RESUMO
ABSTRACT: Decompressive craniectomy (DC) is a surgical procedure in which a large section of the skull is removed, and the underlying dura mater is opened widely. After evacuating a traumatic acute subdural hematoma, a primary DC is typically performed if the brain is bulging or if brain swelling is expected over the next several days. However, a recent randomized trial found similar 12-month outcomes when primary DC was compared with craniotomy for acute subdural hematoma. Secondary removal of the bone flap was performed in 9% of the craniotomy group, but more wound complications occurred in the craniectomy group. Two further multicenter trials found that, whereas early neuroprotective bifrontal DC for mild to moderate intracranial hypertension is not superior to medical management, DC as a last-tier therapy for refractory intracranial hypertension leads to reduced mortality. Patients undergoing secondary last-tier DC are more likely to improve over time than those in the standard medical management group. The overall conclusion from the most up-to-date evidence is that secondary DC has a role in the management of intracranial hypertension following traumatic brain injury but is not a panacea. Therefore, the decision to offer this operation should be made on a case-by-case basis. Following DC, cranioplasty is warranted but not always feasible, especially in low- and middle-income countries. Consequently, a decompressive craniotomy, where the bone flap is allowed to "hinge" or "float," is sometimes used. Decompressive craniotomy is also an option in a subgroup of traumatic brain injury patients undergoing primary surgical evacuation when the brain is neither bulging nor relaxed. However, a high-quality randomized controlled trial is needed to delineate the specific indications and the type of decompressive craniotomy in appropriate patients.
RESUMO
Mangroves in Southeast Asia provide numerous supporting, provisioning, regulating, and cultural services that are crucial to the environment and local livelihoods since they support biodiversity conservation and climate change resilience. However, Southeast Asia mangroves face deforestation threats from the expansion of commercial aquaculture, agriculture, and urban development, along with climate change-related natural processes. Ecotourism has gained prominence as a financial incentive tool to support mangrove conservation and restoration. Through a systematic literature review approach, we examined the relationships between ecotourism and mangrove conservation in Southeast Asia based on scientific papers published from 2010 to 2022. Most of the studies were reported in Indonesia, Malaysia, Philippines, Thailand, and Vietnam, respectively, which were associated with the highest number of vibrant mangrove ecotourism sites and largest mangrove areas compared to the other countries of Southeast Asia. Mangrove-related ecotourism activities in the above countries mainly include boat tours, bird and wildlife watching, mangrove planting, kayaking, eating seafood, and snorkeling. The economic benefits, such as an increase in income associated with mangrove ecotourism, have stimulated infrastructural development in ecotourism destinations. Local communities benefited from increased access to social amenities such as clean water, electricity, transportation networks, schools, and health services that are intended to make destinations more attractive to tourists. Economic benefits from mangrove ecotourism motivated the implementation of several community-based mangrove conservation and restoration initiatives, which attracted international financial incentives and public-private partnerships. Since mangroves are mostly located on the land occupied by indigenous people and local communities, ensuring respect for their land rights and equity in economic benefit sharing may increase their intrinsic motivation and participation in mangrove restoration and conservation initiatives. Remote sensing tools for mangrove monitoring, evaluation, and reporting, and integrated education and awareness campaigns can ensure the long-term conservation of mangroves while sustaining ecotourism's economic infrastructure and social amenities benefits.
Assuntos
Conservação dos Recursos Naturais , Áreas Alagadas , Sudeste Asiático , Mudança Climática , BiodiversidadeRESUMO
OBJECTIVE: To estimate the cost-effectiveness of craniotomy, compared with decompressive craniectomy (DC) in UK patients undergoing evacuation of acute subdural haematoma (ASDH). DESIGN: Economic evaluation undertaken using health resource use and outcome data from the 12-month multicentre, pragmatic, parallel-group, randomised, Randomised Evaluation of Surgery with Craniectomy for Patients Undergoing Evacuation-ASDH trial. SETTING: UK secondary care. PARTICIPANTS: 248 UK patients undergoing surgery for traumatic ASDH were randomised to craniotomy (N=126) or DC (N=122). INTERVENTIONS: Surgical evacuation via craniotomy (bone flap replaced) or DC (bone flap left out with a view to replace later: cranioplasty surgery). MAIN OUTCOME MEASURES: In the base-case analysis, costs were estimated from a National Health Service and Personal Social Services perspective. Outcomes were assessed via the quality-adjusted life-years (QALY) derived from the EuroQoL 5-Dimension 5-Level questionnaire (cost-utility analysis) and the Extended Glasgow Outcome Scale (GOSE) (cost-effectiveness analysis). Multiple imputation and regression analyses were conducted to estimate the mean incremental cost and effect of craniotomy compared with DC. The most cost-effective option was selected, irrespective of the level of statistical significance as is argued by economists. RESULTS: In the cost-utility analysis, the mean incremental cost of craniotomy compared with DC was estimated to be -£5520 (95% CI -£18 060 to £7020) with a mean QALY gain of 0.093 (95% CI 0.029 to 0.156). In the cost-effectiveness analysis, the mean incremental cost was estimated to be -£4536 (95% CI -£17 374 to £8301) with an OR of 1.682 (95% CI 0.995 to 2.842) for a favourable outcome on the GOSE. CONCLUSIONS: In a UK population with traumatic ASDH, craniotomy was estimated to be cost-effective compared with DC: craniotomy was estimated to have a lower mean cost, higher mean QALY gain and higher probability of a more favourable outcome on the GOSE (though not all estimated differences between the two approaches were statistically significant). ETHICS: Ethical approval for the trial was obtained from the North West-Haydock Research Ethics Committee in the UK on 17 July 2014 (14/NW/1076). TRIAL REGISTRATION NUMBER: ISRCTN87370545.
Assuntos
Análise Custo-Benefício , Craniotomia , Craniectomia Descompressiva , Hematoma Subdural Agudo , Anos de Vida Ajustados por Qualidade de Vida , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Craniotomia/economia , Craniotomia/métodos , Craniectomia Descompressiva/economia , Escala de Resultado de Glasgow , Hematoma Subdural Agudo/cirurgia , Hematoma Subdural Agudo/economia , Resultado do Tratamento , Reino UnidoRESUMO
Accurate measuring, mapping, and monitoring of mangrove forests support the sustainable management of mangrove blue carbon in the Asia-Pacific. Remote sensing coupled with modeling can efficiently and accurately estimate mangrove blue carbon stocks at larger spatiotemporal extents. This study aimed to identify trends in remote sensing/modeling employed in estimating mangrove blue carbon, attributes/variations in mangrove carbon sequestration estimated using remote sensing, and to compile research gaps and opportunities, followed by providing recommendations for future research. Using a systematic literature review approach, we reviewed 105 remote sensing-based peer-reviewed articles (1990 - June 2023). Despite their high mangrove extent, there was a paucity of studies from Myanmar, Bangladesh, and Papua New Guinea. The most frequently used sensor was Sentinel-2 MSI, accounting for 14.5 % of overall usage, followed by Landsat 8 OLI (11.5 %), ALOS-2 PALSAR-2 (7.3 %), ALOS PALSAR (7.2 %), Landsat 7 ETM+ (6.1 %), Sentinel-1 (6.7 %), Landsat 5 TM (5.5 %), SRTM DEM (5.5 %), and UAV-LiDAR (4.8 %). Although parametric methods like linear regression remain the most widely used, machine learning regression models such as Random Forest (RF) and eXtreme Gradient Boost (XGB) have become popular in recent years and have shown good accuracy. Among a variety of attributes estimated, below-ground mangrove blue carbon and the valuation of carbon stock were less studied. The variation in carbon sequestration potential as a result of location, species, and forest type was widely studied. To improve the accuracy of blue carbon measurements, standardized/coordinated and innovative methodologies accompanied by credible information and actionable data should be carried out. Technical monitoring (every 2-5 years) enhanced by remote sensing can provide accurate and precise data for sustainable mangrove management while opening ventures for voluntary carbon markets to benefit the environment and local livelihood in developing countries in the Asia-Pacific region.
RESUMO
A [2+3] chiral covalent organic cage is produced through a dynamic covalent chemistry approach by mixing two readily available building units, viz. an enantiopure 3,3'-diformyl 2,2'-BINOL compound (A) with a triamino spacer (B). The two enantiomeric (R,R,R) and (S,S,S) forms of the cage C are formed nearly quantitatively thanks to the reversibility of the imine linkage. The X-ray diffraction analysis of cage (S,S,S)-C highlights that the six OH functions of the BINOL fragments are positioned inside the cage cavity. Upon reduction of the imine bonds of cage C, the amine cage D is obtained. The ability of the cage D to host the 1-phenylethylammonium cation (EH+) as a guest is evaluated through UV, CD and DOSY NMR studies. A higher binding constant for (R)-EH+ cation (Ka=1.7 106±10 %â M-1) related to (S)-EH+ (Ka=0.9 106±10 %â M-1) is determined in the presence of the (R,R,R)-D cage. This enantiopreference is in close agreement with molecular dynamics simulation.
RESUMO
Tropical rainforests of Latin America (LATAM) are one of the world's largest carbon sinks, with substantial future carbon sequestration potential and contributing a major proportion of the global supply of forest carbon credits. LATAM is poised to contribute predominantly towards high-quality forest carbon offset projects designed to reduce emissions from deforestation and forest degradation, halt biodiversity loss, and provide equitable conservation benefits to people. Thus, carbon markets, including compliance carbon markets and voluntary carbon markets continue to expand in LATAM. However, the extent of the growth and status of forest carbon markets, pricing initiatives, stakeholders, amongst others, are yet to be explored and extensively reviewed for the entire LATAM region. Against this backdrop, we reviewed a total of 299 articles, including peer-reviewed and non-scientific gray literature sources, from January 2010 to March 2023. Herein, based on the extensive literature review, we present the results and provide perspectives classified into five categories: (i) the status and recent trends of forest carbon markets (ii) the interested parties and their role in the forest carbon markets, (iii) the measurement, reporting and verification (MRV) approaches and role of remote sensing, (iv) the challenges, and (v) the benefits, opportunities, future directions and recommendations to enhance forest carbon markets in LATAM. Despite the substantial challenges, better governance structures for forest carbon markets can increase the number, quality and integrity of projects and support the carbon sequestration capacity of the rainforests of LATAM. Due to the complex and extensive nature of forest carbon projects in LATAM, emerging technologies like remote sensing can enable scale and reduce technical barriers to MRV, if properly benchmarked. The future directions and recommendations provided are intended to improve upon the existing infrastructure and governance mechanisms, and encourage further participation from the public and private sectors in forest carbon markets in LATAM.
Assuntos
Carbono , Ecossistema , Humanos , Carbono/metabolismo , América Latina , Conservação dos Recursos Naturais/métodos , Florestas , Sequestro de CarbonoRESUMO
BACKGROUND AND OBJECTIVES: Global disparity exists in the demographics, pathology, management, and outcomes of surgically treated traumatic brain injury (TBI). However, the factors underlying these differences, including intervention effectiveness, remain unclear. Establishing a more accurate global picture of the burden of TBI represents a challenging task requiring systematic and ongoing data collection of patients with TBI across all management modalities. The objective of this study was to establish a global registry that would enable local service benchmarking against a global standard, identification of unmet need in TBI management, and its evidence-based prioritization in policymaking. METHODS: The registry was developed in an iterative consensus-based manner by a panel of neurotrauma professionals. Proposed registry objectives, structure, and data points were established in 2 international multidisciplinary neurotrauma meetings, after which a survey consisting of the same data points was circulated within the global neurotrauma community. The survey results were disseminated in a final meeting to reach a consensus on the most pertinent registry variables. RESULTS: A total of 156 professionals from 53 countries, including both high-income countries and low- and middle-income countries, responded to the survey. The final consensus-based registry includes patients with TBI who required neurosurgical admission, a neurosurgical procedure, or a critical care admission. The data set comprised clinically pertinent information on demographics, injury characteristics, imaging, treatments, and short-term outcomes. Based on the consensus, the Global Epidemiology and Outcomes following Traumatic Brain Injury (GEO-TBI) registry was established. CONCLUSION: The GEO-TBI registry will enable high-quality data collection, clinical auditing, and research activity, and it is supported by the World Federation of Neurosurgical Societies and the National Institute of Health Research Global Health Program. The GEO-TBI registry ( https://geotbi.org ) is now open for participant site recruitment. Any center involved in TBI management is welcome to join the collaboration to access the registry.
Assuntos
Lesões Encefálicas Traumáticas , Humanos , Consenso , Lesões Encefálicas Traumáticas/terapia , Lesões Encefálicas Traumáticas/cirurgia , Benchmarking , Estudos Longitudinais , Sistema de RegistrosRESUMO
Urban forests provide direct and indirect benefits to human well-being that are increasingly captured in residential property values. Remote Sensing (RS) can be used to measure a wide range of forest and vegetation parameters that allows for a more detailed and better understanding of their specific influences on housing prices. Herein, through a systematic literature review approach, we reviewed 89 papers (from 2010 to 2022) from 21 different countries that used RS data to quantify vegetation indices, forest and tree parameters of urban forests and estimated their influence on residential property values. The main aim of this study was to understand and provide insights into how urban forests influence residential property values based on RS studies. Although more studies were conducted in developed (n = 55, 61.7%) than developing countries (n = 34, 38.3%), the results indicated for the most part that increasing tree canopy cover on property and neighborhood level, forest size, type, greenness, and proximity to urban forests increased housing prices. RS studies benefited from spatially explicit repetitive data that offer superior efficiency to quantify vegetation, forest, and tree parameters of urban forests over large areas and longer periods compared to studies that used field inventory data. Through this work, we identify and underscore that urban forest benefits outweigh management costs and have a mostly positive influence on housing prices. Thus, we encourage further discussions about prioritizing reforestation and conservation of urban forests during the urban planning of cities and suburbs, which could support UN Sustainable Development Goals (SDGs) and urban policy reforms.
RESUMO
Background: The epidemiology of traumatic brain injury (TBI) is unclear - it is estimated to affect 27-69 million individuals yearly with the bulk of the TBI burden in low-to-middle income countries (LMICs). Research has highlighted significant between-hospital variability in TBI outcomes following emergency surgery, but the overall incidence and epidemiology of TBI remains unclear. To address this need, we established the Global Epidemiology and Outcomes following Traumatic Brain Injury (GEO-TBI) registry, enabling recording of all TBI cases requiring admission irrespective of surgical treatment. Objective: The GEO-TBI: Incidence study aims to describe TBI epidemiology and outcomes according to development indices, and to highlight best practices to facilitate further comparative research. Design: Multi-centre, international, registry-based, prospective cohort study. Subjects: Any unit managing TBI and participating in the GEO-TBI registry will be eligible to join the study. Each unit will select a 90-day study period. All TBI patients meeting the registry inclusion criteria (neurosurgical/ICU admission or neurosurgical operation) during the selected study period will be included in the GEO-TBI: Incidence. Methods: All units will form a study team, that will gain local approval, identify eligible patients and input data. Data will be collected via the secure registry platform and validated after collection. Identifiers may be collected if required for local utility in accordance with the GEO-TBI protocol. Data: Data related to initial presentation, interventions and short-term outcomes will be collected in line with the GEO-TBI core dataset, developed following consensus from an iterative survey and feedback process. Patient demographics, injury details, timing and nature of interventions and post-injury care will be collected alongside associated complications. The primary outcome measures for the study will be the Glasgow Outcome at Discharge Scale (GODS) and 14-day mortality. Secondary outcome measures will be mortality and extended Glasgow Outcome Scale (GOSE) at the most recent follow-up timepoint.
Traumatic brain injury (TBI) is a significant global health problem, which affects 2769 million people every year. After-effects of TBI commonly affect the injured individuals for years. Most patients who sustain a TBI are from developing countries. Research has shown that there are differences in patients' recovery after TBI between countries and hospitals. The causes of these differences are unclear and tackling them could improve TBI treatment worldwide. To address this need, we have recently established the Global Epidemiology and Outcomes Following Traumatic Brain Injury (GEO-TBI) registry. The international collaborative registry aims to collect data related to the causes, treatments and outcomes related to TBI patients. This data will hopefully enable future research to elucidate the causes of the recovery differences between hospitals, which could lead to improved patient outcomes. The GEO-TBI: Incidence study collects data from all TBI patients that are admitted to participating hospitals or undergo a neurosurgical operation due to TBI during a 90-day period. This study looks at the patient's recovery at discharge using the Glasgow Outcome at Discharge Scale (GODS), and at the 2-week mortality. In addition, the study also evaluates recovery at the most recent follow-up timepoint. We hope that this information will enhance our understanding on the causes, treatments, and commonness of TBI. The study results will also help local hospitals compare their treatment results to an international standard.
RESUMO
BACKGROUND: Traumatic acute subdural hematomas frequently warrant surgical evacuation by means of a craniotomy (bone flap replaced) or decompressive craniectomy (bone flap not replaced). Craniectomy may prevent intracranial hypertension, but whether it is associated with better outcomes is unclear. METHODS: We conducted a trial in which patients undergoing surgery for traumatic acute subdural hematoma were randomly assigned to undergo craniotomy or decompressive craniectomy. An inclusion criterion was a bone flap with an anteroposterior diameter of 11 cm or more. The primary outcome was the rating on the Extended Glasgow Outcome Scale (GOSE) (an 8-point scale, ranging from death to "upper good recovery" [no injury-related problems]) at 12 months. Secondary outcomes included the GOSE rating at 6 months and quality of life as assessed by the EuroQol Group 5-Dimension 5-Level questionnaire (EQ-5D-5L). RESULTS: A total of 228 patients were assigned to the craniotomy group and 222 to the decompressive craniectomy group. The median diameter of the bone flap was 13 cm (interquartile range, 12 to 14) in both groups. The common odds ratio for the differences across GOSE ratings at 12 months was 0.85 (95% confidence interval, 0.60 to 1.18; P = 0.32). Results were similar at 6 months. At 12 months, death had occurred in 30.2% of the patients in the craniotomy group and in 32.2% of those in the craniectomy group; a vegetative state occurred in 2.3% and 2.8%, respectively, and a lower or upper good recovery occurred in 25.6% and 19.9%. EQ-5D-5L scores were similar in the two groups at 12 months. Additional cranial surgery within 2 weeks after randomization was performed in 14.6% of the craniotomy group and in 6.9% of the craniectomy group. Wound complications occurred in 3.9% of the craniotomy group and in 12.2% of the craniectomy group. CONCLUSIONS: Among patients with traumatic acute subdural hematoma who underwent craniotomy or decompressive craniectomy, disability and quality-of-life outcomes were similar with the two approaches. Additional surgery was performed in a higher proportion of the craniotomy group, but more wound complications occurred in the craniectomy group. (Funded by the National Institute for Health and Care Research; RESCUE-ASDH ISRCTN Registry number, ISRCTN87370545.).
Assuntos
Craniotomia , Craniectomia Descompressiva , Hematoma Subdural Agudo , Humanos , Craniotomia/efeitos adversos , Craniotomia/métodos , Craniectomia Descompressiva/efeitos adversos , Craniectomia Descompressiva/métodos , Escala de Resultado de Glasgow , Hematoma Subdural Agudo/cirurgia , Qualidade de Vida , Estudos Retrospectivos , Crânio/cirurgia , Resultado do Tratamento , Retalhos Cirúrgicos/cirurgiaRESUMO
Climate teleconnections (CT) remotely influence weather conditions in many regions on Earth, entailing changes in primary drivers of fire activity such as vegetation biomass accumulation and moisture. We reveal significant relationships between the main global CTs and burned area that vary across and within continents and biomes according to both synchronous and lagged signals, and marked regional patterns. Overall, CTs modulate 52.9% of global burned area, the Tropical North Atlantic mode being the most relevant CT. Here, we summarized the CT-fire relationships into a set of six global CT domains that are discussed by continent, considering the underlying mechanisms relating weather patterns and vegetation types with burned area across the different world's biomes. Our findings highlight the regional CT-fire relationships worldwide, aiming to further support fire management and policy-making.
Assuntos
Clima , Incêndios , Ecossistema , Tempo (Meteorologia) , Biomassa , Mudança ClimáticaRESUMO
Hydrocarbon-contaminated soils are considered as one of the major environmental issues that harm human well-being, particularly in arid regions of the world. Phytoremediation is a possible mitigation measure for this issue and has been suggested as it is cost-effective compared with other remediation technologies for soil clean-up, such as soil thermal treatment and soil washing. However, there are still gaps in the literature regarding the behavior of annual and perennial desert plants and their ability to survive in hydrocarbon-contaminated soils in arid ecosystems. Therefore, this study aims to develop an integrated approach using remote sensing techniques to understand the behavior of annual and perennial desert plants over different types of oil-contaminated soils (oil tarcrete, wet-oil lake, bare soil, and vegetation cover) in the Kuwait Desert and to explore the impact of climate and physical soil properties on the regrowth of native desert plants. The Normalized Difference Vegetation Index (NDVI), Normalized Difference Water Index (NDWI), and ferrous iron (Fe2+) index (FI) were used to determine the changes in oil contamination and vegetation cover from 1992 to 2002, and 2013-2020. Subsequently, statistical tests were performed to determine the influence of climatic and soil physical characteristics on changes in hydrocarbon contamination and desert plant behavior. The results showed that hydrocarbon contamination was high at the study sites in the first six years (1992-1997) after contamination, and then decreased in the following years. However, vegetation cover was low in the first six years but significantly increased after 1998, reaching >65%. It was also found that annual plants had the highest distribution rate compared to perennial plants, which mainly depended on the soil type. We concluded that certain annual and perennial plants could successfully grow over tarcrete-contaminated sites, making these sites more suitable for the restoration of native desert plants than hydrocarbon-contaminated sites. We also observed that the succession process of vegetation growth over hydrocarbon-contaminated soils could be associated with vegetation growth on a clean sediment layer covering the oil layer. Additionally, we observed that the remobilization of aeolian sediment over many contaminated sites in Kuwait resulted in the accumulation of organic matter, plant seeds, and dust particles that create layers of nutrient-rich soil for the initial growth of plants.
Assuntos
Ecossistema , Poluentes do Solo , Humanos , Tecnologia de Sensoriamento Remoto , Poluentes do Solo/análise , Solo , Plantas , Biodegradação Ambiental , HidrocarbonetosRESUMO
Various series of lanthanide metal-organic networks denoted Ln-Cy (Ln = La, Ce, Pr, Sm, Eu, Gd, Tb, Dy, Ho, Er, Tm, Yb), were synthesized under solvothermal conditions using potassium cyamelurate (K3Cy) and lanthanide nitrate salts. All obtained materials were fully characterized, and their crystal structures were solved by single-crystal X-ray diffraction. Four types of coordination modes were elucidated for the Ln-Cy series with different Ln3+ coordination geometries. Structural studies were performed to compare the various coordination compounds of the Ln-Cy series. Moreover, the cyamelurate linkers of rich π-conjugated and uncoordinated Lewis basic sites were used as an absorbing chromophore to enhance the luminescence quantum efficiency, the band emission and the luminescence lifetime of the coordinated Ln metal centers. Solid-state UV-visible measurements combined with density functional theory (DFT) and time-dependent density functional theory (TDDFT) calculations were performed to further explore luminescent features of the Ln-Cy series and their origins.
RESUMO
OBJECTIVE: Entrance to neurosurgical training is highly competitive. Without proper advice, information and opportunities, talented individuals may be dissuaded from applying. The Neurology and Neurosurgery Interest Group (NANSIG) organises a Careers Day in Neurosurgery every year. Our objective was to assess the overall utility of a neurosurgery careers day and the perceived factors that attract and detract from the specialty, from attendees of the ninth annual neurosurgery careers day. METHODS: Eighteen-item pre-conference and 19-item post-conference questionnaires were disseminated electronically to conference attendees. Questions aimed to capture: (i) baseline demographics; (ii) previous experience and exposure in neurosurgery; (iii) interest in neurosurgery; (iv) understanding training and a career in neurosurgery; (v) perceived factors of attraction and dissuasion of neurosurgery; and (vi) perceived value, quality and educational purpose of the conference. RESULTS: In total, 77 delegates attended the careers day. Most did not have a formal neurosurgical rotation during medical school (24.7%, n = 19), but almost half had gained neurosurgical experience and presented research work. The careers day increased knowledge of the neurosurgical application process (median Likert score 3/5 to 4/5, p < 0.01), duration of training (72.7-88.3%), and desire to pursue a career in neurosurgery (75.3-81.8%). The most commonly reported factors attracting delegates to neurosurgery were interest in neuroanatomy (80.5%, n = 62), practical skills (64.9%, n = 50), and impact on patients (62.3%, n = 48). The most common dissuasive factors were competition to entry (64.9%, n = 50), long working hours (40.3%, n = 31), and other career interests (35.1%, n = 27). Almost all would recommend the event to a colleague (94.9%, n = 73). CONCLUSIONS: Formal undergraduate exposure to neurosurgery is limited. Neurosurgery careers days increase awareness and understanding of the application process and improve interest in a selected cohort. The factors attracting applicants to neurosurgery remain practical links to neuroanatomy, opportunities in neurosurgery for innovation and research, and direct impact on patients.
Assuntos
Neurologia , Neurocirurgia , Estudantes de Medicina , Humanos , Neurocirurgia/educação , Escolha da Profissão , Opinião Pública , Inquéritos e QuestionáriosRESUMO
Compassion has been one of the greatest virtues of healthcare professionals. In the early phase of the pandemic, a lot of caution was essential, and restrictions were imposed on the hospital visitation of the COVID-19 patients by their family members. The healthcare system was overburdened, and the healthcare workers were apprehensive about the new virus and the rising mortality. Compassion and family-centered care took a step back as survival of the pandemic became the ultimate goal of mankind. "COVID-19 patients admitted to the critical care units, their loved ones and the healthcare professionals caring for these patients took the brunt of the emotional and psychological impacts of the pandemic." However, as we have moved more than a year into the pandemic, knowledge and resources we gained may be leveraged to provide family-centered critical care for COVID-19 patients. Family presence in intensive care units (ICUs) has been associated with higher satisfaction with care, collaboration with the medical team, shared decision-making, reduced delirium, and optimized end-of-life care of COVID-19 patients. The policymakers should review the restrictions, consider a holistic approach, and take appropriate actions to provide safe family-centered critical care for COVID-19 patients. HOW TO CITE THIS ARTICLE: Mohan M, Joy LF, Sivasankar A, Ali S, Meckattuparamban BV. "Compassion Cannot Choose:" A Call for Family-centered Critical Care during the COVID-19 Pandemic. Indian J Crit Care Med 2021;25(9):1049-1050.
RESUMO
BACKGROUND: Flow aneurysms (FAs) associated with brain arteriovenous malformations (AVMs) are thought to arise from increased hemodynamic stress due to high-flow shunting. This study aims to describe the changes in conservatively managed FAs after successful AVM treatment. METHODS: Patients with symptomatic AVMs and associated FAs who underwent successful treatment of the AVM between 2008 and 2017 were included. FA dimensions were measured on surveillance angiography to assess longitudinal changes. RESULTS: Thirty-two patients were identified with 48 FAs. Sixteen (33%) FAs were treated endovascularly; 18 (38%) FAs were treated surgically; and 14 (29%) FAs (11 patients) were monitored. FAs demonstrated a decrease in size from 5.0 mm to 3.8 mm (24%; P = 0.016) and 4.9 mm to 3.6 mm (27%; P = 0.013) in height and width, respectively, over a median 35 months. However, on subgroup analysis, only class IIb aneurysms demonstrated a significant decrease in size (51% reduction in largest diameter, P = 0.046) and only 3 FAs (21%) resolved. There were no hemorrhages observed during follow-up. CONCLUSIONS: While conservatively managed FAs demonstrated a reduction in size after the culprit AVM was treated, this was only significant in FAs located close to an AVM nidus (class IIb). There were no hemorrhages during the median 35 months' follow-up; however, long-term data are lacking. Our data support close observation of all conservatively managed aneurysms and a tailored approach based on the proximity to the nidus and observed changes in size.
Assuntos
Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/patologia , Aneurisma Intracraniano/terapia , Malformações Arteriovenosas Intracranianas/complicações , Adulto , Idoso , Tratamento Conservador , Procedimentos Endovasculares , Feminino , Humanos , Aneurisma Intracraniano/complicações , Malformações Arteriovenosas Intracranianas/cirurgia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Coronavirus disease 2019 (COVID-19) rapidly spread from a city in China to almost every country in the world, affecting millions of individuals. The rapid increase in the COVID-19 cases in the state of Kerala in India has necessitated the understanding of SARS-CoV-2 genetic epidemiology. We sequenced 200 samples from patients in Kerala using COVIDSeq protocol amplicon-based sequencing. The analysis identified 166 high-quality single-nucleotide variants encompassing four novel variants and 89 new variants in the Indian isolated SARS-CoV-2. Phylogenetic and haplotype analysis revealed that the virus was dominated by three distinct introductions followed by local spread suggesting recent outbreaks and that it belongs to the A2a clade. Further analysis of the functional variants revealed that two variants in the S gene associated with increased infectivity and five variants mapped in primer binding sites affect the efficacy of RT-PCR. To the best of our knowledge, this is the first and most comprehensive report of SARS-CoV-2 genetic epidemiology from Kerala.