Search

AbstractDermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive cutaneous sarcoma with a propensity for recurrence. Its management, particularly in the head and neck (H&N) region, presents unique challenges. This study aimed to evaluate the effectiveness of Mohs micrographic surgery (MMS) compared to wide local excision (WLE) in treating H&N DFSP and its impact on recurrence rates and tissue preservation. A comprehensive search was conducted in PubMed/MEDLINE, yielding 29 relevant studies. We included studies comparing MMS and WLE in adult patients with H&N DFSP and reporting local recurrence outcomes. Data were analyzed using random effects analysis, with a meta-analysis performed for comparative studies. Analysis of studies demonstrated a lower recurrence for MMS. Comparative analysis of five studies involving 117 patients showed a significantly lower recurrence rate in the MMS group (2%) compared to the WLE group (19%). Margin status varied between studies, with some achieving negative margins at shorter distances. In the management of H&N DFSP, MMS has emerged as a superior surgical technique, consistently associated with reduced recurrence rates and the potential for tissue preservation. The adoption of MMS should be considered for its capacity to achieve negative margins with fewer processing steps, particularly in anatomically complex regions like the H&N.

Indeterminate thyroid nodules (ITNs) are characterized by an expected malignancy ranging from 5% to 30%, with most patients undergoing a diagnostic, rather than therapeutic, operation. The aim of our study was to compare the approach to ITNs across different regions of the world. In this retrospective, multicentric, international study, according to the WHO classification, we identified the South East Asian Region (SEAR), the Americas Region (AMR), the Eastern Mediterranean Region (EMR), the Europe Region (EUR), and the Western Pacific Region (WPR). One high-volume thyroid centre was included for each region. Demographic, preoperative, and pathologic data were compared among the different regions. Overall, 5737 patients from five high-volume thyroid centres were included in this study. We found that the proportion of ITNs over the global activity for thyroid disease was higher in the EUR (37.6%) than in the other regions (21.1–23.6%). In the EMR, the patients were significantly younger (with a mean of 43.1 years) than in the other regions (range, 48.8–57.4 years). The proportion of lobectomy was significantly higher in the WPR, where 83.2% (114/137) of patients received this treatment, than in the other regions, where lobectomies were performed in 44.1–58.1% of patients. The pathological diagnosis of malignancy was significantly higher in the SEAR centre, being over 60%, than in centres of the other regions, where it ranged from 26.3% to 41.3%. The occurrence of lymph node metastases was higher in the WPR (27.8%), AMR (26.9%), and EMR (20%) centres than in the EUR and SEAR centres, where it was lower than 10%. In summary, we found in our study different approaches and outcomes in the diagnosis and treatment of ITNs among countries. Overall, almost 60% of patients with ITNs who underwent surgery actually presented a benign disease, potentially undergoing an unnecessary operation.

Objetivo: Determinar el impacto del seguimiento farmacoterapéutico ambulatorio en pacientes hipertensos de un centro de salud del norte del Perú. Metodología: Estudio cuasi – experimental, longitudinal en 36 pacientes adultos con diagnóstico de hipertensión arterial, que asisten al Centro de Salud Unión – Trujillo, mediante 9 visitas domiciliarias, utilizando el método DÁDER que evalúa el seguimiento farmacoterapéutico. Se emplearon 4 instrumentos para evaluar los siguientes parámetros: nivel de conocimiento mediante un cuestionario, adherencia al tratamiento mediante la prueba de Morisky-Green-Levine, grado de satisfacción del paciente a través del test The Purdue Pharmacist Directive y monitorización de los valores de hipertensión arterial mediante una hoja de registro. Resultados: Para el nivel de conocimiento, el cuestionario obtuvo una puntuación promedio de 5.3 en la tercera visita y 10 en la novena. Para el grado de adherencia, la prueba alcanzó un valor promedio de 1.9 en la segunda visita domiciliaria, considerándose como No adherente y 0.0 en la novena visita, mostrando una adherencia total al tratamiento farmacológico. En cuanto a la prueba para la determinación del nivel de satisfacción hacia el químico farmacéutico, se obtuvo como resultado 85.7% y 100% durante la cuarta y novena visita domiciliaria, respectivamente. Se encontraron resultados significativos para los 3 parámetros, mostrando 100% de adherencia, satisfacción y nivel de conocimiento adecuado al finalizar el seguimiento farmacoterapéutico. En referencia a los valores de presión arterial, se inició con una media de 138.6/87.1 ± 6.7 mmHg, descendiendo a 118.8/79.3 ± 2.7 mmHg a la novena visita domiciliaria. Conclusiones: El seguimiento farmacoterapéutico tuvo un impacto favorable en el control de los pacientes hipertensos.