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3.
Br J Anaesth ; 126(4): 774-790, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33612249

RESUMEN

BACKGROUND: The risk of complications, including death, is substantially increased in patients with pulmonary hypertension (PH) undergoing anaesthesia for surgical procedures, especially in those with pulmonary arterial hypertension (PAH) and chronic thromboembolic PH (CTEPH). Sedation also poses a risk to patients with PH. Physiological changes including tachycardia, hypotension, fluid shifts, and an increase in pulmonary vascular resistance (PH crisis) can precipitate acute right ventricular decompensation and death. METHODS: A systematic literature review was performed of studies in patients with PH undergoing non-cardiac and non-obstetric surgery. The management of patients with PH requiring sedation for endoscopy was also reviewed. Using a framework of relevant clinical questions, we review the available evidence guiding operative risk, risk assessment, preoperative optimisation, and perioperative management, and identifying areas for future research. RESULTS: Reported 30 day mortality after non-cardiac and non-obstetric surgery ranges between 2% and 18% in patients with PH undergoing elective procedures, and increases to 15-50% for emergency surgery, with complications and death usually relating to acute right ventricular failure. Risk factors for mortality include procedure-specific and patient-related factors, especially markers of PH severity (e.g. pulmonary haemodynamics, poor exercise performance, and right ventricular dysfunction). Most studies highlight the importance of individualised preoperative risk assessment and optimisation and advanced perioperative planning. CONCLUSIONS: With an increasing number of patients requiring surgery in specialist and non-specialist PH centres, a systematic, evidence-based, multidisciplinary approach is required to minimise complications. Adequate risk stratification and a tailored-individualised perioperative plan is paramount.


Asunto(s)
Consenso , Testimonio de Experto/normas , Hipertensión Pulmonar/cirugía , Atención Perioperativa/normas , Complicaciones Posoperatorias/prevención & control , Testimonio de Experto/métodos , Humanos , Hipertensión Pulmonar/diagnóstico , Atención Perioperativa/métodos , Complicaciones Posoperatorias/diagnóstico
7.
JMIR Public Health Surveill ; 7(2): e22483, 2021 02 26.
Artículo en Inglés | MEDLINE | ID: mdl-33635275

RESUMEN

BACKGROUND: The COVID-19 pandemic presents a great public health challenge worldwide, especially given the urgent need to identify effective drugs and develop a vaccine in a short period of time. Globally, several drugs and vaccine candidates are in clinical trials. However, because these drugs and vaccines are still being tested, there is still no definition of which ones will succeed. OBJECTIVE: This study aimed to assess the opinions of over 1000 virus researchers with knowledge on the prevention and treatment of coronavirus-related human diseases to determine the most promising drug and vaccine candidates to address COVID-19. METHODS: We mapped the clinical trials related to COVID-19 registered at ClinicalTrials.gov. These data were used to prepare a survey questionnaire about treatments and vaccine candidates for COVID-19. In May 2020, a global survey was conducted with authors of recent scientific publications indexed in the Web of Science Core Collection related to viruses, severe acute respiratory syndrome coronavirus, coronaviruses, and COVID-19. RESULTS: Remdesivir, immunoglobulin from cured patients, and plasma were considered to be the most promising treatments in May 2020, while ChAdOx1 and mRNA-1273 were considered to be the most promising vaccine candidates. Almost two-thirds of the respondents (766/1219, 62.8%) believed that vaccines for COVID-19 were likely to be available in the next 18 months. Slightly fewer than 25% (289/1219, 23.7%) believed that a vaccine was feasible, but probably not within 18 months. CONCLUSIONS: The issues addressed in this study are constantly evolving; therefore, the current state of knowledge has changed since the survey was conducted. However, for several months after the survey, the respondents' expectations were in line with recent results related to treatments and vaccine candidates for COVID-19.


Asunto(s)
/tratamiento farmacológico , Testimonio de Experto , Pandemias , Investigadores , /epidemiología , Ensayos Clínicos como Asunto , Estudios Transversales , Salud Global , Humanos
9.
Hist Philos Life Sci ; 43(1): 12, 2021 Jan 27.
Artículo en Inglés | MEDLINE | ID: mdl-33502602

RESUMEN

Even before it had been developed there had already been skepticism among the general public concerning a vaccine for COVID-19. What are the factors that drive this skepticism? While much has been said about how political differences are at play, in this article I draw attention to two additional factors that have not received as much attention: witnessing the fallibility of the scientific process play out in real time, and a perceived breakdown of the distinction between experts and non-experts.


Asunto(s)
Movimiento Anti-Vacunación/psicología , Testimonio de Experto , Movimiento Anti-Vacunación/estadística & datos numéricos , Humanos , Política , Ciencia/métodos
10.
Sud Med Ekspert ; 64(1): 64-66, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33511838

RESUMEN

The purpose of the study is to consider the issues of integration and differentiation in forensic examination, to establish their significance in the formation of new types (genera) of forensic examination, in particular traceological and forensic medical examinations, to determine the possibilities of a comprehensive examination at the interdisciplinary level and the role of language in the production of complex examinations.


Asunto(s)
Testimonio de Experto , Medicina Legal
11.
Zhonghua Yi Xue Yi Chuan Xue Za Zhi ; 38(1): 1-6, 2021 Jan 10.
Artículo en Chino | MEDLINE | ID: mdl-33423247

RESUMEN

Glutaricacidemia type 1(GA1) is an autosomal recessive disease caused by reduced or missing glutaryl-CoA dehydrogenase activity which hamps metabolism of lysine, hydroxylysine and tryptophan. The catabolic products of glutarylcarnitine and glutaric acid are abnormally accumulated in the body, resulting in metabolic disorders which primarily lead to damage to the nervous system. Clinical manifestations of patients include macrocephaly, dystonia, dyskinesia, and developmental retardation. Acute encephalopathy may be induced in infants and young children due to infection, vaccination and surgery. For GA1 is a rare disease and its clinical manifestations are similar to other neurological diseases, it may be easily missed or misdiagnosed. To facilitate early diagnosis and treatment and improve the prognosis, this consensus was formulated by pediatric experts from the fields of endocrinology and genetic metabolism through full discussion and reference to the latest literature and guidelines home and abroad.


Asunto(s)
Errores Innatos del Metabolismo de los Aminoácidos , Encefalopatías Metabólicas , Testimonio de Experto , Errores Innatos del Metabolismo de los Aminoácidos/diagnóstico , Errores Innatos del Metabolismo de los Aminoácidos/genética , Errores Innatos del Metabolismo de los Aminoácidos/terapia , Encefalopatías Metabólicas/diagnóstico , Encefalopatías Metabólicas/genética , Encefalopatías Metabólicas/terapia , Niño , Preescolar , Consenso , Glutaril-CoA Deshidrogenasa/genética , Humanos , Lactante
15.
Crit Rev Oncol Hematol ; 157: 103200, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33321152

RESUMEN

The clinical and biological heterogeneity of head and neck cancer (HNC) is paralleled by a plethora of different symptoms that affect the patient's quality of life. These symptoms include, for instance, pain, fatigue, nutritional issues, airways obstruction, voice alterations and psychological distress. In addition, patients with HNC are prone to a high risk of infection, and may also suffer from acute complications, such as hypercalcemia, spine compression by bone metastasis or bleeding. Prolonging survival is also an inherent expectation for all patients. Addressing the above needs is crucial in all patients with HNC, and especially in those with recurrent and/or metastatic (RM) disease. However, research on how to address patients' needs in RM-HNC remains scarce. This paper defines patients' needs for RM HNC and presents an Expert Opinion on how to address them, proposing also some lines of research.


Asunto(s)
Neoplasias de Cabeza y Cuello , Calidad de Vida , Testimonio de Experto , Fatiga , Neoplasias de Cabeza y Cuello/terapia , Humanos , Recurrencia Local de Neoplasia
16.
Unfallchirurg ; 124(1): 34-39, 2021 Jan.
Artículo en Alemán | MEDLINE | ID: mdl-33320299

RESUMEN

An evidence-based psychotraumatological expert assessment should include a thorough clarification of the diagnoses on different levels of findings and an inclusion of modern methods to clarify the authenticity. The surgical examiner is of great importance in the cooperation since he mostly undertakes the initial documentation, including psychological damage, and ultimately evaluates the overall damage after an assessment. A good interdisciplinary understanding and appreciation are therefore the prerequisite for a comprehensible expert assessment.


Asunto(s)
Testimonio de Experto , Trastornos por Estrés Postraumático , Accidentes , Humanos , Masculino
17.
Ann Allergy Asthma Immunol ; 126(1): 61-68, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32745610

RESUMEN

BACKGROUND: Patients treated with peanut oral immunotherapy (OIT) may experience adverse reactions, particularly during up-dosing. OBJECTIVE: To develop the Side Effects of Peanut Oral Immunotherapy Diary (SEPOD), an electronic questionnaire assessing the daily side effects of peanut OIT in clinical trials. METHODS: Content and design of the SEPOD were informed by empirical literature review and meetings with 3 allergy-immunology experts. Interviews to confirm content and inform revisions were conducted in 24 pediatric patients with peanut allergy (14 treated with peanut OIT) aged 6 to 17 years; children aged 6 to 11 years were interviewed with their caregiver. RESULTS: The SEPOD was drafted after literature review and expert interviews; the initial measurement approach comprised 2 SEPOD versions, a patient-reported outcome (PRO) version for children aged 12 to 17 years, and a caregiver-administered PRO version for children aged 6 to 11 years with instructions for caregiver questionnaire administration. Pediatric patients were expected to respond independently on both versions. Patient interviews indicated that some younger children (ie, aged 6-8 years) had difficulty understanding questions, even when reading aloud; therefore, a caregiver-administered outcome version, identical in content to the caregiver-administered PRO version, was developed for this age group. The final electronic SEPOD covered 23 peanut OIT side effects within the following 7 domains: gastrointestinal, dermatologic, itching, nasal, and respiratory, swelling (eyelid or periorbital, lip, tongue, and throat), pain (tongue, mouth, and throat), and dizziness. CONCLUSION: This study yielded the SEPOD, a new clinical outcome assessment instrument with various methods of administration that can be used to assess the side effects of peanut OIT experienced by pediatric patients in a clinical trial setting.


Asunto(s)
Desensibilización Inmunológica/efectos adversos , Hipersensibilidad al Cacahuete/epidemiología , Administración Oral , Alérgenos/inmunología , Arachis/inmunología , Desensibilización Inmunológica/métodos , Testimonio de Experto , Femenino , Humanos , Masculino , Medición de Resultados Informados por el Paciente , Hipersensibilidad al Cacahuete/terapia
18.
Diabetes Metab Syndr ; 15(1): 55-62, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33310177

RESUMEN

BACKGROUND AND AIMS: The ongoing pandemic of coronavirus disease 2019 (COVID-19) is rapidly evolving, thereby posing a profound challenge to the global healthcare system. Cardiometabolic disorders are associated with poor clinical outcomes in persons with COVID-19. Healthcare challenges during the COVID-19 pandemic are linked to resource constraints including shortage of Personal Protective Equipment's (PPE), laboratory tests and medication. In this context, a group of clinical experts discussed the endocrine and cardiology vigilance required in times of COVID-19. Further, the group proposed certain resource husbandry recommendations to be followed during the pandemic to overcome the constraints. METHOD: The clinical experts discussed and provided their inputs virtually. The expert panel included clinical experts comprising endocrinologists, Consultant Physicians and cardiologists from India. The panel thoroughly reviewed existing literature on the subject and proposed expert opinion. RESULTS: The expert panel put forward clinical practice-based opinion for the management of cardiometabolic conditions including diabetes mellitus and hypertension. As these conditions are associated with poor clinical outcomes, the expert panel recommends that these persons be extra-cautious and take necessary precautions during the ongoing pandemic. Further, experts also provided appropriate, affordable, available and accessible solution to the resource constraint situations in times of COVID-19 pandemic. CONCLUSION: The clinical expert opinion put forward in this article will serve as a reference for clinicians treating diabetes and cardiovascular disease during the COVID-19 pandemic.


Asunto(s)
/epidemiología , Enfermedades Cardiovasculares/epidemiología , Testimonio de Experto/tendencias , Recursos en Salud/tendencias , Enfermedades Metabólicas/epidemiología , Glucemia/efectos de los fármacos , Glucemia/metabolismo , /prevención & control , Cardiotónicos/uso terapéutico , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/tratamiento farmacológico , Humanos , Hipertensión/diagnóstico , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Hipoglucemiantes/farmacología , Hipoglucemiantes/uso terapéutico , India/epidemiología , Enfermedades Metabólicas/diagnóstico , Enfermedades Metabólicas/tratamiento farmacológico
19.
Crit Care ; 24(1): 702, 2020 12 24.
Artículo en Inglés | MEDLINE | ID: mdl-33357240

RESUMEN

COVID-19 has caused great devastation in the past year. Multi-organ point-of-care ultrasound (PoCUS) including lung ultrasound (LUS) and focused cardiac ultrasound (FoCUS) as a clinical adjunct has played a significant role in triaging, diagnosis and medical management of COVID-19 patients. The expert panel from 27 countries and 6 continents with considerable experience of direct application of PoCUS on COVID-19 patients presents evidence-based consensus using GRADE methodology for the quality of evidence and an expedited, modified-Delphi process for the strength of expert consensus. The use of ultrasound is suggested in many clinical situations related to respiratory, cardiovascular and thromboembolic aspects of COVID-19, comparing well with other imaging modalities. The limitations due to insufficient data are highlighted as opportunities for future research.


Asunto(s)
/diagnóstico por imagen , Consenso , Ecocardiografía/normas , Testimonio de Experto/normas , Internacionalidad , Sistemas de Atención de Punto/normas , /terapia , Ecocardiografía/métodos , Testimonio de Experto/métodos , Humanos , Pulmón/diagnóstico por imagen , Tromboembolia/diagnóstico por imagen , Tromboembolia/terapia , Triaje/métodos , Triaje/normas , Ultrasonografía/normas
20.
Rev. Ateneo Argent. Odontol ; 63(2): 25-27, nov. 2020.
Artículo en Español | LILACS | ID: biblio-1150464

RESUMEN

Este artículo está dirigido a aquellos profesionales odontólogos que tengan inquietudes en el aspecto legal de nuestra profesión. El trabajo principal del odontólogo es restaurar la salud bucal y la función de la cavidad oral. Sin embargo, los profesionales dentales también pueden participar en actividades médicas legales como odontólogos forenses o ser testigos expertos para testificar en casos de responsabilidad profesional, accidentes automovilísticos y lesiones relacionadas con el trabajo. Se puede desarrollar esta actividad siendo perito de parte en forma privada o como perito judicial siendo auxiliar de justicia. Para ello es muy importante la capacitación del profesional, que brinda las herramientas para un desempeño ético y competente en la confección de informes periciales, que permiten al juez emitir un dictamen (AU)


This article is aimed to those dental professionals who have concerns about the legal aspect of our profession. The main job of the dentist is to restore oral health and function of the oral cavity. However, dental professionals may also participate in legal medical activities such as forensic dentists or be expert witnesses to testify in cases of professional liability, car accidents, and work-related injuries. You can develop this activity as a Private Auxiliar or as a Judicial Expert as an Assistant to the Justice. Therefore, the training of the professional turns into very important tool, which provides the experience for an ethical and competent performance in the preparation of expert reports, which allow the judge to issue an opinion (AU)


Asunto(s)
Odontólogos , Odontología Forense/educación , Heridas y Traumatismos , Accidentes , Responsabilidad Legal , Decisiones Judiciales , Capacitación Profesional , Testimonio de Experto
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