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1.
Gastroenterol Nurs ; 43(5): 375-381, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33003024

RESUMO

Elective surgical and endoscopic procedures were suspended nationwide during the March 2020 COVID-19 pandemic to minimize exposure and healthcare resource utilization. This resulted in an unprecedented backlog of procedures in most clinical practices including pediatrics. Our group developed an internal process toward the rational development of an algorithm prioritizing elective procedures. This was based on patient disease severity defined by the presence of alert symptoms, symptom severity for dysphagia and abdominal pain, and diagnostic investigation findings. The underlying rationale is to prioritize patients in whom suspected disease course would be greatest impacted by endoscopy. We developed a nurse phone call-based process utilizing REDCap®, identifying relevant symptoms categorized by severity, and a validated functional impairment questionnaire for abdominal pain. We abstracted key laboratory and radiological findings also categorized by severity. The order of priority of procedures was established on the basis of a 4-tiered system factoring both presence and severity of symptoms or prior diagnostic testing results. We present the framework that we have adopted toward prioritizing procedures with the assumption that it offers an objective methodology and that can be efficiently and more broadly applied to other similar practice scenarios. Our tool may have wide-ranging implications both in the current COVID-19 pandemic and in other scenarios of limited resource allocation and deserves further investigation.


Assuntos
Agendamento de Consultas , Betacoronavirus , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/prevenção & controle , Procedimentos Cirúrgicos do Sistema Digestório , Procedimentos Cirúrgicos Eletivos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Adolescente , Algoritmos , Criança , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Endoscopia , Feminino , Humanos , Masculino , Seleção de Pacientes , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Avaliação de Sintomas , Triagem
2.
Artigo em Inglês | MEDLINE | ID: mdl-33020395

RESUMO

In the wake of the sudden spread of COVID-19, a large amount of the Italian population practiced incongruous behaviors with the protective health measures. The present study aimed at examining psychological and psychosocial variables that could predict behavioral compliance. An online survey was administered from 18-22 March 2020 to 2766 participants. Paired sample t-tests were run to compare efficacy perception with behavioral compliance. Mediation and moderated mediation models were constructed to explore the association between perceived efficacy and compliance, mediated by self-efficacy and moderated by risk perception and civic attitudes. Machine learning algorithms were trained to predict which individuals would be more likely to comply with protective measures. Results indicated significantly lower scores in behavioral compliance than efficacy perception. Risk perception and civic attitudes as moderators rendered the mediating effect of self-efficacy insignificant. Perceived efficacy on the adoption of recommended behaviors varied in accordance with risk perception and civic engagement. The 14 collected variables, entered as predictors in machine learning models, produced an ROC area in the range of 0.82-0.91 classifying individuals as high versus low compliance. Overall, these findings could be helpful in guiding age-tailored information/advertising campaigns in countries affected by COVID-19 and directing further research on behavioral compliance.


Assuntos
Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/prevenção & controle , Aprendizado de Máquina , Pandemias/prevenção & controle , Cooperação do Paciente/estatística & dados numéricos , Pneumonia Viral/prevenção & controle , Algoritmos , Betacoronavirus , Humanos , Itália
3.
Nat Commun ; 11(1): 4952, 2020 10 02.
Artigo em Inglês | MEDLINE | ID: mdl-33009368

RESUMO

We present the Danish Disease Trajectory Browser (DTB), a tool for exploring almost 25 years of data from the Danish National Patient Register. In the dataset comprising 7.2 million patients and 122 million admissions, users can identify diagnosis pairs with statistically significant directionality and combine them to linear disease trajectories. Users can search for one or more disease codes (ICD-10 classification) and explore disease progression patterns via an array of functionalities. For example, a set of linear trajectories can be merged into a disease trajectory network displaying the entire multimorbidity spectrum of a disease in a single connected graph. Using data from the Danish Register for Causes of Death mortality is also included. The tool is disease-agnostic across both rare and common diseases and is showcased by exploring multimorbidity in Down syndrome (ICD-10 code Q90) and hypertension (ICD-10 code I10). Finally, we show how search results can be customized and exported from the browser in a format of choice (i.e. JSON, PNG, JPEG and CSV).


Assuntos
Progressão da Doença , Software , Algoritmos , Dinamarca , Humanos , Fatores de Tempo
4.
Eur Respir Rev ; 29(157)2020 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-33004526

RESUMO

Artificial intelligence (AI) is transforming healthcare delivery. The digital revolution in medicine and healthcare information is prompting a staggering growth of data intertwined with elements from many digital sources such as genomics, medical imaging and electronic health records. Such massive growth has sparked the development of an increasing number of AI-based applications that can be deployed in clinical practice. Pulmonary specialists who are familiar with the principles of AI and its applications will be empowered and prepared to seize future practice and research opportunities. The goal of this review is to provide pulmonary specialists and other readers with information pertinent to the use of AI in pulmonary medicine. First, we describe the concept of AI and some of the requisites of machine learning and deep learning. Next, we review some of the literature relevant to the use of computer vision in medical imaging, predictive modelling with machine learning, and the use of AI for battling the novel severe acute respiratory syndrome-coronavirus-2 pandemic. We close our review with a discussion of limitations and challenges pertaining to the further incorporation of AI into clinical pulmonary practice.


Assuntos
Algoritmos , Inteligência Artificial , Betacoronavirus , Infecções por Coronavirus/diagnóstico , Assistência à Saúde/métodos , Aprendizado de Máquina , Pneumonia Viral/diagnóstico , Pneumologia/métodos , Humanos , Pandemias
5.
Prog Orthod ; 21(1): 36, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33000308

RESUMO

OBJECTIVE: To compare the accuracy of complete-arch scans and quadrant scans obtained using a direct chairside intraoral scanner. MATERIAL AND METHODS: Intraoral scans were obtained from 20 adults without missing teeth except for the third molar. Maxillary and mandibular complete-arch scans were carried out, and 4 quadrant scans for each arch were performed to obtain right posterior, right anterior, left anterior, and left posterior quadrant scans. Complete-arch scans and quadrant scans were compared with corresponding model scans using best-fit surface-based registration. Shell/shell deviations were computed for complete-arch scans and quadrant scans and compared between the complete-arch scans and each quadrant scans. In addition, shell/shell deviations were calculated also for each individual tooth in complete-arch scans to evaluate factors which influence the accuracy of intraoral scans. RESULTS: Complete-arch scans showed relatively greater errors (0.09 ~ 0.10 mm) when compared to quadrant scans (0.05 ~ 0.06 mm). The errors were greater in the maxillary scans than in the mandibular scans. The evaluation of errors for each tooth showed that the errors were greater in posterior teeth than in anterior teeth. Comparing the right and left errors, the right side posterior teeth showed a more substantial variance than the left side in the mandibular scans. CONCLUSION: The scanning accuracy has a difference between complete-arch scanning and quadrant scanning, particularly in the posterior teeth. Careful consideration is needed to avoid scanning inaccuracy for maxillary or mandibular complete-arch, particularly in the posterior area because a complete-arch scan might have potential error than a quadrant scan.


Assuntos
Anodontia , Mandíbula/diagnóstico por imagem , Adulto , Algoritmos , Humanos
6.
Arch Pathol Lab Med ; 144(10): 1204-1208, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33002153

RESUMO

CONTEXT.­: Glycemic control requires accurate blood glucose testing. The extent of hematocrit interference is difficult to assess to assure quality patient care. OBJECTIVE.­: To predict the effect of patient hematocrit on the performance of a glucose meter and its corresponding impact on insulin-dosing error. DESIGN.­: Multilevel mixed regression was conducted to assess the extent that patient hematocrit influences Roche Accu-Chek Inform II glucose meters, using the Radiometer ABL 837 as a reference method collected during validation of 35 new meters. Regression coefficients of fixed effects for reference glucose, hematocrit, an interaction term, and random error were applied to 4 months of patient reference method results extracted from the laboratory information system. A hospital inpatient insulin dose algorithm was used to determine the frequency of insulin dose error between reference glucose and meter glucose results. RESULTS.­: Fixed effects regression for method and hematocrit predicted biases to glucose meter results that met the "95% within ±12%" for the US Food and Drug Administration goal, but combinations of fixed and random effects exceeded that target in emergency and hospital inpatient units. Insulin dose errors were predicted from the meter results. Twenty-eight percent of intensive care unit, 20.8% of hospital inpatient, and 17.7% of emergency department results were predicted to trigger a ±1 insulin dose error by fixed and random effects. CONCLUSIONS.­: The current extent of hematocrit interference on glucose meter performance is anticipated to cause insulin error by 1-dose category, which is likely associated with low patient risk.


Assuntos
Glicemia/análise , Hipoglicemiantes/administração & dosagem , Insulina/administração & dosagem , Erros Médicos , Algoritmos , Hematócrito , Humanos , Medição de Risco , Estados Unidos
7.
Chaos ; 30(9): 091102, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33003920

RESUMO

This paper introduces a mathematical framework for determining second surge behavior of COVID-19 cases in the United States. Within this framework, a flexible algorithmic approach selects a set of turning points for each state, computes distances between them, and determines whether each state is in (or over) a first or second surge. Then, appropriate distances between normalized time series are used to further analyze the relationships between case trajectories on a month-by-month basis. Our algorithm shows that 31 states are experiencing second surges, while four of the 10 largest states are still in their first surge, with case counts that have never decreased. This analysis can aid in highlighting the most and least successful state responses to COVID-19.


Assuntos
Infecções por Coronavirus/epidemiologia , Modelos Teóricos , Pneumonia Viral/epidemiologia , Algoritmos , Betacoronavirus , Humanos , Pandemias , Capacidade de Resposta ante Emergências , Estados Unidos/epidemiologia
8.
Comput Math Methods Med ; 2020: 1391583, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33029193

RESUMO

Purpose: We aimed to analyze and evaluate the safety signals of ribavirin-interferon combination through data mining of the US Food and Drug Administration Adverse Event Reporting System (FAERS), so as to provide reference for the rationale use of these agents in the management of relevant toxicities emerging in patients with novel coronavirus pneumonia (COVID-19). Methods: Reports to the FAERS from 1 January 2004 to 8 March 2020 were analyzed. The proportion of report ratio (PRR), reporting odds ratio (ROR), and Bayesian confidence interval progressive neural network (BCPNN) method were used to detect the safety signals. Results: A total of 55 safety signals were detected from the top 250 adverse event reactions in 2200 reports, but 19 signals were not included in the drug labels. All the detected adverse event reactions were associated with 13 System Organ Classes (SOC), such as gastrointestinal, blood and lymph, hepatobiliary, endocrine, and various nervous systems. The most frequent adverse events were analyzed, and the results showed that females were more likely to suffer from anemia, vomiting, neutropenia, diarrhea, and insomnia. Conclusion: The ADE (adverse drug event) signal detection based on FAERS is helpful to clarify the potential adverse events related to ribavirin-interferon combination for novel coronavirus therapy; clinicians should pay attention to the adverse reactions of gastrointestinal and blood systems, closely monitor the fluctuations of the platelet count, and carry out necessary mental health interventions to avoid serious adverse events.


Assuntos
Infecções por Coronavirus/tratamento farmacológico , Interferons/efeitos adversos , Pneumonia Viral/tratamento farmacológico , Ribavirina/efeitos adversos , Adolescente , Adulto , Sistemas de Notificação de Reações Adversas a Medicamentos , Idoso , Algoritmos , Teorema de Bayes , Mineração de Dados , Esquema de Medicação , Quimioterapia Combinada/efeitos adversos , Feminino , Humanos , Interferons/administração & dosagem , Masculino , Pessoa de Meia-Idade , Redes Neurais de Computação , Razão de Chances , Pandemias , Segurança do Paciente , Ribavirina/administração & dosagem , Adulto Jovem
9.
Comput Math Methods Med ; 2020: 9017157, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33029196

RESUMO

This paper deals with the mathematical modeling and numerical simulations related to the coronavirus dynamics. A description is developed based on the framework of the susceptible-exposed-infectious-removed model. Initially, a model verification is carried out calibrating system parameters with data from China, Italy, Iran, and Brazil. Results show the model capability to predict infectious evolution. Afterward, numerical simulations are performed in order to analyze different scenarios of COVID-19 in Brazil. Results show the importance of the governmental and individual actions to control the number and the period of the critical situations related to the pandemic.


Assuntos
Simulação por Computador , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Algoritmos , Betacoronavirus , Brasil/epidemiologia , China/epidemiologia , Doenças Transmissíveis/epidemiologia , Humanos , Irã (Geográfico)/epidemiologia , Itália/epidemiologia , Modelos Teóricos , Pandemias , Informática em Saúde Pública , Reprodutibilidade dos Testes
10.
Environ Monit Assess ; 192(11): 696, 2020 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-33040211

RESUMO

For effective planning of irrigation scheduling, water budgeting, crop simulation, and water resources management, the accurate estimation of reference evapotranspiration (ETo) is essential. In the current study, the hybrid support vector regression (SVR) coupled with Whale Optimization Algorithm (SVR-WOA) was employed to estimate the monthly ETo at Algiers and Tlemcen meteorological stations positioned in the north of Algeria under three different optimal input scenarios. Monthly climatic parameters, i.e., solar radiation (Rs), wind speed (Us), relative humidity (RH), and maximum and minimum air temperatures (Tmax and Tmin) of 14 years (2000-2013), were obtained from both stations. The accuracy of the hybrid SVR-WOA model was appraised against hybrid SVR-MVO (Multi-Verse Optimizer), and SVR-ALO (Ant Lion Optimizer) models through performance measures, i.e., mean absolute error (MAE), root-mean-square error (RMSE), index of scattering (IOS), index of agreement (IOA), Pearson correlation coefficient (PCC), Nash-Sutcliffe efficiency (NSE), and graphical interpretation (time-variation and scatter plots, radar chart, and Taylor diagram). The results showed that the SVR-WOA model performed superior to the SVR-MVO and SVR-ALO models at both stations in all scenarios. The SVR-WOA-1 model with five inputs (i.e., Tmin, Tmax, RH, Us, Rs: scenario-1) had the lowest value of MAE = 0.0658/0.0489 mm/month, RMSE = 0.0808/0.0617 mm/month, IOS = 0.0259/0.0165, and the highest value of NSE = 0.9949/0.9989, PCC = 0.9975/0.9995, and IOA = 0.9987/0.9997 for testing period at both stations, respectively. The proposed hybrid SVR-WOA model was found to be more appropriate and efficient in comparison to SVR-MVO and SVR-ALO models for estimating monthly ETo in the study region.


Assuntos
Monitoramento Ambiental , Baleias , Argélia , Algoritmos , Animais , Vento
11.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 47(3): 106-110, jul.-sept. 2020. graf
Artigo em Espanhol | IBECS | ID: ibc-189900

RESUMO

La convivencia con la infección por COVID-19 (coronavirus disease 2019) en todos los entornos hospitalarios y de salud supone un reto actual de adaptación, creación de circuitos, protocolos y nuevos modelos de asistencia. Son todavía bastantes las incógnitas a resolver sobre esta infección en la actualidad, y mucho más desconocido es el impacto que la misma supone si lo trasladamos al terreno quirúrgico. La evidencia respecto al efecto del SARS-CoV-2 y cirugía laparoscópica es escasa y de calidad limitada, pero aun así, la laparoscopia ha sido considerada de elección por las distintas sociedades científicas en pacientes COVID para la mayoría de indicaciones en ginecología, por las conocidas ventajas hacia el paciente respecto a la vía abierta: menor morbilidad y estancia hospitalaria y porque comporta procedimientos quirúrgicos autónomos y contenidos respecto a la liberación de humo y donde, además, el instrumental y la disposición en quirófano permiten un alejamiento del cirujano y del resto de profesionales en el área quirúrgica respecto al paciente. A modo global, las dos recomendaciones fundamentales en quirófano de cirugía laparoscópica en esta época COVID incluyen: el uso de equipo de protección personal adecuado para el personal de quirófano y la adopción de precauciones para reducir la exposición al CO2 y el humo quirúrgico que puede producirse en estos procedimientos


Coexistence with COVID-19 infection (coronavirus disease 2019) in all hospital and health care settings is a current challenge of adaptation, as well as the creation of new protocols and care models. At present, there are still many unknowns about this infection, and much more unknown is the impact into the surgical field. Although evidence regarding the effect of SARS-CoV-2 and laparoscopic surgery is scarce, laparoscopy has been considered the method of choice by different scientific societies for most indications in gynaecology during the COVID-19 pandemic. This is due to the advantages over the open route. There is less morbidity and hospital stay, and in addition, as it involves autonomous and contained surgical procedures with respect to smoke release. Moreover, the instruments and the setting in the operating room mean that there can be safe distance from the surgeon and other staff to the patient. Overall, the main recommendations in laparoscopic surgery during the COVID era include: the use of Personal Protective Equipment for operating room personnel, and the adoption of safety measures to reduce CO2 exposure and surgical smoke reléase


Assuntos
Humanos , Feminino , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Laparoscopia/métodos , Reação em Cadeia da Polimerase , Algoritmos , Aerossóis/administração & dosagem , Aerossóis/normas , RNA Viral/sangue , Fatores de Risco
12.
Environ Monit Assess ; 192(9): 612, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32875360

RESUMO

This study focuses on development of equilibrium strategy based on simulated annealing (SA) algorithm for balancing economic and environmental concerns in waste load allocation (WLA) problem. To resolve conflicts among various stakeholders, including Iran Department of Environment (DoE) as governmental authority and industrial and municipal dischargers, Stackelberg and Nash bargaining games have been applied in this WLA problem and the results have been compared. SA algorithm has been coupled to QUAL2Kw model to derive optimal WLA program and the environmental penalty tariff (EPT) in Nash bargaining and Stackelberg games. The proposed tools and methodologies were illustrated in a case study of multi-stakeholders WLA problem in Gheshlagh River, Sanandaj, Kordestan, Iran. The results indicate that lower BOD removal rates are allocated to the pollutant dischargers in the Stackelberg game compared to the Nash bargaining game. Furthermore, the EPT assigned by Iran DoE in Stackelberg and Nash bargaining games are 11.25 and 3.6 Rials/(gr/month), respectively. The estimated EPT in the Stackelberg game is close to the current tariff (10 Rials/(gr/month)) specified by Iran DoE on impermissible BOD discharges.


Assuntos
Monitoramento Ambiental , Rios , Algoritmos , Indústrias , Irã (Geográfico)
13.
Medicine (Baltimore) ; 99(35): e21327, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871862

RESUMO

The prevalence of type 2 diabetes (T2D) has increased recently in Qatar. Body mass index (BMI) is a predictor of T2D in many populations. However, BMI is based on height and weight measurements and not on body adiposity. Therefore, the utility of BMI for predicting the risk of T2D has been questioned. Visceral adiposity appears to be a better predictor of T2D.This study aimed to assess the relative effectiveness of visceral adiposity index (VAI) and body adiposity index (BAI), in comparison with BMI, for T2D among Qatari adults.A random sample of 1103 adult Qatari nationals and long term residents over 20 years old were included in this study. This data were obtained from the Qatar Biobank (QBB). We performed a multivariate logistic regression to examine the association between VAI, BAI, BMI, and T2D, and computed z-scores for VAI, BAI and BMI.VAI z-scores showed the strongest association with the risk of T2D (OR, 1.44; 95% CI: 1.24-1.68) compared with the z-scores for BAI (OR, 1.15; 95% CI: 0.93-1.43) and BMI (OR, 1.33; 95% CI: 1.11-1.59). ROC curve analysis showed that VAI was a stronger predictor than BAI and BMI (P < .0001). Subgroup analysis indicated that the association was stronger between VAI and T2D in Qatari women than in men.VAI was a stronger and an independent predictor of T2D compared to BAI and BMI among the Qatari adult population. Therefore, VAI could be a useful tool for predicting the risk of T2D among Qatari adults.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Gordura Intra-Abdominal/patologia , Obesidade Abdominal/complicações , Adiposidade , Adulto , Algoritmos , Antropometria/métodos , Índice de Massa Corporal , Estudos de Casos e Controles , Feminino , Humanos , Gordura Intra-Abdominal/crescimento & desenvolvimento , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Catar/epidemiologia
14.
Medicine (Baltimore) ; 99(33): e21556, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872004

RESUMO

Moxa floss is the primary material used in moxibustion, an important traditional Chinese medicine therapy that uses ignited moxa floss to apply heat to the body for disease treatment. Till date, there is no available data regarding quality control of different grades of moxa floss. The objectives of this study were to explore the probative value of the electronic nose (e-nose) in differentiating different quality grades of commercial moxa floss sold in China, and to investigate if data mining techniques could be used to optimize the sensor array while retaining classification accuracy of the samples. The e-nose with 12 metal oxide semiconductor type sensors was used to analyze the odor profiles of 15 commercial moxa floss samples of different quality grades. Feature selection algorithms using principal component analysis (PCA) and BestFirst (BC) coupled with correlation-based feature subset selection (CfsSubsetEval) method were used to obtain the most efficient feature subsets. Results for the BC feature selection method identified 3 optimized sensors (S2, S6, and S11), suggesting that aromatic compounds relate more to the identification of the samples. Radial basis function (RBF), multilayer perceptron (MLP), and random forests (RF) performed well in discriminating the samples, retaining prediction accuracies above 85%, which achieved cost-effectiveness and operational simplicity, while retaining prediction accuracy. The e-nose could be a rapid and nondestructive method for objective preliminary classification of quality grades of moxa floss and may be used for future studies related to moxa products safety and quality.


Assuntos
Medicamentos de Ervas Chinesas/classificação , Nariz Eletrônico , Moxibustão , Fumaça/análise , Algoritmos , China , Mineração de Dados , Humanos , Análise de Componente Principal
15.
J Environ Radioact ; 222: 106355, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32892907

RESUMO

The gamma dose rate caused by airborne radionuclides is a major concern in the mitigation of nuclear accidents. Unfortunately, there is no fast method for calculating the three-dimensional (3D) gamma dose rate field near the source, because the corresponding airborne radionuclide distribution is usually calculated on non-equispaced grids and existing fast methods are only suitable for equispaced grids. This paper presents a method that accurately calculates the 3D dose rate field on non-equispaced grids, accelerating the computation by around two orders of magnitude. This method splits the time-consuming 3D integral in the dose rate model into a large convolution with a regularized smooth function and a small correction term. A nonuniform fast Fourier transform (NFFT) is used to rapidly calculate the convolution, which significantly enhances the computational speed. Our approach is applied to different grids and is compared with the FFT-based convolution method in two complex air dispersion simulations and a field experiment. The results show that the proposed method is in good agreement with the original 3D integral method and avoids grid-dependent interpolation errors in the FFT-based convolution method. This method enables a coupled analysis of wind, radioactivity, and dose rate on arbitrary grids, which is important for simplifying the emergency response in the case of small modular reactors.


Assuntos
Raios gama , Monitoramento de Radiação , Radioisótopos , Algoritmos , Análise de Fourier , Radioisótopos/análise
16.
Rev Col Bras Cir ; 47: e20202528, 2020 Sep 04.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32901706

RESUMO

OBJECTIVE: to evaluate the impact of probable sarcopenia (PS) on the survival of oncological patients submitted to major surgeries. METHOD: prospective cohort bicentrical study enrolling adult oncological patients submitted to major surgeries at Cancer Hospital and Santa Casa de Misericordia in Cuiabá-MT. The main endpoint was the verification of postoperative death. Demographic and clinical data was collected. PS was defined as the presence of 1) sarcopenia risk assessed by SARC-F questionnaire and 2) low muscle strength measured by dynamometry. The cumulative mortality rate was calculated for patients with either PS or non PS using Kaplan Meier curve. The univariate and multivariate Cox regression model was used to evaluate the association of mortality with various investigated confounding variables. RESULTS: a total of 220 patients with a mean (SD) age of 58.7±14.0 years old, 60.5% males participated of the study. Patients with PS had higher risk to postoperative death (RR=5.35 95%CI 1.95-14.66; p=0,001) and for infectious complications (RR=2.45 95%CI 1.12-5.33; p=0.036). The 60 days mean survival was shorter for patients with PS: 44 (IQR=32-37) vs 58 (IQR=56-59) days (log rank <0,001). The Cox multivariate regression showed that PS was an independent risk factor (HR=5.8 95%CI 1.49-22.58; p=0.011) for mortality. CONCLUSION: patients bearing PS submitted to major oncological surgery have less probability of short term survival and preoperative PS is an independent risk for postoperative mortality.


Assuntos
Neoplasias/cirurgia , Sarcopenia/complicações , Adulto , Idoso , Algoritmos , Brasil/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/mortalidade , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Fatores de Risco , Sarcopenia/mortalidade , Inquéritos e Questionários , Taxa de Sobrevida
17.
Orphanet J Rare Dis ; 15(1): 228, 2020 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-32867855

RESUMO

During the COVID-19 outbreak, the European Reference Network on Rare Bone Diseases (ERN BOND) coordination team and Italian rare bone diseases healthcare professionals created the "COVID-19 Helpline for Rare Bone Diseases" in an attempt to provide high-quality information and expertise on rare bone diseases remotely to patients and healthcare professionals. The present position statement describes the key characteristics of the Helpline initiative, along with the main aspects and topics that recurrently emerged as central for rare bone diseases patients and professionals. The main topics highlighted are general recommendations, pulmonary complications, drug treatment, trauma, pregnancy, children and elderly people, and patient associations role. The successful experience of the "COVID-19 Helpline for Rare Bone Diseases" launched in Italy could serve as a primer of gold-standard remote care for rare bone diseases for the other European countries and globally. Furthermore, similar COVID-19 helplines could be considered and applied for other rare diseases in order to implement remote patients' care.


Assuntos
Betacoronavirus , Doenças Ósseas/complicações , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Doenças Raras/complicações , Consulta Remota/normas , Idoso , Algoritmos , Doenças Ósseas/terapia , Criança , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Feminino , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia , Gravidez , Doenças Raras/terapia , Ferimentos e Lesões
18.
Medwave ; 20(7): e8008, 2020 Aug 28.
Artigo em Espanhol | MEDLINE | ID: mdl-32877391

RESUMO

In December 2019, a new strain of the SARS-CoV-2 coronavirus was reported in Wuhan, China, which produced severe lung involvement and progressed to respiratory distress. To date, more than seventeen million confirmed cases and more than half a million died worldwide from COVID-19. Patients with cardiovascular disease are more susceptible to contracting this disease and presenting more complications. We did a literature search on the association of cardiovascular disease and COVID-19 in databases such as Scopus, PubMed/MEDLINE, and the Cochrane Library. The purpose of this review is to provide updated information for health professionals who care for patients with COVID-19 and cardiovascular disease, given that they have a high risk of complications and mortality. Treatment with angiotensin-converting enzyme inhibitors and receptor blockers is controversial, and there is no evidence not to use these medications in patients with COVID-19. Regarding treatment with hydroxychloroquine associated or not with azithromycin, there is evidence of a higher risk with its use than clinical benefit and decreased mortality. Likewise, patients with heart failure are an important risk group due to their condition per se. Patients with heart failure and COVID-19 are a diagnostic dilemma because the signs of acute heart failure could be masked. On the other hand, in patients with acute coronary syndrome, the initial therapeutic approach could change in the context of the pandemic, although only based on expert opinions. Nonetheless, many controversial issues will be the subject of future research.


Assuntos
Betacoronavirus , Doenças Cardiovasculares/complicações , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Síndrome Coronariana Aguda/etiologia , Síndrome Coronariana Aguda/terapia , Algoritmos , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Antivirais/efeitos adversos , Azitromicina/efeitos adversos , Infecções por Coronavirus/tratamento farmacológico , Quimioterapia Combinada , Eletrocardiografia/efeitos dos fármacos , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/terapia , Humanos , Hidroxicloroquina/efeitos adversos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Pandemias , Peptidil Dipeptidase A/metabolismo , Pneumonia Viral/tratamento farmacológico , Prognóstico , Sistema Renina-Angiotensina/fisiologia
20.
Nat Commun ; 11(1): 4217, 2020 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-32868778

RESUMO

The cerebellum plays a crucial role in sensorimotor and associative learning. However, the contribution of molecular layer interneurons (MLIs) to these processes is not well understood. We used two-photon microscopy to study the role of ensembles of cerebellar MLIs in a go-no go task where mice obtain a sugar water reward if they lick a spout in the presence of the rewarded odorant and avoid a timeout when they refrain from licking for the unrewarded odorant. In naive animals the MLI responses did not differ between the odorants. With learning, the rewarded odorant elicited a large increase in MLI calcium responses, and the identity of the odorant could be decoded from the differential response. Importantly, MLIs switched odorant responses when the valence of the stimuli was reversed. Finally, mice took a longer time to refrain from licking in the presence of the unrewarded odorant and had difficulty becoming proficient when MLIs were inhibited by chemogenetic intervention. Our findings support a role for MLIs in learning valence in the cerebellum.


Assuntos
Cerebelo/fisiologia , Condicionamento Operante/fisiologia , Interneurônios/fisiologia , Aprendizagem/fisiologia , Células de Purkinje/fisiologia , Algoritmos , Animais , Cerebelo/citologia , Feminino , Masculino , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Microscopia de Fluorescência por Excitação Multifotônica , Modelos Neurológicos , Odorantes , Recompensa , Fatores de Tempo
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