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BACKGROUND: Novel and highly effective drugs for non-melanoma skin cancer (NMSC) improve patient outcomes, but their high cost strains healthcare systems. Spain's decentralized public health system, managed by 17 autonomous communities (AaCc), raises concerns about equitable access. METHODS: A cross-sectional survey (July-September 2023) was sent to Spanish Multidisciplinary Melanoma Group (GEM Group) members to assess access to new drugs. FINDINGS: Fifty physicians from 15 Spanish AaCc responded to the survey. Access for drug with approved public reimbursement, Hedgehog inhibitors in basal-cell carcinoma and anti PD-L1 antibody in Merkel carcinoma, was observed in 84% and 86% of centers, respectively. For other EMA-approved treatments, but without reimbursement in Spain access decreased to 78% of centers. Heterogeneity in access was mainly observed intra regions. CONCLUSION: Unequal financial support for drugs for NMSC with creates a patchwork of access across Spanish hospitals, with variations even within the same AaCc.
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BACKGROUND: The Spanish Melanoma Group (GEM) developed a national registry of patients with melanoma infected by SARS-CoV-2 ("GRAVID"). METHODS: The main objective was to describe the COVID-19 fatality rate in patients with melanoma throughout the pandemic, as well as to explore the effect of melanoma treatment and tumor stage on the risk of COVID-19 complications. These are the final data of the register, including cases from February 2020 to September 2021. RESULTS: One hundred-fifty cases were registered. Median age was 68 years (range 6-95), 61 (40%) patients were females, and 63 (42%) patients had stage IV. Thirty-nine (26%) were on treatment with immunotherapy, and 17 (11%) with BRAF-MEK inhibitors. COVID-19 was resolved in 119 cases, including 85 (57%) patients cured, 15 (10%) that died due to melanoma, and 20 (13%) that died due to COVID-19. Only age over 60 years, cardiovascular disorders, and diabetes mellitus increased the risk of death due to COVID-19, but not advanced melanoma stage nor melanoma systemic therapies. Three waves have been covered by the register: February-May 2020, August-November 2020, and December 2020-April 2021. The first wave had the highest number of registered cases and COVID-19 mortality. CONCLUSION: Tumor stage or melanoma treatments are non-significant prognostic factors for COVID-19 mortality. During the pandemic in Spain there was a downward trend in the number of patients registered across the waves, as well as in the severity of the infection. GOV IDENTIFIER: NCT04344002.
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COVID-19 , Diabetes Mellitus , Melanoma , Feminino , Humanos , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Masculino , COVID-19/epidemiologia , SARS-CoV-2 , Melanoma/complicações , Melanoma/terapia , Sistema de RegistrosRESUMO
Introducción: La incidencia de eventración post quirúrgica es del 2-20%, se da mayormente en pacientes con factores de riesgo durante los primeros tres años posteriores a la cirugía inicial. La mayoría de las hernias de la pared abdominal pueden ser reparadas fácilmente, sin embargo, las hernias gigantes (>10cm de diámetro) o aquellas con pérdida de domicilio requieren métodos de expansión gradual de la pared abdominal pre y/o transoperatoriamente. Se ha descrito que posterior a la aplicación de toxina botulínica serotipo A (TBA) de forma bilateral en la pared abdominal, los defectos disminuyen clínica y tomográficamente hasta 5.25cm, por su efecto selectivo en terminaciones nerviosas periféricas colinérgicas, provocando atrofia muscular sin fibrosis. El efecto máximo ocurre al mes de la aplicación y dura 28 semanas. Esta técnica permite planear preoperatoriamente la magnitud de la cirugía. Nuestro caso, paciente masculino de 33 años. Quien ingresa por politrauma. Se realiza procedimiento quirúrgico abdominal y posteriormente se eviscera en múltiples ocasiones. Se cierra herida y posteriormente desarrolla hernia ventral gigante con la que egresa. Se realiza TC abdominal evidenciando defecto herniario de 15.9cm, con este resultado se aplica toxina botulínica serotipo A en la pared abdominal bilateral (50 unidades en cada lado) guiado por ultrasonido. 25 días después se realiza TC abdominal control que evidencia defecto herniario de 14.7cm y se decide ingreso para cirugía electiva. Se decide llevar a sala de operaciones donde se realiza hernioplastía con liberación de componentes anteriores mas colocación de malla de polietileno (cuatro semanas posteriores a la aplicación de la toxina), quedando defecto totalmente cerrado y sin tensión. Paciente con adecuada evolución posterior a intervención por lo que egresa. Actualmente sin defecto herniario recurrente. Conclusión: El uso de toxina botulínica serotipo A es un nuevo recurso prequirúrgico para la preparación de pacientes con hernias ventrales gigantes, ya que permite el cierre sin tensión en la mayoría de los casos. Además, ayuda a que transoperatoriamente la separación de componentes se realice de una mejor manera, ya que se da mejor manipulación al momento de desplazar las estructuras musculares. Idealmente se debe de realizar la intervención quirúrgica cuatro semanas posteriores a su aplicación. (AU)
ntroduction: The incidence of post-surgical eventration is 2-20%, it occurs mostly in patients with risk factors during the first three years after the initial surgery. Most abdominal wall hernias can be easily repaired, however, giant hernias (>10cm of diameter) or those with the loss of domain require methods of gradual expansion of the abdominal wall pre or intraoperatively. It has been described that after the application of botulinum toxin A bilaterally in the abdominal wall, the defect can decrease clinically and tomographically up to 5.25cm, due to its selective effect on cholinergic peripheral nerve endings, that cause muscle atrophy without fibrosis. The maximum effect occurs one month after the application and lasts 28 weeks. This technique allows to plan preoperatively the magnitude of the surgery. Description of case: A 33 year old male patient, who entered the emergency room due to polytrauma. Abdominal surgical procedure was performed and later he eviscerates on multiple occasions. The wound was closed and later he develops a giant ventral hernia with which it is discharged. An abdominal CT was performed, showing a hernia defect of 15.9cm. With this result botulinum toxin A was applied guided by ultrasound bilaterally in the abdominal wall (50 U on each side). A control abdominal CT was performed after 25 days, which it revealed a hernia defect of 14.7 cms, so admission was decided for elective surgery. The patient was taken to the operating room where a hernioplasty with anterior components separation plus the placement of a polyethylene mesh was performed (four weeks after the application of the botulinum toxin A), the hernia defect was completely close without tension. The patient had an adequate post-surgical evolution for which it was discharge. Currently without a recurrent hernia defect. Conclusion: The use of botulinum toxin A is a new pre-surgical resource for the preparation of patients with giant ventral hernias, since it allows the closure without tension in most cases. In addition, it helps transoperatively with the components separation, since there is a better manipulation at the time of displacing the muscular structures. Ideally, the surgical intervention should be performed four weeks after its application. (AU)
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Humanos , Masculino , Adulto , Ferimentos e Lesões/complicações , Toxinas Botulínicas Tipo A/administração & dosagem , Hérnia Ventral/cirurgia , Telas Cirúrgicas/tendências , Complicações Intraoperatórias/diagnóstico , Laparotomia/instrumentaçãoAssuntos
Dissidências e Disputas , Ferimentos por Arma de Fogo/patologia , Chile , Balística Forense , Humanos , Radiografia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Ferimentos por Arma de Fogo/diagnóstico por imagem , Ferimentos por Arma de Fogo/etiologia , Ferimentos Penetrantes/diagnóstico por imagem , Ferimentos Penetrantes/etiologia , Ferimentos Penetrantes/patologiaRESUMO
Introducción. La macrosomía fetal es un factor de riesgo para complicaciones maternas y neonatales. Se ha asociado a mal control metabólico del embarazo, diabetes gestacional y pregestacional. A la fecha, no hay estudios locales sobre las características clínicas de madres no diabéticas de hijos macrosómicos. Objetivo. Describir características clínicas de madres sin antecedente de diabetes que tienen hijos macrosómicos, atendidas en la maternidad del Hospital Carlos van Buren durante el año 2017. Materiales y métodos. Se realizó un estudio transversal con enfoque analítico. Se recolectó la información a través de fichas clínicas y carnet prenatal de las pacientes no diabéticas con hijos macrosómicos. Se presentan de manera descriptiva las distintas variables de estudio, y se analizaron las asociaciones entre las variables mediante análisis estadístico. Resultados: Se incluyeron 68 madres con recién nacidos macrosómicos, con un promedio de edad de 25,8 años (±6.3 años). Entre sus hijos, 48 (70.5%) fueron de sexo masculino, con un peso promedio de 4.207,5g (±183g). De las 49 (72%) pacientes multíparas, ninguna presentó historia de diabetes gestacional previa. El índice de masa corporal (IMC) promedio fue de 29,7 (±5.2), el 39,4% (20) presentó acrocordon y el 19,1% (13) acantosis nigricans. La glicemia de ayuno del primer trimestre promedio fue de 83.4 mg/dL (±5.4mg/dL) y el promedio de HbA1c fue 5.2% (±0.3%). El 47% de las pacientes registró complicaciones del parto. Se encontró una asociación significativa entre las complicaciones del parto y la HbA1c (p = 0.014) y una correlación positiva entre el IMC materno con el peso de nacimiento (Rho = 0.23) Conclusiones: La macrosomía se asocia a complicaciones del parto, incluso en hijos de madres no diabéticas. Existe una correlación positiva entre un mayor IMC y el desarrollo de macrosomía. Son necesarios estudios de distinta metodología para desarrollar modelos predictivos en base a factores de riesgo.
Introduction. Fetal macrosomia is a risk factor for maternal and neonatal complications. It has been associated with poor metabolic control of pregnancy, gestational and pregestational diabetes. To date, there are no local studies on the clinical characteristics of non-diabetic mothers of macrosomic children. Objective. Describe clinical characteristics of mothers without a history of diabetes who have macrosomic children, attended in the maternity of Carlos van Buren Hospital during the year 2017. Materials and methods. A cross-sectional study with an analytical approach was carried out. The information was collected through clinical files and prenatal card of non-diabetic patients with macrosomic children. The different study variables are presented in a descriptive way, and the associations between the variables were analyzed through statistical analysis. Results: We included 68 mothers with macrosomic newborns, with an average age of 25.8 years (± 6.3 years). Among their children, 48 (70.5%) were male, with an average weight of 4,207.5g (± 183g). Of the 49 (72%) multiparous patients, none had a history of previous gestational diabetes. The average body mass index (BMI) was 29.7 (± 5.2), 39.4% (20) presented acrocordon and 19.1% (13) acanthosis nigricans. Fasting glycemia in the first quarter was 83.4 mg / dL (± 5.4 mg / dL) and the average HbA1c was 5.2% (± 0.3%). 47% of the patients registered complications of childbirth. A significant association was found between labor complications and HbA1c (p = 0.014) and a positive correlation between maternal BMI and birth weight (Rho = 0.23). Conclusions: Macrosomia is associated with labor complications, even in children of non-diabetic mothers. There is a positive correlation between a higher BMI and the development of macrosomia. Studies of different methodology are necessary to develop predictive models based on risk factors.
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Humanos , Masculino , Feminino , Gravidez , Recém-Nascido , Adulto , Complicações na Gravidez , Macrossomia Fetal/epidemiologia , Índice de Massa Corporal , Paridade , Peso ao Nascer , Hemoglobinas Glicadas , Fatores Sexuais , Estudos Transversais , Idade GestacionalRESUMO
Se realiza un estudio preliminar del rayo láser en verrugas plantares se analizan 70 pacientes tratados con esta terapeútica donde se pudo comprobar que un gran por ciento de ellos fueron tratados con una sola aplicación, utilizando una salida de 25 watt. El dolor desapareció después de la primera aplicación en un 90(por ciento), lo cual indica que este tratamiento supera a los anteriores.