The Effects of the COVID-19 Mask Mandate on Complication Rates in Postmastectomy Tissue Expansion.

INTRODUCTION: Tissue expansion is a commonly used breast reconstructive strategy. Although the procedure is regarded as safe, tissue expander to implant-based breast reconstruction is reported to have the highest rates of postoperative infection among plastic surgery operations. During the COVID-19 pandemic, face masks were required at all hospital facilities at our institution. The purpose of this study is to investigate the effects of COVID-19 mask mandate on in-office breast tissue expansion procedures. METHODS: An institutional review board-approved, retrospective review was completed on all patients who underwent unilateral or bilateral tissue expansion following mastectomy at a single institution in 2017 (prior to the COVID-19 mask mandate) and 2021 (following implementation of the mandate). Variables included were demographics, procedure information, and postoperative outcomes. RESULTS: The analysis included 118 patients in the premandate group and 147 patients in the postmandate group. There was no difference in age, body mass index, smoking status, or diabetes mellitus between the 2 groups (P > 0.05). More patients in the postmandate group underwent bilateral reconstruction as opposed to unilateral when compared with the premandate group (70.7% vs 55.9%, P = 0.014). There were no differences in major complication rate (26.3% vs 30.6%, P = 0.495) or minor complication rate 30.5% vs 26.5%, P = 0.495) between the pre-mask and post-mask mandate groups. CONCLUSION: Our results demonstrated that the use of face masks did not play a significant role in complication rates relating to in-office tissue expansion procedures. It remains up to the discretion and comfortability of the provider if masks should be worn during the procedure.

Caring for people who take care: What is already done?

OBJECTIVE: The growing prevalence and impact of cancer on the family system calls for a palliative care approach with the family as the unit of care. This study aimed at providing an overview of the intervention programs that have been developed to offer support to the family caregivers of oncologic patients receiving palliative care. METHOD: Sixteen articles were included in the final review, encompassing (i) studies focused on intervention programs with family caregivers of cancer patients in palliative care, (ii) studies including a pre- and post-test evaluation of the intervention program, (iii) and studies whose cancer patients were at least 18 years old. RESULTS: A great heterogeneity was verified with respect to care settings, number of sessions, outcome measures, or timing of assessment within the reviewed programs. These findings mirrored the complexity of the palliative care approach, which is difficult to standardize. Nonetheless, some interventions with different features accomplished good and sometimes similar results. The studies' main outcomes were clustered in five categories: psychological symptomatology, general quality of life, caregiving role, family relational variables, and bereavement/grief. Moreover, 44% of the main outcomes were psychological symptomatology of family caregivers, with an emphasis toward anxiety and depression. Also shown was a growing emergence of technology use among these interventions. SIGNIFICANCE OF RESULTS: Results revealed a scarcity of family-oriented programs and lack of certified mental health professionals as interventionists. Future studies and interventions should focus on the positive outcomes of the caregiving experience and must acknowledge the cultural differences when trying to replicate programs. Considering that there is no precise formula for dealing with terminal illness and grief, we submit that family-centered and systemic lenses are excellent approaches for support during this adjustment process. In conclusion, the present study advocates for increased investment in the field, underscoring the importance of family caregivers' mental health.

Toxocara canis 30-35 kDa excretory-secretory antigen is an important marker in mice challenged by inocula containing different parasite load levels

ABSTRACT The Western-blotting technique was applied to identify antigenic fractions of excretory-secretory Toxocara canis antigen recognized by IgG antibodies throughout an experimental infection in mice challenged by different inocula. Mice were inoculated with 5, 50 and 500 embryonated eggs and serum samples were collected 15, 30, 60, 90 and 120 days post-infection. Serum samples were analyzed using an excretory-secretory Toxocara antigen. Antibodies recognized antigenic fractions from 30 to 90 kDa. The protein fraction of 30-35 kDa was the most frequently recognized regardless of the size of inoculum and the stage of infection represented by the different collection times, but the antigenic recognition was more evident in groups infected with 50 and 500 eggs. This study presents an antigenic panel of the excretory-secretory antigen of T. canis and suggests that the 30-35 kDa antigenic fraction is a promising marker of the infection and should be further explored in future studies on experimental toxocariasis.

Redução na Hospitalização e Aumento na Mortalidade por Doenças Cardiovasculares durante a Pandemia da COVID-19 no Brasil / Reduction in Hospitalization and Increase in Mortality Due to Cardiovascular Diseases during the COVID-19 Pandemic in Brazil

Resumo Fundamento Na pandemia pela COVID-19, o aumento da ocorrência e da mortalidade por doenças cardiovasculares (DCV) vem sendo reconhecido no mundo. No Brasil, é essencial que o impacto da COVID-19 na DCV seja analisado. Objetivos Avaliar o impacto desta pandemia nos números de internações hospitalares (IH), óbitos hospitalares (OH) e letalidade intra-hospitalar (LH) por DCV a partir de dados epidemiológicos do Sistema Único de Saúde (SUS). Métodos Estudo observacional de séries temporais por meio da análise comparativa das taxas de IH, OH e LH por DCV registrados entre janeiro e maio de 2020, usando como referência os valores obtidos no mesmo período entre 2016 e 2019 e os valores projetados por métodos de regressão linear para o ano de 2020. O nível significância estatística utilizado foi de 0,05. Resultados Em comparação com o mesmo período de 2019, houve um decréscimo de 15% na taxa de IH e de 9% no total de OH por DCV entre março e maio de 2020, acompanhado de um aumento de 9% na taxa de LH por esse grupo de doenças, sobretudo entre pacientes com idade de 20-59 anos. As taxas de IH e LH registradas em 2020 diferiram significativamente da tendência projetada para o corrente ano (p=0,0005 e 0,0318, respectivamente). Conclusões Durante os primeiros meses da pandemia, observou-se um declínio na IH associado a um aumento da LH por DCV no Brasil. Esses dados possivelmente são consequência do planejamento inadequado no manejo das DCV durante a pandemia, sendo necessária a implementação de ações imediatas para modificar esse cenário. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0)

Abstract Background In the COVID-19 pandemic, the increase in the incidence of cardiovascular diseases (CVD) and mortality from them has been recognized worldwide. In Brazil, the impact of COVID-19 on CVD must be evaluated. Objectives To assess the impact of the current pandemic on the numbers of hospital admissions (HA), in-hospital deaths (ID), and in-hospital fatality (IF) from CVD by use of national epidemiological data from the Brazilian Unified Public Health System. Methods Time-series observational study using comparative analysis of the HA, ID, and IF due to CVD recorded from January to May 2020, having as reference the values registered in the same period from 2016 to 2019 and the values projected by linear regression methods for 2020. The statistical significance level applied was 0.05. Results Compared to the same period in 2019, there was a 15% decrease in the HA rate and a 9% decrease in the total ID due to CVD between March and May 2020, followed by a 9% increase in the IF rate due to CVD, especially among patients aged 20-59 years. The HA and IF rates registered in 2020 differed significantly from the projected trend for 2020 (p = 0.0005 and 0.0318, respectively). Conclusions During the first months of the pandemic, there were a decline in HA and an increase in IF due to CVD in Brazil. These data might have resulted from the inadequate planning of the CVD management during the pandemic. Thus, immediate actions are required to change this scenario. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0)

Scaffolds of PCL combined to bioglass: synthesis, characterization and biological performance.

Biomaterials may be useful in filling lost bone portions in order to restore balance and improve bone regeneration. The objective of this study was to produce polycaprolactone (PCL) membranes combined with two types of bioglass (Sol-Gel and melt-quenched) and determine their physical and biological properties. Membranes were produced through electrospinning. This study presented three experimental groups: pure PCL membranes, PCL-Melt-Bioglass and PCL-Sol-gel-Bioglass. Membranes were characterized using Scanning Electron Microscopy, Fourier Transform Infrared Spectrophotometry (FTIR), Energy-Dispersive Spectroscopy and Zeta Potential. The following in vitro tests were performed: MTT assay, alkaline phosphatase activity, total protein content and mineralization nodules. Twenty-four male rats were used to observe biological performance through radiographic, fracture energy, histological and histomorphometric analyses. The physical and chemical analysis results showed success in manufacturing bioactive membranes which significantly enhanced cell viability and osteoblast differentiation. The new formed bone from the in vivo experiment was similar to that observed in the control group. In conclusion, the electrospinning enabled preparing PCL membranes with bioglass incorporated into the structure and onto the surface of PCL fibers. The microstructure of the PCL membranes was influenced by the bioglass production method. Both bioglasses seem to be promising biomaterials to improve bone tissue regeneration when incorporated into PCL.

A Visual-Analogue Screening Tool for Assessing Mood and Quality of Daily Life Complications in Family Members of People Living With Cancer: Portuguese Version of the Emotion Thermometers: Burden Version.

Cancer is a disease that impacts not only the patient but also affects the entire family. Family members experience high levels of distress. Therefore, screening for cancer-specific distress among family members of people with cancer is important but relatively unexplored. This cross-sectional study aims to analyze the psychometric properties of a screening tool for family members of people with cancer. We examined the usefulness of the emotional thermometers burden version (ET-BV) in detecting caregiver emotional distress. The ET-BV is a simple multidomain visual analogue scale distributed in two major domains: "emotional upset" and "impact." A total of 364 cancer patients' family members completed the ET-BV and Brief Symptom Inventory. Analyses were aimed to examine the diagnostic accuracy (receiver operating characteristic) of the ET-BV. A fair to good diagnostic accuracy was achieved for ET-BV. For emotional upset thermometers, a cutoff of ≥5 was determined and for impact thermometers, a cutoff of ≥4 was established. ET-BV seems to be a useful, quick, and simple tool for distress screening in family members of people with cancer. A revision of a specific thermometer is discussed in order to increase ET screening performance and clinical utility.

Psychological morbidity in family caregivers of people living with terminal cancer: Prevalence and predictors.

OBJECTIVE: The issues surrounding a patient's terminal phase of cancer and the imminent death of the individual represent a major family crisis affecting all its members. The goal of this study was to assess the prevalence of psychological morbidity in family caregivers of persons with terminal cancer in terms of psychological distress, depression, anxiety, somatization, and complicated anticipatory grief, and to determine which factors may influence these responses. METHOD: One hundred and twelve family caregivers of individuals with terminal cancer completed an assessment protocol comprising the Brief Symptom Inventory (depression, anxiety, somatization, and a computed score for global distress), the Marwit-Meuser Caregiver Grief Inventory - Short Form (anticipatory grief), the Family Inventory of Needs (importance and satisfaction of needs), and the Systemic Clinical Outcome Routine Evaluation -15 (family functioning). Prevalence of psychological morbidity was determined through descriptive and frequency statistics. Predictors of psychological morbidity were ascertained through structural equation modelling methods.ResultRegarding the prevalence of psychological morbidity in family caregivers, 66.1% reported high levels of distress, 68.8% showed high risk of depression, 72.3% showed high risk of anxiety, 50.9% reported high levels of somatization, and 25.9% showed high risk of complicated anticipatory grief. It was found that the predictors of age, gender, relationship to the family member with terminal cancer, the caregiving role played (i.e., primary vs. nonprimary), the satisfaction of needs by healthcare professionals, and family functioning play an important role in terms of one's risk of developing psychological morbidity.Significance of resultsThis study revealed an alarming prevalence of psychological morbidity in family caregivers of individuals living with terminal cancer, making it crucial to move forward from a patient-centered approach to a family-centrad approach to reduce the risk of family maladjustment when facing the imminent death of a family member and to prevent postdeath unadjusted responses.

Prenatal care and hypertensive gestational syndromes: A systematic review / Atenção pré-natal e síndromes gestacionais hipertensivas: uma revisão sistemática

Abstract Objective Evaluate the influence of prenatal care on the occurrence of gestational hypertension. Methods The Web of Science, Scopus, Pubmed, Cochrane and ClinicalTrials electronic databases were searched for articles published between January 1st, 2012 and December 31st, 2016. No language restrictions were imposed. The following keywords were used: prenatal care, medical assistance, prenatal education, pregnancy-induced hypertension. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist was employed. Two hundred and forty articles were identified during the initial search, but only seven met the inclusion criteria. This systematic review is registered with the international prospective register of systematic reviews (PROSPERO; #CRD42017064103). Results The seven studies hada lowriskof bias,withmethodological quality scores ranging fromsix to eight points. Five studies found a positive relationship between prenatal care and pregnancy-induced hypertension, whereas two studies found no significant association between the two variables. The divergence among the studies may have been due to the type of healthcare service at which the study was conducted and the sample size. Conclusion Although the studies analyzed differed with regard to methodological aspects, the findings demonstrate the importance of prenatal care during the gestational period as a prevention and health promotion measure.

Resumo Objetivo Avaliar a influência da assistência pré-natal no acometimento de síndromes hipertensivas gestacionais. Métodos A revisão buscou artigos publicados nas plataformas eletrônicas de pesquisa Web of Science, Scopus, Pubmed, Cochrane e Clinical Trials, sem restrições de linguagem e com os artigos publicados entre 01/01/2012 e 31/12/2016. Os descritores utilizados foram: assistência pré-natal, assistência médica, educação pré-natal, hipertensão induzida pela gravidez, gestação. Foi utilizado o checklist preferred reporting items for systematic reviews and meta-analyses PRISMA. A busca na literatura, de acordo com a estratégia adotada, identificou 240 artigos. Contudo, somente 7 artigos foram selecionados de acordo com os critérios de inclusão. A revisão sistemática foi incluída no registro prospectivo internacional de revisões sistemáticas (PROSPERO, na sigla em inglês; #CRD42017064103). Resultados Cinco estudos encontraram relação positiva entre a assistência pré-Natal e síndromes hipertensivas gestacionais. Dois estudos não encontraram uma associação estatística significativa entre estas duas variáveis. Os sete estudos apresentam um baixo risco de viés, com as pontuações na análise de qualidade variando entre seis e oito. As possíveis diferenças entre os achados podem ser devidas ao momento do diagnóstico das síndromes hipertensiva gestacionais, tipo de serviço onde foi realizada a pesquisa e o tamanho amostral. Conclusão Embora os estudos apresentem diferentes aspectos metodológicos, observou-se a importância da implementação da Assistência Pré-Natal durante o período gestacional, o que atuará como medida de promoção e prevenção em saúde.

Effect of sex on Toxocara canis larval migration to the cerebellum during experimental infection of Rattus norvegicus

The presence of Toxocara canis third instar larvae in the cerebellum of Rattus norvegicus may alter rodent behavior and movement. In this study, we investigated whether the sex of the rodent affects the migration of larvae to the cerebellum. Thirty-six Rattus norvegicus specimens (18 males and 18 females) were infected with 300 T. canis eggs and were euthanized after 60 days. The cerebellum was removed and treated with 0.5% HCl to recover the T. canis larvae. The number of larvae recovered from male rodents was significantly higher than in females, suggesting that the sex of the animal influences larval migration to the cerebellum

Effect of low-level laser therapy (λ780 nm) on the mechanically damaged dentin-pulp complex in a model of extrusive luxation in rat incisors.

In order to regenerate the dental pulp, many strategies have been developed as phototherapy. In the pulp repair, we do not know if gallium-aluminum-arsenide (GaAlAs) laser preserves the primary odontoblasts or stimulates the formation of more dentin matrix when dental pulp is damaged. The aim of the present study was to examine the effect of laser phototherapy (λ780 nm) on vascularization, inflammation, density of the primary odontoblast layer, and formation of reactionary and reparative dentin in the dental pulp by provoking extrusion of the rat incisor. The upper incisors were extruded 3 mm and then repositioned into their original sockets followed by a laser irradiation of the palatal mucosa (λ = 780 nm; p = 70 mW; CW; 4.2 J/cm2; 60 s) every 48 h. Non-traumatized and/or non-irradiated incisors were used as the controls. At 8 and 30 days after surgery, incisors were processed for histological and histomorphometric analysis. Morphological analysis revealed no differences in vascularization between groups, but showed discrete inflammation in some non-irradiated and injured specimens, which correlated with a more irregular reparative dentin. The density of primary odontoblasts in the groups treated with lasers was higher when compared to non-irradiated groups, but no statistically significant difference between groups (p > 0.05). The thickness of the tertiary dentin was increased in both traumatized groups with no statistically significant difference between non-irradiated and irradiated groups (p > 0.05).The present findings revealed that the GaAlAs laser induced small changes on dentin-pulp complex, with more regular dentin matrix in the irradiated dental pulps.

Experimental toxocariasis in BALB/c mice: relationship between parasite inoculum and the IgG immune response

BALB/c mice were inoculated with 5-500 Toxocara canis infective eggs, and bled at 15-120 days post infection (dpi) to evaluate the dynamics of IgG antibody response and larvae distribution. Positive results were observed in all occasions for every inoculum, and a direct proportional relationship between antibody detection and the parasitic load was observed. In samples collected at 60 dpi, detection of IgG was more intense, especially with the 50 and 500 egg doses; also, a correlation between antibody level and egg count was observed with these two inocula. At 120 dpi, a decrease in antibody titer was observed for all groups; and at the end of the experiment, larvae were recovered from carcass, liver and brain. In the liver, larvae were only found in mice inoculated with 500 T. canis eggs. In carcasses, these were recovered in all groups, and the group inoculated with 50 eggs showed the highest percentage of larvae in the brain.

Comparative microscopic analysis of nail clippings from patients with cutaneous psoriasis and psoriatic arthritis

Abstract: BACKGROUND: The nail involvement in psoriasis is related to psoriatic arthritis and may represent a predictor of the disease. OBJECTIVES: To analyze, through nail clipping, clinically normal and dystrophic nails of patients with cutaneous psoriasis and psoriatic arthritis. METHODS: This is a cross-sectional multicenter study, conducted between August 2011 and March 2012. Patients were divided into four groups: patients with cutaneous psoriasis and onychodystrophy, patients with cutaneous psoriasis and clinically normal nails, patients with psoriatic arthritis and onychodystrophy and patients with psoriatic arthritis and clinically normal nails. We calculated NAPSI (Nail Psoriasis Severity Index) of the nail with more clinically noticeable change. After collection and preparation of the nail clipping, the following microscopic parameters were evaluated: thickness of the nail plate and subungual region, presence or absence of parakeratosis, serous lakes, blood, and fungi. RESULTS: There were more layers of parakeratosis (p=0.001) and a greater thickness of the subungual region in patients with cutaneous psoriasis and onychodystrophy (p=0.002). Serous lakes were also more present in the same group (p=0.008) and in patients with psoriatic arthritis and normal nails (p=0.047). The other microscopic parameters showed no significant difference between normal and dystrophic nails or between patients with psoriatic arthritis or cutaneous psoriasis. STUDY LIMITATIONS: Small sample size and use of medications. CONCLUSIONS: Nail clipping is a simple and quick method to assess the nails of patients with nail psoriasis although does not demonstrate difference between those with joint changes or exclusively cutaneous psoriasis.

Análisis epidemiológico de las patologías en mujeres de edad reproductiva que acudieron a un hospital general tipo IV / Epidemiological analysis of medical conditions in women of childbearing age who attended a teaching general hospital in Caracas, Venezuela

Analizar la patología médica de las mujeres en edad fértil que fueron atendidas en el Hospital General del Oeste de Caracas, Venezuela. Métodos: se realizó un estudio descriptivo, transversal, de pacientes con edades entre 14 y 44 años evaluadas desde 1º Octubre 2015 al 1º Mayo 2016. Tratamiento estadístico: Se realizó estadística descriptiva con medidas de tendencia central en las variables continuas y de proporción en las cualitativas. Resultados: Se evaluaron 910 pacientes con edad promedio de 25,63 ± 6,69 DS. El grupo entre 14 y 19 años fue el 33,40% y el 17,5% eran adolescentes. El promedio de edad de las embarazadas fue de 23,31 ± 6,08 DS, mientras que en las no gestantes 30,57 ± 7,97 DS. Según el Graffar modificado por Méndez Castellanos predominó la clasificación III en 57,06%. El promedio de la menarquia fue 12,7 ± 1,75 DS y de la sexarquia 16,54 ± 4,04 DS. La edad promedio del primer parto fue 18 ± 1,33 DS. El 73,62% no cumplía control ginecológico anual. Eran gestantes 78% y de ellas, el 80% eran sanas. Las patologías médicas del embarazo fueron preeclampsia 39%, anemia 35,93%, diabetes gestacional 12%, síndrome de HELLP 11%, hiperemesis gravídica 1,56%. Los diagnósticos médicos no relacionados con el embarazo fueron: asma 41,77%, HTA crónica 16,45%, ITU 12,65%, obesidad 7,59%, anemia 5,09%. La violencia doméstica se documentó en 3,4% y 20% ocurrió durante la gestación. En las no gestantes el diagnóstico médico predominó en 48% y los mas frecuentes fueron: anemia 34,84%, ITU 27,77%, HTA crónica 7,57%. Conclusión: La atención médica de la mujer en edad reproductiva debe ser adecuadamente abordada(AU)

To analyze the medical conditions in women of childbearing age who consulted at the Hospital General del Oeste, Caracas, Venezuela. Methods: This is an analitycal, transverse case design, of female patients in a non probabilistic sample, of intentional selection, that included 100% of patients aged 14 - 44 years, who consulted between October 1st 2015 and May 1st 2016- We included hospitalized and outpatients of internal medicine, as well as obstetrics and gynecology. A previous informed consent was obtained. The sample was divided in two groups, pregnant and not pregnant, classified as healthy and with any medical or gynecological pathology. The variables studied were: age, menarche, sexarche, parity, demographics, and final diagnoses, as well as associated complications. Results: We studied 910 patients, with an average age of 25,63 ± 6,69 DS. The group of 14 to 19 years was 3,40% and 17,5% of them were adolescents. The average age of the pregnant women was 23,31 ± 6,08 DS, and in the non-pregnant 30,57 ± 7,97 DS The Graffar score modified by Méndez Castellanos showed a class III in 57,06%. The average age of menarche was 12,7 ± 1,75 DS and of the first sexual intercourse 16,54 ± 4,04 DS. The average age of the first delivery 18 ± 1,33 DS. An important 73,62% did not have an annual gynecological consultation. The pregnant women were 78%. Among them, 80% were healthy. Their pathological conditions of pregnancy were: preeclampsia 39%, anemia 35,93%, gestational diabetes 12%, HELLP syndrome 11%, hyperemesis gravídarum 1,56%. The medical conditions not related to pregnancy were: asthma 41,77%, chronic hypertension 16,45%, UTI 12,65%, obesity 7,59%, anemia 5,09%. Doméstic violence was documented in 3,4%, and 20% ocurred during pregnancy. In non pregnant women there was 48% of medical conditions, being the most frequent anemia 34,84%, UTI 27,77%, chronic hypertension 7,57%, Conclusion: Women in childbearing age must be adequately approached and treated(AU)

Efeito da intensidade de fontes de luz e barreiras de cerâmica na microdureza de cimento resinoso dual / Effect of intensity of light sources and barriers in ceramic hardness of dual-cured cement

Introdução: O cimento resinoso dual é o principal material para cimentação de cerâmicas. Contudo, fatores, como fonte de luz, podem influenciar no desempenho do cimento. Objetivo: Avaliar a influência de duas fontes de luz de diferentes intensidades sobre a microdureza de um cimento resinoso quando fotoativado sob diferentes cerâmicas. Material e método: Foram fotoativados 40 espécimes de cimento resinoso dual (10 mm × 1,0 mm) por meio de duas fontes de luz LED, com intensidades de 1.000 mW/cm² e 800 mW/cm² durante 40 segundos, sob cerâmicas (15 mm × 2 mm) à base de zircônia, espinélio MgAl2O4 e dissilicato de lítio. No grupo controle, foi utilizada uma placa de vidro de mesma dimensão. As amostras tiveram a superfície regularizada com lixa d`água (600 e 1200). Após armazenagem a seco no escuro (24 h), foram realizadas as medidas de microdureza Vickers (HMV Shimadzu - 50g/10 segundos). Os dados foram submetidos à Anova fatorial e ao teste de Tukey com nível de significância de 5%. Resultado: O cimento polimerizado apresentou valor médio de microdureza e desvio padrão para o grupo controle de 43,9±1,5 e 43,4±1,3, para as intensidades de 1.000 mW/cm2 e 800 mW/cm2, respectivamente. O menor valor de microdureza do cimento foi observado para a cerâmica à base de espinélio MgAl2O4, polimerizado a 800 mW/cm², com valor de 34,3±3,3.