Neuromodulación de raíces sacras (Medtronic InterStim® System) en el tratamiento de disfunción miccional

ResumenLa neuromodulación de raíces sacras (NRS) utiliza un generador de impulsos implantable, éste representa una opción terapéutica para pacientes con diversas formas de disfunción miccional refractaria a tratamiento conservador.Se presenta el caso de una paciente femenina de 47 años de edad, con incontinencia urinaria de 5 años de evolución refractaria a tratamiento conservador y farmacológico; su evaluación diagnóstica cumplía con criterios de inclusión para este tratamiento.La cirugía se llevó a cabo sin complicaciones, se colocó el implante definitivo, presentando disminución significativa en los índices de gravedad de la incontinencia urinaria (Sandvik Severity Index) y en el cuestionario de impacto de la incontinencia urinaria en la calidad de vida (Potenziani).La NRS con implante de un generador de impulso es una opción terapéutica que puede mejorarlas condiciones clínicas de pacientes con incontinencia urinaria refractaria.AbstractSacral neuromodulation (SNM) utilizes an implantable pulse generator and is a therapeutic option for patients with different types of voiding dysfunction that are refractory to conservative treatment.A 47-year-old woman presented with urinary incontinence of 5-year progression that was refractory to conservative and pharmacologic treatment. Her diagnostic evaluation met the inclusion criteria for SNM treatment.The surgery was performed with no complications. The device was placed definitively, resulting in a significant decrease in the Sandvik Severity Index and an improvement in the impact of urinary incontinence on quality of life measured by the Potenziani questionnaire

Global characteristics and outcomes of SARS-CoV-2 infection in children and adolescents with cancer (GRCCC): a cohort study

Background: Previous studies have shown that children and adolescents with COVID-19 generally have mild disease. Children and adolescents with cancer, however, can have severe disease when infected with respiratory viruses. In this study, we aimed to understand the clinical course and outcomes of SARS-CoV-2 infection in children and adolescents with cancer. Methods: We did a cohort study with data from 131 institutions in 45 countries. We created the Global Registry of COVID-19 in Childhood Cancer to capture de-identified data pertaining to laboratory-confirmed SARS-CoV-2 infections in children and adolescents (<19 years) with cancer or having received a haematopoietic stem-cell transplantation. There were no centre-specific exclusion criteria. The registry was disseminated through professional networks through email and conferences and health-care providers were invited to submit all qualifying cases. Data for demographics, oncological diagnosis, clinical course, and cancer therapy details were collected. Primary outcomes were disease severity and modification to cancer-directed therapy. The registry remains open to data collection. Findings: Of 1520 submitted episodes, 1500 patients were included in the study between April 15, 2020, and Feb 1, 2021. 1319 patients had complete 30-day follow-up. 259 (19·9%) of 1301 patients had a severe or critical infection, and 50 (3·8%) of 1319 died with the cause attributed to COVID-19 infection. Modifications to cancer-directed therapy occurred in 609 (55·8%) of 1092 patients receiving active oncological treatment. Multivariable analysis revealed several factors associated with severe or critical illness, including World Bank low-income or lower-middle-income (odds ratio [OR] 5·8 [95% CI 3·8–8·8]; p<0·0001) and upper-middle-income (1·6 [1·2–2·2]; p=0·0024) country status; age 15–18 years (1·6 [1·1–2·2]; p=0·013); absolute lymphocyte count of 300 or less cells per mm3 (2·5 [1·8–3·4]; p<0·0001), absolute neutrophil count of 500 or less cells per mm3 (1·8 [1·3–2·4]; p=0·0001), and intensive treatment (1·8 [1·3–2·3]; p=0·0005). Factors associated with treatment modification included upper-middle-income country status (OR 0·5 [95% CI 0·3–0·7]; p=0·0004), primary diagnosis of other haematological malignancies (0·5 [0·3–0·8]; p=0·0088), the presence of one of more COVID-19 symptoms at the time of presentation (1·8 [1·3–2·4]; p=0·0002), and the presence of one or more comorbidities (1·6 [1·1–2·3]; p=0·020). Interpretation: In this global cohort of children and adolescents with cancer and COVID-19, severe and critical illness occurred in one fifth of patients and deaths occurred in a higher proportion than is reported in the literature in the general paediatric population. Additionally, we found that variables associated with treatment modification were not the same as those associated with greater disease severity. These data could inform clinical practice guidelines and raise awareness globally that children and adolescents with cancer are at high-risk of developing severe COVID-19 illness. Funding: American Lebanese Syrian Associated Charities and the National Cancer Institute