RESUMO
Introduction: Pandemics are extraordinary circumstances that necessitate a multifaceted approach to getting the most out of healthcare systems. Health authorities should be aware of the beliefs and attitudes of healthcare professionals before adopting control measures and communication campaigns. We aimed to find out how hospital staff members in three economically diverse regions perceive their facility's preparedness for pandemics. Methodology: A hospital-based cross sectional study was done in three separate world regions, classified according to the World Bank's economics, using a web-based questionnaire. A convenience sample of 450 healthcare workers was collected and analyzed using SPSS version 20. Results: Physicians made up 94.4% of the 450 participants, with 50.3% from High-Income Foreign Countries (HIFC), 20.4% from High-Income Arab Countries (HIAC), and 29.3% from Lower Middle-Income Countries (LMIC). 81.5% of participants from HIAC had formal PPE training, compared to 22.7% and 64.4% of participants from LMIC and HIFC, respectively. Evidently, 39.4% of the HIFC's participants stated that the level of their hospital precautions during the pandemic was above average, as compared to 50% and 14.4% of participants from HIAC and LMIC, respectively. Compared to 42.4% of HIAC participants and 36.4% of LMIC participants, 44.6% of HIFC participants reported feeling at risk because of their clinical role. Conclusion: In all three regions, hospital readiness was well viewed by healthcare professionals; nevertheless, more needs to be done to provide them with psychological and social support. This research may help health authorities put up a suitable preparedness plan to face emerging pandemics. Further research is needed to determine the best course of action to combat comparable pandemics at various economic levels.
RESUMO
The aim of this review is to evaluate the current evidence regarding the best management in terms of active surveillance of angiomyolipoma (AML) cases less than 4 cm, particularly the optimal timing of active surveillance. In addition, we aimed to describe their initial size, clinical presentation, and growth rates. The present systematic review included prospective and retrospective studies that evaluated and followed up patients with AML through active surveillance. Studies were retrieved through an online bibliographic search of the Medline database via PubMed, SCOPUS, Web of Science, and Cochrane Library from their inception to January 2022. Seven studies were included in the present systematic review. Concerning the active surveillance protocol, only four studies describe the frequency of active surveillance and the utilized imaging modality. Some studies followed up lesions by ultrasound annually for two to five years, while other studies followed-up patients twice for the first year, then annually for a median follow-up period of 49 (9-89) months. The used modalities were ultrasound, CT, and magnetic resonance imaging (MRI). Notably, the incidence of spontaneous bleeding was consistent across the included studies (ranging from 2.3 - 3.1%), except for one study which showed an incidence rate of 15.3%. In terms of the need for active treatment, the rate of active treatment was slightly higher in some studies than the others. However, this variation could not be considered clinically relevant to favor one surveillance strategy over the other. We concluded that active surveillance is the first line of management in all small asymptomatic ALMs. ALMs less than 2 cm do not require active surveillance. The current published literature suggested that active surveillance for two years may provide the same benefits as a five-year surveillance strategy, with fewer radiation hazards and less socioeconomic burden.