Estilos de vida asociados a cáncer de seno en la premenopausia : un estudio de casos y controles en el Hospital Universitario Mayor de Méderi, Bogotá

El cáncer de mama muestra aumento en las tasas de presentación a nivel global. En Colombia la incidencia para 2018 se encuentra en 44.1 por 100.000 mujeres (RAE) siendo el segundo cáncer con mayor número de casos nuevos para ese año en el país. (1) Son cada vez más las mujeres premenopáusicas que padecen esta patología, lo que genera gran impacto económico y social. (2) Con el fin de establecer las posibles asociaciones entre el estilo de vida y la enfermedad, se consideró el estudio de casos y controles por sus ventajas sobre otros diseños (3). Se conformo una población de estudio de 330 pacientes menores de 55 años premenopáusica con patología mamaria, atendidas entre los años 2013 y 2017, quienes bajo criterios de selección conformaron los dos grupos de comparación. Se realizó un análisis retrospectivo inicial de los registros clínicos, y luego la implementación de un instrumento vía telefónica. El análisis multivariado demuestra que las variables; mayor nivel educativo y consumo de alimentos integrales (trigo, arroz, maíz, avena, centeno y cebada, etc.) se asocian de manera inversa a la presencia de la enfermedad. (OR= 0.675 IC del 95%: 0.433,1.053 p=0.048 y OR= 0.579 IC del 95%: 0.339,0.991 p=0.046). Mientras que el consumo de pescado muestra una relación positiva con la misma (OR= 2.560 IC del 95%:1.200,5.460 p=0.015). La asociación entre variables dietarías y la presencia del cáncer de mama en la premenopausia ameritan estudios prospectivos que permitan una mejor caracterización y análisis de esta variable.Breast cancer shows increase in presentation rates globally. In Colombia, the incidence for 2018 is 44.1 per 100,000 women (ASR), being the second cancer with the highest number of new cases for that year in the country. More and more premenopausal women suffer from this pathology, which generates great economic and social impact. In order to establish possible associations between lifestyle and disease, case-control study was considered for its advantages over other designs. A study population of 330 patients under 55 premenopausal with mammary pathology, attended between 2013 and 2017, who under the selection criteria formed the two comparison groups was conformed. An initial retrospective analysis of the clinical records was carried out, followed by the implementation of a telephone instrument. The multivariate analysis shows that the variables; Higher educational level and consumption of whole foods (wheat, rice, corn, oats, rye and barley, etc.) are inversely associated with the presence of the disease. (OR = 0.675 95% CI: 0.433.1.053 p = 0.048 and OR = 0.579 95% CI: 0.339.0.991 p = 0.046). While fish consumption shows a positive relationship with it (OR = 2,560 95% CI: 1,200.5,460 p = 0.015). The association between dietary variables and the presence of breast cancer in premenopausal women must be prospective studies that allow a better characterization and analysis of this variable

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.The aim of this study was to inform vaccination prioritization by modelling the impact of vaccination on elective inpatient surgery. The study found that patients aged at least 70 years needing elective surgery should be prioritized alongside other high-risk groups during early vaccination programmes. Once vaccines are rolled out to younger populations, prioritizing surgical patients is advantageous

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care