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Rev Paul Pediatr ; 39: e2020217, 2021.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32876096


OBJECTIVE: To analyze the current scientific literature to document, in an integrative review, the main findings that correlate Kawasaki disease (KD) to COVID-19. DATA SOURCES: The search was carried out in June 2020 in the following databases: Biblioteca Virtual em Saúde (BVS), periódico da CAPES and U.S National Library of Medicine (PubMed). The combination of descriptors used was [(COVID-19 OR SARS-CoV-2) AND (Kawasaki disease)], and the inclusion criteria stipulated were studies published from January 2019 to June 2020, without restriction of language or location, and available online in full. News, editorials, comments, and letters, as well as duplicates and articles that did not answer the guiding question were excluded. DATA SYNTHESIS: A total of 97 articles were identified, of which seven comprised this review. The association of KD to the new coronavirus appears to trigger a severe clinical condition of vasculitis. Different from the usual, in this inflammatory syndrome, patients are older, and prevalence is higher in children from African or Caribbean ancestry; clinical and laboratory manifestations are also atypical, with a predominance of abdominal complaints and exaggerated elevation of inflammatory markers. In addition, there was a greater report of rare complications and greater resistance to the recommended treatment for KD. CONCLUSIONS: Pediatric COVID-19 and its potential association to severe KD, still unfamiliar to health professionals, reinforces the importance of testing patients with vasculitis for the new coronavirus and the need to wage high surveillance and preparation of the health system during the current pandemic.

Infecções por Coronavirus , Síndrome de Linfonodos Mucocutâneos , Pandemias , Pneumonia Viral , Síndrome de Resposta Inflamatória Sistêmica/virologia , Betacoronavirus/isolamento & purificação , Criança , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/fisiopatologia , Gerenciamento Clínico , Humanos , Síndrome de Linfonodos Mucocutâneos/epidemiologia , Síndrome de Linfonodos Mucocutâneos/terapia , Síndrome de Linfonodos Mucocutâneos/virologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/imunologia , Pneumonia Viral/fisiopatologia
Adv Exp Med Biol ; 1287: 1-7, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33034022


The evolutionary conserved Notch pathway that first developed in metazoans and that was first discovered in fruit flies (Drosophila melanogaster) governs fundamental cell fate decisions and many other cellular key processes not only in embryonic development but also during initiation, promotion, and progression of cancer. On a first look, the Notch pathway appears remarkably simple, with its key feature representing a direct connection between an extracellular signal and transcriptional output without the need of a long chain of protein intermediaries as known from many other signaling pathways. However, on a second, closer look, this obvious simplicity exerts surprising complexity. There is no doubt that the enormous scientific progress in unraveling the functional mechanisms that underlie this complexity has recently greatly increased our knowledge about the role of Notch signaling for pathogenesis and progression of many types of cancer. Moreover, these new scientific findings have shown promise in opening new avenues for cancer prevention and therapy, although this goal is still challenging. Vol. III of the second edition of the book Notch Signaling in Embryology and Cancer, entitled Notch Signaling in Cancer, summarizes important recent developments in this fast-moving and fascinating field. Here, we give an introduction to this book and a short summary of the individual chapters that are written by leading scientists, covering the latest developments in this intriguing research area.

Neoplasias/prevenção & controle , Neoplasias/terapia , Receptores Notch/metabolismo , Transdução de Sinais , Animais , Diferenciação Celular , Humanos , Neoplasias/patologia
Adv Exp Med Biol ; 1287: 81-103, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33034028


Head and neck cancer is a group of neoplastic diseases affecting the facial, oral, and neck region. It is one of the most common cancers worldwide with an aggressive, invasive evolution. Due to the heterogeneity of the tissues affected, it is particularly challenging to study the molecular mechanisms at the basis of these tumors, and to date we are still lacking accurate targets for prevention and therapy. The Notch signaling is involved in a variety of tumorigenic mechanisms, such as regulation of the tumor microenvironment, aberrant intercellular communication, and altered metabolism. Here, we provide an up-to-date review of the role of Notch in head and neck cancer and draw parallels with other types of solid tumors where the Notch pathway plays a crucial role in emergence, maintenance, and progression of the disease. We therefore give a perspective view on the importance of the pathway in neoplastic development in order to define future lines of research and novel therapeutic approaches.

Neoplasias de Cabeça e Pescoço , Receptores Notch , Neoplasias de Cabeça e Pescoço/metabolismo , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Transdução de Sinais , Microambiente Tumoral
Adv Exp Med Biol ; 1287: 201-222, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33034034


Notch is a key evolutionary conserved pathway, which has fascinated and engaged the work of investigators in an uncountable number of biological fields, from development of metazoans to immunotherapy for cancer. The study of Notch has greatly contributed to the understanding of cancer biology and a substantial effort has been spent in designing Notch-targeting therapies. Due to its broad involvement in cancer, targeting Notch would allow to virtually modulate any aspect of the disease. However, this means that Notch-based therapies must be highly specific to avoid off-target effects. This review will present the newest mechanistic and therapeutic advances in the Notch field and discuss the promises and challenges of this constantly evolving field.

Imunoterapia , Terapia de Alvo Molecular , Neoplasias/terapia , Receptores Notch/antagonistas & inibidores , Humanos , Neoplasias/imunologia , Fenótipo , Receptores Notch/metabolismo
An. pediatr. (2003. Ed. impr.) ; 92(4): 241.e1-241.e11, abr. 2020. mapas, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-186847


El 31 de diciembre de 2019, la Comisión Municipal de Salud y Sanidad de Wuhan (provincia de Hubei, China) informó sobre la existencia de 27 casos de neumonía de etiología desconocida con inicio de síntomas el 8 de diciembre, incluyendo 7 casos graves, con exposición común a un mercado de marisco, pescado y animales vivos en la ciudad de Wuhan. El 7 de enero de 2020, las autoridades chinas identificaron como agente causante del brote un nuevo tipo de virus de la familia Coronaviridae, denominado temporalmente «nuevo coronavirus», 2019-nCoV. El 30 de enero de 2020 la Organización Mundial de la Salud (OMS) declara el brote una Emergencia Internacional. El día 11 de febrero la OMS le asigna el nombre de SARS-CoV2 e infección COVID-19 (Coronavirus Infectious Disease). El Ministerio de Sanidad convoca a las Sociedades de Especialidades para la elaboración de un protocolo clínico de manejo de la infección. La Asociación Española de Pediatría nombra un grupo de trabajo de las Sociedades de Infectología Pediátrica y Cuidados Intensivos Pediátricos que se encargan de elaborar las presentes recomendaciones con la evidencia disponible en el momento de su realización

On 31 December 2019, the Wuhan Municipal Committee of Health and Healthcare (Hubei Province, China) reported that there were 27 cases of pneumonia of unknown origin with symptoms starting on the 8 December. There were 7 serious cases with common exposure in market with shellfish, fish, and live animals, in the city of Wuhan. On 7 January 2020, the Chinese authorities identified that the agent causing the outbreak was a new type of virus of the Coronaviridae family, temporarily called «new coronavirus», 2019-nCoV. On January 30th, 2020, the World Health Organisation (WHO) declared the outbreak an International Emergency. On 11 February 2020 the WHO assigned it the name of SARS-CoV2 and COVID-19 (SARS-CoV2 and COVID-19). The Ministry of Health summoned the Specialties Societies to prepare a clinical protocol for the management of COVID-19. The Spanish Paediatric Association appointed a Working Group of the Societies of Paediatric Infectious Diseases and Paediatric Intensive Care to prepare the present recommendations with the evidence available at the time of preparing them

Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Coronavirus/classificação , Coronavirus/genética , Reação em Cadeia da Polimerase em Tempo Real , Índice de Gravidade de Doença , Sociedades Médicas , Espanha
Rev. enferm. UERJ ; 28: e35054, jan.-dez. 2020.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1117622


Objetivo: avaliar a mobilidade do cliente com dermatose imunobolhosa antes e após aplicação do curativo com gaze vaselinada. Método: estudo quase experimental, interinstitucional, com clientes com dermatoses imunobolhosas hospitalizados em um hospital estadual e um hospital federal do Estado do Rio de Janeiro e uma instituição do Mato Grosso do Sul. Utilizou-se a lógica fuzzy para classificar a mobilidade dos sujeitos antes, 24 horas após e uma semana após aplicação do curativo. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa. Resultados: Incluídos 14 participantes, sendo nove com pênfigo vulgar, dois com pênfigo foliáceo e três com penfigóide bolhoso, entre 27 e 82 anos, predominando 11 mulheres. Após 24 horas, nenhum participante se considerou com baixa mobilidade, sete passaram a mobilidade média, e sete, alta, o que foi mantido uma semana após aplicação do curativo. Conclusão: constatou-se significativo aumento da mobilidade logo nas primeiras 24 horas após aplicação do curativo.

Objective: to assess the mobility of clients with immunobullous dermatoses, before and after applying vaseline gauze dressings. Method: in this quasi-experimental, interinstitutional study of inpatients with immunobullous dermatoses at a state hospital and a federal hospital in Rio de Janeiro State and an institution in Mato Grosso do Sul (Brazil), patient mobility before, 24 hours after, and one week after applying the dressing was classified using fuzzy logic. The study was approved by the research ethics committee. Results: 14 participants, nine with pemphigus vulgaris, two with pemphigus foliaceus, and three with bullous pemphigoid, aged between 27 and 82 years old, and predominantly (11) women. After 24 hours, none of the participants considered their mobility to be poor, seven began to be moderately mobile, and seven were highly mobile, and continued so one week after applying the dressing. Conclusion: mobility increased significant in the first 24 hours after applying the dressing.

Objetivo: evaluar la movilidad de clientes con dermatosis inmunobullosa, antes y después de la aplicación de apósitos de gasa con vaselina. Método: en este estudio cuasi-experimental, interinstitucional de pacientes hospitalizados con dermatosis inmunobullosa en un hospital estatal y un hospital federal en el estado de Río de Janeiro y una institución en Mato Grosso do Sul (Brazil), la movilidad del paciente antes, 24 horas después y una semana después la aplicación del apósito se clasificó mediante lógica difusa. El estudio fue aprobado por el comité de ética en investigación. Resultados: se incluyeron 14 participantes, nueve con pénfigo vulgar, dos con pénfigo foliáceo y tres con penfigoide ampolloso, con edades comprendidas entre 27 y 82 años, y predominantemente mujeres (n=11). Después de 24 horas, ninguno de los participantes consideró que su movilidad fuera pobre, siete comenzaron a ser moderadamente móviles y siete eran altamente móviles, y así continuaron una semana después de la aplicación del apósito. Conclusión: la movilidad aumentó significativamente en las primeras 24 horas después de la aplicación del apósitoconsideraba con baja movilidad, siete comenzaron a tener movilidad media y siete, alta, que se mantuvo una semana después de aplicar el apósito. Conclusión: hubo un aumento significativo en la movilidad en las primeras 24 horas después de aplicar el apósito.

Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Vaselina/uso terapêutico , Bandagens , Dermatopatias Vesiculobolhosas/terapia , Penfigoide Bolhoso/terapia , Pênfigo/terapia , Limitação da Mobilidade , Brasil , Lógica Fuzzy , Lesão por Pressão/prevenção & controle , Prevenção Secundária , Ensaios Clínicos Controlados não Aleatórios como Assunto , Hospitais Públicos , Pacientes Internados , Cuidados de Enfermagem
Rev. enferm. UERJ ; 28: 42281, jan.-dez. 2020.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1094844


Objetivo: identificar evidências acerca do uso seguro da hipotermia terapêutica em recém-nascidos. Método: revisão integrativa realizada entre junho e julho de 2018, em fontes eletrônicas da Biblioteca Virtual de Saúde e PubMed, por meio da pergunta:"Que evidências podem subsidiar o cuidado de enfermagem voltado para a redução de sequelas em recém-nascidos submetidos à hipotermia terapêutica?".Foram eleitos nove artigos para análise, sendo oito internacionais e um nacional. Resultados:o resfriamento deve acontecer por 72 horas, com hipotermia leve. As indicações para inclusão no protocolo foram: primeiras seis horas de vida, idade gestacional maior que 35 semanas e acidose na primeira hora de vida.São cuidados essenciais: monitoração hemodinâmica, observação da pele, controle térmico retal, vigilância do Eletroencefalograma de Amplitude Integrada. Conclusão: a terapêutica apresenta benefícios, porém sua aplicação depende de protocolo institucional e treinamento das equipes com foco nas potenciais complicações.

Objective: to identify the evidence on safe use of therapeutic hypothermia in newborns. Method: integrative review of the literature, conducted between June and July of 2018, in electronic sources from the Virtual Health Library and PubMed, through the question: "What evidence can support nursing care aimed at reducing sequelae in newborns undergoing therapeutic hypothermia?". Analysis was conducted for nine selected article, being eight from international literature and one from Brazilian national literature. Results: cooling should occur for 72 hours with mild hypothermia. Indications for inclusion in the protocol were: first six hours of life, gestational age greater than 35 weeks and acidosis in the first hour of life. Essential care includes hemodynamic monitoring, skin observation, rectal thermal control, Integrated Amplitude Electroencephalogram surveillance. Conclusion: the therapy has benefits, but its application depends on institutional protocol and team training focusing on potential complications.

Objetivo: identificar la evidencia sobre el uso seguro de la hipotermia terapéutica en recién nacidos. Método: revisión integradora de la literatura, realizada entre junio y julio de 2018, en fuentes electrónicas de la Biblioteca Virtual de Salud y PubMed, a través de la pregunta: "¿Qué evidencia puede apoyar la atención de enfermería dirigida a reducir las secuelas en los recién nacidos que sufren hipotermia terapéutica?". Se realizaron análisis para nueve artículos seleccionados, ocho de literatura internacional y uno de literatura nacional brasileña. Resultados: el enfriamiento debe ocurrir durante 72 horas con hipotermia leve. Las indicaciones para la inclusión en el protocolo fueron: primeras seis horas de vida, edad gestacional mayor de 35 semanas y acidosis en la primera hora de vida. El cuidado esencial incluye monitoreo hemodinámico, observación de la piel, control térmico rectal, vigilancia integrada de electroencefalograma de amplitud. Conclusión: la terapia tiene beneficios, pero su aplicación depende del protocolo institucional y del entrenamiento del equipo, enfocándose en posibles complicaciones.

Humanos , Recém-Nascido , Protocolos Clínicos/normas , Hipóxia-Isquemia Encefálica/terapia , Segurança do Paciente/normas , Hipotermia Induzida/métodos , Hipotermia Induzida/normas , Asfixia Neonatal/complicações , Hipóxia-Isquemia Encefálica/etiologia , Hipotermia Induzida/efeitos adversos , Hipotermia Induzida/enfermagem
Rev. bioét. derecho ; (50): 99-112, nov. 2020.
Artigo em Espanhol | IBECS | ID: ibc-191348


En el marco de una pandemia a escala mundial como la que representa el COVID-19 uno de los mayores dilemas bioéticos que se plantean es el de la gestión de determinados medios asistenciales escasos, tales como los respiradores (ventilación mecánica asistida), pues del acceso a los mismos dependen las posibilidades de supervivencia de numerosos pacientes en estado crítico. El presente trabajo trata de determinar los criterios para la gestión de dichos soportes vitales en un contexto de escasez extrema de los mismos para hacer frente a las necesidades de la totalidad de los pacientes que los requieren, analizando la literatura comparada sobre el particular, así como diferentes informes institucionales y de organismos en la esfera de la bioética

In the context of a worldwide pandemic such as COVID-19, one of the greatest bioethical dilemmas that arise is the management of certain scarce medical devices, such as ventilators (mechanical ventilation), since the survival of many critically ill patients depends on the access to these ventilators. The present paper tries to determine the criteria applicable for the management of these medical devices in a context of extreme scarcity to face the needs of all the patients who require them. To this end, the comparative literature on the subject as well as different institutional and academic reports in the field of bioethics are analysed

En el marc d'una pandèmia a escala mundial com la que representa la COVID-19 un dels majors dilemes bioètics que es plantegen és el de la gestió de determinats mitjans assistencials escassos, com ara els respiradors (ventilació mecànica assistida), ja que de l'accés als mateixos depenen les possibilitats de supervivència de nombrosos pacients en estat crític. El present treball pretén determinar els criteris per a la gestió d'aquests suports vitals en un context d'escassetat extrema dels mateixos per fer front a les necessitats de la totalitat dels pacients que els requereixen, analitzant la literatura comparada sobre el particular, així com diferents informes institucionals I d'organismes en l'esfera de la bioètica

Humanos , Sistemas de Manutenção da Vida/estatística & dados numéricos , Administração dos Cuidados ao Paciente , Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Pandemias , Triagem , Respiração Artificial , Ventiladores Mecânicos/provisão & distribução , Unidades de Terapia Intensiva/provisão & distribução
Rev. bioét. derecho ; (50): 167-188, nov. 2020. graf
Artigo em Espanhol | IBECS | ID: ibc-191352


La llegada de la pandemia por coronavirus SARS-CoV-2 (la enfermedad de la COVID-19) a España también ha repercutido en el acceso parental a las Unidades de Cuidados Intensivos Neonatales (UCIN). Al comienzo de la pandemia se tomaron las medidas que, fundamentadas en criterios de salud pública, se consideraron necesarias. A medida que avanzaba el conocimiento científico sobre la COVID-19, y en base a los nuevos datos obtenidos, se comenzaron a adaptar las medidas inicialmente establecidas. Sin embargo, creemos que la adaptación de alguno de estos protocolos, en concreto el del acceso parental a las UCIN, no ha sido la idónea desde el punto de vista bioético y del interés superior del menor. A lo largo de este artículo exponemos esas insuficiencias

The arrival of the SARS-CoV-2 coronavirus pandemic (COVID-19 disease) in Spain has also had an impact on parental access to Neonatal Intensive Care Units (NICU). At the beginning of the pandemic, measures were taken that, based on public health criteria, and were considered necessary. As scientific knowledge about COVID-19 advanced, and based on the new data obtained, the measures initially established began to be adapted. However, we believe that the adaptation of some of these protocols, specifically that of parental access to NICU, has not been the ideal one from the bioethical point of view and in the best interest of the minor. Throughout this article we expose these insufficiencies

L'arribada de la pandèmia per coronavirus SARS-CoV-2 (la malaltia de la COVID-19) a Espanya també ha repercutit en l'accés parental a les Unitats de Cures Intensives Neonatals (UCIN). A l'inici de la pandèmia es van prendre les mesures que, fonamentades en criteris de salut pública, es van considerar necessàries. A mesura que avançava el coneixement científic sobre la COVID-19, I en base a les noves dades obtingudes, es van començar a adaptar, les mesures inicialment establertes. No obstant això, creiem que l'adaptació d'algun d'aquests protocols, en concret el de l'accés parental a les UCIN, no ha estat la idònia des del punt de vista bioètic I de l'interès superior del menor. Al llarg d'aquest article exposem aquestes insuficiències

Humanos , Masculino , Feminino , Gravidez , Recém-Nascido , Terapia Intensiva Neonatal/ética , Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Pandemias , Pais , Isolamento de Pacientes , Acompanhantes Formais em Exames Físicos/ética , Acompanhantes Formais em Exames Físicos/legislação & jurisprudência , Humanização da Assistência
Ann Acad Med Singap ; 49(7): 434-448, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33000106


INTRODUCTION: Singapore was one of the first countries affected by the coronavirus disease 2019 (COVID-19) pandemic but has been able to prevent its healthcare system and intensive care units (ICU) from being overwhelmed. We describe the clinical features, management and outcomes of COVID-19 patients with respiratory failure admitted to our ICU. MATERIALS AND METHODS: A case series of COVID-19 patients admitted to our ICU for respiratory failure from 7 February, with data censoring at 30 June 2020, was performed from a review of medical records. RESULTS: Twenty-two COVID-19 patients were admitted to our ICU for respiratory failure. The median age was 54.5 years (IQR 30-45.5), 72.7% were male and had at least one comorbidity. The Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were 2.5 (IQR 1.25-7) and 10 (8.25-12) respectively. Thirteen patients required invasive mechanical ventilation (IMV) and had a median PaO2/FiO2 ratio of 194 mmHg (IQR 173-213) after intubation. The 28-day survival was 100%, with 2 patients demising subsequently. The overall ICU mortality rate was 9.1% at the time of data censoring. In IMV survivors, length of IMV and ICU stay were 11 days (IQR 9-17.75) and 16 days (IQR 12-32) respectively. CONCLUSION: Low COVID-19 ICU mortality was observed in our "pandemic-ready" ICU. This was achieved by having adequate surge capacity to facilitate early ICU admission and IMV, lung protective ventilation, and slow weaning. Being able to maintain clinical standards and evidence-based practices without having to resort to rationing contributed to better outcomes.

Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , Cuidados Críticos/organização & administração , Pneumonia Viral/complicações , Pneumonia Viral/terapia , Insuficiência Respiratória/terapia , Insuficiência Respiratória/virologia , APACHE , Adulto , Idoso , Infecções por Coronavirus/mortalidade , Feminino , Mortalidade Hospitalar , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/mortalidade , Respiração Artificial , Insuficiência Respiratória/mortalidade , Estudos Retrospectivos , Singapura
Ann Acad Med Singap ; 49(7): 449-455, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33000107


INTRODUCTION: As the coronavirus disease 2019 (COVID-19) pandemic continues to spread on an unprecedented scale from around the world, we described our experience in treating early COVID-19 cases in India. MATERIALS AND METHODS: An observational study of COVID-19 patients admitted to a tertiary care centre in North India between 2 March-4 April 2020 was performed. The clinical, epidemiological, laboratory, treatment and outcome data of patients were evaluated. RESULTS: A total of 75 patients were treated and 56 (74.66%) were men. The clinical spectrum of COVID-19 ranged from asymptomatic to acute respiratory distress syndrome (ARDS). Fever (85.36%) was the most common symptom followed by cough (56.09%) and dyspnoea (19.51%). Findings from hemogram analysis showed that 32%, 21.33% and 18.67% of patients had lymphopaenia, eosinopenia and thrombocytopaenia, respectively. Inflammatory markers such as C-reactive protein, D-dimer, ferritin, fibrin degradation product and interleukin-6 were significantly elevated (P <0.05) in patients who required oxygen therapy than those who did not require it, suggesting the potential role such markers could play in predicting prognosis in patients. Mean hospital stay was 9.2 days and 72 (96%) patients made a complete recovery, but 3 (4%) patients demised after progressing to ARDS. CONCLUSION: The clinical and epidemiological spectrum of COVID-19 has jeopardised the health system in India. Without a proven therapy to combat this pandemic and with no sight of vaccines in the near future, a preventive strategy should be adopted to contain the spread of this infectious disease.

Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Centros de Atenção Terciária , Adolescente , Adulto , Criança , Pré-Escolar , Infecções por Coronavirus/epidemiologia , Feminino , Hospitalização , Humanos , Índia , Lactente , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Oxigenoterapia , Pandemias , Pneumonia Viral/epidemiologia , Avaliação de Sintomas , Adulto Jovem
BMC Med Educ ; 20(1): 342, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008374


Worldwide it is being discussed whether medical students might be of help during the present COVID-19 epidemic. Although this question is probably a legitimate one, one should however discuss this thoroughly before deciding whether medical students are to be included in this kind of medical care on a larger scale.Various arguments should be weighted, and potential tasks should be chosen carefully. This period could however be also an opportunity for medical students to learn things they would probably never learn about. Nevertheless, medical students have a deficit concerning knowledge about epidemics, and they are also not really well skilled in many hygiene measures. Furthermore, some of the known medical students' behaviour could be a risk factor for further spread of the virus as well. Then, young adults are at risk of getting infected themselves. Last but not least, medical students in general are under a great deal of pressure from their studies which could lead to the development of anxiety and other mental disorders. One could only speculate on the effects of this epidemic on their further mental well-being. Therefore, medical students participating in direct care of patients with COVID-19 should first be trained well, and then properly supervised at all times. Only then it might be a really useful and exceptional experience, for healthcare, medical schools as well as for society.

Betacoronavirus , Infecções por Coronavirus/terapia , Educação Médica/organização & administração , Conhecimentos, Atitudes e Prática em Saúde , Pneumonia Viral/terapia , Estudantes de Medicina/psicologia , Infecções por Coronavirus/epidemiologia , Humanos , Pandemias , Pneumonia Viral/epidemiologia
Curr Opin Ophthalmol ; 31(6): 455-461, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33009076


PURPOSE OF REVIEW: Optic nerve sheath meningiomas (ONSMs) are rare benign tumors of the anterior visual pathway which present with slowly progressive and painless vision loss and account for approximately 2% of all orbital tumors. This article provides an overview as well as an update on the ONSMs with regards to cause, epidemiology, clinical presentation, diagnosis, and management in adults and pediatric population. RECENT FINDINGS: The clinical presentation and prognosis of ONSMs can vary and largely depend on the location of tumor as well as the histologic type. Overall, the diagnosis is based on clinical presentation, examination, and neuroimaging findings. Nevertheless, delays in diagnosis or misdiagnosis are not uncommon and can result in higher morbidity rates. Recent advances in diagnostic as well as more effective and less-invasive treatment options are discussed in this review. SUMMARY: ONSMs are a rare cause of slowly progressive and inexorable visual loss. Although ONSM diagnosis depends on the characteristic clinical and radiologic findings, prompt diagnosis, and appropriate management is critical for favorable visual outcomes. Thus, current focus is optimizing diagnostic as well-treatment methods for patients with ONSMs.

Meningioma , Neoplasias do Nervo Óptico , Humanos , Meningioma/diagnóstico , Meningioma/terapia , Neuroimagem , Neoplasias do Nervo Óptico/diagnóstico , Neoplasias do Nervo Óptico/terapia , Prognóstico , Transtornos da Visão/etiologia
Curr Opin Ophthalmol ; 31(6): 469-474, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33009078


PURPOSE OF REVIEW: Orbital disease represents a diverse spectrum of pathology and can result in a variety of neuro-ophthalmic manifestations. The aim of this review is to provide updates on recent advances in our understanding of orbital disease secondary to thyroid eye disease, myositis, IgG4-related disease, sarcoidosis, granulomatosis with polyangiitis and various tumours. RECENT FINDINGS: With regards to thyroid eye disease, there have been recent advances in the development of steroid-sparing therapies, new modalities for objectively monitoring disease activity and increased understanding of the role of environmental risk factors. There has been interest in characterizing the clinical course and underlying mechanism of optic nerve disease secondary to orbital disorders, which has led to advances in how we monitor for and prevent permanent vision loss. Increased knowledge of orbital tumour subtype histopathology and the development of novel classification systems has had prognostic value and aided medical decision-making. SUMMARY: Orbital disease occurs secondary to a wide variety of diseases and can lead to neuro-ophthalmic manifestations with significant morbidity. Advances in our understanding of different subtypes of orbital disease have improved our ability to treat these potentially debilitating conditions.

Doenças Orbitárias , Humanos , Oftalmologia , Doenças do Nervo Óptico , Doenças Orbitárias/terapia , Prognóstico , Vasculite Sistêmica/complicações
Curr Opin Ophthalmol ; 31(6): 475-482, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33009079


PURPOSE OF REVIEW: Recent studies have increased our understanding of the biochemical and structural bases of visual hallucinations in patients with a variety of underlying causes. RECENT FINDINGS: Visual hallucinations may be related to disruption of functional connectivity networks, with underlying biochemical dysfunction such as decreased in cholinergic activity. Structural abnormalities in primary and higher order visual processing areas also have been found in patients with visual hallucinations. The occurrence of visual hallucinations after vision loss, the Charles Bonnet syndrome, may have more functional similarity to psychiatric and neurodegenerative causes than previously suspected despite retained insight into the unreal nature of the phenomena. SUMMARY: Visual hallucinations are common, and patients may not report them if specific inquiries are not made. Presence or absence of hallucinations may be of diagnostic and therapeutic importance, especially in patients with neurodegenerative conditions that have overlapping features. Treatment of visual hallucinations remains challenging and must be tailored to each patient based on the underlying cause and comorbid conditions.

Alucinações , Animais , Cognição , Alucinações/diagnóstico , Alucinações/etiologia , Alucinações/psicologia , Alucinações/terapia , Humanos , Corpos de Lewy , Visão Ocular
Curr Opin Ophthalmol ; 31(6): 495-502, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33009082


PURPOSE OF REVIEW: This review discusses general features and organ-specific presentations of Susac syndrome as well as diagnosis and treatment. RECENT FINDINGS: Latest literature regarding demographics, new diagnostic modalities such as optical coherence tomography and treatment options for Susac syndrome are discussed in detail in this review, summarizing the most recent updated information. SUMMARY: Susac syndrome is a rare, underdiagnosed, and often misdiagnosed disease that can lead to severe complications such as deafness, vision loss, dementia, and death. It involves the central nervous system and may mimic other neurological and neuro-ophthalmological diseases.

Síndrome de Susac , Transtornos da Visão/etiologia , Encéfalo , Humanos , Síndrome de Susac/complicações , Síndrome de Susac/diagnóstico , Síndrome de Susac/terapia , Tomografia de Coerência Óptica , Transtornos da Visão/epidemiologia