Revista Medica Clinica Las Condes最新文献

In western countries, pancreatic ductal adenocarcinoma (PDAC) has shown a rising incidence and is currently one of the leading causes of cancer related mortality. Due to its aggressive biology, most patients diagnosed with PDAC present with advanced disease not suitable for curative treatment. An early detection strategy could potentially improve results by detecting more PDAC patients within the initial stages of the disease.

Currently, diagnosis of PDAC is mostly based in cross sectional imaging, including computed tomography and magnetic resonance imaging (MRI) as well as biomarkers such as CA 19-9. Selected cases might be further studied using endoscopic ultrasound (EUS) with the option of EUS guided biopsy if histology is needed to confirm diagnosis.

Due to its low incidence, screening general population for PDAC has been shown to be an ineffective and expensive approach. For this reason, efforts have shifted towards surveillance of specific groups of patients known to be at risk for development of PDAC. In these groups, screening has shown to have a higher yield for early cases and improved results in terms of resection rates and survival. These groups include carriers of certain oncogenic germline mutations, patients with strong family history for PDAC, and patients diagnosed with mucinous cystic neoplasms of the pancreas. Patients over 50 years old diagnosed with new-onset diabetes and patients living with chronic pancreatitis are also considered to be at risk for PDAC development. Patients selected for surveillance should be included in screening protocols including periodic imaging with MRI or EUS.

Development of biomarkers is an area of active research in the field of pancreatic cancer. New genetic or molecular biomarkers, to be measured in an isolated or combined manner, are an interesting approach looking to improve current diagnostic capabilities and to provide new tools for effective screening in wider groups of patients.

The aim of this article is to describe strategies currently available for early detection of PDAC, including promising research areas for the near future.

Cervical cancer is a global health challenge, with high incidence and mortality rates, particularly in countries with lower levels of human development. The progression of cervical cancer is well understood, from human papillomavirus infection to precancerous lesions and invasive cancer. This disease can be prevented through effective vaccination and early detection programs, which allow timely treatments, especially for pre-invasive conditions. In 2020, the World Health Organization launched a global initiative to eliminate cervical cancer, introducing the 90-70-90 strategy. This intervention seeks 90% vaccination coverage in girls under 15 years of age, at least two HPV screenings before the age of 45, and timely treatment for 90% of diagnosed patients. This paper aims to describe national and international updates in cervical cancer prevention, highlighting the progress of primary and secondary prevention with regards to decreasing its incidence.

Introduction

Knowing and satisfying the needs of breast cancer (BC) patients (P) and their caregivers (CG) during treatment can help to improve their quality of life. This study assessed the needs of BC-P, their CG and health professionals (HP) and their perception before and after an intervention aiming to improve healthcare. Methods. The study included an academic center (AC) and a public hospital (PH). Data were obtained from interviews, focus groups and self-completed surveys. A content analysis was performed using Nvivo software. Due to COVID19 restrictions, educational videos were delivered to HPs describing the identified needs. Finally, satisfaction surveys were applied to P and CG, before and after this intervention.

Results

A total of 22 participants were interviewed (7P, 5CG and 10HP). Three main needs were identified: 1) Healthcare related needs, 2) Financial issues and 3) Social support. Subsequently, a satisfaction survey was applied to users (stage I; n = 93) and the identified needs were used to design an intervention that consisted of educational videos directed towards HP. Following the intervention a second survey was applied (stage II; n = 71). Both surveys revealed high levels of satisfaction among users. Following the second survey, we noticed the emergence of other needs, mainly related to nutrition and the improvement of facilities.

Conclusions

This is the first study in Chile assessing BC-P needs from the perspective of P, their CG and HP. All participants indicated that information and social/financial support were the most relevant needs.

Bone metastases are frequent in cancer patients and are a frequent cause of complications due to the structural damage they cause at bone level, generating complications called “skeletal-related events” (SREs), which lead to significant deterioration in patient quality of life.

In the management of bone metastases, one of the objectives is to reduce pain and manage complications when they have already occurred, but another objective, no less important, is the prevention of SREs. Regarding the prevention of SRE, there is extensive knowledge and literature that supports the use of surgery and systemic treatments such as hormone therapy, bisphosphonates, radiopharmaceuticals and other agents. However, radiotherapy also has a role in the prevention of SRE in cancer patients with bone metastases since it has been shown to produce a greater latency for the occurrence of an SRE and a lower hospitalization rate, which translates into lower treatment costs and better. quality of life for patients. For this reason, the objective of the present work is to comment on the indications and benefits of prophylactic radiotherapy in the context of SRE prevention.

Objective

To report a case of peripartum cardiomyopathy with cardiogenic shock and cardiorespiratory arrest, which presented an adequate response to treatment with minimal sequelae.

Clinical case

31-year-old female, with a full-term pregnancy, without comorbidities. A scheduled cesarean section was performed due to a double circular cord. During the procedure, the patient presented cardiorespiratory arrest with return to spontaneous circulation. The patient later presents cardiogenic shock, arrhythmias and thromboembolic events, requiring management in the intensive care unit. The patient had a favorable clinical evolution, allowing for withdrawal of support measures and outpatient management of minor complications.

Peripartum cardiomyopathy is a pathology with an infrequent presentation. In order to be addressed in a timely manner, high suspicion is required to reach an early diagnosis. The use of implements such as echocardiography is essential in the initial evaluation. Multidisciplinary management in a specialized center is required.

Colorectal cancer (CRC) is the second cause of cancer in Chile and represents a public health problem due to its high morbidity and mortality. In the last 20 years, a progressive increase in its incidence has been described in patients under 50 years old. Early screening in general population is indicated in asymptomatic patients over 45 years old and has been shown to have an impact on mortality. The genetic and pathophysiological features of CRC make it susceptible to be screened using many strategies. The objective of this work is to review the latest emerging non-invasive screening methodologies currently being studied and developed using fecal, blood and urine samples, which may improve patient adherence to colorectal cancer screening programs.

Introduction

Chest pain is a common reason for consultation in clinical practice. Precordial catch syndrome seems to be one of the primary but less known causes.

Methods

A narrative review was conducted and expanded using the snowball method to find relevant articles.

Results

16 articles were found, only in English. Precordial catch syndrome is characterized by a brief stabbing pain, which worsens by breathing. No additional tests are required for diagnosis and the treatment focuses on patient education. Its etiology is not yet established.

Conclusion

Precordial catch syndrome is a common presentation of chest pain, especially in the young population. Future studies may be helpful in elucidating its incidence, etiology and risk factors, as well as raising awareness of a condition that is not well known in the medical community.

Lymphocytic thrombophilic arteritis or macular arteritis presents as macular hyperpigmentation in the lower extremities and typically has a chronic indolent course. The diagnosis of this disease represents a challenge for the clinician. Histologically, it is characterized by a dense lymphocytic infiltrate around medium-sized vessels located in the reticular dermis and subcutaneous cellular tissue, together with a ring-shaped intraluminal deposit of fibrin.

Objective

Describe the clinical and histopathological characteristics of macular arteritis in order to obtain a correct diagnosis and apply appropriate treatment.

Case report

We present a 27-year-old female patient who came to the emergency room due to asymptomatic pigmented macules on the lower limbs of two months’ duration without any accompanying systemic symptoms.

Results

The skin biopsy described an inflammatory infiltrate where lymphocytes predominate around a medium-sized vessel at the dermo-hypodermis junction along with fibrinoid necrosis. After a clinical-pathological correlation, we issued the diagnosis of macular arteritis. An entity still under discussion, as there are authors who consider it part of the cutaneous polyarteritis nodosa spectrum and others who consider it a different pathology.

Conclusion

We present a young patient with macular arteritis. The infrequency of this entity gives importance to our case, expanding our knowledge regarding this vasculitis both in clinical and pathological terms.

Fulminant hepatic failure (FHF) and acute on chronic liver failure (ACLF) are entities with high morbidity and mortality, with liver transplantation being, in most cases, the only effective therapeutic alternative. The shortage of donors makes it necessary to have liver function support systems, which allow the patient to be kept in adequate conditions until transplantation or improvement. Despite greater knowledge of the pathophysiology of FHF, ACLF, as well as technological advances, we still do not have extracorporeal artificial liver support systems that allow complete replacement of liver function, acting mainly as palliative or symptomatic therapies while awaiting liver transplantation. The systems currently available combine different methods that purify toxins and molecules of different sizes and types, based on dialysis enriched with albumin. In recent years, promising new adsorption filters have been developed and conventional techniques, such as plasma exchange, are under reevaluation. There is still no consensus, however, regarding ideal therapy in different clinical scenarios. The objective of this article is to offer a state of the art view of available technologies and results in different clinical scenarios.