Prevalencia de fístulas vaginales en Pacientes con cáncer de cuello Uterino, sometidas a tratamiento de Radioterapia Externa e Intracavitaria en el Hospital Oncológico Solca Quito: Vaginal fistulas prevalence in cervical cancer patients, treated with external and in-tracavitary radiotherapy in the Oncological Hospital Solca Quito

Treatment of cervical cancer in locally advanced stages is based primarily on ionizing radiation therapy and radiosensitizing chemotherapy. This type of therapy has among its most serious and morbid adverse effects,the generation of vaginal fistulas. It is important to establish the punctual prevalence of this adverse effect inour environment as well as to establish the risk factors for the generation of fistulas associated with the treatment. An observational, retrospective, study was conducting. Patients who received external radiotherapy 2D or 3D mode plus brachytherapy or external boost were enrolling, with or without concurrentchemotherapy. The specific prevalences of fistulas were obtein for each case and the respective association with the controls was make using the Odds Ratio. The punctual prevalence of fistulas in our center was 2.93%, 1.62% were under conventional radiotherapy and 1.31% conformational, 1.62% patients who receivedconcurrence and 1.31% who did exclusive radiotherapy. The proportion of fistulas was 50% for external boost, 33% for brachytherapy and 17% without boost or brachytherapy. The external boost vs. brachytherapyshowed an OR = 4.77 95% CI (1.66 - 13.65). The prevalence of fistulas in our center is in accordance with the world reality; however, the association of external radiotherapy boost with more fistulas vs brachytherapyreinforcement shows the importance of bringing the largest number of patients to brachytherapy.El tratamiento del cáncer de cuello uterino en estadios localmente avanzados se basa fundamentalmente en la terapia con radiaciones ionizantes y la quimioterapia radiosensibilizadora. Este tipo de terapia tiene entre sus efectos adversos más graves y mórbidos, la generación de fístulas vaginales. Es importante establecer la prevalencia puntual de este efecto adverso en nuestro medio así como establecer los factores de riesgo para la generación de fístulas asociados al tratamiento. Se realizó un estudio de tipo observacional, retrospectivo. Se registraron las pacientes que recibieron radioterapia externa ya sea en modalidad 2D o 3D más braquiterapia o refuerzo externo de dosis, con quimioterapia concurrente o sin esta última. Se obtuvieron las prevalencias puntuales de fístulas para cada caso y se efectuó la respectiva asociación mediante la Razón de Momios La prevalencia puntual de fístulas en nuestro centro fue del 2.93%, 1.62% fueron bajo modalidad de radioterapia convencional y 1.31% conformacional, 1.62% pacientes que recibieron concurrencia y 1.31% quienes hicieron Radioterapia exclusiva. La proporción de fístulas fue del 50% para refuerzo externo, 33% para braquiterapia y 17% sin refuerzo. El refuerzo externo vs braquiterapia mostro un OR=4.77 IC 95% (1.66 – 13.65) La prevalencia de fístulas en nuestro centro está acorde a la realidad mundial, sin embargo la asociación del refuerzo de radioterapia externa con mayor cantidad de fístulas vs el refuerzo con braquiterapia pone de manifiesto la importancia de llevar el mayor número de pacientes a braquiterapia

Comparación de la dosis estimada en recto y vejiga con planificación de Braquiterapia 3D vs 2D: Estimated dose comparison in the rectum and bladder with 3D vs. 2D brachytherapy planning

Cervical cancer is one of the main female neoplasia the treatment requires multidisciplinary management.Intracavity brachytherapy occupies a fundamental role. Brachytherapy represented an important improvement in the last years with the growth of the three-dimensional planning. But in many countries, two dimensional planning is still the only option of treatment. We seek to establish the benefit that is obtained with brachytherapy in three dimensions, in the protection to organs of risk. This is an observational, longitudinal cohort study; we extrapolated treatment schemes in three dimensions, to planning in two dimensions. Then turned to move this planning, to the tridimensional system again and we got doses- olume histograms of rectum and bladder. Finally, we determined the average of doses received in 2cc of rectum and bladder in three-dimensional planning and compared with those obtained in the two dimensional planning, using Student’s T test. The dose average in 2cc bladder in two-dimensional plan was 5.5 Gy. And in three-dimensional plan was 5.1 Gy (p=0.01). The dose average in 2cc rectum in two-dimensional plan was 2.8 Gy, and in three-dimensional plan was 3.0 Gy (p=0.06). This study gives an approximation to the dosimetry improvement obtained through the using of the three- dimensional planning, for the reduction of doses in the bladder.El cáncer de cuello uterino se ubica entre las principales neoplasia femeninas, su tratamiento requiere del manejo multidisciplinario, donde la braquiterapia ocupa un sitial fundamental. Está ha presentado una importante evolución en los últimos años con el surgimiento de la planificación en tres dimensiones. En muchas partes del mundo, la modalidad en dos dimensiones sigue siendo la única opción de tratamiento. Como objetivo buscamos establecer el beneficio que se obtiene con braquiterapia en tres dimensiones sobre la técnica convencional de braquiterapia, en la protección a los órganos de riesgo. Planteamos un estudio observacional de cohorte longitudinal, extrapolando planificaciones de tratamiento en tres dimensiones, a planificación en dos dimensiones. Posteriormente se volvió a trasladar esta planificación, al sistema en tres dimensiones y se obtuvo histogramas dosis volumen de recto y vejiga. Determinamos el promedio de dosis recibidas en 2 cc de recto y vejiga en la planificación tridimensional y comparamos con las obtenidos en la planificación en dos dimensiones, mediante la T de Student. El promedio de la planificación de las dosis en vejiga con dos dimensiones fue 5.5 Gy, y con tres dimensiones fue 5.1 Gy, p= 0.01. El promedio de la planificación de las dosis en recto con dos dimensiones fue 2.8 Gy; y con tres dimensiones fue 3.0 Gy p= 0.06. Este estudio nos da una aproximación al beneficio dosimétrico que se obtiene mediante el uso de la planificación tridimensional, para la reducción de dosis que llega a vejiga

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Reduction of cardiac imaging tests during the COVID-19 pandemic: The case of Italy. Findings from the IAEA Non-invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Background: In early 2020, COVID-19 massively hit Italy, earlier and harder than any other European country. This caused a series of strict containment measures, aimed at blocking the spread of the pandemic. Healthcare delivery was also affected when resources were diverted towards care of COVID-19 patients, including intensive care wards. Aim of the study: The aim is assessing the impact of COVID-19 on cardiac imaging in Italy, compare to the Rest of Europe (RoE) and the World (RoW). Methods: A global survey was conducted in May–June 2020 worldwide, through a questionnaire distributed online. The survey covered three periods: March and April 2020, and March 2019. Data from 52 Italian centres, a subset of the 909 participating centres from 108 countries, were analyzed. Results: In Italy, volumes decreased by 67% in March 2020, compared to March 2019, as opposed to a significantly lower decrease (p &lt; 0.001) in RoE and RoW (41% and 40%, respectively). A further decrease from March 2020 to April 2020 summed up to 76% for the North, 77% for the Centre and 86% for the South. When compared to the RoE and RoW, this further decrease from March 2020 to April 2020 in Italy was significantly less (p = 0.005), most likely reflecting the earlier effects of the containment measures in Italy, taken earlier than anywhere else in the West. Conclusions: The COVID-19 pandemic massively hit Italy and caused a disruption of healthcare services, including cardiac imaging studies. This raises concern about the medium- and long-term consequences for the high number of patients who were denied timely diagnoses and the subsequent lifesaving therapies and procedures

International Impact of COVID-19 on the Diagnosis of Heart Disease

Background: The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified. Objectives: The study sought to assess COVID-19's impact on global cardiovascular diagnostic procedural volumes and safety practices. Methods: The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained. Results: Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoracic echocardiography decreased by 59%, transesophageal echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p &lt; 0.001 for each procedure). In multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower–middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and telehealth. Conclusions: COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world's economically challenged. Further study of cardiovascular outcomes and COVID-19–related changes in care delivery is warranted

Impact of COVID-19 on Diagnostic Cardiac Procedural Volume in Oceania: The IAEA Non-Invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Objectives: The INCAPS COVID Oceania study aimed to assess the impact caused by the COVID-19 pandemic on cardiac procedure volume provided in the Oceania region. Methods: A retrospective survey was performed comparing procedure volumes within March 2019 (pre-COVID-19) with April 2020 (during first wave of COVID-19 pandemic). Sixty-three (63) health care facilities within Oceania that perform cardiac diagnostic procedures were surveyed, including a mixture of metropolitan and regional, hospital and outpatient, public and private sites, and 846 facilities outside of Oceania. The percentage change in procedure volume was measured between March 2019 and April 2020, compared by test type and by facility. Results: In Oceania, the total cardiac diagnostic procedure volume was reduced by 52.2% from March 2019 to April 2020, compared to a reduction of 75.9% seen in the rest of the world (p&lt;0.001). Within Oceania sites, this reduction varied significantly between procedure types, but not between types of health care facility. All procedure types (other than stress cardiac magnetic resonance [CMR] and positron emission tomography [PET]) saw significant reductions in volume over this time period (p&lt;0.001). In Oceania, transthoracic echocardiography (TTE) decreased by 51.6%, transoesophageal echocardiography (TOE) by 74.0%, and stress tests by 65% overall, which was more pronounced for stress electrocardiograph (ECG) (81.8%) and stress echocardiography (76.7%) compared to stress single-photon emission computerised tomography (SPECT) (44.3%). Invasive coronary angiography decreased by 36.7% in Oceania. Conclusion: A significant reduction in cardiac diagnostic procedure volume was seen across all facility types in Oceania and was likely a function of recommendations from cardiac societies and directives from government to minimise spread of COVID-19 amongst patients and staff. Longer term evaluation is important to assess for negative patient outcomes which may relate to deferral of usual models of care within cardiology