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1.
Braz. j. biol ; 82: e227703, 2022. tab, graf
Artigo em Inglês | LILACS-Express | MEDLINE, LILACSEXPRESS | ID: biblio-1285590

RESUMO

Abstract A research was conducted to evaluate the impact of various nitrogen and phosphorus levels along with beneficial microbes to enhance canola productivity. The research was carried out at Agronomy Research Farm, The University of Agriculture Peshawar in winter 2016-2017. The experiment was conducted in randomized complete block factorial design. The study was comprised of three factors including nitrogen (60, 120 and 180 kg ha-1), phosphorous (70, 100 and 130 kg ha-1) and beneficial microbes (with and without BM). A control treatment with no N, P and BM was also kept for comparison. Application of beneficial microbes significantly increased pods plant, seed pod, seed filling duration, 1000 seed weight, biological yield and seed yield as compared to control plots. Nitrogen applied at the rate of 180 kg ha-1 increased pods plant-1, seed pod, seed filling duration, seed weight, biological yield and seed yield. Maximum pods plant-1, seed pod, early seed filling, heavier seed weight, biological yield, seed yield, and harvest index were observed in plots treated with 130 kg.ha-1 phosphorous. As comparison, the combine treated plots have more pods plant-1, seeds pod-1, seed filling duration, heaviest seeds, biological yield, seed yield and harvest index as compared to control plots. It is concluded that application of beneficial microbes with N and P at the rate of 180 kg ha-1 and 130 kg ha-1, respectively, increased yield and its attributes for canola.


Resumo Uma pesquisa foi realizada para avaliar o impacto de vários níveis de nitrogênio e fósforo, juntamente com micróbios benéficos, para aumentar a produtividade da canola. A pesquisa foi realizada no inverno de 2016-17 no Agronomy Research Farm, Universidade de Agricultura do Peshawar. O experimento foi conduzido por planejamento fatorial aleatorizado em blocos. O estudo focou-se em três fatores, incluindo o teor de nitrogênio, N, (60, 120 e 180 kg.ha-1), o teor de fósforo, P, (70, 100 e 130 kg ha-1) e a presença de micróbios benéficos (com BM e sem BM). Para fins de comparação, um tratamento controle sem N, P e BM também foi incluído no estudo. A aplicação de micróbios benéficos aumentou significativamente as vagens das plantas e de sementes, a duração do enchimento das sementes, o peso de 1000 sementes, o rendimento biológico e o rendimento de sementes em comparação com os resultados do controle. O nitrogênio aplicado na taxa de 180 kg ha-1 aumentou as vagens por planta, vagem, duração do enchimento, peso da semente, rendimento biológico e rendimento de sementes. Vagens máximas por planta, vagem, enchimento precoce de sementes, peso maior de semente, rendimento biológico, rendimento de sementes e índice de colheita foram observados em parcelas tratadas com 130 kg.ha-1 de fósforo. Em comparação aos blocos cultivados de controle, os blocos cultivados tratados combinados têm mais vagens por planta e sementes por vagem, maior duração do enchimento das sementes, maior número de sementes mais pesadas e maior rendimento biológico, rendimento de sementes e índice de colheita. Conclui-se que a aplicação de micróbios benéficos junto com N e P nas doses de 180 kg ha-1 e 130 kg ha-1, respectivamente, aumentou a produtividade e atributos de produtividade para a canola.

2.
Anaesthesia ; 2021 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-34545943

RESUMO

Haematoma after thyroid surgery can lead to airway obstruction and death. We therefore developed guidelines to improve the safety of peri-operative care of patients undergoing thyroid surgery. We conducted a systematic review to inform recommendations, with expert consensus used in the absence of high-quality evidence, and a Delphi study was used to ratify recommendations. We highlight the importance of multidisciplinary team management and make recommendations in key areas including: monitoring; recognition; post-thyroid surgery emergency box; management of suspected haematoma following thyroid surgery; cognitive aids; post-haematoma evacuation care; day-case thyroid surgery; training; consent and pre-operative communication; postoperative communication; and institutional policies. The guidelines support a multidisciplinary approach to the management of suspected haematoma following thyroid surgery through oxygenation and evaluation; haematoma evacuation; and tracheal intubation. They have been produced with materials to support implementation. While these guidelines are specific to thyroid surgery, the principles may apply to other forms of neck surgery. These guidelines and recommendations provided are the first in this area and it is hoped they will support multidisciplinary team working, improving care and outcomes for patients having thyroid surgery.

3.
Ann R Coll Surg Engl ; 103(8): 599-603, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34464571

RESUMO

INTRODUCTION: The COVID-19 pandemic has demanded radical changes in service delivery. Our centre adopted the use of outpatient telemedicine to reduce close-contact interactions between patients and staff. We hypothesised that incidental gains may be associated with this. We evaluated financial, practical and environmental implications of substituting virtual clinics (VCs) for in-person urology outpatient appointments. METHODS: VCs were studied over a 3-month period. Based on patient-reported 'usual mode of transport' to the hospital, travel distance, time, petrol and parking costs, and the carbon emissions avoided by virtue of remote consultations were calculated. The underlying symptom/diagnosis and the 'effectiveness' of the VC were evaluated. RESULTS: Of 1,016 scheduled consultations, 736 (72.44%) were conducted by VCs over the study period. VCs resulted in an agreed treatment plan in 98.4% of a representative patient sample. The use of VCs was associated with an overall travel distance saving for patients of 31,038 miles (49,951km) over 3 months, with an average round-trip journey of 93.8 miles (151km) avoided for each rural-dwelling patient and an average financial saving of £25.91 (€28.70) per rural-dwelling car traveller. An estimated 1,257.8 hours of patient time were saved by avoidance of travel and clinic waiting times. Based on car-travelling patients alone, a 6.07-tonne reduction in carbon emissions was achieved with the use of VCs. CONCLUSIONS: In appropriate clinical circumstances, VCs appear to provide efficiency across a number of domains. Future healthcare may involve offering outpatients the option of telemedicine as an alternative to physical attendance.


Assuntos
Redução de Custos , Consulta Remota , Viagem , Emissões de Veículos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19 , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reino Unido , Urologia , Adulto Jovem
4.
Braz J Biol ; 82: e227703, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34287525

RESUMO

A research was conducted to evaluate the impact of various nitrogen and phosphorus levels along with beneficial microbes to enhance canola productivity. The research was carried out at Agronomy Research Farm, The University of Agriculture Peshawar in winter 2016-2017. The experiment was conducted in randomized complete block factorial design. The study was comprised of three factors including nitrogen (60, 120 and 180 kg ha-1), phosphorous (70, 100 and 130 kg ha-1) and beneficial microbes (with and without BM). A control treatment with no N, P and BM was also kept for comparison. Application of beneficial microbes significantly increased pods plant, seed pod, seed filling duration, 1000 seed weight, biological yield and seed yield as compared to control plots. Nitrogen applied at the rate of 180 kg ha-1 increased pods plant-1, seed pod, seed filling duration, seed weight, biological yield and seed yield. Maximum pods plant-1, seed pod, early seed filling, heavier seed weight, biological yield, seed yield, and harvest index were observed in plots treated with 130 kg.ha-1 phosphorous. As comparison, the combine treated plots have more pods plant-1, seeds pod-1, seed filling duration, heaviest seeds, biological yield, seed yield and harvest index as compared to control plots. It is concluded that application of beneficial microbes with N and P at the rate of 180 kg ha-1 and 130 kg ha-1, respectively, increased yield and its attributes for canola.


Assuntos
Nitrogênio , Fósforo , Agricultura , Estações do Ano , Sementes
5.
JBJS Rev ; 9(7)2021 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-34270501

RESUMO

¼: In 2016, a total of 48,771 hospital-acquired conditions (HACs) were reported in U.S. hospitals. These incidents resulted in an excess cost of >$2 billion, which translates to roughly $41,000 per patient per HAC. ¼: In the settings of total hip arthroplasty (THA) and total knee arthroplasty (TKA), increased age, a body mass index of >35 kg/m2, male sex, diabetes mellitus, electrolyte disturbances, and a history of anemia increase the likelihood of surgical site infections. ¼: Institution-specific (surgical) risk factors such as increased tourniquet time, an operative time of >130 minutes, bilateral procedures, a femoral nerve block, and general anesthesia increase the risk of HACs in the settings of THA and TKA.

6.
Surg Endosc ; 2021 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-34231070

RESUMO

BACKGROUND: Colonoscopy is a technically challenging procedure. The colonoscope is prone to forming loops in the colon, which can lead patient discomfort and even perforation. We hypothesized that expert endoscopists use techniques to avoid loop formation, identify and straighten loops earlier, and thus exert less force. METHODS: Using a commercially available physical colon simulator model (Kyoto Kagaku), electromagnetic tracking markers (NDI Medical) were placed along the mobile segments of the colon (sigmoid, transverse) to measure the degree of displacement of the colon as the scope was advanced to the cecum. The colon model was set for each participant to simulate a redundant alpha loop in the sigmoid colon. Gastroenterology and surgical trainees and attendings were assessed. Demographic data were collected for each participant. RESULTS: Seventy-five participants were enrolled in the study. There were 17 (22.7%) attending physicians, and 58 (77.3%) trainees. Attending physicians advanced the scope to the cecum faster. The mean time required for procedure completion was 360.5 s compared to 178.4 s for the trainee and attending groups respectively (mean difference: 182.1 s, 95% CI: 93.0, 269.7; p = 0.0002). Attending physicians exerted significantly lower mean colonic displacement than trainees. The mean colonic displacement was 79.8 mm for the trainee group and 57.9 mm for the attending group (mean difference: 21.9 mm, 95% CI: 2.6, 41.2; p = 0.04). Those who used torque steering caused lower maximum colonic displacement than those who used knob steering. CONCLUSION: Attending physicians advance the scope during colonoscopy in a manner that results in significantly less colonic displacement than resident trainees. Although prior studies have shown a difference in force application between endoscopists and inexperienced students, ours is the first to differentiate across varying degrees of endoscopic skill. Future studies will define metrics for incorporation into endoscopic training curricula, focusing on techniques that encourage safety and comfort for patients.

7.
Acta Otolaryngol ; 141(7): 719-723, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34003719

RESUMO

BACKGROUND: With the large number of VNS implants performed worldwide, the need for removal or replacement of the device in selected cases is emerging, this removal or replacement of VNS can be challenging. AIMS/OBJECTIVE: To describe the feasibility and safety of revising vagal nerve stimulation surgery in terms of the indications, surgical techniques, and outcomes. MATERIALS AND METHODS: A retrospective study, a series of eight cases with VNS implants that needed revision surgery have been reviewed, four devices were completely removed and four were only revised. The revision surgery was performed after a range of 7 months to 6 years, due to different reasons. Initial surgeries and revisions were performed at the otolaryngology department in a major tertiary center. CONCLUSIONS AND SIGNIFICANCE: We concluded that the previously implanted vagal nerve stimulation electrodes can be completely removed without any significant sequelae on the nerve. It may also be re-implanted safely at the previously used segment of the vagus nerve with a similar outcome in seizure control as the initial implantation.

8.
Artigo em Inglês | MEDLINE | ID: mdl-33945483

RESUMO

DNA sequencing techniques are critical in order to investigate genes' functions. Obtaining fast, accurate, and affordable DNA bases detection makes it possible to acquire personalized medicine. In this article, a semi-empirical technique is used to calculate the electron transport characteristics of the developed z-shaped graphene device to detect the DNA bases. The z-shaped transistor consists of a pair of zigzag graphene nanoribbon (ZGNR) connected through an armchair graphene nanoribbon (AGNR) channel with a nanopore where the DNA nucleobases are positioned. Non-equilibrium Green's function (NEGF) integrated with semi-empirical methodologies are employed to analyze the different electronic transport characteristics. The semi-empirical approach applied is an extension of the extended Hückel (EH) method integrated with self-consistent (SC) Hartree potential. By employing the NEGF+SC-EH, it is proved that each one of the four DNA nucleobases positioned within the nanopore, with the hydrogen passivated edge carbon atoms, results in a unique electrical signature. Both electrical current signal and transmission spectrum measurements of DNA nucleobases inside the device's pore are studied for the different bases with modification of their orientation and lateral translation. Moreover, the electronic noise effect of various factors is studied. The sensor sensitivity is improved by using nitrogen instead of hydrogen to passivate the nanopore and by adding a dual gate to surround the central semiconducting channel of the z-shaped graphene nanoribbon.

9.
Niger J Clin Pract ; 24(4): 576-583, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33851681

RESUMO

Aims: To establish normative values for functional, lateral, and Oblique Direction Reach Tests (ODRT) and to assess the validity and reliability of the ODRT in Saudi children of age 6-15 years. Methods: Three hundred Saudi children of age 6-15 years children were recruited by using snowball sampling. Children were measured for distance reached in forward, lateral, and oblique direction on a graph paper, which was mounted on a wall/cardboard. Results: The Mean ± SD for forward, lateral and oblique direction reach was 25.63 ± 6.95, 18.91 ± 5.66, 22.08 ± 5.98 cm respectively. The Intraclass Correlation Coefficient values of intra and inter-rater reliability of ODRT shown to be 0.94 and 0.91, respectively. Concurrent validity of ODRT with forward and lateral reach test is 0.87 and 0.84, respectively. Conclusion: : We established the normal values for functional, lateral, and ODRT in 6-15 years of Saudi children. We found that ODRT is a valid and reliable for measuring limits of stability in oblique direction.


Assuntos
Movimento , Psicometria , Adolescente , Criança , Humanos , Valores de Referência , Reprodutibilidade dos Testes , Arábia Saudita
10.
Cutis ; 107(2): 79-86, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33891836
11.
Niger J Clin Pract ; 24(4): 600-607, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33851684

RESUMO

Background: High-altitude disease prevalence varies according to types of exposure and the effects of hypoxic and hypobaric environments, with the result that people at high altitudes present many different physiological responses. Aims: The research aims to analyze the effects of resistance training (RT) exercises at high altitudes on obese subjects and to explain the determinants that make obese people more susceptible to various chronic illnesses such as diabetes mellitus, hypertension, asthma, etc. Methods: This study recruited 225 subjects living in the high-altitude region of Aseer, Saudi Arabia, and divided them into three groups. The first two groups consisted of obese people, out of which one group received RT and one did not. The third group consisted of average-weight individuals, according to their BMI, who received RT. Biochemical parameters were checked for all three groups before commencing with the RT and at the 4th and 8th week to measure the effects of the exercise. Results: Mean and standard deviations of the demographic variables: age was 34.2 ± 8.9 years, weight was 69.3 ± 8.5 kg, and height was 1.6 ± 0.06 meters. RT had a significant effect on the total levels of cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, adiponectin, interleukin-6, and testosterone. Post-hoc comparisons using the Fisher's Least Significant Difference test indicated that the mean scores between the groups differed significantly. Conclusion: Our findings show that RT would be a useful and practical substitute to improve the health status of obese patients. It helps to decrease body fat and to improve lipid profiles and hormonal control.


Assuntos
Altitude , Treinamento de Força , Adulto , Biomarcadores , Índice de Massa Corporal , Humanos , Obesidade/epidemiologia , Arábia Saudita
12.
J Dairy Sci ; 2021 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-33838890

RESUMO

Subclinical mastitis (SCM) represents a significant burden and challenge to modern dairy management. Multidrug-resistant Escherichia coli (MDR E. coli) in milk poses a public health threat to humans especially via the consumption of unpasteurized dairy products. This study aimed to determine the occurrence of MDR E. coli in cows and buffalo in the households of the western part of the Chitwan district of Nepal. A total of 243 lactating cows and buffalo were included in this study. Milk samples (n = 972) were screened using the California Mastitis Test (CMT). The E. coli was isolated from milk samples that were positive for CMT using standard bacteriological protocols. A semi-structured questionnaire was administered to farmers to identify the risk factors associated with the occurrence of SCM in cows and buffalo. Of the 243 dairy animals screened, 42.8% (n = 104/243) showed positive CMT results. However, of the 972 quarters sampled, only 19.3% (n = 188/972) were positive for SCM. The prevalence of E. coli in these animals was found to be 16.5% in animals (n = 40/243). However, E. coli was isolated from only 5% (n = 49/972) of the quarters. Of the 49 E. coli isolated, the resistance to ceftriaxone (38.8%, n = 19/49) and ciprofloxacin (37.7%, n = 17/49) were the most prevalent. Animals with a history of mastitis were 3.57 times more likely to have SCM than other animals. Similarly, lactating animals with previous teat abrasions were 3.22 times more likely to develop SCM than animals without teat injuries. As expected, cleaning the barn once in 2 to 3 d was associated with an increased occurrence of SCM in lactating cows. This study reports the occurrence of MDR E. coli in SCM, which poses a public health threat. Creating awareness of milk pasteurization, and food safety practices are necessary among the farmers.

13.
J Appl Microbiol ; 2021 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-33896080

RESUMO

AIMS: The present research aimed to examine the use of magnetite nanoparticles (MNPs) in combination with phyto-beneficial rhizobacterium (PhBR) for improvement of applied N recovery (ANR) from urea fertilizer in rice grown under deficient and optimum watering conditions. METHODS AND RESULTS: The Bacillus sp. MR-1/2 was positive for acetylene reduction, phosphate solubilization and ACC deaminase activity at temperature ranges 35-45°C. In a pot experiment, urea, MNPs and Bacillus sp. MR-1/2 were applied either alone or in combination to rice plants grown in pots under water deficit and optimal watering conditions. Combined application of urea, MNPs and Bacillus sp. MR-1/2 increased the plant N content and ANR by 27 and 65%, respectively, over their respective control values in rice grown under optimum watering conditions, whereas these increases were 27 and 41%, respectively, in rice grown under water deficit conditions. This treatment also increased the kernel weight and plant dry matter by 36 and 60%, respectively, over control (urea alone) values in rice grown under water deficit conditions, whereas these increases were 31 and 21·8%, respectively, in rice grown under optimum watering conditions. Values of malondialdehyde (MDA) contents, ascorbate peroxidase (APX), catalase and ethylene concentration were higher in control treatment under both the watering regimes. The application of Bacillus sp. MR-1/2 either alone or in combination with MNPs and urea reduced MDA contents, APX, catalase and ethylene production in the rice plants. CONCLUSION: The combined application of MNPs+Bacillus sp. MR-1/2 reduced the N losses from applied urea, increased N uptake and ANR in rice, decreased MDA contents, APX and catalase activity and ethylene level in rice grown under deficit and optimum water conditions. SIGNIFICANCE AND IMPACT OF THE STUDY: The application of MNPs together with Bacillus sp. MR-1/2 may help to increase ANR and rice productivity under water deficit conditions with low cost of production.

14.
PLoS One ; 16(3): e0247523, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33657138

RESUMO

Rabies is a highly fatal disease that is endemic in Nigeria. The poor community awareness and knowledge of canine rabies have thwarted the realization of zero deaths from dog mediated human rabies. This study aimed to assess the awareness and knowledge of canine rabies in Kwara state. A total of 1,460 questionnaires were administered to respondents in the three senatorial zones of the state using open data kit (ODK) on mobile phones between September 2019 to January 2020. The rabies awareness rate was 38.1%. The mean knowledge score was 3.78 ± 2.15. Only 10.6% (n = 59/557) of the respondents had satisfactory knowledge of canine rabies. Respondents had poor knowledge of the mode of transmission, symptoms, prevention, and the control measures needed to eliminate canine rabies. Only 20.1% of respondents owned at least a dog. Dog owners were 3.85× (95% CI: 2.89, 5.13; p < 0.01) more likely to be aware of canine rabies and were 1.78× (95% CI: 1.22-2.60; p = 0.003) more likely to have satisfactory knowledge about canine rabies than non-dog owners. Respondents with tertiary education were at least 6.81× (95% CI: 4.24, 10.92; p < 0.01) more likely to be aware of rabies than respondents with no formal education. The findings of this study showed very low awareness and knowledge of canine rabies among residents of Kwara state. Mass sensitization of the populace on the dangers of rabies should be intensified. Such interventions should be targeted at the general public and dog owners.


Assuntos
Conscientização , Mordeduras e Picadas/virologia , Doenças do Cão/epidemiologia , Cães/virologia , Doenças Endêmicas/veterinária , Animais de Estimação/virologia , Vírus da Raiva , Raiva/epidemiologia , Raiva/veterinária , Adulto , Animais , Estudos Transversais , Doenças do Cão/virologia , Feminino , Humanos , Masculino , Nigéria/epidemiologia , Propriedade , Raiva/mortalidade , Inquéritos e Questionários
15.
J Surg Res ; 263: 71-77, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33639372

RESUMO

BACKGROUND: Same-day surgery is an increasingly utilized and cost-effective strategy to manage common surgical conditions. However, many institutions limit ambulatory surgical services to only healthy individuals. There is also a paucity of data on the safety of same-day discharge among high-risk patients. This study aims to determine whether same-day discharge is associated with higher major morbidity and readmission rates compared with overnight stay in high-risk general surgery patients. METHODS: This is a retrospective cohort using the data from the National Surgical Quality Improvement Program from 2005 to 2017. Patients with an American Society of Anesthesiologists class ≥3 undergoing general surgical procedures amenable to same-day discharge were identified. Primary and secondary outcomes were major morbidity and readmission at 30 d. A multivariable logistic regression model using mixed effects was used to adjust for the effect of same-day discharge. RESULTS: Of 191,050 cases, 137,175 patients (72%) were discharged on the same day. At 30 d, major morbidity was 1.0%, readmission 2.2%, and mortality <0.1%. Adjusted odds ratio of same-day discharge was 0.59 (95% confidence interval 0.54-0.64; P < 0.001) for major morbidity and 0.75 (95% confidence interval 0.71-0.80; P < 0.001) for readmission. Significant risk factors for morbidity and readmission included nonindependent functional status, ascites, renal failure, and disseminated cancer. CONCLUSIONS: Major morbidity and readmission rates are low among this large sample of high-risk general surgery patients undergoing common ambulatory procedures. Same-day discharge was not associated with increased adverse events and could be considered in most high-risk patients after uncomplicated surgery.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Tempo de Internação/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Fatores de Tempo , Adulto Jovem
16.
J Laryngol Otol ; 135(2): 168-172, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517925

RESUMO

OBJECTIVE: The coronavirus disease 2019 pandemic resulted in the cessation of elective surgery. The continued provision of complex head and neck cancer surgery was extremely variable, with some UK centres not performing any cancer surgery. During the pandemic, Guy's and St Thomas' NHS Foundation Trust received high numbers of coronavirus disease 2019 admissions. This paper presents our experience of elective complex major head and neck cancer surgery throughout the pandemic. METHODS: A head and neck cancer surgery hub was set up that provided a co-ordinated managed care pathway for cancer patients during the pandemic; the Guy's Cancer Centre provided a separate, self-enclosed coronavirus-free environment within the hospital campus. RESULTS: Sixty-nine head and neck cancer patients were operated on in two months, and 13 patients had a microvascular free tissue transfer. Nosocomial infection with coronavirus disease 2019 was detected in two cases (3 per cent), neither required critical care unit admission. Both patients made a complete recovery and were discharged home. There were no deaths. CONCLUSION: Performing major head and neck surgery, including free flap surgery, is possible during the pandemic; however, significant changes to conventional practice are required to achieve desirable patient outcomes.


Assuntos
COVID-19/epidemiologia , Infecção Hospitalar/epidemiologia , Neoplasias de Cabeça e Pescoço/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Retalhos de Tecido Biológico , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória , Hemorragia Pós-Operatória/epidemiologia , SARS-CoV-2 , Infecção da Ferida Cirúrgica/epidemiologia , Reino Unido/epidemiologia , Adulto Jovem
17.
Surg Endosc ; 2021 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-33398584

RESUMO

BACKGROUND: Bariatric surgery in older patients is safe and effective. Current guidelines do not endorse age limits for surgery; however, older patients may encounter difficulties with access given perceived risks. This study compares the adjusted probability of failing to receive bariatric surgery between older (≥ 60 years) and younger (< 60 years) patients referred to a publicly funded program. STUDY DESIGN: This is a retrospective cohort study of adult patients referred to a bariatric surgery program in Ontario from 2010-2016. Ontario health administrative databases and the Ontario Bariatric Registry were used for the analysis. The primary outcome was receipt of bariatric surgery within 3 years of referral. A multivariable logistic regression analysis was performed to determine the adjusted effect of older age (≥ 60 years) on the probability of not receiving surgery. Sensitivity analysis was performed using only healthy patients. RESULTS: Among 19,510 patients referred to the program, 1,795 patients (9.2%) were ≥ 60 years old, of which 60% received bariatric surgery within 3 years compared to 90% in younger patients. The odds older patients do not receive surgery after adjustment were significantly higher compared to younger patients (OR 1.69 [1.52-1.88], P < .001). This effect persists even among a subgroup of older patients with a Charlson Comorbidity Index = 0 (OR 1.78 [1.56-2.04], P < .001). CONCLUSIONS: Age alone, rather than comorbidities had a more significant effect on the access to bariatric surgery in older patients. Given the demonstrated benefits of bariatric surgery in older populations, ensuring equity in access to bariatric surgery should be encouraged. Future research is required to explore the underlying reasons why older patients who could benefit from bariatric surgery may not have the opportunity.

18.
Asian Pac J Cancer Prev ; 22(1): 61-68, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33507680

RESUMO

PURPOSE: To compare radiotherapy-induced toxicity for localized prostate-cancer (PCa) treated with versus without daily image-guidance. PATIENTS AND METHODS: We identified consecutive intermediate and high-risk localized PCa patients treated with definitive radiotherapy using intensity-modulated radiotherapy (IMRT) with variable duration of androgen-deprivation therapy (ADT) within 2015-2016 (Arm-A) and 2005-2007 (Arm-B). Arm-A cases received daily online imaging guidance (IGRT) using cone-beam computed tomography (CBCT) unlike Arm-B candidates with no daily IGRT. After reporting demographic, clinico-pathological features and treatment details, we compared acute (within 3 months post-therapy) and late RT-induced toxicities between study groups graded by RTOG/CTCAE criteria. Uni/multivariate analyses (UVA/MVA) were performed to identify independent predictors for RT-related side-effects. RESULTS: We were able to identify 257 cases who met our inclusion criteria. Overall, median age was 73 years (48-85), 67% had intermediate-risk and 47% received ADT. Arm-A included 72 patients who received IMRT delivered using volumetric-modulated arc therapy (VMAT), whereas, Arm-B was formed of 185 cases who utilized step-and-shoot static IMRT. Clinico-pathological features and treatment details were non-different across study arms except that Arm-A had more Grade Group 3, higher median total dose (79.2 vs. 74 Gy) and more pelvic lymph-nodes RT (p <0.05). Although acute toxicity was similar across groups, Arm-B encountered higher late toxicity score, more intense late genitourinary side-effects (P=0.008), with non-different late lower-gastrointestinal toxicities. On MVA, lack of daily CBCT, African-American race and higher comorbidities were independently predictive for late toxicities.  Conclusion: IMRT with daily CBCT permitted safe delivery of dose-escalated IMRT with improved toxicity profile for higher-risk prostate cancer.


Assuntos
Tomografia Computadorizada de Feixe Cônico/métodos , Neoplasias da Próstata/radioterapia , Lesões por Radiação/diagnóstico , Radioterapia Guiada por Imagem/métodos , Radioterapia de Intensidade Modulada/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Lesões por Radiação/diagnóstico por imagem , Lesões por Radiação/etiologia , Dosagem Radioterapêutica , Estudos Retrospectivos
19.
J Pediatr Surg ; 56(4): 816-820, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33422328

RESUMO

PURPOSE: To describe the use of the internal mammary vein as an alternative access for central venous catheters. METHODS: We performed a retrospective review of patients who underwent placement of central venous catheters via the internal mammary vein. Patient demographics, indication for venous access, technical success, catheter type, dwell time and indication for exchange or removal were recorded. RESULTS: Placement of central venous catheters via the internal mammary vein was attempted in 11 patients including 8 children (4 males, mean age 5.7 years) and 3 adults. The most common indication was parenteral nutrition in patients with intestinal failure (7/11). Initial needle access of the vein was successful in all patients. Catheter placement was successful in 9 and unsuccessful in 2 patients due to occlusion of the superior vena cava. There were no immediate complications. A total of 20 catheters of various sizes (3-14.5 French) and lengths (8-23 cm) were either placed (n = 12) or exchanged (n = 8). The most common indications for catheter exchange were poor function and malposition (7/8). Four catheters were removed for infection and 4 were accidentally removed. The mean dwell time was 141 days (range 0-963 days) per catheter for a total of 2829 catheter days. The total mean dwell time per patient, including primarily placed and exchanged catheters, was 314 days (range 5-963 days). CONCLUSIONS: The internal mammary vein may provide a safe alternative route for patients who have lost their traditional access veins.


Assuntos
Cateterismo Venoso Central , Cateteres Venosos Centrais , Doenças Vasculares , Adulto , Cateteres de Demora , Criança , Pré-Escolar , Humanos , Masculino , Estudos Retrospectivos , Veia Cava Superior
20.
Plant Biol (Stuttg) ; 23(3): 485-496, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33423379

RESUMO

Lodging in maize results in grain yield reduction. This experiment investigated the effects of different application rates of the growth retardant, uniconazole (UCZ), and nitrogen (N) on medium and high maize population densities on lodging resistance and yield. UCZ was applied to maize seeds at concentrations of 0 (U0 ) and 25 (U25 ) mg kg-1 , and three different N application rates, 0 (N0 ), 150 (N150 ) and 225 (N225 ) kg ha-1 , at plant densities of 75,000 (D1 ) and 105,000 plants ha-1 (D2 ). UCZ application, different N rates and plant population density affected the lodging resistance and yield attributes of maize. The diameter, plumpness, cortex penetration and bending strengths of the internodes were enhanced with UCZ and N application at medium and high plant density, where maximum values were obtained with U25 N150 D1 . Internode length increased in the high-density population and higher N rate, whereas UCZ reduced internode length, where maximum internode length was obtained with U0 N225 D2 . Plant height, centre of gravity height, ear and height above ear-bearing node were higher with the high N rate, while UCZ reduced it significantly. UCZ, N rate and plant density enhanced lignin accumulation in the third internode and ear-bearing internode, where maximum values were obtained with U25 N150 D1 . Yield and yield attributes were also improved by UCZ, N rate and population density. Treatment with U25 N150 D2 significantly improved grain yield of maize compared with the other treatments.


Assuntos
Nitrogênio , Zea mays , Lignina , Triazóis
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