Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.873.320
Filtrar
1.
Rev. Odontol. Araçatuba (Impr.) ; 42(2): 3-8, maio-ago. 2021. graf
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-1252889

RESUMO

Dentes necrosados com rizogêneze incompleta representam um desafio para os endodontistas e odontopediatras, visto que as paredes radiculares desses dentes são mais finas, o que as tornam mais susceptíveis a fraturas. Durante muitos anos a técnica preconizada foi a apicificação que ainda é bastante utilizada. Nesta técnica são realizadas trocas constantes de medicação intracanal. O dente continua fragilizado e existe o risco do paciente não concluir o tratamento já que tal técnica demanda várias sessões clínicas. Com os avanços da ciência, surge a revascularização pulpar, trazendo vários beneficíos, entre os quais estão a continuidade apical e o ganho de espessura das paredes, além do benefício de conclusão do tratamento em uma ou duas sessões. Entretanto é necessária sua proservação que leva em média dois anos. O objetivo desta pesquisa foi avaliar o nível de conhecimento dos odontopediatras e endodontistas do município de Ilhéus-Bahia, frente a casos de necrose pulpar de dentes com formação radicular incompleta. O método e forma de análise de dados foram de um estudo observacional, transversal, realizado em consultórios do município de Ilhéus-BA que foram selecionados por amostragem aleatória. Os dados foram coletados por meio de um questionário contendo 10 questões de múltipla escolha sobre revascularização pulpar, especialização do profissional e tempo de formação. 20 profissionais aceitaram participar da pesquisa. Desses, 10% não sabiam ou nunca tinham ouvido falar sobre a revascularização pulpar. Conclui-se que ainda existem especialistas no Município de Ilhéus-BA que apresentam conhecimento insuficiente sobre a terapia endodôntica regenerativa, sendo que os mesmos deveriam ter conhecimento desta técnica já que são os profissionais que prestam o atendimento ao paciente jovem com dentes necrosados, reforçando a necessidade de elaboração de estratégia de conscientização e educação de saúde para habilitação e atualização dos mesmos(AU)


Necrotic teeth with incomplete rizogenesis representa challenge for endodontists and pediatric dentists, since the root walls of these teeth are thinner, which makes them more susceptible to fractures. For many years the recommended technique was apexification, which is still widely used. In this technique, constant changes of intracanal medication are performed. The tooth remains fragile and there is a risk that the patient will not complete the treatment as this technique requires several clinical sessions. With advances in science, pulp revascularization appears, bringing several benefits, among which are the apical continuity and the gain in thickness of the walls, in addition to the benefit of completing the treatment in one or two sessions. However, its preservation is necessary, which takes on average two years. The objective of this research was to evaluate the level of knowledge of pediatric dentists and endodontists in the municipality of Ilhéus-Bahia, in the face of cases of pulp necrosis of teeth with incomplete root formation. The method and form of data analysis were from an observational, cross-sectional study, carried out in offices in the municipality of Ilheus-BA that were selected by random sampling. Data were collected through a questionnaire containing 10 multiple-choice questions about pulp revascularization, professional specialization and training time. 20 professionals agreed to participate in the research. Of these, 10% did not know or had never heard of pulp revascularization. It is concluded that there are still specialists in the municipality of Ilhéus-BA who have insufficient knowledge about regenerative endodontic therapy, and they should have knowledge of this technique since they are the professionals who provide care to young patients with necrotic teeth, reinforcing the need to develop a health awareness and education strategy to enable and update them(AU)


Assuntos
Humanos , Masculino , Feminino , Necrose da Polpa Dentária , Conhecimentos, Atitudes e Prática em Saúde , Necrose da Polpa Dentária/terapia , Conhecimento , Odontólogos , Endodontistas , Endodontia Regenerativa
2.
Rev. Odontol. Araçatuba (Impr.) ; 42(2): 9-17, maio-ago. 2021. ilus
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-1252898

RESUMO

As reabsorções radiculares são classificadas em interna e externa e um correto diagnóstico é fundamental para o sucesso no tratamento e é de suma importância que a resolução clínica seja feita precocemente para que se tenha um prognóstico clínico favorável. Reabsorção interna não é comum em dentes permanentes, e seu processo se caracteriza por um aumento do canal radicular de forma oval. O presente estudo teve como objetivos demonstrar e descrever através de um relato de prontuário o tratamento de reabsorção radicular interna de incisivos superiores permanentes. Através da seleção de uma paciente pela disciplina de Triagem da clínica odontológica do Centro Universitário da Serra Gaúcha, a qual apresentou alterações radiográficas compatíveis com reabsorção radicular interna inflamatória na região de dois incisivos superiores permanentes, com lesão periapical estabelecida em ambos, concluiu-se o tratamento para então gerar este estudo do tipo retrospectivo observacional. A reabsorção quando não tratada pode avançar e envolver estruturas além do tecido conjuntivo inflamado e a lesão pode avançar em direção apical. Após estabelecido o diagnóstico, iniciou-se os tratamentos endodônticos dos elementos utilizando hidróxido de cálcio como medicação intracanal, após as trocas de medicações as reabsorções foram controladas e então, as obturações dos canais foram realizadas, buscando um preenchimento adequado para o caso. A reabsorção radicular interna inflamatória causa danos irreversíveis, mas seu processo foi controlado através de terapia endodôntica. Este desempenho é considerado uma patologia, e pode comprometer qualquer extensão da raiz, é comum que os casos permaneçam assintomáticos, portanto, deve ser tratado o mais breve possível assim que descobertos para evitar sua progressão, e consequentemente danos maiores(AU)


Root resorption is classified as either internal or external, and a correct diagnosis is essential for successful treatment. Internal resorption is not common in permanent teeth, and its process is characterized by an enlarged oval root canal. The present study aims to demonstrate and describe, through a medical record, the treatment of internal root resorption of permanent upper incisors. A patient was selected from the Triage Course of the Dental Clinic (Centro Universitário da Serra Gaúcha) who presented radiographic changes associated with inflammatory internal root resorption in two permanente upper incisors, with a periapical lesion established in both and a treatment was then carried out in order to generate this retrospective observational study. Resorption when left untreated can progress and involve structures beyond the inflamed connective tissue and the lesion can advance in the apical direction. After the diagnosis was confirmed, endodontic treatments were initiated using calcium hydroxide as an intracanal medication. After changing the medication, the resorption was controlled and then the canal fillings were performed, seeking an adequate filling for the case. Inflammatory internal root resorption causes irreversible damage, but its process has been controlled through endodontic therapy. This performance is considered a pathology, and can compromise any extension of the root, it is common for the cases to remain asymptomatic, therefore, it should be treated as soon as it's discovered to prevent its progression, and consequently greater damage(AU)


Assuntos
Humanos , Feminino , Adulto , Tratamento do Canal Radicular , Reabsorção da Raiz , Reabsorção da Raiz/terapia , Incisivo , Hidróxido de Cálcio , Dentição Permanente , Dente não Vital , Cavidade Pulpar
3.
Med. intensiva (Madr., Ed. impr.) ; 45(5): 289-297, jun.-jul. 2021. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-186896

RESUMO

Objetivo: Describir las características y la evolución de los pacientes con bronquiolitis ingresados en una unidad de cuidados intensivos pediátricos. Comparar el tratamiento administrado pre y pospublicación de la guía de práctica clínica de la Academia Americana de Pediatría. Diseño: Estudio descriptivo y observacional realizado entre septiembre de 2010 y septiembre de 2017. Configuración: Unidad de cuidados intensivos pediátricos. Pacientes: Menores de un año con bronquiolitis grave. Intervenciones: Se compararon 2 períodos (2010-14 y 2015-17), antes y después de la modificación del protocolo de manejo de la bronquiolitis en el hospital, según las guías de la Academia Americana de Pediatría. Principales variables: Sexo, edad, comorbilidades, gravedad, etiología, tratamiento administrado, infecciones bacterianas, soporte respiratorio e inotrópico, estancia y mortalidad. Resultados: Se recogieron 706 pacientes, 414 (58,6%) varones, con una mediana de edad de 47 días (RIC 25-100,25). Mediana de escala de gravedad de bronquiolitis (BROSJOD) al ingreso: 9 puntos (RIC 7-11). La etiología por virus respiratorio sincitial se dio en 460 (65,16%) pacientes. El primer período (2010-14) incluyó 340 pacientes y el segundo (2015-17), 366 pacientes. En el segundo período se administraron más nebulizaciones de adrenalina y suero salino hipertónico, y más tratamiento con corticoides. Se usó más ventilación no invasiva y menos ventilación mecánica convencional y precisaron menos soporte inotrópico, sin diferencias significativas. La tasa de antibioterapia disminuyó de forma estadísticamente significativa (p = 0,003). Conclusiones: Pese a la disminución en la antibioterapia, se debería limitar la utilización de nebulizaciones y corticoides en estos pacientes, como recomienda la guía


Objective: To describe the characteristics and evolution of patients with bronchiolitis admitted to a pediatric intensive care unit, and compare treatment pre- and post-publication of the American Academy of Pediatrics clinical practice guide. Design: A descriptive and observational study was carried out between September 2010 and September 2017. Setting: Pediatric intensive care unit. Patients: Infants under one year of age with severe bronchiolitis. Interventions: Two periods were compared (2010-14 and 2015-17), corresponding to before and after modification of the American Academy of Pediatrics guidelines for the management of bronchiolitis in hospital. Main variables: Patient sex, age, comorbidities, severity, etiology, administered treatment, bacterial infections, respiratory and inotropic support, length of stay and mortality. Results: A total of 706 patients were enrolled, of which 414 (58.6%) males, with a median age of 47 days (IQR 25-100.25). Median bronchiolitis severity score (BROSJOD) upon admission: 9 points (IQR 7-11). Respiratory syncytial virus appeared in 460 (65.16%) patients. The first period (2010-14) included 340 patients and the second period (2015-17) 366 patients. More adrenalin and hypertonic saline nebulizations and more corticosteroid treatment were administered in the second period. More noninvasive ventilation and less conventional mechanical ventilation were used, and less inotropic support was needed, with no significant differences. The antibiotherapy rate decreased significantly (P = .003). Conclusions: Despite the decrease in antibiotherapy, the use of nebulizations and glucocorticoids in these patients should be limited, as recommended by the guide


Assuntos
Humanos , Masculino , Feminino , Lactente , Bronquiolite/terapia , Guias de Prática Clínica como Assunto , Tomada de Decisão Clínica , Doença Aguda/terapia , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Academias e Institutos/normas , Infecções por Vírus Respiratório Sincicial/etiologia , Insuficiência Respiratória/etiologia , Estudos Retrospectivos , Algoritmos
5.
Clin Transl Gastroenterol ; 12(6): e00365, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34060496

RESUMO

INTRODUCTION: The initial surge of the coronavirus disease 2019 (COVID-19) pandemic prompted national recommendations to delay nonurgent endoscopic procedures. The objective of this study was to provide real-world data on the impact of COVID-19 on endoscopic procedures in a safety-net healthcare system and cancer center affiliated with a tertiary academic center. METHODS: This retrospective cohort study used a combination of electronic health record data and a prospective data tool created to track endoscopy procedures throughout COVID-19 to describe patient and procedural characteristics of endoscopic procedures delayed during the initial COVID-19 surge. RESULTS: Of the 480 patients identified, the median age was 57 years (interquartile range 46-66), 55% (n = 262) were male, and 59% self-identified as white. Colonoscopy was the most common type of delayed procedure (49%), followed by combined esophagogastroduodenoscopy (EGD) and colonoscopy (22%), and EGD alone (20%). Colorectal cancer screening was the most common indication for delayed colonoscopy (35%), and evaluation of suspected bleeding (30%) was the most common indication for delayed combined EGD and colonoscopy. To date, 46% (223/480) of delayed cases have been completed with 12 colorectal, pancreatic, and stomach cancers diagnosed. Sociodemographic factors, procedure type, and sedation type were not significantly associated with endoscopy completion. The median time to endoscopy after delayed procedure was 88 days (interquartile range 63-119) with no differences by procedure type. DISCUSSION: To minimize potential losses to follow-up, delayed, or missed diagnoses and to reduce progression of gastrointestinal diseases, all efforts should be used to ensure follow-up in those whose endoscopic procedures were delayed because of COVID-19.


Assuntos
COVID-19/epidemiologia , Diagnóstico Tardio , Endoscopia Gastrointestinal/estatística & dados numéricos , Gastroenteropatias/diagnóstico , Pandemias , Idoso , Feminino , Gastroenteropatias/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , SARS-CoV-2 , Tempo para o Tratamento , Washington/epidemiologia
6.
Int J Mol Sci ; 22(10)2021 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-34064849

RESUMO

Adnexal tumors of the skin are a rare group of benign and malignant neoplasms that exhibit morphological differentiation toward one or more of the adnexal epithelium types present in normal skin. Tumors deriving from apocrine or eccrine glands are highly heterogeneous and represent various histological entities. Macroscopic and dermatoscopic features of these tumors are unspecific; therefore, a specialized pathological examination is required to correctly diagnose patients. Limited treatment guidelines of adnexal tumor cases are available; thus, therapy is still challenging. Patients should be referred to high-volume skin cancer centers to receive an appropriate multidisciplinary treatment, affecting their outcome. The purpose of this review is to summarize currently available data on pathogenesis, diagnosis, and treatment approach for apocrine and eccrine tumors.


Assuntos
Glândulas Apócrinas/patologia , Glândulas Écrinas/patologia , Neoplasias de Anexos e de Apêndices Cutâneos/diagnóstico , Neoplasias de Anexos e de Apêndices Cutâneos/terapia , Animais , Terapia Combinada , Humanos
7.
Int J Mol Sci ; 22(10)2021 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-34065020

RESUMO

Although optical hyperthermia could be a promising anticancer therapy, the need for high concentrations of light-absorbing metal nanoparticles and high-intensity lasers, or large exposure times, could discourage its use due to the toxicity that they could imply. In this article, we explore a possible role of silica microparticles that have high biocompatibility and that scatter light, when used in combination with conventional nanoparticles, to reduce those high concentrations of particles and/or those intense laser beams, in order to improve the biocompatibility of the overall procedure. Our underlying hypothesis is that the scattering of light caused by the microparticles would increase the optical density of the irradiated volume due to the production of multiple reflections of the incident light: the nanoparticles present in the same volume would absorb more energy from the laser than without the presence of silica particles, resulting either in higher heat production or in the need for less laser power or absorbing particles for the same required temperature rise. Testing this new optical hyperthermia procedure, based on the use of a mixture of silica and metallic particles, we have measured cell mortality in vitro experiments with murine glioma (CT-2A) and mouse osteoblastic (MC3T3-E1) cell lines. We have used gold nanorods (GNRs) that absorb light with a wavelength of 808 nm, which are conventional in optical hyperthermia, and silica microparticles spheres (hereinafter referred to as SMSs) with a diameter size to scatter the light of this wavelength. The obtained results confirm our initial hypothesis, because a high mortality rate is achieved with reduced concentrations of GNR. We found a difference in mortality between CT2A cancer cells and cells considered non-cancer MC3T3, maintaining the same conditions, which gives indications that this technique possibly improves the efficiency in the cell survival. This might be related with differences in the proliferation rate. Since the experiments were carried out in the 2D dimensions of the Petri dishes, due to sedimentation of the silica particles at the bottom, whilst light scattering is a 3D phenomenon, a large amount of the energy provided by the laser escapes outside the medium. Therefore, better results might be expected when applying this methodology in tissues, which are 3D structures, where the multiple reflections of light we believe will produce higher optical density in comparison to the conventional case of no using scattering particles. Accordingly, further studies deserve to be carried out in this line of work in order to improve the optical hyperthermia technique.


Assuntos
Glioblastoma/terapia , Hipertermia Induzida , Nanopartículas Metálicas/administração & dosagem , Osteoblastos/citologia , Dióxido de Silício/química , Animais , Sobrevivência Celular , Células Cultivadas , Glioblastoma/patologia , Lasers , Nanopartículas Metálicas/química , Camundongos
9.
Med Sci Monit ; 27: e933369, 2021 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-34075014

RESUMO

In early 2020, at the beginning of the coronavirus disease 2019 (COVID-19) pandemic due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), rare cases were reported in children and adolescents of multisystem inflammatory syndrome in children (MIS-C). MIS-C is characterized by fever, systemic inflammation, and multiorgan dysfunction and usually presents late in SARS-CoV-2 infection. Since May 2020, the Centers for Disease Control and Prevention (CDC) has recorded all reported cases of COVID-19 and MIS-C in children and adolescents in the USA. In April 2021, the American College of Rheumatology (ACR) revised its clinical guidelines for diagnosing and managing hyperinflammation and MIS-C. There are several challenges ahead for preventing, diagnosing, and managing MIS-C, particularly following the rapid emergence of new strains of SARS-CoV-2. This Editorial aims to present an update on the current status of the clinical presentation, diagnosis, and management of MIS-C and includes some updates from population studies and clinical guidelines.


Assuntos
COVID-19/diagnóstico , COVID-19/terapia , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/terapia , Adolescente , Teste para COVID-19 , Criança , Gerenciamento Clínico , Humanos , SARS-CoV-2/isolamento & purificação
10.
BMC Emerg Med ; 21(1): 67, 2021 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-34078273

RESUMO

BACKGROUND: Coronavirus disease highly contagious, is prevalent in all age and sex groups infecting the respiratory system. The present study seeks to investigate the epidemiology and effective factors in mortality of patients with COVID-19 in Ardabil province, northwestern Iran. METHODS: In a retrospective study, the hospitalized patients with laboratory-diagnosed COVID-19 between February to August 2020 were enrolled. The data registration portal was designated according to Iranian Ministry of Health and Medical Education guidelines. In this portal, demographic information, clinical presentation, laboratory and imaging data were registered for patients in all hospitals in the same format. The Hosmer-Lemeshow strategy was used for variable selection in a multiple model. RESULTS: Of the patients involved 2812(50.3%) were male and 150 (2.7%) had contact with a confirmed case of COVID-19 in the last 14 days. Pre-existing comorbidity was reported in 1310 (23.4%) patients. Of all patients, 477(8.5%) died due to COVID-19. the result of the multiple logistic regression model indicated that after adjusting for other factors, higher age (OR = 3.11), fever or chills (OR = 1.61), shortness of breath (OR = 1.82), fatigue (OR = 0.71), headache (OR = 0.64), runny nose (OR = 1.54), Skeletal muscle pain (OR = 1.53), hospitalization (OR = 5.66), and hospitalization in ICU (OR = 5.12) were associated with death. CONCLUSIONS: Hospitalization had the strongest effect on mortality followed by hospitalization in ICU, and higher age. This study showed that having some extra-pulmonary symptoms in contrast with pulmonary symptoms can predict as good prognostic factors.


Assuntos
COVID-19/mortalidade , Hospitalização/estatística & dados numéricos , Pneumonia Viral/mortalidade , Adulto , Distribuição por Idade , Fatores Etários , Idoso , COVID-19/terapia , Comorbidade , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/terapia , Estudos Retrospectivos , Fatores de Risco
11.
Curr Cardiol Rep ; 23(7): 90, 2021 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-34081219

RESUMO

PURPOSE OF REVIEW: Coronavirus disease 2019 (COVID19) involves the heart, including pericardium. This article reviews the possible pathophysiological mechanisms in pericardial involvement in COVID19 and pericardial manifestations of COVID19. It also summarizes the patients with pericarditis secondary to COVID19 and outlines the contemporary treatment strategies in this patient population. RECENT FINDINGS: A high degree of suspicion is required to identify the pericardial involvement in COVID19 patients. It is proposed that an underlying hyperinflammatory reaction in COVID19 leads to pericardial inflammation. Acute pericarditis with or without myocardial involvement is diagnosed on clinical presentation, serum inflammatory markers, electrocardiogram, and echocardiogram. Multimodality imaging may also have an additional diagnostic value. Patients are usually managed medically, but some patients develop a life-threatening pericardial tamponade necessitating pericardial drainage. Pericardial involvement is an important clinical manifestation of COVID19 requiring a proper workup. Timely diagnosis and a specific management plan based on the presentation and concomitant organ involvement usually lead to a complete recovery.


Assuntos
COVID-19 , Tamponamento Cardíaco , Derrame Pericárdico , Pericardite , Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/etiologia , Humanos , Pericardite/diagnóstico por imagem , Pericardite/terapia , Pericárdio/diagnóstico por imagem , SARS-CoV-2
12.
BMC Infect Dis ; 21(1): 522, 2021 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-34082705

RESUMO

BACKGROUND: Leptospirosis is a zoonotic spirochetal disease caused by Leptospira interrogans. The clinical presentation ranges from an asymptomatic state to a fatal multiorgan dysfunction. Neurological manifestations including aseptic meningitis, spinal cord and peripheral nerve involvement, cranial neuropathies and cerebellar syndrome are well recognized with varying frequencies among patients with this disease. Posterior reversible encephalopathy syndrome is a very rare occurrence in leptospirosis and only two cases are reported in the medical literature up to now. We report a case of posterior reversible encephalopathy syndrome in a patient with leptospirosis with rhabdomyolysis and acute kidney injury. CASE PRESENTATION: A 21 year-old male presented with fever and oliguric acute kidney injury with rhabdomyolysis. A diagnosis of leptospirosis was made and he was being managed according to the standard practice together with regular hemodialysis. The clinical condition was improving gradually. On day 8 of the illness, he developed headache and sudden painless complete bilateral vision loss followed by several brief generalized tonic clonic seizure attacks. Examination was significant for a Glasgow Coma Scale of 14/15, blood pressure of 150/90 mmHg and complete bilateral blindness. The findings of magnetic resonance imaging of the brain were compatible with posterior reversible encephalopathy syndrome. He was managed with blood pressure control and antiepileptics with supportive measures and standard treatment for leptospirosis and made a complete recovery. CONCLUSION: Posterior reversible encephalopathy syndrome, though very rare with leptospirosis, should be considered as a differential diagnosis in a patient with new onset visual symptoms and seizures, especially during the immune phase. Optimal supportive care together with careful blood pressure control and seizure management would yield a favourable outcome in this reversible entity.


Assuntos
Injúria Renal Aguda/complicações , Leptospirose/complicações , Síndrome da Leucoencefalopatia Posterior/etiologia , Rabdomiólise/complicações , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/fisiopatologia , Injúria Renal Aguda/terapia , Encéfalo/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Leptospirose/diagnóstico , Leptospirose/fisiopatologia , Leptospirose/terapia , Imageamento por Ressonância Magnética , Masculino , Síndrome da Leucoencefalopatia Posterior/diagnóstico , Síndrome da Leucoencefalopatia Posterior/fisiopatologia , Síndrome da Leucoencefalopatia Posterior/terapia , Rabdomiólise/diagnóstico , Rabdomiólise/fisiopatologia , Rabdomiólise/terapia , Resultado do Tratamento , Adulto Jovem
13.
Ann Transplant ; 26: e931832, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34083502

RESUMO

BACKGROUND Kidney transplant services all over the world were severely impacted by the coronavirus disease 2019 pandemic. The optimum management of kidney transplant recipients with coronavirus disease 2019 remains uncertain. MATERIAL AND METHODS We conducted a multicenter cohort study of kidney transplant recipients with coronavirus disease 2019 infection in Saudi Arabia. Multivariable Cox regression analysis was used to study predictors of graft and patient outcomes at 28 days after coronavirus disease 2019 diagnosis. RESULTS We included 130 kidney transplant recipients, with a mean age of 48.7(±14.4) years. Fifty-nine patients were managed at home with daily follow-up utilizing a dedicated clinic, while 71 (54.6%) required hospital admission. Acute kidney injury occurred in 35 (26.9%) patients. Secondary infections occurred in 38 (29.2%) patients. SARS-CoV-2 antibodies testing was carried out in 84 patients, of whom 70 tested positive for IgG and/or IgM. Fourteen patients died (10.8%). A multivariable Cox regression analysis showed that age, creatinine at presentation, acute kidney injury, and use of azithromycin were significantly associated with worse patient survival. Graft loss was associated with requiring renal replacement therapy and development of secondary infections. CONCLUSIONS Despite kidney transplant recipients with coronavirus disease 2019 infection having higher rate of hospital admission and mortality compared to the general population, a significant number of them can be managed using a telemedicine clinic. Most kidney transplant patients seem to mount an antibody response following coronavirus disease 2019 infection, and it remains to be seen if they will have a similar response to the incoming vaccines.


Assuntos
COVID-19/complicações , COVID-19/terapia , Falência Renal Crônica/cirurgia , Transplante de Rim , Adulto , COVID-19/diagnóstico , Estudos de Coortes , Feminino , Hospitalização , Humanos , Falência Renal Crônica/virologia , Masculino , Pessoa de Meia-Idade , Terapia de Substituição Renal , Arábia Saudita , Telemedicina , Eliminação de Partículas Virais
15.
BMC Musculoskelet Disord ; 22(1): 515, 2021 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-34090406

RESUMO

BACKGROUND: Enhancing self-efficacy to manage symptoms and functions is an important aspect of self-management for patients with knee osteoarthritis (OA). Many reports have investigated the effects of self-management education programmes for arthritis patients. However, a study that exclusively focuses on patients with OA in the same joints is required to clarify the effects of self-management programmes because individuals with knee OA experience physical and psychological difficulties different from those experienced by individuals with other arthritis diseases. Furthermore, previous studies have reported a wide range of delivery styles of self-management education programmes. This systematic review aimed to evaluate the effects of group-based and face-to-face self-management education programmes conducted by health professionals targeting self-efficacy for knee OA exclusively. METHODS: The MEDLINE, CENTRAL, EMBASE, CINAHL, Web of Science, and PEDro databases were searched to identify quantitative measures used in randomised controlled trials (RCTs) to assess the effects of self-management education programmes targeting self-efficacy in patients with knee OA. We included studies in which medical professional-delivered self-management education programmes were conducted in a group-based and face-to-face manner in community or outpatient settings. RESULTS: Seven RCTs from five countries were included in this review. Our retrieved studies included various types of self-management education programmes such as cognitive behavioural counselling, pain management education, physical education, weight management education, and arthritis self-efficacy management education, and control arms. They assessed various aspects of self-efficacy, including pain, physical function, arthritis symptoms excluding pain, weight management, mobility, and self-regulation. The total score of the Arthritis Self-Efficacy Scale was also measured. Some studies have reported beneficial effects of group-based and face-to-face self-management education programmes on self-efficacy for management of pain and other symptoms and for self-regulatory, knee OA. However, the results of the included studies were varied and inconsistent. CONCLUSIONS: The current review only included seven studies, and there was a wide range of clinical heterogeneity among these studies. Thus, the effects of group-based and face-to-face self-management education programmes conducted by health professionals on self-efficacy for knee OA exclusively are inconclusive to date. Therefore, high-quality studies are required to provide significant information on clinicians, patients, and healthcare professionals in the future.


Assuntos
Osteoartrite do Joelho , Autogestão , Escolaridade , Humanos , Articulação do Joelho , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/terapia , Autoeficácia
16.
BMC Health Serv Res ; 21(1): 555, 2021 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-34090425

RESUMO

BACKGROUND: Healthcare costs are disproportionately incurred by a relatively small group of people often described as high-cost users. Understanding the factors associated with high-cost use of health services among people experiencing homelessness could help guide service planning. METHODS: Survey data from a general cohort of adults with a history of homelessness and a cohort of homeless adults with mental illness were linked with administrative healthcare records in Ontario, Canada. Total costs were calculated using a validated costing algorithm and categorized based on population cut points for the top 5%, top 6-10%, top 11-50% and bottom 50% of users in Ontario. Multinomial logistic regression was used to identify the predisposing, enabling, and need factors associated with higher healthcare costs (with bottom 50% as the reference). RESULTS: Sixteen percent of the general homeless cohort and 30% percent of the cohort with a mental illness were in the top 5% of healthcare users in Ontario. Most healthcare costs for the top 5% of users were attributed to emergency department and inpatient service costs, while the costs from other strata were mostly for physician services, hospital outpatient clinics, and medications. The odds of being within the top 5% of users were higher for people who reported female gender, a regular medical doctor, past year acute service use, poor perceived general health and two or more diagnosed chronic conditions, and were lower for Black participants and other racialized groups. Older age was not consistently associated with higher cost use; the odds of being in the top 5% were highest for 35-to-49-year year age group in the cohort with a mental illness and similar for the 35-49 and ≥ 50-year age groups in the general homeless cohort. CONCLUSIONS: This study combines survey and administrative data from two cohorts of homeless adults to describe the distribution of healthcare costs and identify factors associated with higher cost use. These findings can inform the development of targeted interventions to improve healthcare delivery and support for people experiencing homelessness.


Assuntos
Pessoas em Situação de Rua , Transtornos Mentais , Adulto , Idoso , Feminino , Custos de Cuidados de Saúde , Humanos , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Ontário/epidemiologia , Problemas Sociais
17.
BMC Health Serv Res ; 21(1): 554, 2021 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-34090447

RESUMO

BACKGROUND: In the case of ischemic stroke, access to a Computed Tomography (CT) scanner and the start of thrombolytic therapy immediately is imperative. Transport to the nearest hospital from the remote, rural area of Hallingdal in Norway entails a 2-3 h drive. The local medical centre in this area has a CT-scanner operated by radiographers during office hours. Out-of-hours stroke evaluation and treatment has been the focus of a research project. Paramedics position the patient in the CT-scanner. A radiographer at the participating hospital runs a remote-controlled scan and a junior doctor instructs a paramedic in the performance of a neurological examination. The aim of this study was to explore how radiographers, paramedics and junior doctors experience conducting telemedicine-based stroke evaluation and treatment. METHODS: Six semi-structured interviews were conducted with radiographers, paramedics and junior doctors; with remote control, CT examination and stroke management as central issues. Core issues in the interview guide were: communication; cooperation; competence; service quality and training. The study employed thematic content analysis in analysing the data inductively. RESULTS: The analysis gave an overview of the patient flow and communication routines in this service. Further findings were divided into two main themes, "Teamwork" and "Quality". The theme "Teamwork" included three categories "Communication", "Trust and confidence", and "Task and task shifting". The theme "Quality" included two categories "Education and training" and "Safety and routines". The respondents considered the service to be of high quality and that the team functioned at a high level as a result of regular training sessions. However, communication and image reading routines could be improved. CONCLUSIONS: The telemedicine-based, remote controlled, stroke evaluation and treatment was experienced, by the participants, to be well organised and of high quality. Communication and image reading appear to be the salient challenges. Regular training sessions and follow-up, as well as an evaluation of incidents by the project manager, proved to be of great importance in retaining and securing the continued running of the service and ensuring high-quality treatment. Further research is indicated in the comparison of this telemedicine service with stroke treatment given in a mainstream hospital.


Assuntos
Acidente Vascular Cerebral , Telemedicina , Pessoal Técnico de Saúde , Humanos , Corpo Clínico Hospitalar , Noruega , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/terapia
18.
World J Surg Oncol ; 19(1): 162, 2021 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-34090476

RESUMO

BACKGROUND: Pituitary adenomas are one type of intracranial tumor, which can be divided into microadenoma (≤ 1 cm), macroadenoma (> 1 cm), and giant adenoma (≥ 4 cm) according to their diametral sizes. They are benign, typically slow-progressing, whereas the biological behavior of some of them is invasive, which presents a major clinical challenge. Treatment of some pituitary adenomas is still difficult due to drug resistance or multiple relapses, usually after surgery, medication, and radiation. At present, no clear prediction and treatment biomarkers have been found in pituitary adenomas and some of them do not cause clinical symptoms, so patients are often found to be ill through physical examination, and some are even found through autopsy. With the development of research on pituitary adenomas, the immune response has become a hot spot and may serve as a novel disease marker and therapeutic target. The distribution and function of immune cells and their secreted molecules in pituitary adenomas are extremely complex. Researchers found that infiltration of immune cells may have a positive effect on the treatment and prognosis of pituitary adenomas. In this review, we summarized the advance of tumor immunity in pituitary adenomas, revealing the immunity molecules as potential biomarkers as well as therapeutic agents for pituitary adenomas. CONCLUSION: The immune studies related to pituitary adenomas may help us find relevant immune markers. At the same time, the exploration of immunotherapy also provides new options for the treatment of pituitary adenomas.


Assuntos
Adenoma , Neoplasias Hipofisárias , Adenoma/terapia , Humanos , Imunoterapia , Recidiva Local de Neoplasia , Neoplasias Hipofisárias/terapia , Prognóstico
19.
J Headache Pain ; 22(1): 52, 2021 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-34092221

RESUMO

BACKGROUND: Cluster headache (CH) is a trigeminal autonomic cephalalgia (TAC) characterized by a highly disabling headache that negatively impacts quality of life and causes limitations in daily functioning as well as social functioning and family life. Since specific measures to assess the quality of life (QoL) in TACs are lacking, we recently developed and validated the cluster headache quality of life scale (CH-QoL). The sensitivity of CH-QoL to change after a medical intervention has not been evaluated yet. METHODS: This study aimed to test the sensitivity to change of the CH-QoL in CH. Specifically we aimed to (i) assess the sensitivity of CH-QoL to change before and following deep brain stimulation of the ventral tegmental area (VTA-DBS), (ii) evaluate the relationship of changes on CH-QoL with changes in other generic measures of quality of life, as well as indices of mood and pain. Ten consecutive CH patients completed the CH-QoL and underwent neuropsychological assessment before and after VTA-DBS. The patients were evaluated on headache frequency, severity, and load (HAL) as well as on tests of generic quality of life (Short Form-36 (SF-36)), mood (Beck Depression Inventory, Hospital Anxiety and Depression Rating Scale), and pain (McGill Pain Questionnaire, Headache Impact Test, Pain Behaviour Checklist). RESULTS: The CH-QoL total score was significantly reduced after compared to before VTA-DBS. Changes in the CH-QoL total score correlated significantly and negatively with changes in HAL, the SF-36, and positively and significantly with depression and the evaluative domain on the McGill Pain Questionnaire. CONCLUSIONS: Our findings demonstrate that changes after VTA-DBS in CH-QoL total scores are associated with the reduction of frequency, duration, and severity of headache attacks after surgery. Moreover, post VTA-DBS improvement in CH-QoL scores is associated with an amelioration in quality of life assessed with generic measures, a reduction of depressive symptoms, and evaluative pain experience after VTA-DBS. These results support the sensitivity to change of the CH-QoL and further demonstrate the validity and applicability of CH-QoL as a disease specific measure of quality of life for CH.


Assuntos
Cefaleia Histamínica , Estimulação Encefálica Profunda , Cefaleia Histamínica/terapia , Humanos , Dor , Qualidade de Vida , Área Tegmentar Ventral
20.
Ned Tijdschr Tandheelkd ; 128(6): 307-309, 2021 Jun.
Artigo em Holandês | MEDLINE | ID: mdl-34096929

RESUMO

Current therapies for dry mouth have several drawbacks and limitations. Therefore, some patients turn to alternative medicine, such as acupuncture. Three systematic reviews of the literature found that acupuncture may have a positive effect on reducing complaints. However, in these studies, no effect on the salivary secretion rate was observed. Considering the limited number of studies and the low quality of evidence, caution is advised when recommending acupuncture as an alternative therapy for dry mouth.


Assuntos
Terapia por Acupuntura , Xerostomia , Humanos , Xerostomia/terapia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...