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1.
Artigo em Inglês | MEDLINE | ID: mdl-32503333

RESUMO

Virus outbreaks are threats to humanity, and coronaviruses are the latest of many epidemics in the last few decades in the world. SARS-CoV (Severe Acute Respiratory Syndrome Associated Coronavirus) is a member of the coronavirus family, so its study is useful for relevant virus data research. In this work, we conduct a proposed approach that is non-medical/clinical, generate graphs from five features of the SARS outbreak data in five countries and regions, and offer insights from a visual analysis perspective. The results show that prevention measures such as quarantine are the most common control policies used, and areas with strict measures did have fewer peak period days; for instance, Hong Kong handled the outbreak better than other areas. Data conflict issues found with this approach are discussed as well. Visual analysis is also proved to be a useful technique to present the SARS outbreak data at this stage; furthermore, we are proceeding to apply a similar methodology with more features to future COVID-19 research from a visual analysis perfective.


Assuntos
Análise de Dados , Surtos de Doenças/prevenção & controle , Surtos de Doenças/estatística & dados numéricos , Internacionalidade , Quarentena/estatística & dados numéricos , Síndrome Respiratória Aguda Grave/epidemiologia , Síndrome Respiratória Aguda Grave/prevenção & controle , Conferências de Consenso como Assunto , Hong Kong/epidemiologia , Humanos , Controle de Infecções , Síndrome Respiratória Aguda Grave/transmissão , Fatores de Tempo , Organização Mundial da Saúde
2.
Ann Rheum Dis ; 79(6): 700-712, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32434812

RESUMO

OBJECTIVE: To update the European League Against Rheumatism (EULAR) recommendations for the pharmacological treatment of psoriatic arthritis (PsA). METHODS: According to the EULAR standardised operating procedures, a systematic literature review was followed by a consensus meeting to develop this update involving 28 international taskforce members in May 2019. Levels of evidence and strengths of recommendations were determined. RESULTS: The updated recommendations comprise 6 overarching principles and 12 recommendations. The overarching principles address the nature of PsA and diversity of both musculoskeletal and non-musculoskeletal manifestations; the need for collaborative management and shared decision-making is highlighted. The recommendations provide a treatment strategy for pharmacological therapies. Non-steroidal anti-inflammatory drugs and local glucocorticoid injections are proposed as initial therapy; for patients with arthritis and poor prognostic factors, such as polyarthritis or monoarthritis/oligoarthritis accompanied by factors such as dactylitis or joint damage, rapid initiation of conventional synthetic disease-modifying antirheumatic drugs is recommended. If the treatment target is not achieved with this strategy, a biological disease-modifying antirheumatic drugs (bDMARDs) targeting tumour necrosis factor (TNF), interleukin (IL)-17A or IL-12/23 should be initiated, taking into account skin involvement if relevant. If axial disease predominates, a TNF inhibitor or IL-17A inhibitor should be started as first-line disease-modifying antirheumatic drug. Use of Janus kinase inhibitors is addressed primarily after bDMARD failure. Phosphodiesterase-4 inhibition is proposed for patients in whom these other drugs are inappropriate, generally in the context of mild disease. Drug switches and tapering in sustained remission are addressed. CONCLUSION: These recommendations provide stakeholders with an updated consensus on the pharmacological management of PsA, based on a combination of evidence and expert opinion.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Artrite Psoriásica/tratamento farmacológico , Produtos Biológicos/uso terapêutico , Glucocorticoides/uso terapêutico , Sociedades Médicas , Consenso , Conferências de Consenso como Assunto , Tomada de Decisão Compartilhada , Europa (Continente) , Humanos , Interleucina-12/antagonistas & inibidores , Interleucina-17/antagonistas & inibidores , Interleucina-23/antagonistas & inibidores , Inibidores de Janus Quinases/uso terapêutico , Inibidores da Fosfodiesterase 4/uso terapêutico , Medicamentos Sintéticos/uso terapêutico , Revisões Sistemáticas como Assunto , Fator de Necrose Tumoral alfa/antagonistas & inibidores
3.
Braz Oral Res ; 34(supp1 1): e027, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32294680

RESUMO

Periodontal diseases are considered a worldwide public health problem, owing to their high prevalence in developed and developing countries. Periodontitis may lead to tooth loss, which can impact oral health-related quality of life. Gingivitis and periodontitis have been extensively studied regarding their etiopathogenesis, epidemiology, prevention and treatment outcomes. However, most of these aspects are studied and discussed globally, which may hamper a clear interpretation of the findings and the design of effective plans of action for specific regions or populations. For example, in Latin America, epidemiological data about the distribution of periodontal diseases is still scarce, mainly when it comes to nationwide representative samples. This Consensus aimed to address the following topics related to periodontal diseases in Latin America: a) The impact of the global burden of periodontal diseases on health: a global reality; b) Periodontal diseases in Latin America; c) Strategies for the prevention of periodontal diseases in Latin America; d) Problems associated with diagnosis of periodontal conditions and possible solutions for Latin America; e) Treatment of Periodontitis. This consensus will help to increase awareness about diagnosis, prevention and treatment of periodontal diseases, in the context of Latin American countries.


Assuntos
Conferências de Consenso como Assunto , Doenças Periodontais/terapia , Feminino , Gengivite/diagnóstico , Gengivite/epidemiologia , Gengivite/terapia , Carga Global da Doença , Humanos , América Latina/epidemiologia , Masculino , Saúde Bucal , Doenças Periodontais/diagnóstico , Doenças Periodontais/epidemiologia , Periodontite/diagnóstico , Periodontite/epidemiologia , Periodontite/terapia , Qualidade de Vida
6.
Br J Radiol ; 93(1110): 20200117, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32207989

RESUMO

Among lesions with uncertain malignant potential found at percutaneous breast biopsy, atypical ductal hyperplasia (ADH) carries both the highest risk of underestimation and the closest and most pathologist-dependent differential diagnosis with ductal carcinoma in situ (DCIS), matching the latter's features save for size only. ADH is therefore routinely surgically excised, but single-centre studies with limited sample size found low rates of upgrade to invasive cancer or DCIS. This suggests the possibility of surveillance over surgery in selected subgroups, considering the 2% threshold allowing for follow-up according to the Breast Imaging Reporting and Data System. A recent meta-analysis on 6458 lesions counters this approach, confirming that, surgically excised or managed with surveillance, ADH carries a 29% and 5% upgrade rate, respectively, invariably higher than 2% even in subgroups considering biopsy guidance and technique, needle calibre, apparent complete lesion removal. The high heterogeneity (I2 = 80%) found in this meta-analysis reaffirmed the need to synthesise evidence from systematic reviews to achieve generalisable results, fit for guidelines development. Limited tissue sampling at percutaneous biopsy intrinsically hampers the prediction of ADH-associated malignancy. This prediction could be improved by using contrast-enhanced breast imaging and applying artificial intelligence on both pathology and imaging results, allowing for overtreatment reduction.


Assuntos
Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Mama/patologia , Carcinoma Intraductal não Infiltrante/patologia , Carcinoma Intraductal não Infiltrante/cirurgia , Inteligência Artificial , Biópsia/métodos , Biópsia por Agulha Fina/métodos , Mama/cirurgia , Calcinose/patologia , Conferências de Consenso como Assunto , Feminino , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Conduta Expectante
7.
Einstein (Sao Paulo) ; 18: eAE4799, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32215466

RESUMO

The Brazilian Consensus on Nutrition in Hematopoietic Stem Cell Transplantation: Graft- versus -host disease was approved by Sociedade Brasileira de Transplante de Medula Óssea , with the participation of 26 Brazilian hematopoietic stem cell transplantation centers. It describes the main nutritional protocols in cases of Graft- versus -host disease, the main complication of hematopoietic stem cell transplantation.


Assuntos
Conferências de Consenso como Assunto , Doença Enxerto-Hospedeiro/dietoterapia , Doença Enxerto-Hospedeiro/etiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Terapia Nutricional/normas , Necessidades Nutricionais , Brasil , Congressos como Assunto , Gastroenteropatias/dietoterapia , Gastroenteropatias/etiologia , Gastroenteropatias/fisiopatologia , Doença Enxerto-Hospedeiro/fisiopatologia , Humanos , Terapia Nutricional/métodos , Índice de Gravidade de Doença
10.
Ann Allergy Asthma Immunol ; 124(5): 479-486, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32007568

RESUMO

BACKGROUND: Peanut allergy is a potentially severe and lifelong allergy, with few effective treatments or preventive measures. OBJECTIVE: To convene an expert panel of allergists, pediatricians, and advocates to discuss and highlight unmet needs in the prevention and management of peanut allergies. METHODS: Literature searches of PubMed were performed. The panel evaluated published data on the prevention of peanut allergy, treatment of existing peanut allergy, and management of reactions after unintentional peanut exposures. RESULTS: The following key unmet needs in the prevention and management of peanut allergy were identified: (1) enhancing and optimizing implementation of early peanut introduction as a means of preventing the development of peanut allergy, (2) developing knowledge translation strategies regarding the safety and efficacy data for current and emerging immunotherapies for peanut-allergic children to support their use in clinical practice, and (3) promoting understanding of true exposure risk in allergic individuals and ensuring access to epinephrine for unintentional exposures that provoke severe reactions. Practitioners should help educate caregivers about the actual risks associated with peanut allergy and its prevention and management so that treatment decisions can be evidence based rather than fear based. Support tools are needed to help address caregiver goals, expectations, and psychological barriers, as well as identify facilitators for prevention and treatment strategies. CONCLUSION: There are significant unmet needs in our understanding of peanut allergy; addressing these needs will help to enhance understanding of how to most effectively prevent and treat peanut allergy, as well as educate the food-allergic and nonallergic community regarding current evidence-based practices.


Assuntos
Anafilaxia/epidemiologia , Anafilaxia/prevenção & controle , Prática Clínica Baseada em Evidências , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hipersensibilidade a Amendoim/epidemiologia , Fatores Etários , Cuidadores , Criança , Conferências de Consenso como Assunto , Dessensibilização Imunológica , Prova Pericial , Humanos , Disseminação de Informação , Educação de Pacientes como Assunto , Risco , Estados Unidos/epidemiologia
11.
Arq Neuropsiquiatr ; 78(1): 50-52, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-32074188

RESUMO

Although headaches have recognized impact, there are no public policies in Brazil addressing this problem. The Brazilian Headache Society and the Brazilian Association of Cluster Headache and Migraine promoted a summit to discuss Public Policy and Advocacy for headache disorders. Professionals from various segments, representing various sectors of society, gathered in April 2019 in Brasília, defining the most important points for achieving advances in public policies in headache in Brazil, such as: inclusion in the chronic diseases surveillance agenda; improving public understanding and access to diagnosis and treatment; teaching in colleges and medical residences, structuring care networks, intervention models, clinical protocols and legislation supporting public policies in headache.


Assuntos
Conferências de Consenso como Assunto , Transtornos da Cefaleia Primários/terapia , Política Pública , Brasil , Humanos
13.
Am Heart J ; 219: 1-8, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31707323
15.
Crit Care Med ; 48(1): e26-e33, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31634233

RESUMO

OBJECTIVES: To assess the incidence, severity, and outcomes of pediatric acute respiratory distress syndrome following trauma using Pediatric Acute Lung Injury Consensus Conference criteria. DESIGN: Retrospective cohort study. SETTING: Level 1 pediatric trauma center. PATIENTS: Trauma patients less than or equal to 17 years admitted to the ICU from 2009 to 2017. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We queried electronic health records to identify patients meeting pediatric acute respiratory distress syndrome oxygenation criteria for greater than or equal to 6 hours and determined whether patients met complete pediatric acute respiratory distress syndrome criteria via chart review. We estimated associations between pediatric acute respiratory distress syndrome and outcome using generalized linear Poisson regression adjusted for age, injury mechanism, Injury Severity Score, and serious brain and chest injuries. Of 2,470 critically injured children, 103 (4.2%) met pediatric acute respiratory distress syndrome criteria. Mortality was 34.0% among pediatric acute respiratory distress syndrome patients versus 1.7% among patients without pediatric acute respiratory distress syndrome (adjusted relative risk, 3.7; 95% CI, 2.0-6.9). Mortality was 50.0% for severe pediatric acute respiratory distress syndrome at onset, 33.3% for moderate, and 30.5% for mild. Cause of death was neurologic in 60.0% and multiple organ failure in 34.3% of pediatric acute respiratory distress syndrome nonsurvivors versus neurologic in 85.4% of nonsurvivors without pediatric acute respiratory distress syndrome (p = 0.001). Among survivors, 77.1% of pediatric acute respiratory distress syndrome patients had functional disability at discharge versus 30.7% of patients without pediatric acute respiratory distress syndrome patients (p < 0.001), and only 17.5% of pediatric acute respiratory distress syndrome patients discharged home without ongoing care versus 86.4% of patients without pediatric acute respiratory distress syndrome (adjusted relative risk, 1.5; 1.1-2.1). CONCLUSIONS: Incidence and mortality associated with pediatric acute respiratory distress syndrome following traumatic injury are substantially higher than previously recognized, and pediatric acute respiratory distress syndrome development is associated with high risk of poor outcome even after adjustment for underlying injury type and severity.


Assuntos
Síndrome do Desconforto Respiratório do Adulto/etiologia , Ferimentos e Lesões/complicações , Lesão Pulmonar Aguda/diagnóstico , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Conferências de Consenso como Assunto , Feminino , Humanos , Incidência , Lactente , Escala de Gravidade do Ferimento , Masculino , Síndrome do Desconforto Respiratório do Adulto/complicações , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Síndrome do Desconforto Respiratório do Adulto/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de Doença
18.
Anatol J Cardiol ; 22(6): 282-286, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31789617

RESUMO

Supraventricular arrhythmias are frequent, and symptomatic patients often need medical therapy or catheter ablation. The recently published 2019 European Society of Cardiology (ESC) Guidelines for the management of patients with supraventricular tachycardia (SVT) give a comprehensive overview of current developments in the field and provides recommendations for the management of adults with SVT. In this paper, we briefly summarized major new recommendations and significant changes from the former ESC guideline published 16 years ago.


Assuntos
Guias de Prática Clínica como Assunto , Taquicardia Supraventricular/terapia , Cardiologia , Conferências de Consenso como Assunto , Europa (Continente) , Humanos , Sociedades Médicas
19.
Neurology ; 93(14): 630-639, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31570638

RESUMO

Multiple system atrophy (MSA) is a neurodegenerative disorder characterized by a combination of autonomic failure, cerebellar ataxia, and parkinsonism. Laryngeal stridor is an additional feature for MSA diagnosis, showing a high diagnostic positive predictive value, and its early occurrence might contribute to shorten survival. A consensus definition of stridor in MSA is lacking, and disagreement persists about its diagnosis, prognosis, and treatment. An International Consensus Conference among experts with methodological support was convened in Bologna in 2017 to define stridor in MSA and to reach consensus statements for the diagnosis, prognosis, and treatment. Stridor was defined as a strained, high-pitched, harsh respiratory sound, mainly inspiratory, occurring only during sleep or during both sleep and wakefulness, and caused by laryngeal dysfunction leading to narrowing of the rima glottidis. According to the consensus, stridor may be recognized clinically by the physician if present at the time of examination, with the help of a witness, or by listening to an audio recording. Laryngoscopy is suggested to exclude mechanical lesions or functional vocal cord abnormalities related to different neurologic conditions. If the suspicion of stridor needs confirmation, drug-induced sleep endoscopy or video polysomnography may be useful. The impact of stridor on survival and quality of life remains uncertain. Continuous positive airway pressure and tracheostomy are both suggested as symptomatic treatment of stridor, but whether they improve survival is uncertain. Several research gaps emerged involving diagnosis, prognosis, and treatment. Unmet needs for research were identified.


Assuntos
Conferências de Consenso como Assunto , Atrofia de Múltiplos Sistemas/diagnóstico , Atrofia de Múltiplos Sistemas/fisiopatologia , Sons Respiratórios/fisiopatologia , Humanos , Atrofia de Múltiplos Sistemas/terapia , Prognóstico , Resultado do Tratamento
20.
Prehosp Disaster Med ; 34(6): 644-652, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31599218

RESUMO

In the present world, International Consensus Frameworks, commonly called global frameworks or global agendas, guide international development policies and practices. They guide the development of all countries and influence the development initiatives by their respective governments. Recent global frameworks, adopted mostly post-2015, include both a group of over-arching frameworks (eg, the Sendai Framework for Disaster Risk Reduction [SFDRR]) and a group of frameworks addressing specific issues (eg, the Dhaka Declaration on Disability and Disaster Risk Management). These global frameworks serve twin purposes: first, to set a global development standard, and second, to set policies and approaches to achieve these standards. A companion group of professional standards, guidelines, and tools (ie, Sphere's Humanitarian Charter and Minimum Standards) guide the implementation and operationalization of these frameworks on the ground.This paper gathers these global frameworks and core professional guidelines in one place, presents an analytical review of their essential features, and highlights the commonalities and differences between and among these frameworks. The aim of this paper is to facilitate understanding of these frameworks and to help in designing development and resilience policy, planning, and implementation, at international and national levels, where these frameworks complement and contribute to each other.This Special Report describes an important and evolving aspect of the discipline and provides core information necessary to progress the science. Additionally, the report will help governments and policy makers to define their priorities and to design policies/strategies/programs to reflect the global commitments. Development practitioners can pre-empt the focus of the international community and the assistance coming from donors to the priority sectors, as identified in the global agenda. This would then help governments and stakeholders to develop and design a realistic plan and program and prepare the instruments and mechanisms to deliver the goals.


Assuntos
Planejamento em Desastres/organização & administração , Modelos Organizacionais , Política Pública , Conferências de Consenso como Assunto , Saúde Global , Humanos , Guias de Prática Clínica como Assunto
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