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The aim of the research is to examine the relationships between the following variables (a) Theory of Planned Behavior (TPB), composed of Attitudes (ATT), Subjective Norms (SN), and Perceived Behavioral Control (PBC); and (b) Consciousness (EC) on the dependent variable Environmentally Responsible Purchase Intention (ERPI) from the perspective of the Latin American consumer in a pandemic. Currently, the literature on the relationships proposed in the explanatory model is still scarce at a theoretical and practical level, without empirical evidence in Latin America. The data collection is from 1624 voluntary responses from consumers in Chile (n = 400), Colombia (n = 421), Mexico (n = 401), and Peru (n = 402) collected through online surveys. Using structural equation modeling (SEM) and multi-group to test invariance analysis and the moderating effects, we can determine the relationship between the variables in the proposed model, generating evidence from Latin American countries. The empirical analysis verified that Attitude (ATT), Perceived Behavioral Control (PBC), and Environmental Consciousness (CE) have a positive and significant effect on Environmentally Responsible Purchase Intention (ERPI). The results also show that the generation variable presents invariance. Therefore, the groups are not different at the model level for the generation variable, becoming relevant to the difference at the path level. Therefore, the results of this study become a relevant contribution, indicating a moderating effect on the generation variable. This research provides insights for understanding Latin American consumers, and managerial implications are also provided for developing strategies to promote sustainable consumption.
Assuntos
COVID-19 , Mudança Social , Humanos , América Latina , Teoria Psicológica , Atitude , Intenção , Inquéritos e Questionários , Comportamento do ConsumidorRESUMO
Las encefalitis autoinmunes son una condición emergente, caracterizada por la aparición repentina de síntomas psicóticos o depresivos "de novo", crisis convulsivas o estatus epiléptico refractario, o demencia rápidamente progresiva. Las encefalitis autoinmunes están asociadas a diversos fenómenos desencadenantes, como infecciones virales previas entre las más comunes, y se asocian con la presencia de anticuerpos antineuronales y/o onconeuronales, que deben estudiarse ante la sospecha de esta entidad. Es muy importante desarrollar un diagnóstico presuntivo y precoz, ya que la terapia con inmunosupresores como los corticoides -iniciados en el momento oportuno-, puede cambiar su evolución hacia la mejoría clínica. Presentamos un paciente con encefalitis autoinmunes y anticuerpos anti-Titina positivos (habitualmente presentes en timoma y miastenia gravis), no asociados a neoplasia conocida y con buena respuesta a esteroides.
Autoimmune Encephalitis, are an emerging condition, characterized by the sudden onset of psychotic or depressive symptoms "de novo", refractory seizures or epilepsy, or rapidly progressive dementias. The autoimmune encephalitis are associated to various triggered phenomena as a previous viral infections among others; it's related to the presence of antineuronal and/or onconeuronal antibodies, and there must be studied when autoimmune encephalitis is suspected. It is very important to develop a presumptive and early diagnosis, since steroid therapy -on opportunity time- can change its evolution towards clinical improvement. We present a patient with autoimmune encephalitis, and positive anti-Titin antibodies (usually presents in thymoma and myasthenia gravis) not associated with known neoplasia, and with a good response to steroids.
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El Síndrome de Ramsay-Hunt (SRH), es la segunda causa de parálisis facial periférica (PFP). Causado por el virus Varicella zoster (VVZ), ipsilateral a la PFP,presenta unaerupción herpetiforme y cefalea en distribución del nervio facial. Presentamos el caso de una mujer, 54 años, con SRH y cefalea persistente cuyo líquido cerebroespinal (LCE) fue compatible con meningitis. Se indicó aciclovir endovenoso (EV). La literatura no recomienda estudio de LCE en PFP; y en SRH se sugiere en inmunosuprimidos y complicaciones del SRH como queratopatía, accidentes-cerebrovasculares, y meningitis. Un LCE alterado en SRH, indica modificar la conducta terapéutica.
Ramsay-Hunt Syndrome (RHS) is the second leading cause of peripheral facial palsy (PFP). Caused by the Varicella zoster virus (VZV), ipsilateral to the PFP, it presents a herpetiform rash and headache in the facial nerve distribution. We present the case of a 54-year-old woman with RHS and persistent headache whose cerebrospinal fluid (CSF) was compatible with meningitis. Intravenous acyclovir was indicated. The literature does not recommend an CSF study in PFP; in RHS it is suggested in immunosuppressed patients and complications of RHS such as keratopathy, cerebrovascular accidents, and meningitis. An altered CSF in RHS indicates modifying the therapeutic conduct.
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BACKGROUND: Thymic tumors are unusual neoplasms, representing 0.2 to 1.5% of tumors in humans, but correspond to 20% of mediastinal tumors and 50% of those that occur in the anterior mediastinum. They tend to appear around the fourth and fifth decades of life without gender predilection. Up to 30% of patients are asymptomatic, therefore many are incidentally diagnosed. Radical thymectomy is the treatment of choice with high survival rates when detected in the early stages. METHODS: This was a retrospective descriptive study, including 18 adult patients' diagnosis of thymic neoplasm, who were managed with surgical resection from 2011 to 2019. Information about demographics, clinical characteristics, imaging findings, surgical and medical management, plus histological findings was obtained and reported. RESULTS: 18 patients with thymic tumors were included, of which specific histologic studies reveled thymomas, carcinomas, neuroendocrine tumors, thymolipoma and thymic cyst. Mean age was 52.7 years, with a predominance of male population. The main symptom was dyspnea, followed by cough and chest pain. Paraneoplastic syndromes such as myasthenia gravis, aplastic anemia and Cushing syndrome were reported. 89% of cases were treated by radical thymectomy alone, while only 2 cases required chemotherapy and radiotherapy. There were no surgical complications. Mean hospital stay length was 11. 9 days, with only 1 mortality during hospital admission. 5-year survival rate was 81%. CONCLUSIONS: The treatment of choice is radical thymectomy, which has been shown to positively impact patient mortality. Early detection is key to improve patient outcomes.
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Síndromes Paraneoplásicas/epidemiologia , Timectomia , Timo/patologia , Neoplasias do Timo/cirurgia , Idoso , Carcinoma/complicações , Carcinoma/diagnóstico , Carcinoma/mortalidade , Carcinoma/cirurgia , Colômbia/epidemiologia , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Lipoma/complicações , Lipoma/diagnóstico , Lipoma/mortalidade , Lipoma/cirurgia , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/complicações , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/mortalidade , Tumores Neuroendócrinos/cirurgia , Síndromes Paraneoplásicas/etiologia , Estudos Retrospectivos , Taxa de Sobrevida , Timoma/complicações , Timoma/diagnóstico , Timoma/mortalidade , Timoma/cirurgia , Timo/diagnóstico por imagem , Timo/cirurgia , Neoplasias do Timo/complicações , Neoplasias do Timo/diagnóstico , Neoplasias do Timo/mortalidadeRESUMO
BACKGROUND: The sternum is considered an unusual tumor site, corresponding to 15% of all thoracic wall tumors. Primary sternal tumors are even rarer and most commonly malignant. We present the case of a young man who consulted with a painful sternal mass, which after its resection is confirmed to be a cavernous hemangioma. CASE PRESENTATION: A 39-year-old man, with unremarkable medical history besides a 2-year-long sternal pain, non-irradiated, which worsens over the last few months and is accompanied by the appearance of a sternal palpable mass. On physical exam, there was a bulging of the sternal manubrium, with no inflammatory changes. Thoracic CT scan shows an expansive and lytic lesion of the sternum, compromising the manubrium and extending to the third sternocostal joint, without intrathoracic compromise nor cleavage plane with mediastinal vascular structures. The patient is taken to resection of the mass and sternal reconstruction using prosthetic material and pectoral and fasciocutaneous muscular flaps. Histopathological findings: cavernous hemangioma with negative borders and no other malignant findings. CONCLUSIONS: Sternal hemangiomas can cause defects in the bone structure and show an expansive growth, challenging the differentiation between a benign or malignant lesion. Therefore, they should be considered malignant until shown otherwise. Management involves radical surgery with curative purposes and posterior reconstruction to improve quality of life, as shown with our patient.
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Hemangioma Cavernoso/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Esterno/cirurgia , Parede Torácica/cirurgia , Adulto , Hemangioma Cavernoso/diagnóstico por imagem , Humanos , Masculino , Qualidade de Vida , Esterno/diagnóstico por imagem , Parede Torácica/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
Solitary fibrous tumors of the pleura (SFTP) are rare mesenchymal neoplasms that originate from mesenchymal growth in the pleura, tend to be single tumors, usually have an indolent course and show nonspecific symptoms. SFTP can be often diagnosed from an incidental finding of a single mass in the thorax and should be confirmed by biopsy and immunohistochemistry. A minority of cases may present Doege-Potter syndrome (DPS, episodes of refractory hypoglycemia) associated with production of insulin-like growth factor 2 (IGF-2). Both SFTP and DPS are rare occurrences with less than 2000 cases reported worldwide. The curative treatment is tumor resection. Two cases of patients with DPS caused by SFTP are presented below.
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BACKGROUND: Lipomas are the most common benign soft tissue tumors in the general population. These lesions can appear on any part of the body and usually develop in the subcutaneous superficial tissue. Lipomas that show ossifying changes are very rare, representing less than 1% of the reported lipomas. They usually manifest as hard nodular lesions in the head and neck, the extremities, the sternoclavicular region, and the subcutaneous tissue in general; they are rare in the costal arches. CASE PRESENTATION: We report the case of a patient with a history of multiple diseases and 2 tumor-like lesions with internal lytic areas detected in the fourth right costal arch and in the eighth left costal arc; we describe his clinical manifestations, radiological and laboratory findings as well as the pathological results and outcome. CONCLUSIONS: Ossifying lipomas are rare benign tumors with asymptomatic clinical presentation. It is important to perform an adequate radiological differentiation from other more aggressive lesions such as liposarcomas.
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INTRODUCTION: Paragangliomas (PGGL) are rare neuroendocrine tumors arising from non-epithelial extra-adrenal chromaffin cells. They have been described in different sites: abdomen, pelvis, head, neck and thorax. Incidence is very low, occurring in less than 2-8/million per year. PGGL's of the lung are extremely rare, they have a slow growth and present as painless lesions. Biopsy is the method of choice for diagnosis and prognosis. PRESENTATION OF CASE: This is a 70-year-old woman with chronic cough, with a CT-scan showing a 3.3-cm mass in the left lower lobe. After video-assisted thoracic surgery, histologic findings confirmed a non-functioning pulmonary paraganglioma. We present the clinical, radiological, pathological findings and clinical course. DISCUSSION: Primary pulmonary PGGL's are extremely rare neuroendocrine tumors with low-grade malignancy, difficult to distinguish from other pulmonary tumors relying only on imaging techniques. In this case, PGGL presented as an incidentaloma during the evaluation of chronic cough. After histological diagnosis, genetic testing are ideally performed to identify somatic or germline mutations that may condition a higher risk of malignancy and metastasis. CONCLUSION: PGGL's must be considered when other diagnoses are unlikely due to immunohistochemistry findings. Larger studies in this field are needed to determine the risk factors for its development and to determine which populations have the greatest potential for malignant transformation.
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BACKGROUND: The term goiter is used to describe any abnormal growth of the thyroid gland, which can be diffuse or nodular, and can be associated with normal, diminished, or increased thyroid function. Multinodular goiter is a common disease whose prevalence increases at age 50. Clinical manifestations can be due to thyroid function impairment or related to size and location of the gland with compressive symptoms. Intrathoracic location is less frequent, can be mistaken with pulmonary lesions and usually implies a difficult surgical approach. CASE PRESENTATION: A 66-year-old woman with a history of subtotal thyroidectomy presented with 7-month dyspnea, dry cough. There was no evidence of neck masses, or jugular engorgement. Physical examination was normal. Chest x-ray showed an 11 cm mass in the upper right hemithorax. Computed tomography (CT)-scan, showed calcifications, and compression of the superior vena cava without infiltration, the right subclavian vein and left displacement of the trachea. Distinction between intrapulmonary or mediastinal location was not clear. Biopsy showed thyroid origin, and bilateral thoracotomy was performed with confirmation of a giant multinodular goiter. CONCLUSIONS: Intrathoracic goiter should undergo surgical or ablative management if compressive symptoms of the airway and cervical or thoracic vessels are present. The large size of the tumor along with the presentation after thyroidectomy and the seeming location in the right upper lobe made this particular case striking. Specially in the elderly, multidisciplinary perioperative management is key for a successful recovery.
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Pulmonary complications are prevalent among patients with hematologic malignancies, who are at high risk of developing acute respiratory distress syndrome (ARDS). Although diffuse alveolar damage is considered the diagnostic hallmark of ARDS, there are plenty of other non-diffuse alveolar damage etiologies that can mimic ARDS and benefit from a specific therapy, therefore correcting the underlying cause. When the etiology remains unclarified despite noninvasive procedures, a surgical lung biopsy (either open via thoracotomy or video-assisted thoracoscopic surgery [VATS]) may be warranted. However, the role of surgical lung biopsy has not been extensively studied in patients with hematologic malignancy and ARDS and so doubt exists about the risk-benefit relationship of such procedures. In this article, we report a series of 8 critically ill patients with hematologic malignancies and ARDS, who underwent VATS lung biopsy, in a specialized institution in Cali, Colombia, from 2015 to 2019, with special emphasis on its diagnostic yield, modifications in treatment protocol, and safety. VATS lung biopsy is a minimally invasive procedure that appears to be a relatively safe with few postoperative complications and minimal perioperative mortality. It has a high diagnostic yield, resulting in a modification of treatment in a nondepreciable percentage of patients. However, this subset of patients was critically ill, with a high risk of mortality, and the lung biopsy did not appear to affect in this aspect. Future randomized controlled trials are needed to further clarify this topic.