Bước đầu khảo sát tình hình bệnh nhân nhiễm Covid-19 nặng có tổn thương phần mềm tại Trung tâm Hồi sức Tích cực Người bệnh Covid-19 Bệnh viện Trung ương Huế tại Thành phố Hồ Chí Minh

TÓM TẮT Đặt vấn đề: Tổn thương phần mềm là loại tổn thương da, tổ chức dưới da, cân, cơ... do nhiều nguyên nhân khác nhau như loét tỳ đè, bỏng, viêm da cơ địa, viêm da tiếp xúc, Zona, viêm da bọng nước,… xảy ra trên bệnh nhân nhiễm Covid-19 nặng, các tổn thương này có thể có từ trước hoặc sau khi bị nhiễm COVID-19. Chúng tôi thực hiện đề tài này nằm mục tiêu (1) nhận định đặc điểm chung của bệnh nhân nhiễm COVID-19 nặng có tổn thương phần mềm, (2) bước đầu nhận định tình trạng có tổn thương phần mềm xảy ra ở bệnh nhân nhiễm Covid-19 nặng và (3) tìm hiểu mối tương quan giữa quá trình chăm sóc vết thương và thời gian lành vết thương của bệnh nhân. Đối tượng và phương pháp: 25 bệnh nhân có tổn thương phần mềm trên tổng số 1.094 bệnh nhân nhiễm COVID-19 nặng, trung tâm hồi sức tích cực người bệnh COVID-19 bệnh viện Trung ương Huế tại thành phố Hồ Chí Minh từ 15.09 - 01.11 năm 2021 (khảo sát nhanh trong 45 ngày). Kết quả: Khảo sát nhanh trong 45 ngày trên 1.094 bệnh nhân bị COVID-19 nặng đang điều trị tại trung tâm hồi sức tích cực Người bệnh COVID-19 bệnh viện Trung ương Huế tại thành phố Hồ Chí Minh có 25 trường hợp bị tổn thương phần mềm: Hầu hết những bênh nhân này đều có bệnh lý nền nặng kèm theo, nam gặp ít hơn nữ (44%/56%), nam ở lứa tuổi 30 - < 50 tuổi chiếm cao nhất, nữ từ 50 tuổi trở lên là chủ yếu chiếm 92,86%. Đa số bệnh mắc phải lớn tuổi, trên 50 tuổi. Loét tỳ đè chiếm đa số 76% (19/25 trường hợp) so với các thương tổn khác, trong khi đó bệnh nhân bị tổn thương trong quá trình điều trị tại trung tâm chiếm 36,8% (7/19 trường hợp) còn phát hiện trước lúc vào viện là 63,2% (12/19 trường hợp). Tỷ lệ thương tổn phần mềm trên tổng số bệnh nhân điều trị tại thời điểm khảo sát chiếm 2,29% (25/1.094 bệnh nhân), do LDTĐ chiếm 0,64% bị tại trung tâm (7/1.094 bệnh nhân). Điều trị nội khoa chiếm đa số 76% nhiều hơn so với phẫu thuật, tỷ lệ phẫu thuật chiếm 24% (6/25 trường hợp). Thời gian điều trị liền vết thương trước 14 ngày chiếm đa số 56%. Kết luận: Quá trình chăm sóc và điều trị bệnh có mối tương quan với quá trình lành vết thương và dự phòng các thương tổn phần mềm. Chiếu tia Plasma lạnh góp phần trong quá trình liền vết thương. Chăm sóc và điều trị các tổn thương phần mềm có hiệu quả, tái tạo biểu bì mô nhanh chóng, tỷ lệ thương tổn thấp, góp phần giúp bệnh nhân sớm hồi phục, giảm tỷ lệ tử vong. ABSTRACT SURVEY OF COVID-19 PATIENTS HAVINGSOFT TISSUE DAMAGE AT THE COVID-19 INTENSIVE CARE CENTER OF HUE CENTRAL HOSPITAL IN HO CHI MINH CITY Backgrounds: Soft tissue damage is damage to the skin, subcutaneous tissue, scales, muscles caused by various causes such as pressure ulcers, burns, atopic dermatitis, contact dermatitis, shingles, bullous dermatitis occurring in patients with severe COVID-19 infection. These lesions may be present before or after a COVID-19 infection. This study aims to (1) identify the general characteristics of severe COVID-19 patients with soft tissue damage, (2) assess the status of soft tissue damage in patients with severe COVID-19 infection, and (3) find out the correlation between the wound care process and the healing time of the wound. Methods: Twenty - five patients have soft tissue lesions in a total of 1.094 patients with severe COVID-19 infection at COVID-19 Intensive Care Center operated by Hue Central Hospital in Ho Chi Minh city from September 15 to November 1, 2021 (quick survey in 45 days). Results: A quick 45 - day survey of 1.094 severe COVID-19 patients showed that there were 25 cases with soft tissue damage: most of these patients have severe underlying medical conditions, men less than women (44%/56%, men aged 30 - < 50 years old account for the highest number, women aged 50 years and older accounted for the majority of cases ( 92.86%) Most of the patients are over 50 years old. Pressure ulcers (PU) accounted for the majority of cases at 76% (19/25 cases) compared with other lesions, in which patients injured during treatment at the center accounted for 36.8% (7/19 cases). Meanwhile, PU detected before hospital admission was 63.2% (12/19 cases). The rate of soft tissue lesions on the total number of patients treated at the survey time accounted for 2.29% (25/1.094 patients), due to pressure ulcers accounting for 0.64% at the center (7/1.094 patients). Internal Medicine treatment accounted for most cases (76%), more than surgery treatment, 24% (6/25 cases). The time of wound healing before 14 days accounted for most cases at 56%. Conclusion: The care and treatment process correlates to the healing process and the prevention of soft tissue injuries. Adequate care and treatment of soft tissue injuries help to quickly heal epidermal tissue, reduce injury rates, lead to early recovery and low mortality. Keywords: Pressure ulcers, Intensive Care Unit, COVID-19.

Spectrum of soft tissue lesions in upper and lower extremities on fine needle aspiration cytology: A three years’ experience from Western Indian population

Soft tissue lesions have a wide spectrum which includes non- neoplastic, benign & malignant lesions. FNAC act as preliminary diagnostic tool providing a predictive diagnosis of a benign or malignant soft tissue neoplasm and thus helps for further intervention. This study discusses the spectrum of FNAC of soft tissue lesions in upper and lower limbs.All cytology smears of soft tissue lesions from both upper and lower limbs were included over a period of three years at tertiary care hospital. The most common age group was 31 to 40 years with male to female ratio being 1.3:1. The spectrum included broadly neoplastic (65.7%) & non-neoplastic (34.3%) cases. The neoplasms were further divided as benign (42.8 %), malignant (18.6%) and suspicious for neoplasm (4.3%) whereas (34.3 %) were non-neoplastic lesions. The most common lesion was giant cell tumor (GCT) of tendon sheath. The most common site was hand (24%) followed by feet (22.5%). FNAC of soft tissue lesions is useful for differentiating various lesions and neoplasms in extremities so as to help patients in further management.

Comparison of PSMA PET/CT With Fluoride PET/CT for Detection of Bone Metastatic Disease in Prostate Cancer

18F-NaF positron emission tomography/computed tomography (fluoride PET/CT) is considered the most sensitive technique to detect bone metastasis in prostate cancer (PCa). 68Ga-PSMA-11 (PSMA) PET/CT is increasingly used for staging of PCa. This study primarily aimed to compare the diagnostic performance of fluoride PET/CT and Gallium based PSMA PET/CT in identifying bone metastasis followed by a comparison of PSMA PET/CT with contrast-enhanced CT (CE-CT) in identifying soft tissue lesions as a secondary objective. Methods: Twenty-eight PCa patients with high suspicion of disseminated disease following curative treatment were prospectively evaluated. PET/CT examinations using fluoride and PSMA were performed. All suspicious bone lesions were counted, and the tracer uptake was measured as standardized uptake values (SUV) for both tracers. In patients with multiple findings, ten bone lesions with highest SUVmax were selected from which identical lesions from both scans were considered for direct comparison of SUVmax. Soft tissue findings of local and lymph node lesions from CE-CT were compared with PSMA PET/CT. Results: Both scans were negative for bone lesions in 7 patients (25%). Of 699 lesions consistent with skeletal metastasis in 21 patients on fluoride PET/CT, PSMA PET/CT identified 579 lesions (83%). In 69 identical bone lesions fluoride PET/CT showed significantly higher uptake (mean SUVmax: 73.1±36.8) compared to PSMA PET/CT (34.5±31.4; p<0.001). Compared to CE-CT, PSMA PET/CT showed better diagnostic performance in locating local (96% vs 61%, p=0.004) and lymph node (94% vs 46%, p<0.001) metastasis. Conclusion: In this prospective comparative study PSMA PET/CT detected the majority of bone lesions that were positive on fluoride PET/CT. Further, this study indicates better diagnostic performance of PSMA PET/CT to locate soft tissue lesions compared to CE-CT.

Comparison of PSMA PET/CT with fluoride PET/CT for detection of bone metastatic disease in prostate cancer

18F-NaF positron emission tomography/computed tomography (fluoride PET/CT) is considered the most sensitive technique to detect bone metastasis in prostate cancer (PCa). 68Ga-PSMA-11 (PSMA) PET/CT is increasingly used for staging of PCa. This study primarily aimed to compare the diagnostic performance of fluoride PET/CT and PSMA PET/CT in identifying bone metastasis followed by a comparison of PSMA PET/CT with contrast-enhanced CT (CE-CT) in identifying soft tissue lesions as a secondary objective. Methods: Twenty-eight PCa patients with high suspicion of disseminated disease following curative treatment were prospectively evaluated. PET/CT examinations using fluoride and PSMA were performed. All suspicious bone lesions were counted, and the tracer uptake was measured as standardized uptake values (SUV) for both tracers. In patients with multiple findings, ten bone lesions with highest SUVmax were selected from which identical lesions from both scans were considered for direct comparison of SUVmax. PSA at scan was correlated with findings of both scans. Results: Both scans were negative for bone lesions in 7 patients (25%). Of 699 lesions consistent with skeletal metastasis in 21 patients on fluoride PET/CT, PSMA PET/CT identified 579 lesions (83%). In 69 identical bone lesions fluoride PET/CT showed significantly higher uptake (mean SUVmax:73.1 ± 36.8) compared to PSMA PET/CT (34.5 ± 31.4; p < 0.001). PSA at scan was correlated with SUVmax of PSMA PET/CT (r = 0.58; p = 0.01). No correlation was observed between PSA and fluoride PET/CT measurements. Compared to CE-CT, PSMA PET/CT showed better diagnostic performance in locating local (96% vs 61%, p = 0.004) and lymph node (94% vs 46%, p < 0.001) metastasis. Conclusion: PSMA PET/CT was able to detect majority of bone lesions that were positive on fluoride PET/CT and was better correlated with PSA at time of scan. Further, this study indicates better diagnostic performance of PSMA PET/CT to locate soft tissue lesions compared to CE-CT.

Evaluation of prevalence of oral soft tissue lesions in a public sector oral health facility of Karachi, Pakistan.

Objective: The aim of this study is to determine the prevalence of oral soft tissue lesions in patients attending the outpatient department. Study Design: Cross Sectional, Observational study. Setting: Department of Oral and Medicine DUHS. Period: October 2019 to March 2020. Material & Methods: A total of three hundred and eighty five (385) patients were enrolled in the study. Detailed history and thorough intra and extra oral examination of each patient were done. Results: The overall prevalence of oral mucosal lesions was found to be 58.7%. The most frequent oral mucosal lesions were reported as white with 58% of all soft tissue lesions, while the most common site was observed as buccal mucosa with 58% of all sites. As far as texture was concerned, soft texture (47%) was recorded as most frequent. Conclusion: Early detection and identification of oral mucosal lesions is crucial, especially in a population where multifaceted tobacco consumption, oral precancerous and cancerous lesions are reported as one of the highest in the world. The high prevalence of oral mucosal lesions, as reported in our study and their potential for malignant transformation necessitates extensive soft tissue examination of the oral cavity, in adjunct to routine dental checkup.

Profil lesi jaringan lunak rongga mulut anak stunting kategori pendek dan sangat pendekProfile of oral soft tissue lesions in stunted and severely stunted children

Pendahuluan: Stunting adalah keadaan kekurangan gizi kronis yang dipresentasikan secara antropometri berdasarkan nilai Z-score tinggi badan kurang dari -2 standar deviasi (SD) WHO Child Growth Standards pada kelompok umur dan jenis kelamin yang sama. Salah satu faktor utama penyebab stunting adalah defisiensi mikronutrien kronis pada 1000 hari pertama kehidupan secara spesifik pada vitamin B2, vitamin B6, zinc, dan zat besi Di sisi lain, defisiensi tersebut pun dapat menyebabkan berbagai lesi pada rongga mulut. Anak stunting memiliki risiko lebih tinggi pada lesi, penyakit bahkan kematian terutama pada anak stunting kategori sangat pendek. Tujuan penelitian untuk mengetahui profil lesi jaringan lunak rongga mulut pada anak stunting kategori pendek dan sangat pendek. Metode: Jenis penelitian observasional deskriptif dengan pendekatan cross sectional. Teknik pengambilan sampel dengan purposive sampling. Penelitian ini menggunakan data sekunder berupa data rekap bulanan status gizi berdasarkan Z-score oleh Puskesmas Jelbuk dan data primer berupa hasil pemeriksaan rongga mulut pada anak stunting. Hasil: Lesi jaringan lunak rongga mulut pada anak stunting kategori pendek adalah; Glositis (41,9%), Angular cheilitis (16,1%), Ulser (9,6%), Recurrent Apthous Stomatitis (6,4%), Oral Candidiasis (3,3%). Anak stunting kategori sangat pendek: Glositis (53,5%), Angular cheilitis (17,8%), Ulser (3,5%), Recurrent Apthous Stomatitis (7,1%), Oral Candidiasis (3,5%). Simpulan: Lesi jaringan lunak rongga mulut dengan prevalensi terbesar pada kedua kelompok kategori stunting adalah Athropic glossitis. Hal ini perlu mendapat perhatian khusus oleh praktisi kesehatan maupun pemerintah setempat karena kesehatan rongga mulut secara utuh akan memengaruhi asupan nutrisi bagi anak dan sebaliknya.Kata kunci: stunting; jaringan lunak rongga mulut; anak; lesiABSTRACTIntroduction: Stunting is a condition of chronic malnutrition presented anthropometrically based on the Z-score of height less than -2 standard deviations (SD) of the WHO Child Growth Standards in the same age and sex group. One of the main factors of stunting is chronic micronutrient deficiency in the first 1000 days of life, specifically of vitamin B2, vitamin B6, zinc, and iron. On the other hand, these deficiencies can also cause various lesions in the oral cavity. Stunting children have a higher lesion risk, disease, and even death, especially in severely stunted children. This study was aimed to examine the profile of oral soft tissue lesions in stunted and severely stunted children. Methods: The type of research used was descriptive observational research with a cross-sectional approach. The sampling technique used was purposive sampling. This study uses secondary data in the form of monthly recap data on the nutritional status based on Z-score by Jelbuk Health Center and primary data in oral cavity examination results in stunted children. Results: Oral soft tissue lesions in stunted children were glossitis (41.9%), angular cheilitis (16.1%), ulcer (9.6%), recurrent aphthous stomatitis (6.4%), and oral candidiasis (3.3%). Severely stunted children: Glossitis (53.5%), angular cheilitis (17.8%), ulcer (3.5%), recurrent aphthous stomatitis (7.1%), oral candidiasis (3.5%). Conclusions: The oral soft tissue lesion with the highest prevalence in both groups of stunting children was atrophic glossitis. This condition needs special attention from health practitioners and local governments because oral health will affect nutritional intake for children and vice versa.Keywords: stunting, oral soft tissue; children; lesion