Particularities of seborrheic dermatitis – research of 64 patients

Generalităţi. Dermatita seboreică este o afecţiune destul de frecvent întâlnită, fiind semnalată la circa 5% din populaţie la nivel global. Din punct de vedere medical, afecţiunea nu este una gravă, dar impactul estetic şi social, precum şi evoluţia cronică a bolii cu recăderi periodice, provoacă un disconfort psihoemoţional vădit, diminuând semnificativ calitatea vieţii pacientului. Boala apare, de regulă, odată cu pubertatea şi evoluează în pusee, cu un vârf în jurul vârstei de 40 de ani. Barbaţii sunt mai frecvent afectaţi decât femeile, deoarece activitatea glandelor sebacee este controlată de hormonii masculini. Specificarea profilului pacientului cu dermatită seboreică a constituit scopul prezentului studiu. Material şi metode. A fost efectuat un studiu prospectiv, observaţional şi descriptiv pe un eşantion de 64 de pacienţi (38 de bărbaţi şi 26 de femei), care s-au adresat pentru consultaţie în 2015. Rezultate. S-a demonstrat o prevalenţă a bolii la sexul masculin (59,4%). Vârsta pacienţilor a fost în limitele 14 şi 50 de ani. Grupurile de vârstă au constituit 4 categorii: 14-18 ani – 8 (12,5%) pacienţi; 19-25 de ani – 17 (26,6%) pacienţi; 30-45 de ani – 37 (57,8%) pacienţi; peste 45 de ani – 2 (3,1%) pacienţi. Originea urbană a fost constatată la 55% femei şi 45% bărbaţi. În funcţie de durata afecţiunii, s-au reliefat 4 grupuri: până la 1 an – 4 pacienţi (6%); 1-5 ani – 12 (19%) pacienţi; 6-10 ani – 10 (16%) pacienţi; mai mult de 10 ani – 38 (59%) de pacienţi. Au fost identificaţi o serie de factori, care pot duce la agravarea afecţiunii: alimentari – 2 (3%) persoane; stres psihoemoţional – 6 (9%); factori termici – 8 (13%); schimbarea produsului de îngrijire – 12 (19%); factori polivalenţi nespecificaţi – 34 (53%) de persoane. În relaţie cu factorul sezonier, s-a constatat că acutizările survin preponderent iarna la 26 (41%) de pacienţi; primăvara – la 12 (19%); vara – la 11 (17%); toamna – la 15 (23%) pacienţi. Asocierea pruritului a fost semnalată la 26 (41%) de pacienţi. Topografia erupţiilor a pus în evidenţă afectarea preponderentă a scalpului la 62 (98%) de persoane, dintre care 38 (60%) aveau focare doar pe scalp; 24 (38%) – cu afectarea feţei şi 2 (3,1%) pacienţi - cu localizarea erupţiilor pe torace. Dintre afecţiunile concomitente a fost semnalată patologia gastrointestinală la 45% femei şi la 32% bărbaţi. Impactul maladiei asupra calităţii vieţii este mult mai sever la femei. Pentru ele aspectul fizic influenţează direct calitatea vieţii, făcându-le dificilă integrarea în societate şi la locul de muncă. Concluzii. Acutizarea afecţiunii are loc preponderent în sezonul rece (iarna). Chiar dacă este o afecţiune asimptomatică, dermatita seboreică poate avea un impact negativ asupra calităţii vieţii.Introduction. Seborrheic dermatitis is a quite frequent condition, encountered at about 5% of the global population. In terms of medical condition it is not a serious disease, but the aesthetic and social impact, the chronic recurrent evolution with periodic exacerbations cause discomfort, reducing significantly the quality of life. The disease occurs, usually with puberty and develops in spikes, with a peak around the age of 40 years. Men are more frequently affected than women because the sebaceous glands are controlled by male hormones. The purpose of the research was to identify the profile of patients with seborrheic dermatitis. Material and methods. A prospective, observational and descriptive research was performed on 64 patients (38 men and 26 women) who have addressed for examination in 2015. Results. It was observed a predominance of the disease in males 59.4%. The patients’ age was between 14 and 50 years. There were 4 categories of age: 14-18 years - 8 patients (12.5%); 19-25 years - 17 patients (26.6%); 30-45 years - 37 patients (57.8%); over 45 years - 2 patients (3.1%). Urban origin was observed in 55% of women and 45% of men. Depending on the duration of illness there were highlighted 4 groups: up to 1 year - 4 patients (6%); 1-5 years - 12 patients (19%); 6-10 years old - 10 patients (16%); more than 10 years - 38 patients (59%). There was identified a number of factors that can lead to disease exacerbation: alimentary factor - 2 (3%) persons; psycho-emotional stress - 6 (9%) persons; thermal factors - 8 (13%) persons; cosmetics change - 12 (19%) persons; unspecified multivalent factors - 34 (53%) persons. In connection with the seasonal factors was observed that the exacerbation occurs predominantly in winter – 26 (41%) patients; in spring - 12 (19%) patients; in summer - 11 (17%) patients; in fall - 15 (23%) patients. The presence of itching has been reported at 26 (41%) patients. Mainly affected region was the scalp at 62 (96.9%) persons, 38 (60%) patients of them had affected only the scalp; at 24 (38%) patients face was affected and 2 (3.1%) patients with lesions on the upper part of the chest. Concomitant diseases of gastrointestinal pathology were detected in 45% of women and 32% of men. The impact of disease on quality of life is much more severe in women’s case, for them physical layout directly influences quality of life, making them difficult to integrate into society and the workplace. Conclusion. Exacerbation of the disease occurs predominantly in the cold season (winter). Even if it is an asymptomatic illness, seborrheic dermatitis can have a negative impact on life quality

Efficiency of combined methods for the treatment of genital warts

Generalităţi. Condiloamele acuminate reprezintă o manifestare clinică a unei infecţii active cutaneo-mucoase a regiunii genitale, perigenitale şi perianale, masculine şi feminine, cu anumite tipuri de papiloma virusuri umane (HPV). Scopul studiului. Identificarea noilor remedii în tratamentul verucilor genitale prin reducerea intensităţii simptomatologiei, reducerea duratei infecţiei şi a severităţii, respectiv creşterea intervalului dintre recidive şi controlul asupra lor. Material şi metode. Studiul a fost efectuat pe un lot de 104 pacienţi, diagnosticaţi cu condiloame acuminate. Metodele curente în tratamentul leziunilor, induse de HPV şi aplicate în Clinica SANCOS, sunt crioterapia şi electroterapia, aplicate o dată la două săptămâni, care au o rată de eficacitate de 85-90% după 2-4 cure. În 33% din cazuri s-a indicat şi un tratament sistemic cu Isoprinosine (Groprinosine), 3g/zi, administrat fracţionat, în prize egale, timp de 5 zile/săpt., 2 săptămâni consecutiv, timp de 3 luni. Totodată, s-au prescris şi aplicaţii locale cu spray Epigen intim, de 3-4 ori/zi, timp de 5-8 zile, în asociere cu crioterapie şi electroterapie. Concluzii. Tratamentul combinat, caracterizat prin asocierea crio- şi electroterapiei cu tratamentul sistemic şi local, antiviral şi imunomodulator, a demonstrat rezultate promiţătoare, în sensul obţinerii unui control de durată al infecţiei respective.Introduction. Genital warts are soft growths that occur on the genitals. Genital warts are a sexually transmitted infection (STI) caused by certain strains of the human papillomavirus (HPV). Objectives. Finding new cures in the treatment of genital warts by reducing the intensity of symptomatology, duration and severity of the infection and increasing the interval between recurrences and their control. Material and methods. The study was performed on a group of 104 patients diagnosed with genital warts. Current methods applied in Clinic of Aesthetic Medicine SANCOS for treatment of HPV lesions are cryotherapy and electrotherapy applied once every two weeks which have a rate of efficacy of 85 – 90 %, after 2-4 sessions. In 33% of cases has been recommended also a systemic treatment with administration of Isoprinosine (Groprinosine) 3 g/day, divided into equal doses administered for 5 days/week, 2 weeks consecutive, during 3 months, and local applications with spray Epigen intim 3-4 times/day, during 5-8 days in association with crio and electrotherapy. Conclusion. The combined treatment, characterized by the association of the crio and electrotherapy with systemic local antiviral and immunostimulatory treatment may give promising results and keep the infection under control

Outcomes of elective liver surgery worldwide: a global, prospective, multicenter, cross-sectional study

Background: The outcomes of liver surgery worldwide remain unknown. The true population-based outcomes are likely different to those vastly reported that reflect the activity of highly specialized academic centers. The aim of this study was to measure the true worldwide practice of liver surgery and associated outcomes by recruiting from centers across the globe. The geographic distribution of liver surgery activity and complexity was also evaluated to further understand variations in outcomes. Methods: LiverGroup.org was an international, prospective, multicenter, cross-sectional study following the Global Surgery Collaborative Snapshot Research approach with a 3-month prospective, consecutive patient enrollment within January–December 2019. Each patient was followed up for 90 days postoperatively. All patients undergoing liver surgery at their respective centers were eligible for study inclusion. Basic demographics, patient and operation characteristics were collected. Morbidity was recorded according to the Clavien–Dindo Classification of Surgical Complications. Country-based and hospital-based data were collected, including the Human Development Index (HDI). (NCT03768141). Results: A total of 2159 patients were included from six continents. Surgery was performed for cancer in 1785 (83%) patients. Of all patients, 912 (42%) experienced a postoperative complication of any severity, while the major complication rate was 16% (341/2159). The overall 90-day mortality rate after liver surgery was 3.8% (82/2,159). The overall failure to rescue rate was 11% (82/ 722) ranging from 5 to 35% among the higher and lower HDI groups, respectively. Conclusions: This is the first to our knowledge global surgery study specifically designed and conducted for specialized liver surgery. The authors identified failure to rescue as a significant potentially modifiable factor for mortality after liver surgery, mostly related to lower Human Development Index countries. Members of the LiverGroup.org network could now work together to develop quality improvement collaboratives

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research