No abstract

Non-small cell lung cancer (NSCLC) is the most frequent form of lung cancer and represents a set of histological entities that have an ominous long-term prognosis, for example, adenocarcinoma, squamous carcinoma and large cell carcinoma. Both small cell and non-small cell lung cancer are the main causes of oncological death and the oncological diseases with the highest incidence worldwide. With regard to clinical approaches for NSCLC, several advances have been achieved in diagnosis and treatment; the analysis of different molecular markers has led to the development of new targeted therapies that have improved the prognosis for selected patients. Despite this, most patients are diagnosed in an advanced stage, presenting a limited life expectancy with an ominous short-term prognosis. Numerous molecular alterations have been described in recent years, allowing for the development of therapies directed against specific therapeutic targets. The correct identification of the expression of different molecular markers has allowed for the individualization of treatment throughout the disease course, expanding the available therapeutic arsenal. The purpose of this article is to summarize the main characteristics of NSCLC and the advances that have occurred in the use of targeted therapies, thus explaining the limitations that have been observed in the management of this disease.

OBJECTIVES. The achievement of a good health-related quality of life (HRQoL) has become one of the primary objectives of medical–surgical interventions. The objective of this study is to determine the HRQoL of patients who underwent abdominal aortic aneurysm (AAA) surgery and to analyse the influence of age on HRQoL. MATERIALS AND METHODS. This is an observational cross-sectional study with 151 male patients who underwent an operation for AAAs between January 2013 and December 2020 in two hospital centres. HRQoL was assessed with the Spanish version of the 36-Item Short Form Survey (SF-36), starting in the month following the surgical intervention. Statistical analyses were performed using hypothesis tests and multivariate linear regression. RESULTS: The mean age of the patients was 73 years (SD: 7), and the mean interval between surgery and the interview was 37 months (SD: 27). The scores of the Physical Function (p = 0.001), Vitality (p = 0.016), Social Function (p = 0.014), and Mental Health (p = 0.007) dimensions of the SF-36 were significantly lower in the older age groups. In addition, the scores on the Physical Summary Component (p = 0.003) and the Mental Summary Component (p = 0.026) were significantly lower among individuals older than 70 years of age. The HRQoL in patients who underwent operations for AAAs was similar to that reported in the general population of Spain. Patients with an aorto-aortic shunt had better scores on the Physical Function (Beta: 10; p = 0.014) and Mental Health (Beta: 8.12; p = 0.040) dimensions than those who had an aorto-bi-iliac or bifemoral shunt, regardless of the age of the patients at operation. CONCLUSION: Among patients who underwent an operation for an AAA, there was a negative association between the age at operation and scores on the Physical Function, Vitality, Social Function, and Mental Health dimensions of the SF-36. The type of surgical technique influences the evolution of Physical Function and Mental Health scores, regardless of age.

Objectives: The aim of this study was to analyze the prognostic factors of survival in patients with peritoneal metastasis (PM) from colorectal cancer (CRC). The type of relationship between survival and the PM time of detection was used to determine whether it was synchronous with the primary tumor or metachronous. Patients and Methods: Retrospective observational study. It included patients treated for colorectal adenocarcinoma diagnosed between January 2005 and December 2019 who presented PM at the time of diagnosis or during follow-up. Variables, such as sex, age, differentiation grade, positive adenopathy (pN+), tumor size (pT), tumor location, mucinous component, peritoneal carcinomatosis index (PCI), and KRAS mutational status, were analyzed. Results: During the study period, 1882 patients were surgically treated for CRC in our hospital. Of these, 240 patients (12.8%) were included in the study after evidence of PM. The mean age was 67 ± 12 years (range: 32–92 years), and 114 patients were female (47.5%). The mean follow-up was 20 ± 13 months (median 12 months). The Kaplan–Meier survival at 36 months was higher in patients with metachronous PM (24% vs. 8%; p = 0.002), WT-KRAS tumors (31% vs. 15%; p < 0.001), N0 stage (30% vs. 19%; p < 0.001), T3 stage tumors (18% vs. 19% in T4A and 3% in T4B; p > 0.001), and tumors with classic adenocarcinoma histology (18% vs. 8%; p = 0.011). Patients with a PCI of 1–10 showed a likelihood of survival at 36 months of 56%, which was longer than that found in patients with a PCI of 11–20 (8%) or a PCI of >20 (0%) (p < 0.001). In the multiple regression analysis, the factors with an independent prognostic value were: poor grade of differentiation (HR 1.995; 95% CI: 1.294–3.077), KRAS mutation (HR 1.751; 95% CI: 1.188–2.581), PCI 11–20 (HR: 9.935; 95% CI: 5.204–18.966) and PCI > 20 (HR: 4.011; 95% CI: 2.291–7.023). Conclusions: PCI should continue as the as the most useful prognostic indicator in order to assess prognostic estimations as well as therapeutic and surgical decisions, but tumor grade and KRAS mutational status may help in the treatment decision process by providing complementary information. The time of PM detection did not achieve statistical significance in the multiple regression analysis.

Objectives: To determine the degree of long-term health-related quality of life (HRQoL) of patients undergoing surgery for abdominal aortic aneurysm (AAA) and to analyze the results according to the type of treatment, namely, open abdominal repair (OAR) or endoprosthesis (EVAR). Patients and Methods: This was a prospective cross-sectional observational study. Patients receiving intervention for AAA between January 2013 and December 2020 were included. The Spanish version of the SF-36 questionnaire was used. A single survey was performed on all patients, and the time elapsed since the intervention was recorded. Results: On all health scales and in the two groups of patients, the highest scores were recorded at six months postoperatively. At that time, the EVAR and OAR groups had similar values. Between 13 and 16 months postoperatively, EVAR patients presented a transient but significant decrease in their scores for physical function (p = 0.016), vitality (p = 0.035) and social function (p = 0.041). From that moment, there were progressive decreases in the scores of the two groups of patients on all the scales of the SF-36 questionnaire, although this trend was less pronounced in the OAR group. At 60 months after the intervention, the latter group showed significantly higher values than EVAR for physical function (p = 0.01), vitality (p = 0.032) and mental health (p = 0.029). Additionally, at 60 months after the intervention, the Sum of the psychological component (MCS) and Sum of the physical component (PCS) scores were significantly higher in the OAR group (p = 0.040 and p = 0.039, respectively). Conclusions: In the short term, patients treated for AAA by EVAR or OAR showed similar results on the SF-36 questionnaire. In the long term, patients treated by EVAR had lower scores on the physical function, vitality and mental health scales.

1) Antecedentes: La atención quirúrgica es parte esencial de la atención de salud y se asocia con una mayor esperanza de vida, sin embargo, muchos países de bajos y medios ingresos no logran alcanzar niveles básicos en este servicio. Las mejoras en la capacidad y la prestación de servicios quirúrgicos deben ser un componente principal del fortalecimiento de los sistemas de salud. 2) Método: Se realiza una búsqueda en PubMed mediante la combinación de palabras claves como “Surgery", "Low and middle income countries", "Health care", "Infrastructure", "Africa", "Cooperation”. Se utiliza los registros de los pacientes, screening y procedimientos quirúrgicos, facilitados por el proyecto “Cirugía en Turkana”. 3) Resultados: Los procedimientos quirúrgicos están entre las intervenciones de salud más rentables y ha empezado a tomar fuerza el papel de la cirugía como parte de la asistencia sanitaria primaria. Las intervenciones realizadas en la campaña 2018 de “Cirugía en Turkana” fueron patologías de cirugía general (58%), traumatología (24%), ginecología (12%), cirugía maxilofacial (6%) y cirugías de urgencias (9,5%). Las patologías más demandadas por especialidades fueron los tumores de partes blandas, fracturas óseas, prolapsos uterinos y labios leporinos. 4) Conclusión: La cirugía es una parte esencial de la atención médica. Las complicaciones son comunes. El quirófano debe ser un entorno de trabajo seguro para los profesionales y para los pacientes. Es importante formar al personal local y concienciar a las autoridades políticas para mejorar las infraestructuras. Los proyectos de cooperación quirúrgicos permiten tratar patologías y disminuir discapacidades.

La Enfermería como disciplina profesional ofrece cuidados a personas, familias y grupos poblacionales en la promoción, prevención y protección de la salud. La palabra cuidado afecta a la totalidad del ser humano. Muchos científicos  han dado a conocer este término desde diferentes perspectivas, pero siempre teniendo en cuenta la importancia de este para la humanidad. Me gustaría hacer una reflexión sobre la concepción del cuidado en las diferentes culturas (teniendo en cuenta que las culturas se crean, se transforman y se relacionan), su evolución y resultados. En definitiva, brindar unos fundamentos teóricos y filosóficos sobre el significado del cuidado enfermero, teniendo en cuenta que estamos inmersos en un prisma de sociedades multiculturales, las transformaciones sociales y el impacto sobre la salud y la enfermerdad. La enfermera, al prestar cuidados, actúa en el escenario social de la vida. El cuidado es una realidad intrínseca del ser humano, una dimensión cuyo análisis no puede eludir la Antropología, como ciencia que se interesa por el pensamiento del hombre.

La enfermedad venosa crónica (EVC) se trata de una amplia variedad de anomalías del sistema venoso de gran prevalencia en nuestra sociedad. Frecuentemente, se manifiesta en las extremidades inferiores en forma de vena varicosa (VV), cursando como una situación de hipertensión venosa ambulatoria que se agrava conforme progresa la enfermedad. Cada vez más estudios evidencian la importancia de los cambios moleculares y de la matriz extracelular en la fisiopatogenia de la EVC. EGFL-7 (Epidermal growth factor-like domain-containing protein 7) es un componente de gran importancia en el desarrollo y patología del sistema vascular, aunque su papel en la EVC todavía no ha sido esclarecido. Así, el objetivo del presente trabajo es analizar la expresión génica y proteica de EGFL7 en la pared venosa de pacientes con EVC (n=35) y sanos (n=27), mediante la realización de RT-qPCR e immunohistoquímica, respectivamente. Nuestros resultados muestran como existe una disminución en la expresión de EGFL-7 en pacientes con EVC en comparación con las venas de individuos sanos. En su conjunto, nuestro trabajo apoya el papel de EGFL7 en la pérdida de la homeostasis vascular asociada a la EVC. Futuros estudios son necesarios para profundizar en las implicaciones de estos cambios en el tejido venoso patológico, así como el desarrollo de posibles estrategias dirigidas a esta diana.