Medwave最新文献

Since surgery is a complex procedure due to multiple factors, it is more difficult to rigorously evaluate innovative processes in this field than clinical trials of new drugs. Being able to carry out an adequate study design with all its corresponding implications, achieving high-quality standards for these studies, ensuring respect for patients' rights, and verifying that their principles of beneficence, minimization of the risk of harm, justice and autonomy are a challenge for many researchers and professionals involved in the surgical process. Hence, it is advantageous to have guides that guarantee the methodological quality of research on innovative surgical procedures and that these guides include the ethical aspects involved in each of their stages. This review aims to make a historical overview of what has been published on the ethical approach to surgical innovation. In addition, the ethical aspects of the stages of the IDEAL framework for surgical innovation will be explained.

Breast cancer is the second most common neoplasm and the deadliest among women worldwide. Its incidence varies according to human development and is associated with several risk factors, including age, genetic factors, obesity, and dietary habits. Recent research has revealed a significant influence of dietary habits on the onset and progression of this disease, which is why this review aims to comprehensively analyze the available literature to understand better the role played by the mediterranean diet in the development and management of breast cancer. The mediterranean diet has anti-inflammatory and antioxidant effects, may influence gene regulation, and produce hormonal and intestinal microbiota changes, resulting in improved quality of life for breast cancer patients by alleviating symptoms such as pain, inflammation, and reducing the risk and mortality from this disease. Evidence suggests that greater adherence to the mediterranean diet reduces the risk of breast cancer, as well as an improvement in patients' quality of life and mortality. These findings underscore its potential relevance in the context of dietary patterns associated with breast cancer prevention and management, which could inform considerations for public health policies. Further research is needed to confirm these observations and to understand the underlying mechanisms better.

Introduction: Handgrip strength is a key indicator of functional health and overall muscular strength. These parameters are essential for assessing physical performance and health status. This study aims to assess handgrip strength and body composition in young Ecuadorian university adults.

Methods: This was a cross-sectional study conducted among university students from the Faculty of Health Sciences at Universidad Católica de Santiago de Guayaquil. Participants completed a self-administered questionnaire for demographic variables. Handgrip strength was assessed in both hands with an hydraulic dynamometer. Body composition was measured using a bioelectrical impedance device.

Results: 350 participants were included in the study, consisting of 65.5% (n=233) females and 33.4% (n=177) males. The mean age was 22 ± 2.09 years. The mean muscle mass was 24.4 ± 6.9 kg, and the mean fat mass was 22.0 ± 12.9 kg. The visceral fat value was 8.0 ± 3.1 points. The mean handgrip strength for males was 39.6 ± 8.07 kg in the right arm and 38.5 ± 8.07 kg in the left hand, and for females, was 23.0 ±5.57 kg in the right arm and 22.0 ± 5.84 kg in the left arm. Muscle mass positively correlated with handgrip strength in both sexes and both hands, with Rho = 0.813 (p<0.001) for the right arm and Rho = 0.798 (p<0.001) for the left arm.

Conclusions: We established reference values for handgrip strength and body composition in healthy young Ecuadorian adults, showing handgrip strength's positive association with muscle mass and anthropometric variables.

Cocaine abuse poses a significant public health challenge, leading to severe systemic and localized complications. Intranasal cocaine use can result in chronic rhinitis, septal perforation, and palatal perforation due to its vasoconstrictive effects, which cause ischemia and tissue necrosis. We present the case of a 44- year-old woman with a 10-month history of palatal perforation, attributed to 12 years of chronic cocaine use, presented with nasal regurgitation, feeding difficulties, and cachexia. Examination revealed a 3 x 2 cm palatal perforation, nasal asymmetry, and a saddle nose deformity. Computerized tomography scans showed extensive nasal septum perforation and sinus mucosal thickening. Initial treatment involved antibiotics for sinusitis, followed by the fabrication of an obturator prosthesis to improve speech and feeding. The chronicity and extent of the palatal and nasal damage illustrates the severe consequences that can arise from sustained abuse. This case highlights not only the physical manifestations but also the challenges in managing such cases, emphasizing the necessity of a multidisciplinary approach. The integration of dental, otolaryngological, and psychological care is crucial for both immediate and long-term management. The main lesson from this case is the importance of comprehensive, patient-centered care that prioritizes stabilization and quality of life while supporting the patient's path to rehabilitation. Provisional treatment with an obturator prosthesis can provide significant improvement in speech and feeding, providing a viable solution until the patient can maintain abstinence. Conservative management and prosthetic rehabilitation remain effective options, reinforcing the need for individualized, multidisciplinary care strategies.

Introduction: Lung cancer is the leading cause of death by cancer worldwide and has a high lethality. The best treatment for patients with localized disease is anatomical surgical resection, granting good average survival in the long term. We did not find Chilean studies focusing on complications, long term survival or potential association with pathological or clinical factors. The aim of this work is to describe clinical characteristics, surgical complications and 5-to-10-year survival of a cohort of lung cancer patients operated in the Clinical Hospital of University of Chile and explore possible prognostic factors influencing in it.

Methods: A 107 patient's cohort of operated lung cancer patients in a single center from 2004 to 2015 was analyzed. We included patients with curative intent surgery performed in our hospital and excluded non- primary lung cancer histology or biopsies analyzed in other center. Clinical, perioperative and histopathologic data were collected. 5-10 year overall survival was determined and an exploratory analysis of prognostic factors on survival was performed.

Results: We found 107 surgeries fulfilling criteria, with 27% morbidity and 5.6% and 6.5% mortality at 30 and 90 days, respectively. 5- and 10-year overall survival was 44.7% and 32.3%, respectively. Univariate analysis found that gender, age, histology, disease stage, loco-regional dissemination and postoperative complications were factors associated with survival. Multivariate analysis confirmed that gender, age, loco-regional dissemination and postoperative complications were independent factors associated with survival.

Conclusions: Surgical results of a cohort of patients operated in a Chilean center show that 30 and 90-days mortality aligned with data reported worldwide. Overall survival in these selected patients is far better than reported in lung cancer patients. Risk factors that may be screened in preoperative analysis were found, which could change prognosis. Those findings suggest that improving preoperative evaluation could optimize patient selection to obtain better performance in surgical results and overall long-term survival.

The World Health Organization (WHO) highlights the importance of improving the design of public health interventions and policies by applying principles from the behavioral sciences. These sciences play a crucial role in modifying behaviors and addressing a wide range of health challenges, from pandemics and chronic diseases to the climate crisis. This article examines the transformative impact of behavioral sciences on public health promotion, focusing on the factors that influence decision-making and intervention strategies based on the six principles developed by the WHO Technical Advisory Group. Additionally, it addresses the significant shortage of Spanish-language literature on this topic, reviewing contributions from influential scientists and key theoretical models. The WHO's recommendations for the effective implementation of these interventions in public health are also discussed. This work not only fills a critical gap in the Spanish-language literature but also provides practical tools to improve public health in Spanish-speaking countries.

This analysis article aimed to identify and analyze all articles published on the post-COVID-19 condition in Latin America and the Caribbean, focusing on epidemiology, clinical characteristics, and risk of bias. We did a systematic survey of the literature with broad inclusion criteria. The only exclusion criteria were articles referring to post-acute COVID-19 sequelae after an intensive care unit stay, which we distinguish from the post-COVID-19 condition. We searched MEDLINE/PubMed, LILACS, SciELO, Scopus, Web of Science, and Epistemonikos. We included 55 records, of which 48 were original articles (44 were observational research, 29 of which had a comparison group; and four reviews). Various definitions for long COVID were reported, or none, and few used the World Health Organization criteria. None of the included studies reported prevalence rates for the region. We extracted the reported signs and symptoms of long COVID for our region. Using the Johanna Briggs Institute critical appraisal tools for observational analytic research, we found that most included studies were prone to limitations and biases. We conclude that more research should be done on the post-COVID-19 condition in Latin America and the Caribbean, using rigorous study designs to inform public health strategies.

Female genital prolapse, especially apical prolapse, significantly affects women's health and quality of life. Sacrospinous hysteropexy is a widely used surgical procedure to address this condition, presenting few postoperative complications. However, one of the reported complications is neuropathic pain resulting from damage to the branches of the pudendal nerve. Despite the frequency of this complication, there are few standardized management alternatives. This article presents a clinical case of a 62-year-old patient who experienced persistent neuropathic pain after a sacrospinous hysteropexy, in whom traditional approaches such as physical therapy and medications were ineffective. Therefore, it was decided to perform a corticosteroid infiltration in the painful sites via the vaginal route with local anesthesia. The patient experienced immediate pain relief, which lasted for months without the need to repeat the infiltration. The available literature is scarce regarding the long-term success of this therapeutic technique, so this case highlights the potential mid-term efficacy of this alternative in managing postoperative neuropathic pain. This case contributes to the growing evidence that corticosteroid infiltration can be a viable option for the treatment of postoperative neuropathic pain, offering an improvement in the quality of life of affected patients. While this case shows an initial successful approach, further research is needed to validate and establish the applicability of vaginal corticosteroid infiltration in similar cases.

Introduction: Cervical dysplasia is a precursor lesion of cervical cancer, one of the leading causes of morbidity and mortality in women, especially in developing countries. This study aimed to identify the risk factors associated with the development of cervical dysplasia in women treated at the Santa María del Socorro Hospital in Ica, Peru, between 2017 and 2019.

Methods: An observational case-control study was conducted with 92 cases of women with confirmed high-grade intraepithelial lesion and 184 controls with consecutive negative results in Pap smears. Sociodemographic, behavioral, and clinical data were collected. Bivariate and multivariate logistic regression analyses were performed to identify factors associated with precancerous cervical lesions.

Results: The factors significantly associated with cervical dysplasia were age under 35 years (odds ratio: 1.2; 95% confidence interval: 0.1 to 0.7), having a partner (7.4; 2.3 to 23.5), body mass index ≥ 25 (12.9; 3.9 to 42.0), more than three sexual partners (71.4; 16.4 to 310.9), bacterial vaginosis (101.2; 12.2 to 838.2), grand multiparity (39.0; 7.1 to 225.4), rural origin (0.2; 0.1 to 0.8), use of injectables (0.2; 0.1 to 0.6), and intrauterine devide (0.04; 0.01 to 0.2).

Conclusions: Identifying these risk factors is crucial for cervical cancer prevention. It is recommended to implement early detection programs targeted at women with risk factors, especially those under 35 years and with multiple sexual partners.

Psychiatric symptoms are frequent in neurocognitive disorders and dementias. Psychotic symptoms, mainly hallucinations and delusions, may appear in up to 50% of cases, influencing morbidity and mortality. Genetic, neurobiological, and environmental factors are involved in their onset. We conducted a narrative review of primary articles developed in humans that analyzed the genetic and neurobiological basis of psychosis in dementias. Evidence suggests that there are genetic risk variants for presenting psychosis in dementia. How genetic variants are related to schizophrenia, dementia, and other neurodegenerative disorders is under discussion. Candidate gene studies have found and genetic variants are associated with psychosis in dementia while genome-wide association studies have shown variants located in y . Epigenetic studies are scarce but have detected differences in the methylome of people with dementia and psychosis. On the other hand, alterations of the cholinergic, serotonergic, dopaminergic, and gabaergic neurotransmitter systems and the excitatory-inhibitory balance have been described in dementia. From a functional and anatomical point of view, there are alterations in several regions, mainly in the frontal area and other sensory processing and integration areas. Finally, we describe the influence of cognitive alterations in the genesis and maintenance of delusions and discuss the phenomenological overlap with confabulations. Multiple genetic, neurobiological, structural, and cognitive factors influence the occurrence of delusions and hallucinations in persons with dementia. Further research is needed to understand the pathophysiology of psychosis in dementias. This approach would support the understanding of psychosis as a transdiagnostic entity.