < 0.001). Sixty-three patients needed a second course of treatment at a median time interval of 12 weeks (range 9-14). The mean VAS score before treatment was 8 (range 3-10). After treatment, it was 5 (range 1-10). After 3, 6 and 12 months, the mean VAS scores were 4 (range 0-9), 3 (range 0-9) and 3.5 (range 0-9), respectively. Seventy patients reported functionality improvements after LDRT according to the von Pannewitz score. No acute or late complications were observed. CONCLUSION: LDRT appears to be safe and useful for HOA and is associated with good rates of pain relief and functionality improvements. However, further studies are necessary to confirm these promising results.
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Articulação da Mão , Osteoartrite/radioterapia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Dosagem Radioterapêutica , Resultado do TratamentoRESUMO
PURPOSE: To explore the feasibility of image-guided and respiratory-gated Stereotactic Body Radiation Therapy (SBRT) for Accelerated Partial Breast Irradiation (APBI) in patients with very early breast cancer. MATERIAL AND METHODS: Selected patients with early breast carcinoma after breast-conserving surgery were enrolled in this phase II trial. A fiducial marker was percutaneously placed close to surgical bed and five external fiducials were set on the skin. A CT scan for planning was acquired at free breathing. The treatment was planned and DVH were assessed according to international recommendations. Prescription dose was 30 Gy in five consecutive fractions of 6 Gy. A 6MV monoenergetic LINAC (linear accelerator) that combines stereoscopic X-ray imaging system and ExacTrac Adaptive Gating technique was used. PTV (planning target volume) intrafraction motion was controlled and PTV was irradiated in a selected gated area of the respiratory cycle. Shifts for a correct, gated set-up were calculated and automatically applied. RESULTS: Between April 2013 and October 2015, a total of 23 patients were included. The median tumor size was 12 mm. The mean PTV volume was 114 cc. The mean ipsilateral lung V9 Gy was 2.2% and for left-sided breast cancers, the volume of the heart receiving 1.5 Gy was 11.5%. Maximum skin dose was 30.8 Gy. Acute toxicity was grade1 in all the patients and 100% experienced excellent/good breast cosmesis outcomes. With a median follow-up of 66 months (range 8-99 months) local-relapse-free-survival reaches 100%. One patient developed a second breast cancer outside the treated quadrant after 25.1 months. CONCLUSION: APBI with SBRT and ExacTrac Adaptive Gating System was feasible. The acute and late toxicities were almost null and cosmesis was excellent. We also found that the margins of 5 mm applied from CTV to PTV were sufficient to compensate for geometric uncertainties.
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Neoplasias da Mama/radioterapia , Carcinoma Ductal de Mama/radioterapia , Radiocirurgia/métodos , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/patologia , Carcinoma Ductal de Mama/cirurgia , Intervalo Livre de Doença , Fracionamento da Dose de Radiação , Estudos de Viabilidade , Feminino , Marcadores Fiduciais , Coração/efeitos da radiação , Humanos , Pulmão/efeitos da radiação , Mastectomia Segmentar , Pessoa de Meia-Idade , Movimentos dos Órgãos , Órgãos em Risco/efeitos da radiação , Cuidados Pós-Operatórios/métodos , Estudos Prospectivos , Radiocirurgia/instrumentação , Respiração , Pele/efeitos da radiação , Fatores de Tempo , Tomografia Computadorizada por Raios X , Carga TumoralRESUMO
Resumen El clivus corresponde a una región de la fosa craneal posterior conformada por la unión del cuerpo del hueso esfenoidal y la porción basilar del hueso occipital, siendo sus lesiones poco frecuentes. Dentro de las lesiones clivales las más frecuentes son los cordomas (40%), condrosarcomas, adenomas ectópicos, linfomas, entre otros. Los linfomas no Hodgkin primario de hueso corresponden a una presentación extranodal, muy infrecuente en adultos, constituyendo sólo un 1% a 2% de estos en la base de cráneo. Se presentan principalmente con cefalea, síntomas B, diplopia y parestesias trigeminales. El origen primario clival es una manifestación aún más infrecuente, siendo su principal síntoma la cefalea. La sospecha debe ser alta requiriendo neuroimágenes, luego biopsia ya sea endoscópica o abierta. El manejo es con quimioterapia R-CHOP con un 67% de respuesta completa, 16% de detención de la progresión y 16% de progresión pese a tratamiento.
Abstract The clivus corresponds to a posterior cranial fossa region formed by the union of the body of the sphenoid bone and the basilar portion of the occipital bone, being its pathology very rare. Among the clival lesions, the most frequent are chordomas (40%), chondrosarcomas, ectopic adenomas, lymphomas, among others. Primary bone non-Hodgkin lymphomas correspond to an extranodal presentation, which is very infrequent in adults, while the skull base presentation corresponds only to 1% to 2%. They present mainly with headache, B symptoms, diplopia, and trigeminal paresthesia. The primary clival origin is an even more infrequent manifestation, with headache being its main symptom. The clinical suspicious must be high, requiring neuroimaging, then an endoscopic or open surgery biopsy. Management is standardized with R-CHOP chemotherapy with a 67% of complete response, 16% stop of progression and 16% progression despite treatment.
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BACKGROUND: The type VI protein secretion system (T6SS) is important in diverse cellular processes in Gram-negative bacteria, including interactions with other bacteria and with eukaryotic hosts. In this study we analyze the evolution of the T6SS in the genus Xanthomonas and evaluate its importance of the T6SS for virulence and in vitro motility in Xanthomonas phaseoli pv. manihotis (Xpm), the causal agent of bacterial blight in cassava (Manihot esculenta). We delineate the organization of the T6SS gene clusters in Xanthomonas and then characterize proteins of this secretion system in Xpm strain CIO151. RESULTS: We describe the presence of three different clusters in the genus Xanthomonas that vary in their organization and degree of synteny between species. Using a gene knockout strategy, we also found that vgrG and hcp are required for maximal aggressiveness of Xpm on cassava plants while clpV is important for both motility and maximal aggressiveness. CONCLUSION: We characterized the T6SS in 15 different strains in Xanthomonas and our phylogenetic analyses suggest that the T6SS might have been acquired by a very ancient event of horizontal gene transfer and maintained through evolution, hinting at their importance for the adaptation of Xanthomonas to their hosts. Finally, we demonstrated that the T6SS of Xpm is functional, and significantly contributes to virulence and motility. This is the first experimental study that demonstrates the role of the T6SS in the Xpm-cassava interaction and the T6SS organization in the genus Xanthomonas.
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Biologia Computacional/métodos , Sistemas de Secreção Tipo VI/genética , Xanthomonas/patogenicidade , Técnicas de Inativação de Genes , Transferência Genética Horizontal , Mutação , Filogenia , Análise de Sequência de DNA , Virulência , Xanthomonas/classificação , Xanthomonas/genética , Xanthomonas/fisiologiaRESUMO
PURPOSE: Conventional post-prostatectomy radiation therapy comprises 6.5-8 weeks of treatment, therefore, hypofractionated and shortened schemes arouse increasing interest. We describe our experience regarding feasibility and clinical outcome of a post-prostatectomy moderate hypofractionated image-guided radiotherapy schedule MATERIALS AND METHODS: From Oct 2015-Mar 2020, 113 patients, median age of 62 years-old (range 45-76) and prostate adenocarcinoma of low risk (30%), intermediate risk (49%) and high risk (21%) were included for adjuvant (34%) or salvage radiation therapy (66%) after radical prostatectomy (RP). All patients underwent radiotherapy with image-guided IMRT/VMAT to a total dose of 62.5 Gy in 2.5 Gy/fraction in 25 fractions. Sixteen patients (14%) received concomitant androgen deprivation therapy. RESULTS: With a median follow-up of 29 months (range 3-60 months) all patients but three are alive. Eleven patients (10%) developed exclusive biochemical relapse while 19 patients (17%) presented macroscopically visible relapse: prostatectomy bed in two patients (2%), pelvic lymph nodes in 13 patients (11.5%) and distant metastases in four patients (4%). The 3 years actuarial rates for OS, bFRS, and DMFS were 99.1, 91.1 and 91.2%, respectively. Acute and late tolerance was satisfactory. Maximal acute genitourinary (AGU) toxicity was G2 in 8% of patients; maximal acute gastrointestinal (AGI) toxicity was G2 in 3.5% of patients; maximal late genitourinary (LGU) toxicity was G3 in 1% of patients and maximal late gastrointestinal (LGI) toxicity was G2 in 2% of patients. There were no cases of severe acute or late toxicity. No relationship was found between acute or late GI/GU adverse effects and dosimetric parameters, age, presence of comorbidities or concomitant treatments. CONCLUSIONS: Hypofractionated radiotherapy (62.5 Gy in 25 2.5 Gy fractions) is feasible and well tolerated with low complication rates allowing for a moderate dose-escalation that offers encouraging clinical results for biochemical control and survival in patients with prostate cancer after radical prostatectomy.
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Prostatectomia , Neoplasias da Próstata/radioterapia , Neoplasias da Próstata/cirurgia , Hipofracionamento da Dose de Radiação , Idoso , Institutos de Câncer , Terapia Combinada , Estudos de Viabilidade , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Radioterapia Guiada por Imagem , Estudos Retrospectivos , Centros de Atenção Terciária , Resultado do TratamentoRESUMO
OBJECTIVES: This study explores the experiences of incarcerated women living with their children in the Women Chorrillos Penitentiary, Lima, Peru, 2020. MATERIAL AND METHOD: Qualitative, exploratory study with a phenomenological design, through semi-structured interviews with inmates who lived with their minor in the prison. In total there were 13 interviews considering the theoretical saturation of categories. RESULTS: The experiences consisted of mostly negative intrapersonal experiences, related to different individual aspects and the conditions of confinement and prison treatment. Serious deficiencies perceived in the health care of inmates and children stand out, with emphasis on mistreatment and indifference on the part of the staff. Other factors involved in the construction of these experiences were identified. DISCUSSION: The results provide evidence of serious structural and organizational deficiencies that violate the fundamental rights of the population group studied. Government efforts to date are partial and insufficient. Sustainable policies and programs are urgently needed that prioritize quality health care and adequate prison treatment for these people with an emphasis on preventive promotional actions. There is a need for evidence-based interventions to reduce the harmful effects of childhood incarceration.
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Prisioneiros , Prisões , Criança , Feminino , Humanos , Mães , Peru , Pesquisa QualitativaRESUMO
El vestíbulo nasal corresponde a la primera porción de la fosa nasal, éste se encuentra delimitado lateralmente por los cartílagos alares y medialmente por el borde caudal del septum nasal y la columela. Las enfermedades infecciosas del vestíbulo nasal son patologías frecuentes en la práctica clínica; su diagnóstico se realiza en base a sospecha clínica y examen físico, requiriendo habitualmente solo manejo médico ambulatorio. Desde el punto de vista etiológico pueden ser virales, bacterianas y fúngicas. Las principales especies bacterianas involucradas corresponden a Staphylococcus coagulasa negativa, S. epidermidis, S. hominis y S. haemolyticus, difteroides spp y S. aureus. Su manejo es esencialmente médico con casos excepcionales requiriendo manejo quirúrgico. En la actualidad existe escasa información epidemiológica al respecto, lo que dificultad la clasificación de los dichos cuadros clínicos. Se realizó una revisión de la literatura sobre cuadros infecciosos que afectan el vestíbulo nasal para lograr sistematizar y clarificar las distintas patologías y sus tratamientos.
The nasal vestibule corresponds to the first portion of the nasal passage, limited laterally by the lateral crus and medially by the caudal edge of the nasal septum and columella. Infectious diseases of the nasal vestibule are frequent in clinical practice, diagnosis is made based on clinical suspicion and physical examination, usually requiring only ambulatory medical management. In terms of etiology, they can be viral, bacterial and fungal. The main bacterial species involved correspond: Coagulase-negative Staphylococcus, S. epidermidis, S. hominis and S. haemolyticus, difteroides spp and S. aureus. Management is essentially medical and only exceptionally requires surgery. Currently, there is a lack of epidemiological information in this regard, which makes it difficult to classify these clinical conditions. A review of the literature on infectious conditions that affect the nasal vestibule was performed, to systematize and clarify the different pathologies and their management.