RESUMO
The 2020 Atlantic hurricane season was notable for a record-setting 30 named storms while, contemporaneously, the COVID-19 pandemic was circumnavigating the globe. The active spread of COVID-19 complicated disaster preparedness and response actions to safeguard coastal and island populations from hurricane hazards. Major hurricanes Eta and Iota, the most powerful storms of the 2020 Atlantic season, made November landfalls just two weeks apart, both coming ashore along the Miskito Coast in Nicaragua's North Caribbean Coast Autonomous Region. Eta and Iota bore the hallmarks of climate-driven storms, including rapid intensification, high peak wind speeds, and decelerating forward motion prior to landfall. Hurricane warning systems, combined with timely evacuation and sheltering procedures, minimized loss of life during hurricane impact. Yet these protective actions potentially elevated risks for COVID-19 transmission for citizens sharing congregate shelters during the storms and for survivors who were displaced post-impact due to severe damage to their homes and communities. International border closures and travel restrictions that were in force to slow the spread of COVID-19 diminished the scope, timeliness, and effectiveness of the humanitarian response for survivors of Eta and Iota. Taken together, the extreme impacts from hurricanes Eta and Iota, compounded by the ubiquitous threat of COVID-19 transmission, and the impediments to international humanitarian response associated with movement restrictions during the pandemic, acted to exacerbate harms to population health for the citizens of Nicaragua.
RESUMO
BACKGROUND: Intraoperative frozen section (FS) often is performed in patients who undergo thyroid lobectomy to determine the need for completion thyroidectomy. At our institution, if FS pathology is benign, final pathology is expedited overnight. The aim of this study was to determine the utility of FS and to identify a cost-effective management algorithm for thyroid lobectomy. METHODS: A retrospective review was performed of patients who underwent thyroid lobectomy between January 2009 and May 2013. Preoperative cytology ranged from "benign" to "suspicious for malignancy." Clinically significant cancers were defined as >1 cm in size, or multifocal microcarcinomas. RESULTS: Of the 192 patients who underwent thyroid lobectomy with FS, FS was suspicious for malignancy in 5 (3%) patients; 1 (0.5%) underwent immediate completion thyroidectomy. On final pathology, 9 (5%) patients had clinically significant cancers and underwent completion thyroidectomy. FS had a sensitivity and positive predictive value of 22% and 40%, respectively, in identifying clinically significant thyroid cancer. Cost of thyroid lobectomy at varying rates of same-day discharge favored thyroid lobectomy without FS but with expedited pathology for all scenarios. CONCLUSION: At our institution, there appears to be limited utility of FS at the time of thyroid lobectomy given the low predictive value for diagnosing a clinically significant thyroid cancer. In patients who are admitted overnight, expedited pathology is slightly less costly and may improve patient quality-of-life and decrease costs by avoiding delayed completion thyroidectomy. Overnight pathology for patients who undergo thyroid lobectomy may achieve modest cost-savings depending on institutional FS results and rates of malignancy.
Assuntos
Secções Congeladas , Cuidados Intraoperatórios/métodos , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Protocolos Clínicos , Análise Custo-Benefício , Técnicas de Apoio para a Decisão , Feminino , Secções Congeladas/economia , Humanos , Cuidados Intraoperatórios/economia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/economia , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/economia , Nódulo da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/cirurgia , Wisconsin , Adulto JovemRESUMO
OBJECTIVES: The Micropuncture® 21-gauge needle may reduce complications related to vessel trauma from inadvertent venous or posterior arterial wall puncture. METHODS: This was a single-center, multiple-user trial. Four hundred and two patients undergoing possible or definite percutaneous coronary intervention (PCI) were randomized 1:1 to an 18-gauge versus a 21-gauge needle. Patients and personnel pulling the sheaths and performing the follow-up were blinded. The primary end point was a composite of access bleeding. Events were tabulated following sheath removal, ≤ 24 h after the procedure and at the follow-up (at 1-2 weeks). End points were blindly adjudicated. RESULTS: The event rate overall was 12.4% and did not differ significantly between groups, although the 21-gauge needle was found to reduce events by more than one third. An exploratory subgroup analysis of prespecified variables indicated that: patients who did not undergo PCI or elective procedures, female patients and those with a final sheath size of ≤ 6 Fr all had a significant or near-significant reduction of complications with Micropuncture. CONCLUSIONS: Although no significant differences between the use of the 18- and 21-gauge needles were observed, there was a 50-75% reduction with Micropuncture in several subgroups. The study was terminated prematurely. Access site complications may be reduced by the use of the 21-gauge needle, particularly when the risk of bleeding is not high. Further multicenter data will be required to confirm these hypothesis-generating observations.
Assuntos
Doença da Artéria Coronariana/cirurgia , Artéria Femoral , Agulhas , Intervenção Coronária Percutânea/instrumentação , Hemorragia Pós-Operatória/prevenção & controle , Punções/instrumentação , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Hemorragia Pós-Operatória/etiologia , Punções/efeitos adversos , Resultado do TratamentoAssuntos
Doença da Artéria Coronariana/complicações , Estenose Coronária/complicações , Trombose Coronária/complicações , Infarto do Miocárdio/etiologia , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/terapia , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/terapia , Trombose Coronária/diagnóstico por imagem , Trombose Coronária/terapia , Progressão da Doença , Humanos , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/terapia , Intervenção Coronária Percutânea , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco , Índice de Gravidade de Doença , Trombectomia , Fatores de TempoRESUMO
The management of patients with drug eluting stents (DES) who require early surgical intervention prior to the completion of antiplatelet therapy is challenging. Available literature suggests that bridging these high risk patients with glycoprotein IIb/IIIa (g2b3a) inhibitors could be efficacious in preventing stent thrombosis (Ben Morrison et al., Catheter Cardiovasc Interv 2012;79;575-582). However, this still remains to be proven in larger prospective studies. We report a case of stent thrombosis in a patient with DES planned for neurosurgery while on bridging g2b3a inhibitors therapy in the perioperative period.
Assuntos
Doença da Artéria Coronariana/terapia , Trombose Coronária/etiologia , Stents Farmacológicos , Procedimentos Neurocirúrgicos , Peptídeos/administração & dosagem , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/instrumentação , Inibidores da Agregação Plaquetária/administração & dosagem , Complexo Glicoproteico GPIIb-IIIa de Plaquetas/antagonistas & inibidores , Idoso , Aspirina/administração & dosagem , Clopidogrel , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico , Trombose Coronária/diagnóstico , Trombose Coronária/terapia , Substituição de Medicamentos , Quimioterapia Combinada , Eptifibatida , Feminino , Humanos , Procedimentos Neurocirúrgicos/efeitos adversos , Peptídeos/efeitos adversos , Período Perioperatório , Inibidores da Agregação Plaquetária/efeitos adversos , Ticlopidina/administração & dosagem , Ticlopidina/análogos & derivados , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia de IntervençãoRESUMO
Magnetotactic bacteria are a morphologically, metabolically and phylogenetically disparate array of bacteria united by the ability to biomineralize membrane-encased, single-magnetic-domain mineral crystals (magnetosomes) that cause the cell to orientate along the Earth's geomagnetic field. The most commonly observed type of magnetotactic bacteria is the ubiquitous magnetotactic cocci, which comprise their own phylogenetic group. Strain MC-1(T), a member of this group, was isolated from water collected from the oxic-anoxic interface of the Pettaquamscutt Estuary in Rhode Island, USA, and cultivated in axenic culture. Cells of strain MC-1(T) are roughly spherical, with two sheathed bundles of flagella at a single pole (bilophotrichous). Strain MC-1(T) uses polar magnetotaxis, and has a single chain of magnetite crystals per cell. Cells grow chemolithoautotrophically with thiosulfate or sulfide as the electron donors, and chemo-organoheterotrophically on acetate. During autotrophic growth, strain MC-1(T) relies on the reductive tricarboxylic acid cycle for CO2 fixation. The DNA G+C content is 54.2 mol%. The new genus and species Magnetococcus marinus gen. nov., sp. nov. are proposed to accommodate strain MC-1(T) (â=âATCC BAA-1437(T) â=âJCM 17883(T)), which is nominated as the type strain of Magnetococcus marinus. A new order (Magnetococcales ord. nov.) and family (Magnetococcaceae fam. nov.) are proposed for the reception of Magnetococcus and related magnetotactic cocci, which are provisionally included in the Alphaproteobacteria as the most basal known lineage of this class.
Assuntos
Alphaproteobacteria/classificação , Filogenia , Alphaproteobacteria/genética , Alphaproteobacteria/isolamento & purificação , Técnicas de Tipagem Bacteriana , Composição de Bases , Ciclo do Ácido Cítrico , DNA Bacteriano/genética , Ácidos Graxos/análise , Magnetossomos/microbiologia , Dados de Sequência Molecular , Fixação de Nitrogênio , RNA Ribossômico 16S/genética , Rhode Island , Água do Mar/microbiologia , Análise de Sequência de DNARESUMO
The no reflow phenomenon can happen during elective or primary percutaneous coronary intervention. This phenomenon is thought to be a complex process involving multiple factors that eventually lead to microvascular obstruction and endothelial disruption. Key pathogenic components include distal atherothrombotic embolization, ischemic injury, reperfusion injury, and susceptibility of coronary microcirculation to injury. Thus, pharmacologic and mechanical strategies to prevent and treat no reflow target these mechanisms. Specifically, pharmacologic therapy consisting of vasodilators and antiplatelet agents have shown benefit in the treatment of no-reflow and mechanical therapies such as distal protection and aspiration thrombectomy have also shown benefit.
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Fenômeno de não Refluxo/terapia , Intervenção Coronária Percutânea/métodos , Inibidores da Agregação Plaquetária/uso terapêutico , Trombectomia/métodos , Vasodilatadores/uso terapêutico , Humanos , Complexo Glicoproteico GPIIb-IIIa de Plaquetas/antagonistas & inibidoresRESUMO
The key first step in evaluating pathogen levels in suspected contaminated water is concentration. Concentration methods tend to be specific for a particular pathogen group, for example US Environmental Protection Agency Method 1623 for Giardia and Cryptosporidium, which means multiple methods are required if the sampling program is targeting more than one pathogen group. Another drawback of current methods is the equipment can be complicated and expensive, for example the VIRADEL method with the 1MDS cartridge filter for concentrating viruses. In this article we describe how to construct glass wool filters for concentrating waterborne pathogens. After filter elution, the concentrate is amenable to a second concentration step, such as centrifugation, followed by pathogen detection and enumeration by cultural or molecular methods. The filters have several advantages. Construction is easy and the filters can be built to any size for meeting specific sampling requirements. The filter parts are inexpensive, making it possible to collect a large number of samples without severely impacting a project budget. Large sample volumes (100s to 1,000s L) can be concentrated depending on the rate of clogging from sample turbidity. The filters are highly portable and with minimal equipment, such as a pump and flow meter, they can be implemented in the field for sampling finished drinking water, surface water, groundwater, and agricultural runoff. Lastly, glass wool filtration is effective for concentrating a variety of pathogen types so only one method is necessary. Here we report on filter effectiveness in concentrating waterborne human enterovirus, Salmonella enterica, Cryptosporidium parvum, and avian influenza virus.
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Cryptosporidium parvum/isolamento & purificação , Enterovirus/isolamento & purificação , Filtração/instrumentação , Vidro , Salmonella enterica/isolamento & purificação , Microbiologia da Água , Zoonoses/microbiologia , Animais , Aves , Filtração/métodos , Humanos , Influenza Aviária/virologia , Orthomyxoviridae/isolamento & purificação , Zoonoses/virologiaRESUMO
PURPOSE: To study the interobserver variability of MRI for visualization of the internal os and measuring the distance between tumor and the internal os in patients with early cervical carcinoma and to compare the distance between tumor and the internal os measured on MRI with invasion of the internal os determined by histopathology. MATERIALS AND METHODS: All T2-weighed MRI examinations between January 2003 and December 2007 of patients who underwent hysterectomy, of ≤40 years, with clinical stage IB1 cervix carcinoma and tumor size ≤2cm were retrieved. 27 patients fulfilled these criteria. Two radiologists retrospectively reviewed the images for visualization of the internal os and the distance between tumor and the internal os; agreement and intraclass correlation coefficients (ICCs) were calculated to determine interobserver variability. The distance between tumor and the internal os measured on MRI was compared with invasion of the internal os determined by histopathology. RESULTS: In 26 patients, visualization of the internal was rated as good or moderate by both radiologists (agreement 96%). In 15 patients, both radiologists observed a tumor and the ICC for the distance between tumor and the internal os was 0.752 (95%CI: 0.406-0.909). Assuming 5mm distance between tumor and the internal os on MRI as criterion for invasion of the internal os, 1 true-positive, 2 false-positives and none false-negatives were observed. Assuming 1cm as criterion increases the number of false-positives, respectively 3 and 5 by radiologist 1 and radiologist 2. CONCLUSION: MRI has high interobserver values for visualization of the internal os and no false-negatives for involvement of the internal os.
Assuntos
Colo do Útero/patologia , Imageamento por Ressonância Magnética/métodos , Neoplasias do Colo do Útero/patologia , Adulto , Feminino , Humanos , Histerectomia , Invasividade Neoplásica , Estadiamento de Neoplasias , Variações Dependentes do Observador , Estudos Retrospectivos , Neoplasias do Colo do Útero/cirurgiaRESUMO
OBJECTIVES: This study sought to assess the ability of coronary computed tomography angiography (CTA) in identifying complex coronary stenosis morphology before invasive coronary angiography (ICA) and percutaneous coronary intervention (PCI). BACKGROUND: Complexity of stenosis morphology affects PCI success. Whether CTA can detect the entire spectrum of recognized complex stenosis morphologies has not been investigated. METHODS: All nonbypassed, nonstented, >or=2-mm-diameter native coronary arterial segments in 85 consecutive patients who underwent ICA
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Angiografia Coronária/métodos , Estenose Coronária/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Angioplastia Coronária com Balão , Meios de Contraste , Estenose Coronária/terapia , Reações Falso-Positivas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de TempoRESUMO
OBJECTIVES AND BACKGROUND: The purpose of this study was to determine the effectiveness and vascular response of a pimecrolimus drug eluting stent and a combination (pimecrolimus + paclitaxel) stent as compared with bare metal controls in the porcine coronary model. METHODS AND RESULTS: In the first phase of the study, cobalt chromium stents were loaded with an erodible polymer and either a slow release or a fast release formulation of pimecrolimus. Thirty stents (metal, n = 10; pimecrolimus slow, n = 10; pimecrolimus fast, n = 10) were implanted in the coronary arteries of 10 pigs. At 30 days, neointimal proliferation and inflammation were both significantly less in the pimecrolimus fast release group as compared with the bare metal controls. Endothelialization was complete and equal in all three groups of stents. In the second phase of the study, stents were loaded with an erodible polymer with alternating reservoirs of paclitaxel and pimecrolimus. Twenty stents (8 control stents and 12 dual stents) were implanted in the coronary arteries of seven pigs. At 30 days, neointimal proliferation was significantly less in the dual drug group as compared with the bare metal controls. Endothelialization was complete in both groups of stents, suggesting complete healing of the arteries. CONCLUSIONS: In a 30-day porcine stent model, pimecrolimus inhibits neointimal proliferation as compared with bare metal stents. Also, the proof of concept of a dual drug eluting stent was established showing both safety and efficacy.
Assuntos
Implante de Prótese Vascular/instrumentação , Materiais Revestidos Biocompatíveis , Reestenose Coronária/prevenção & controle , Vasos Coronários/patologia , Paclitaxel/farmacologia , Stents , Tacrolimo/análogos & derivados , Animais , Antineoplásicos Fitogênicos/farmacologia , Inibidores de Calcineurina , Proliferação de Células/efeitos dos fármacos , Angiografia Coronária , Reestenose Coronária/diagnóstico por imagem , Reestenose Coronária/patologia , Vasos Coronários/efeitos dos fármacos , Modelos Animais de Doenças , Combinação de Medicamentos , Seguimentos , Oclusão de Enxerto Vascular/prevenção & controle , Imunossupressores/farmacologia , Suínos , Tacrolimo/farmacologia , Resultado do Tratamento , Túnica Íntima/efeitos dos fármacos , Túnica Íntima/patologiaRESUMO
OBJECTIVE: To investigate pulse oximetry in neonates who require arterial access as represented by the clinical data recorded to manage their care. STUDY DESIGN: Analysis of simultaneous SpO(2) and SaO(2) from: 7-year historical NICU data (N=31905); 4-month prospective NICU data (N=566); verification data using two hemoximeters (N=52); and NICU data from two collaborating centers (N=95 and 168). The bias function (SpO(2)-SaO(2)) was regressed against the measured "gold" standard, SaO(2). RESULTS: A significant negative correlation was found for each of the data sets between the bias function and SaO(2). This bias was similar for devices from several manufacturers (Datex-Ohmeda, Masimo, Nellcor, and Spacelabs). Maximum operational performance occurred with peaks between 92 and 97% SaO(2), but declined markedly above and below this narrow range. In all, 71 to 95% of patients exhibited data with significant bias(.) CONCLUSION: These operational data suggest that with the methodology and devices currently in use, SpO(2) values in most all neonates who require arterial lines inaccurately correlate with measured arterial saturation.