Introduction:Knowledge of how patients experience pain and patterns of resolution beyond the first days after surgery is limited. Acute neuropathic pain (ANeuP) following surgery is rarely assessed. Objectives:We aimed to characterize pain intensity, pain-related functional impairment, ANeuP, and to describe patterns of resolution in a large cohort undergoing diverse surgical procedures up to 1 month postoperatively, the subacute period. Methods:This was an observational, multicentre study. Outcomes were assessed on postoperative days (PODs) 1/7/30 using the PAIN OUT registry methodology. The primary endpoint was the change in pain-related interference between POD7 and POD30. Patient subgroups were identified using cluster analysis. Results:A cohort of 1,153 patients (median age 49; 67% female) was enrolled. By POD30, pain-related functional interference decreased (P < 0.001, moderate-to-large effect). The cluster analysis identified 3 subgroups: Minimal-pain resolution (16% of the cohort), Slow-pain resolution (30.5%), and Fast-pain resolution (53.5%). By POD30, patients in the Slow- and Fast-pain resolution clusters had largely recovered, differing in recovery rate. Those in the Minimal-pain resolution cluster showed limited improvement from POD1. By POD30, these patients still experienced mild-moderate pain and interference, with 40% screening positive for ANeuP and 24% taking opioids. Risk factors included chronic preexisting pain and thoracic or orthopaedic surgery. Conclusion:Although the majority of patients in the cohort largely recovered in terms of pain and interference by POD30, 16% belonged to the Minimal-pain resolution cluster. These patients may benefit from proactive identification and management by anaesthetists, surgeons, and practitioners in the community before surgery or in the early weeks after surgery.
OBJECTIVE:Locally advanced breast cancer (LABC) is an inoperable breast adenocarcinoma that is commonly treated with neoadjuvant chemotherapy. Neoadjuvant chemotherapy is given to patients as the first step in treatment to reduce tumor size before surgery. However, no biomarkers are currently available to predict early response to chemotherapy. METHODS:The differential expression of miRNAs between malignant and normal cells from patients with breast cancer reflects tumor dynamics and may reflect an individual's resistance or sensitivity to drugs used in chemotherapy. Ten patients with LABC who responded to chemotherapy, five patients with LABC who did not respond, and three healthy controls were included in this study. RESULTS:This study found that miRNAs miR-214-3p, miR-222-3p, and let-7e-5p indicated a patient's sensitivity to neoadjuvant chemotherapy. Whereas miR-20a-5p, miR-27a-3p, miR-424-5p, miR-152-3p, and miR-195-5p suggested a patient's resistance to it. CONCLUSION:Therefore, these findings suggest that miRNAs may serve as predictive biomarkers and potential therapeutic targets in the management of breast cancer.
OBJECTIVE: To evaluate the type and intensity of response to benralizumab and identify responders and super-responders amongst patients with severe uncontrolled eosinophilic asthma managed in Mexico. METHODS: A multicenter study in 3 hospitals in Mexico evaluating the Asthma Control Test and Asthma Control Questionnaire (ACT) scores; mini Asthma Quality of Life Questionnaire; peripheral blood eosinophils; exhaled fraction of nitric oxide; forced expiratory volume in 1 second before and after benralizumab treatment and the number of exacerbations at 12 months. RESULTS: The record of 28 patients with severe uncontrolled eosinophilic asthma were included. At 12-months, 82.1% were considered in asthma control, where 82% were responders and 64% classified as super-responders. 75% of patients had no exacerbations, with ACT scores improvement in 89% and 79% of patients discontinued maintenance corticosteroids. A total of 82% presented forced expiratory volume in 1 second values over 500 ml. ACT scores showed an average decrease of 1.35 points and a statistically significant decrease in serum eosinophils was observed. CONCLUSION: This is the first study in Mexico to evaluate the subgroup of super-responders to benralizumab who had clinical, laboratory and quality of life improvements. Besides the vast majority were responders and 64% super-responders at 12-months of treatment. KEYWORDS: Benralizumab; Asthma; Asthma Control Test and Asthma Control Questionnaire (ACT); Eosinophils; Exhaled fraction of nitric oxide; Corticosteroids; Quality life.
Vaginal vault dehiscence with evisceration is a rare but severe complication following pelvic reconstructive surgery. Late presentations after sacrospinous ligament fixation (SSLF) are particularly uncommon. We report a rare case of late vaginal vault dehiscence with omental evisceration in a menopausal patient 2 years after SSLF, along with a structured review of the literature. A 65-year-old menopausal woman presented with acute pelvic pain and vaginal protrusion of omental tissue 13 years after a vaginal hysterectomy and 2 years after SSLF. Examination revealed a 2-cm vaginal cuff defect with omental evisceration. She underwent urgent transvaginal surgery, including partial omentectomy, reduction of viable tissue, vaginal cuff repair, and McCall culdoplasty. Recovery was uneventful. Late vaginal vault dehiscence after SSLF is rare but should be considered a surgical emergency. Our accompanying literature review highlights the spectrum of delayed presentations, common triggers, and management strategies, emphasizing the need for long-term surveillance. Isolated omental evisceration may represent a precursor phase of vault failure before bowel involvement. Prompt diagnosis and management are essential to prevent progression to bowel involvement and associated morbidity.
