Palpable breast lumps an age-based approach to evaluation and diagnosis

A palpable breast lump is a common presentation of breast disease to a general practitioner. Fortunately, investigation of most of these lumps will lead to a benign diagnosis. It is essential to have a clear and systematic approach when investigating a palpable breast lump to avoid over investigation with the resultant increase in healthcare cost and anxiety. This article will discuss an approach to evaluating and diagnosing a palpable breast lump in the primary care setting

Facteurs de risque et prise en charge de la rupture utérine dans une structure de 1ere référence du Mali: cas du district sanitaire de Bougouni / Risk factors and management of uterine rupture in a 1st reference structure in Mali: case of the Bougouni health district

L'objectif était d'évaluer les facteurs de risque de la RU et de proposer les aspects thérapeutiques. Matériels et méthodes : Nous avons réalisé une étude cas-témoins au centre de santé de Référence de Bougouni en 2019. Résultats : De janvier au 31 décembre 2019; sur 1161 accouchements 43 RU ont été enregistrées soit 3,7% correspondant à une RU pour 27 accouchements. Les patientes de 35 ans et plus ont été plus touchée par la RU (44,2%) avec ORaIC95%= 6,3 [1,5 - 26,3]. Les évacuations obstétricales avaient un ORaIC95%=25,6 [7,8- 83,7]. La totalité des patientes étaient des femmes au foyer (97,7%) des cas versus (82,3%) des témoins avec ORaIC95%= 8,9 (1,1-69). Les Paucipares et multipares avaient respectivement un ORaIC95%= 6,2 [1,8 - 20,3] et 4,1[1,3 - 12,9]. La cicatrice utérine (20,9%) des cas contre 8,1 % les témoins avait un ORaIC95%= 2,9 [1,1 - 8,7]. En effet l'absence de CPN étaient un facteur de risque, ORaIC95%= 3,0 [1,3 ­ 6,9]. Le délai de la RU était ˂ 6 heures chez 95%. En effet 34 RU complètes (79,1%) et 9 RU incomplètes (20,9%) ont été notées. Seulement 2,3 % des cas avaient accouché par voie basse. Le traitement de la RU reposait sur la chirurgie (100%) complétée par celui du choc (51,2%) des cas et de l'infection (100%) des cas. Conclusion: La RU est fréquente dans nos pays sous médicalisés. Sa prévention efficace passe par des stratégies visant à agir sur les facteurs de risque

The objective was to assess the risk factors for and to suggest therapeutic aspects. Materials and methods: We carried out a case-control study at the Bougouni Reference health center in 2019. Results: From January to December 31, 2019; out of 1161 deliveries, 43 uterine rupture were recorded, 3.7% corresponding to one uterine rupture for 27 deliveries. Patients 35 years and older were more affected by uterine rupture (44.2%) with ORaIC95% = 6.3 [1.5 - 26.3]. Obstetric evacuations had an ORaIC95% = 25.6 [7.8-83.7]. All of the patients were housewives (97.7%) versus (82.3%) controls with ORaIC95% = 8.9 (1.1-69). Pauciparous and multiparous had an ORaIC95% = 6.2 [1.8 - 20.3] and 4.1 [1.3 - 12.9], respectively. The uterine scar (20.9%) of cases versus 8.1% of controls had a 95% ORaIC95% = 2.9 [1.1 - 8.7]. Indeed the absence of ANC was a risk factor, ORaIC95% = 3.0 [1.3 - 6.9]. The time to uterine rupture was ˂ 6 hours in 95%. In fact 34 complete uterine rupture (79.1%) and 9 incomplete uterine rupture (20.9) were noted. Only 2.3% of cases gave birth vaginally. Treatment of uterine rupture was based on surgery (100%) supplemented by shock (51.2%) of cases and infection (100%) of cases. Conclusion: Uterine rupture is common in our countries under medical care. Its effective prevention involves strategies aimed at acting on risk factors.

Plasma de convaleciente para el tratamiento de la COVID-19: Protocolo para el acceso y uso en Venezuela / Convalescent Plasma for the Treatment of COVID-19: Protocol for access and use in Venezuela

En diciembre 2019, en Wuhan, China, se registró un aumento inusual de casos de infección respiratoria aguda de rápida progresión y alta letalidad. Al poco tiempo es identificado el agente causal, un coronavirus denominado SARS-CoV-2 y se caracteriza una nueva enfermedad, COVID-19. En ausencia hasta el momento de tratamientos específicos, eficaces y seguros, se justifica explorar alternativas científicamente fundamentadas a nuestro alcance como el uso de Plasma de Convaleciente (PC-CoV19) como coadyuvante para el tratamiento de la COVID-19. El plasma de pacientes recuperados de una enfermedad infecciosa, Plasma de Convaleciente, ha sido utilizado en el tratamiento de patologías infecciosas. Hay antecedentes inmediatos de su uso en enfermedades producidas por otro tipo de coronavirus y se registran experiencias y estudios clínicos con resultados preliminares durante esta pandemia. Quimbiotec, empresa productora de hemoderivados y fármacos recombinantes del Estado venezolano, y el Banco Municipal de Sangre, definen un protocolo para promover condiciones para la aféresis, procesamiento, conservación, almacenamiento, distribución, transfusión y evaluación de la seguridad y eficacia del PC-CoV19 como alternativa en el tratamiento de la COVID-19 en Venezuela. Se incluye la identificación de capacidades y de talento, la estructura física, equipos y especialistas necesarios, así como la definición de procesos para establecer rutinas controladas y auditables para sentar bases del acceso y uso del PC-CoV19 en el Sistema Nacional de Salud de Venezuela y preparar el diseño y ejecución de estudios clínicos. Se presenta el Protocolo y algunos nudos críticos en su ejecución a la fecha, herramientas y estrategias utilizadas para su solución(AU)

On December 2019, in Wuhan, China, there was an unusual increase in cases of a fast-progressing acute respiratory infection with high fatality rate. Soon after, the causing agent is identiied, a coronavirus called SARS-CoV-2, and a new disease, COVID-19 is characterized. Currently, in the absence of specific, effective and safe treatments, it is justified to explore all scientifically based alternatives available to us, such as the use of Convalescent Plasma (PC-CoV19) as acoadjutant treatment of COVID-19.Plasma from patients who have recovered from an infectious disease, Convalescent Plasma, has been used in the treatment of other infectious disease. There is recent history of its use in diseases caused by another type of coronavirus, and clinical experiences and studies have already been published with preliminary results during this pandemic. Quimbiotec, a Venezuelan State public company that produces blood products and recombinant drugs, and Banco Municipal de Sangre, deined a protocol to promote conditions for aphaeresis, processing, conservation, storage, distribution, transfusion, and evaluation of safety and eficacy of PC-CoV19 as an alternative for the treatment of COVID-19 in Venezuela. This protocol includes identification of capacities, physical structure, equipment and skills, talent, professionals needed, as well as a definition of processes to establish controlled and auditable routines to lay the foundations for access and use of PC-CoV19 in the Venezuela Health System, and prepare the design and implementation of clinical studies. The protocol and currently critical points in its implementation, as well as tools and strategies used for its solution, are presented(AU)

Diagnostic performance of a commercial ELISA used as a complementary test for bovine tuberculosis in two bovine herds with different disease status / Desempenho diagnóstico de um ELISA comercial usado como teste complementar para tuberculose bovina em dois rebanhos bovinos com diferentes estágios de controle da doença

Bovine tuberculosis is a worldwide spread zoonotic disease. Intradermal tuberculinizations are the most used diagnostic tests in the world. Serological tests can be an ancillary diagnosis for bovine tuberculosis. The objective of this study was to evaluate the diagnostic performance of the ELISA Mycobacterium Bovis Antibody Test Kit IDEXX ™ in infected herds, which were in different disease control stages. One hundred and twenty animals from two dairy herds of Minas Gerais state, Brazil, were subjected to the ELISA serological test and the comparative cervical tuberculin test (CCT). Diagnostic test parameters were estimated using Bayesian latent class models and concordance between tests estimated by the frequentist approach. The ELISA test presented lower sensitivity than CCT in both herds. Its sensitivity was higher in the herd in sanitation process. Specificity estimates were above 95% in both herds. Kappa index indicated low concordance or even disagreement between tests. According to the results, the ELISA IDEXX should not be used as substitution for CCT. The tests must not be associated in series. Parallel association increased diagnostic sensitivity in the herd which was in the process of sanitation.(AU)

A tuberculose bovina é uma zoonose de distribuição mundial cujos testes mais utilizados para o diagnóstico são as tuberculinizações intradérmicas, simples e compartivas. Contudo, testes sorológicos podem constituir diagnósticos auxiliares. O objetivo deste estudo foi avaliar o desempenho diagnóstico do teste ELISA Mycobacterium Bovis Antibody Test Kit IDEXX ® em rebanhos bovinos infectados, que se encontravam em diferentes estágios de controle da doença. Cento e vinte animais de dois rebanhos leiteiros provenientes do estado de Minas Geais-Brasil foram submetidos ao ELISA e à tuberculinização cervical compartiva (TCC). Avaliou-se o desempenho dos testes por meio de modelos Bayesianos de classe latente e a concordância entre os eles, por meio de estatística frequentista. Uma maior sensibilidade do teste foi observada no rebanho previamente tuberculinizado. Em ambos os rebanhos o TCC foi mais sensível que o ELISA. Especificidade acima de 95% foi encontrada em ambos os rebanhos. Foram observadas baixa concordância ou mesmo discordância entre os testes. De acordo com os resultados obtidos, o teste ELISA-IDEXX não deve ser utilizado em substituição à TCC, tampouco devem ser associados em série. Houve aumento da sensibilidade quando os testes foram associados em paralelo no rebanho que já se encontrava em processo de saneamento.(AU)

Validez y fiabilidad de prueba diagnóstica en entrenamiento sobre procedimientos laparoscópicos básicos / Validity and reliability of diagnostic testing in training on basic laparoscopic procedures

Introducción: la falta de uniformidad en las competencias de cirugía mínimamente invasiva motivó la utilización de la evaluación diagnóstica para determinar los conocimientos previos que poseen los educandos de posgrado sobre este tema.Objetivo: constatar la validez y fiabilidad de los resultados que se obtuvieron con la prueba diagnóstica del entrenamiento "Intensivo en procedimientos laparoscópicos básicos". Métodos: se exploraron los niveles cognoscitivos de las dimensiones: sutura laparoscópica, disección del Triangulo de Calot en la colecistectomía laparoscópica, tratamiento de la litiasis coledociana y Apendicectomía Laparoscópica. Se aplicó un test de Verdadero o Falso a especialistas en Cirugía General, Pediátrica y Coloproctología. Se utilizó la consulta a expertos como fuente de evidencia de validez de contenido de la prueba y la fórmula de Kuder-Richardson 20 para determinar su coeficiente de fiabilidad. Resultados: se consideró apropiada la validez en la definición precisa del universo de contenido que se deseaba medir. El 75 por ciento de los ítems no se diseñaron apropiadamente por lo que no se acreditó la validez en el grado de suficiencia del ámbito que se deseaba evaluar. Conclusiones: no se constató la validez y fiabilidad de los resultados que se obtuvieron con la prueba diagnóstica del entrenamiento "Intensivo en procedimientos laparoscópicos básicos". Se perfeccionó el instrumento de evaluación diagnóstica de dicho entrenamiento a partir del análisis de la validez y fiabilidad de los resultados obtenidos(AU)

Introduction: the lack of uniformity in basic skills of laparoscopic surgery led to the use of diagnostic assessment to determine prior knowledge level by graduate students. Objective: to prove the validity and reliability of the results obtained with the diagnostic test for students of "Basic laparoscopic procedures intensive training". Methods: there were explored the following cognitive dimensions: Laparoscopic suturing, dissection of Calot triangle in laparoscopic cholecystectomy, Treatment of cholelithiasis and Laparoscopic appendectomy. A True or False Test was applied to specialists in General Surgery, Pediatric and Coloproctology. Consulting experts was considered as a source of evidence for content validity of the test and the Kuder-Richardson formula 20 was used to determine the reliability coefficient. Results: it was considered appropriated the validity in the definition of content, which was intended to measure. 75 percent of items were not appropriated designed, that's why validity in sufficiency's grade was not accredited. Conclusions: the diagnosed test for "Basic laparoscopic procedures intensive training" was improved like consequence of validity and fidelity's analysis from the obtained results(AU)

Utilização da escala de dificuldade percebida na produção da fala na avaliação aeróbia em cicloergometro (Talk Test) / Use the scale of perceived difficulty in production of speech in the assessment aerobic cycle ergometer (Talk Test)

O Talk Test (TT) é uma ferramenta que avalia subjetivamente a intensidade ótima para a prática de exercício com base na capacidade de manter uma conversa confortável durante o esforço. O objetivo do presente estudo foi obter evidências de validade (concorrente e de constructo) do TT. Quatorze sujeitos, 7 mulheres e 7 homens (22 ± 8 anos, 69 ± 15 Kg, 169 ± 10 cm, 21 ± 12 %G) foram submetidos a um teste progressivo em cicloergmetro, carga inicial de 25 watts e incremento de 25 watts a cada 2 minutos (60-70 RPM) até a exaustão. Ao final dos estágios o avaliado recitava três vezes uma frase conhecida, indicando a sua Dificuldade Percebida na Produção da Fala (DPPF) de acordo com a escala proposta por Rotstein et al. (2004). A carga com valor 7, correspondente à “difícil” (L7DPPF) foi utilizada como indicadora do segundo limiar fisiológico, assim como o do Ponto de Deflexão da Freqüência Cardíaca (PDFC), identificado pelo Dmáx positivo da diferença entre um ajuste polinomial de terceira ordem e ajuste linear de todos os pontos da relação FC / Carga. Para as análises foram empregados os testes Kolmogorov-Smirnov, Kruskall-Wallis, post-hoc de Dunn’s, e o método de Bland- Altman, além da correlação de Spearman (p<0,05). Não foram identificadas iferenças significativas entre L7DPPF e PDFC (p=0,03), além de serem associados à carga máxima atingida no teste (r=0,90 e r=0,81). As duas técnicas de identificação do LTF2 – PDFC e o L7DPPF – se mostraram semelhante pelo método Bland-Altman, (IC 95% = 0,41 – 1,46). Sendo o TT um indicador de aptidão aeróbia, o L7DPPF pode ser considerado um método para predizer LTF2.

Talk Test is a tool used to to evaluate by a subjective manner the optimal exercise intensity. It is based on individual capacity to maintain a confortable speech during the effort. The aim of the study was to verify evidence of validitiy (concurrent and constructo) of the Talk Test. Fourteen subjects (7 males and 7 females) volunteered to a cicle ergometer progressive test with intial load of 25 Watts and increments of 25 Watts each 2 minutes until exhaustion. Subjects should recite a known sentence for three times at the end of each stage and indicate their Perceived Speech Production Difficult (DPPF) accoding to the scale of Rotstein et al., (2004) where the load at the level 7 which is “difficult” was taken as a physiological threshold indicator. The Second Physiological Threshold (LT2) was considered the Heart Rate Deflection Point (PDFC) identified by the positive Dmax method. For analyzes were employed olmogorov-Smirnov test, Kruskal-Wallis post hoc Dunn's, and Bland- Altman, beyond the Spearman correlation (p <0.05). No significant differences were identified between L7DPPF and PDFC (p = 0.03), and are associated with the maximum load reached in the test (r = 0.90 and r = 0.81). Both techniques of identification of LTF2 - PDFC and L7DPPF - were similar by Bland- Altman method (95% CI = 0.41 to 1.46). TT being an indicator of aerobic fitness, the L7DPPF could be considered a method to predict LTF2.