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2.
Goiânia; SES-GO; 15; 21 maio 2021. 1-52 p. ilus, tab.
Non-conventional in Portuguese | LILACS, Coleciona SUS, CONASS, SES-GO | ID: biblio-1096093

ABSTRACT

O surto da doença respiratória causada pelo novo coronavírus (SARS-CoV-2) aconteceu na cidade de Wuhan, capital da província de Hubei, na China, em dezembro de 2019, a qual disseminou-se de forma acelerada e, logo, atingiu mais de uma centena de países dos cinco continentes. Em 12 de março de 2020, a situação foi caracterizada como pandemia pela Organização Mundial de Saúde (OMS, 2020). Em razão da disseminação o do Coronavírus pelo mundo, o Ministério da Saúde declarou Emergência de Saúde Pública de Importância Nacional (ESPIN) em decorrência da infecção pelo novo coronavírus (COVID-19) e estabeleceu o Centro de Operações de Emergência em Saúde Pública (COE-COVID-19) como mecanismo de gestão coordenada da resposta à ESPIN no país (BRASIL, 2020a). Seguindo a linha mundial, o Ministério da Saúde elaborou e publicou "Plano de Contingência Nacional para Infecção Humana pelo Novo Coronavírus COVID-19" para organizar a detecção, monitoramento e resposta dos serviços de saúde à doença (BRASIL, 2020b). O Estado de Goiás instituiu o Centro de Operações Estratégicas de Saúde Pública (COE) em 18 de fevereiro de 2020 (GOIÁS, 2020a). E, seguindo as orientações nacionais, propõe o presente PLANO ESTADUAL DE CONTINGÊNCIA PARA O ENFRENTAMENTO DA DOENÇA PELO CORONAVÍRUS (COVID-19), a fim de organizar e fortalecer as políticas públicas de saúde, visto que, para que atinjam eficácia e eficiência, é necessário atuação conjunta e ordenada dos entes federados, bem como dos setores públicos e privados.


The outbreak of respiratory disease caused by the new coronavirus (SARS-CoV-2) occurred in Wuhan city, capital of Hubei province, China, in December 2019, which spread rapidly and thus reached more than a hundred countries on five continents. On March 12, 2020, the situation was characterized as a pandemic by the World Health Organization (WHO, 2020). Due to the spread of Coronavirus around the world, the Ministry of Health declared a Public Health Emergency of National Importance (ESPIN) due to infection by the new coronavirus (COVID-19) and established the Center for Emergency Operations in Public Health (COE-COVID-19) as a mechanism for coordinated management of the response to ESPIN in the country (BRASIL, 2020a). Following the global line, the Ministry of Health elaborated and published "National Contingency Plan for Human Infection by the New Coronavirus COVID-19" to organize the detection, monitoring and response of health services to the disease (BRASIL, 2020b). The State of Goiás established the Center for Strategic Operations of Public Health (COE) on February 18, 2020 (GOIÁS, 2020a). And, following the national guidelines, it proposes this State CONTINGENCY PLAN FOR COPING WITH CORONAVIRUS DISEASE (COVID-19), in order to organize and strengthen public health policies, since, in order to achieve effectiveness and efficiency, joint and orderly action of federal entities, as well as public and private sectors, is necessary.


Subject(s)
Humans , Male , Female , Pregnancy , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Public Health , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/prevention & control , Coronavirus Infections/therapy , Coronavirus Infections/transmission , Pandemics
4.
Rev. ecuat. pediatr ; 22(1): 1-10, Abril 30, 2021.
Article in English | LILACS | ID: biblio-1222381

ABSTRACT

Introducción: La hipercolesterolemia familiar (HF) un trastorno genético autosómico domi-nante que produce un desarrollo prematuro de enfermedades cardiovasculares. Las estati-nas han sido el medicamento de elección en estos pacientes, sin embargo, un buen por-centaje de pacientes no pueden alcanzar sus objetivos terapéuticas con las dosis máximas por lo que la Lomitapida se podría establecer como una nueva alternativa de tratamiento. Objetivo: El objetivo de esta revisión sistemática es determinar si la Lomitapida reduce los eventos cardiovasculares en pacientes con diagnóstico de Hipercolesterolemia familiar comparado con estatinas. Métodos: Se incluirán ensayos controlados aleatorios (ECA) y cuasialeatorios de pacientes con diagnóstico de HF. Las medidas de resultado los niveles de LDL, HDL pos tratamiento y eventos cardiovasculares. Las búsquedas electrónicas se realizarán en PUBMED, The Coch-rane Central Register of Controlled Trials (CENTRAL), EMBASE y Scientific electronic library (Scielo). En la evaluación del riesgo de sesgo se utilizará la herramienta de Cochrane. Las medidas del efecto del tratamiento serán las diferencias de medias (DM) y los intervalos de confianza (IC) del 95%. La evaluación de heterogeneidad se realizará mediante la inspec-ción visual del diagrama de embudo. La evaluación de la calidad de la evidencia se reali-zará usando la evaluación GRADE.


Introduction: Familial hypercholesterolemia (FH) is an autosomal dominant genetic disor-der that produces hypercholesterolemia and premature development of cardiovascular diseas-es. Statins are the drug of choice in these patients; however, a high percentage of patients cannot achieve their therapeutic goals with the maximum recommended doses, so Lo-mitapide may prove to be useful as a new treatment alternative to traditional statins. Objective: The objective of this systematic review is to determine if Lomitapide is better than statins at reducing cardiovascular events in patients with a diagnosis of FH. Methods: Randomized controlled trials (RCTs) and quasi-randomized trials of patients di-agnosed with FH will be included. Primary outcome measures included several parameters: 1. Post-treatment low- and high-density lipoprotein (LDL and HDL, respectively) levels and 2. Presence of cardiovascular events. Electronic searches will be conducted in PUBMED, The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, and the scientific elec-tronic library (Scielo). The assessment of the risk of bias will be used by the Cochrane tool. The measures of the treatment effect will be considered the mean differences (MD) and the 95% confidence intervals (CI). The evaluation of heterogeneity will be done by visual inspec-tion of the funnel diagram. The evaluation of the quality of the evidence will be done using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) ap-proach.


Subject(s)
Cardiovascular Diseases , Systematic Review , Hydroxymethylglutaryl CoA Reductases , Lipoproteins, LDL , Protocols , Hypercholesterolemia , Cholesterol, LDL , Anticholesteremic Agents
5.
Rev. ecuat. pediatr ; 22(1): 1-10, Abril 30, 2021.
Article in English | LILACS | ID: biblio-1222382

ABSTRACT

Introducción: La hipercolesterolemia familiar (HF) un trastorno genético autosómico domi-nante que produce un desarrollo prematuro de enfermedades cardiovasculares. Las estati-nas han sido el medicamento de elección en estos pacientes, sin embargo, un buen por-centaje de pacientes no pueden alcanzar sus objetivos terapéuticas con las dosis máximas por lo que la Lomitapida se podría establecer como una nueva alternativa de tratamiento. Objetivo: El objetivo de esta revisión sistemática es determinar si la Lomitapida reduce los eventos cardiovasculares en pacientes con diagnóstico de Hipercolesterolemia familiar comparado con estatinas. Métodos: Se incluirán ensayos controlados aleatorios (ECA) y cuasialeatorios de pacientes con diagnóstico de HF. Las medidas de resultado los niveles de LDL, HDL pos tratamiento y eventos cardiovasculares. Las búsquedas electrónicas se realizarán en PUBMED, The Coch-rane Central Register of Controlled Trials (CENTRAL), EMBASE y Scientific electronic library (Scielo). En la evaluación del riesgo de sesgo se utilizará la herramienta de Cochrane. Las medidas del efecto del tratamiento serán las diferencias de medias (DM) y los intervalos de confianza (IC) del 95%. La evaluación de heterogeneidad se realizará mediante la inspec-ción visual del diagrama de embudo. La evaluación de la calidad de la evidencia se reali-zará usando la evaluación GRADE.


Introduction: Familial hypercholesterolemia (FH) is an autosomal dominant genetic disor-der that produces hypercholesterolemia and premature development of cardiovascular diseas-es. Statins are the drug of choice in these patients; however, a high percentage of patients cannot achieve their therapeutic goals with the maximum recommended doses, so Lo-mitapide may prove to be useful as a new treatment alternative to traditional statins. Objective: The objective of this systematic review is to determine if Lomitapide is better than statins at reducing cardiovascular events in patients with a diagnosis of FH. Methods: Randomized controlled trials (RCTs) and quasi-randomized trials of patients di-agnosed with FH will be included. Primary outcome measures included several parameters: 1. Post-treatment low- and high-density lipoprotein (LDL and HDL, respectively) levels and 2. Presence of cardiovascular events. Electronic searches will be conducted in PUBMED, The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, and the scientific elec-tronic library (Scielo). The assessment of the risk of bias will be used by the Cochrane tool. The measures of the treatment effect will be considered the mean differences (MD) and the 95% confidence intervals (CI). The evaluation of heterogeneity will be done by visual inspec-tion of the funnel diagram. The evaluation of the quality of the evidence will be done using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) ap-proach.


Subject(s)
Cardiovascular Diseases , Systematic Review , Hydroxymethylglutaryl CoA Reductases , Lipoproteins, LDL , Protocols , Hypercholesterolemia , Cholesterol, LDL , Anticholesteremic Agents
6.
Rev. ecuat. pediatr ; 22(1): 1-10, Abril 30, 2021.
Article in English | LILACS | ID: biblio-1222385

ABSTRACT

Introducción: La hipercolesterolemia familiar (HF) un trastorno genético autosómico domi-nante que produce un desarrollo prematuro de enfermedades cardiovasculares. Las estati-nas han sido el medicamento de elección en estos pacientes, sin embargo, un buen por-centaje de pacientes no pueden alcanzar sus objetivos terapéuticas con las dosis máximas por lo que la Lomitapida se podría establecer como una nueva alternativa de tratamiento. Objetivo: El objetivo de esta revisión sistemática es determinar si la Lomitapida reduce los eventos cardiovasculares en pacientes con diagnóstico de Hipercolesterolemia familiar comparado con estatinas. Métodos: Se incluirán ensayos controlados aleatorios (ECA) y cuasialeatorios de pacientes con diagnóstico de HF. Las medidas de resultado los niveles de LDL, HDL pos tratamiento y eventos cardiovasculares. Las búsquedas electrónicas se realizarán en PUBMED, The Coch-rane Central Register of Controlled Trials (CENTRAL), EMBASE y Scientific electronic library (Scielo). En la evaluación del riesgo de sesgo se utilizará la herramienta de Cochrane. Las medidas del efecto del tratamiento serán las diferencias de medias (DM) y los intervalos de confianza (IC) del 95%. La evaluación de heterogeneidad se realizará mediante la inspec-ción visual del diagrama de embudo. La evaluación de la calidad de la evidencia se reali-zará usando la evaluación GRADE.


Introduction: Familial hypercholesterolemia (FH) is an autosomal dominant genetic disor-der that produces hypercholesterolemia and premature development of cardiovascular diseas-es. Statins are the drug of choice in these patients; however, a high percentage of patients cannot achieve their therapeutic goals with the maximum recommended doses, so Lo-mitapide may prove to be useful as a new treatment alternative to traditional statins. Objective: The objective of this systematic review is to determine if Lomitapide is better than statins at reducing cardiovascular events in patients with a diagnosis of FH. Methods: Randomized controlled trials (RCTs) and quasi-randomized trials of patients di-agnosed with FH will be included. Primary outcome measures included several parameters: 1. Post-treatment low- and high-density lipoprotein (LDL and HDL, respectively) levels and 2. Presence of cardiovascular events. Electronic searches will be conducted in PUBMED, The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, and the scientific elec-tronic library (Scielo). The assessment of the risk of bias will be used by the Cochrane tool. The measures of the treatment effect will be considered the mean differences (MD) and the 95% confidence intervals (CI). The evaluation of heterogeneity will be done by visual inspec-tion of the funnel diagram. The evaluation of the quality of the evidence will be done using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) ap-proach.


Subject(s)
Cardiovascular Diseases , Systematic Review , Hydroxymethylglutaryl CoA Reductases , Lipoproteins, LDL , Protocols , Hypercholesterolemia , Cholesterol, LDL , Anticholesteremic Agents
7.
Oncol. (Guayaquil) ; 31(1): 15-34, Abril 30, 2021.
Article in Spanish | LILACS | ID: biblio-1222456

ABSTRACT

Introducción: el uso de sales de platinos en patologías oncológicas es ampliamente usado, una de las preocupaciones de los profesionales de la salud es la presencia de eventos adversos en este grupo de pacientes que suelen ser vulnerables, por lo que es necesario la generación de consensos para realizar una selección óptima de pacientes candidatos a terapias basadas en platinos Objetivo: Realizar un consenso de expertos para la inelegibilidad al uso de platinos de acuerdo a varios criterios para realizar un tratamiento óptimo de acuerdo a la selección y categorización de pacientes Pregunta de salud cubierta por la Guía: ¿Qué pacientes portadores de cáncer de origen otorrinolaringológico no son elegibles para tratamiento con platinos? Población: La población objetivos son pacientes adultos con cáncer otorrinolaringológico. Resultados: Se establecieron consensos para la inelegibilidad al uso de platinos sobre los siguientes criterios: Edad >70 años, ECOG >1, Pérdida involuntaria de peso >20%, función auditiva "borderline": alteraciones Grado I, Alteraciones neurológicas Grado I, Trastornos de la función renal: CrCL <60 ml/min, Alteración hepática ≥ grado II Child-Pugh B, Comorbilidades: diabetes, HTA, alteraciones pulmonares, anemia e Insuficiencia cardiaca


Introduction: the use of platinum salts in oncological pathologies is widely used, one of the concerns of health professionals is the presence of adverse events in this group of patients who are usually vulnerable, so it is necessary to generate of consensus to make an optimal selection of candidate patients for platinum-based therapies Objective: To carry out a consensus of experts for the ineligibility for the use of points according to several criteria to carry out an optimal treatment according to the selection and categorization of patients Health question covered by the Guide: Which patients with otorhinolringological origin cancer are not eligible for treatment with platinums? Population: The target population is adult patients with ENT cancer. Results: consensus was established for the ineligibility for the use of lenses on the following crite-ria: Age> 70 years, ECOG> 1, Involuntary weight loss> 20%, "borderline" hearing function: Grade I al-terations, Neurological alterations Grade I, Renal function disorders: CrCL <60 ml / min, Hepatic im-pairment ≥ grade II Child-Pugh B, Comorbidities: diabetes, hypertension, pulmonary disorders, anemia and heart failure.


Subject(s)
Laryngeal Neoplasms , Platinum Compounds , Otolaryngology , Otorhinolaryngologic Diseases , Practice Guidelines as Topic
9.
Arch. argent. pediatr ; 119(2): e121-e128, abril 2021. tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1151878

ABSTRACT

Dados los avances sobre mucopolisacaridosis Icon posterioridad al consenso publicado en la Argentina por un grupo de expertos en 2008, se revisan recomendaciones respecto a estudios genéticos, seguimiento cardiológico, cuidado de la vía aérea, alertas sobre aspectos auditivos, de la patología espinal y neurológica. Se hace revisión de la terapéutica actual y se enfatiza en la necesidad de un diagnóstico y tratamiento precoces, así como de un seguimiento interdisciplinario


Considering the advances made on mucopolysaccharidosis type I after the consensus study published by a group of experts in Argentina in 2008, recommendations about genetic testing, cardiological follow-up, airway care, hearing impairment detection, spinal and neurological conditions, as well as current treatments, were reviewed. Emphasis was placed on the need for early diagnosis and treatment, as well as an interdisciplinary follow-up


Subject(s)
Humans , Mucopolysaccharidosis I/diagnosis , Mucopolysaccharidosis I/therapy , Pediatrics , Mucopolysaccharidosis I/etiology , Mucopolysaccharidosis I/genetics , Aftercare
10.
Arch. argent. pediatr ; 119(2): s54-s66, abril 2021. tab, ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1152164

ABSTRACT

La urticaria es una de las afecciones cutáneas más comunes en niños. Se define urticaria aguda cuando persiste hasta 6 semanas, y crónica, cuando la duración es mayor. Afecta al 25 % de la población. La forma aguda es la más frecuente. La crónica representa el 0,1 %, con mayor predominio en mujeres (el 60 %). Se subdivide en urticaria crónica inducible cuando hay un desencadenante externo específico y urticaria crónica espontánea si este no está presente.Aunque la fisiopatología es compleja, la degranulación del mastocito se considera un evento clave. Los antihistamínicos anti-H1 de segunda generación son la primera línea de tratamiento tanto en la urticaria aguda como en la crónica. En pacientes no respondedores, se considerarán otras terapias.Se hará énfasis en urticaria crónica dada la dificultad en su diagnóstico, el aumento de su prevalencia y la gran afectación que produce en la calidad de vida de los niños.


Urticaria is one of the most common skin disorders in children. We define acute urticaria when it persists for less than 6 weeks, and chronic urticaria (CU), when it persists longer. Urticaria affects 25 % of the population; in most cases, it is acute urticaria. CU represents 0.1 %, with higher prevalence in women (60 %). CU is subclassified in chronic inducible urticaria when there is a specific external trigger and chronic spontaneous urticaria if it is not present.Although the pathophysiology is complex, mast cell degranulation is recognized as a key event. Second-generation H1 antihistamines are the first line of treatment in both, acute urticaria and CU. In unresponsive patients, other therapies will be considered.We will emphasize in CU due to the difficulty in its diagnosis, the increase in its prevalence and the severe impairment it causes in children ́s quality of life.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Chronic Urticaria/diagnosis , Chronic Urticaria/therapy , Chronic Urticaria/etiology , Chronic Urticaria/physiopathology , Histamine H1 Antagonists/therapeutic use
11.
Rev. cuba. anestesiol. reanim ; 20(1): e682, ene.-abr. 2021. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1156372

ABSTRACT

Introducción: Múltiples son los artículos publicados que abordan el tema de la ciencia abierta y su importancia para la sociedad, especialmente para la comunidad de investigadores. Esta constituye, ineludiblemente, el presente y futuro de las revistas científicas como método de expandir las investigaciones con alta calidad y credibilidad. La ciencia abierta como movimiento, tiene varios componentes y dentro de ellos, la gestión de citas y referencias de datos, códigos y materiales, que fundamentan la necesidad de que los autores tengan disponibles los contenidos subyacentes a los artículos que se publican y que constituyen la base de los resultados obtenidos en cada investigación. Objetivo: Evaluación de la eficacia de los protocolos de recuperación mejorada en cirugía cardiaca. Métodos: El protocolo que se propone fue elaborado por la investigadora principal (registro público cubano de ensayos clínicos RPCEC00000304) y se describe acorde a las recomendaciones de la lista internacional de chequeo para ensayos clínicos (SPIRIT). Conclusiones: Estarían en relación a si se puede demostrar, después de terminada la investigación, si el protocolo motivo de la Intervención, es mejor, igual o peor que el protocolo de control(AU)


Introduction: There are multiple articles published that address the subject of open science and its importance for society, especially for the research community. This constitutes, inevitably, the present and future of scientific journals as a method of expanding research with high quality and credibility. Open science, as a movement, has several components including the management of citations and references of data, codes and materials, which support the need for authors to have available the underlying content of the articles published and constituting the base for the results obtained in each investigation. Objective: Assessment of the efficacy of improved recovery protocols in cardiac surgery. Methods: The proposed protocol was prepared by the main researcher (Cuban public registry of clinical trials: RPCEC00000304) and is described according to the recommendations of the international checklist for clinical trials (SPIRIT). Conclusions: They would be related to whether it can be demonstrated, after the end of the investigation, if the protocol reason for the intervention is better, equal to, or worse than the control protocol(AU)


Subject(s)
Humans , Myocardial Ischemia/epidemiology , Protocols , Enhanced Recovery After Surgery/standards , Perioperative Care/standards , Perioperative Medicine/methods
13.
Bol. malariol. salud ambient ; 61(1): 47-53, 10 de marzo de 2021.
Article in Spanish, English | LILACS-Express | LILACS | ID: biblio-1177561

ABSTRACT

Según la OMS, bioseguridad, es un conjunto de normas y medidas para proteger la salud del personal, frente a riesgos biológicos, químicos y físicos a los que está expuesto en el desempeño de sus funciones. La pandemia COVID-19 supone un nuevo reto a la salud pública debido al mecanismo de transmisión del SARS-CoV-2, los protocolos y normas de bioseguridad hospitalaria se han ajustados bajo medidas estrictas de protección para el personal que integran la primera línea de atención, los profesionales de enfermería. En base a lo expuesto se realizó un análisis de la perspectiva respecto al protocolo de bioseguridad, equipo de protección personal, cuidado, autocuidado y temor al contagio por SARS-CoV-2 que enfrenta el personal de enfermería que laboran en la pandemia COVID-19. La investigación tuvo un enfoque cualitativa-fenomenológica, conformada por cinco informantes voluntarios profesionales de enfermería, los datos se recolectaron por medio de entrevistas grabadas, éstas fueron transcritas y analizadas en categorías, construyendo así resultados y conclusión de la investigación. Las entrevistas realizadas al personal de enfermería revelaron preocupación respecto a la disponibilidad de insumos para protección y normas de bioseguridad ante el COVID-19, debido al desabastecimiento del equipo de protección personal a nivel mundial, el incremento adquisitivo y la baja producción, siendo esto un peligro potencial para la salud física al momento de la exposición para brindar los cuidados a los pacientes contagiados. Concluyendo que la disponibilidad o ausencia de EPP pone en juego incluso hasta la calidad de atención que se pueda otorgar a los pacientes, demostrando la importancia de cuidar a quien en este momento tan crucial de la historia de la humanidad, se encuentra ofrendando hasta su propia vida por salvar, la de los demás..


According to the WHO, biosecurity, it is a set of standards and measures to protect the health of personnel, against biological, chemical and physical risks to which they are exposed in the performance of their duties. The COVID-19 pandemic represents a new challenge to public health due to the transmission mechanism of SARS-CoV-2, the hospital biosafety protocols and standards have been adjusted under strict protection measures for the personnel that make up the first line of care, nursing professionals. Based on the above, an analysis of the perspective regarding the biosafety protocol, personal protective equipment, care, self-care and fear of contagion by SARS-CoV-2 faced by nursing personnel working in the COVID-19 pandemic was carried out. . The research had a qualitative-phenomenological approach, made up of five volunteer nursing professional informants, the data was collected through recorded interviews, they were transcribed and analyzed in categories, thus constructing results and conclusion of the investigation. The interviews carried out with the nursing staff revealed concern regarding the availability of supplies for protection due to the shortage of personal protective equipment worldwide, the increase in purchasing power and the low production, this being a potential danger to physical health at the time of delivery. exposure to provide care for infected patients. Concluding that the availability or absence of PPE puts at stake even the quality of care that can be given to patients, demonstrating the importance of caring for someone who, at this crucial moment in the history of humanity, is offering up their own life to save, that of others.

14.
Int. braz. j. urol ; 47(2): 359-373, Mar.-Apr. 2021. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1154467

ABSTRACT

ABSTRACT Background: Non-metastatic castration resistant prostate cancer (M0 CRPC) has seen important developments in drugs and diagnostic tools in the last two years. New hormonal agents have demonstrated improvement in metastasis free survival in M0 CRPC patients and have been approved by regulatory agencies in Brazil. Additionally, newer and more sensitive imaging tools are able to detect metastasis earlier than before, which will impact the percentage of patients staged as M0 CRPC. Based on the available international guidelines, a group of Brazilian urology and medical oncology experts developed and completed a survey on the diagnosis and treatment of M0 CRPC in Brazil. These results are reviewed and summarized and associated recommendations are provided. Objective: To present survey results on management of M0 CRPC in Brazil. Design, setting, and participants: A panel of six Brazilian prostate cancer experts determined 64 questions concerning the main areas of interest: 1) staging tools, 2) treatments, 3) side effects of systemic treatment/s, and 4) osteoclast-targeted therapy. A larger panel of 28 Brazilian prostate cancer experts answered these questions in order to create country-specific recommendations discussed in this manuscript. Outcome measurements and statistical analysis: The panel voted publicly but anonymously on the predefined questions. These answers are the panelists' opinions, not a literature review or meta-analysis. Therapies not yet approved in Brazil were excluded from answer options. Each question had five to seven relevant answers including two non-answers. Results were tabulated in real time. Conclusions: The results and recommendations presented can be used by Brazilian physicians to support the management of M0 CRPC patients. Individual clinical decision making should be supported by available data, however, for Brazil, guidelines for diagnosis and management of M0 CRPC patients have not been developed. This document will serve as a point of reference when confronting this disease stage.

16.
Trends psychiatry psychother. (Impr.) ; 43(1): 57-64, Jan.-Mar. 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1156994

ABSTRACT

Abstract Objective Many adolescents suffer from depressive and anxiety disorders simultaneously and current treatment methods do not put enough emphasis on comorbidity of these disorders. The unified protocol for treating emotional disorders in adolescents is a transdiagnostic therapy which targets mutual fundamental factors. Therefore, the current study aims to compare the effectiveness of the unified protocol alone with the unified protocol combined with mindfulness as an additional treatment in adolescents suffering from emotional disorders. Method A quasi-experimental study was conducted with adolescents. The participants had been diagnosed with emotional disorders and were divided into a control group (15 participants) and an experimental group (16 participants). Both groups were offered 14 sessions of therapy. They were assessed at pre-test, post-test, and two-month follow-up. Scales used in the study included the Child Behavior Checklist (CBCL), the Children's Depression Inventory (CDI), and the Youth Anxiety Measure for DSM-5 (YAM-5). Results The results showed that both of the treatment methods effectively reduced adolescents' emotional problems, but improvements were more significant in the group administered the additional mindfulness program. Among the variables assessed, non-phobic anxiety disorders and depression improved more than specific phobia and behavioral problems. Between-subjects (Group) partial etas for non-phobic anxiety, depression, specific phobia, and behavioral problems were 0.67, 0.50, 0.23, and 0.16, respectively. Conclusion According to the findings of this study, additional treatment methods such as mindfulness could increase the effectiveness of the unified transdiagnostic protocol for adolescents (UP-A). The therapeutic implications are discussed.

17.
Arch. cardiol. Méx ; 91(1): 58-65, ene.-mar. 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1152861

ABSTRACT

Abstract Objective: The aim of this study was to develop, train, and test different neural network (NN) algorithm-based models to improve the Global Registry of Acute Coronary Events (GRACE) score performance to predict in-hospital mortality after an acute coronary syndrome. Methods: We analyzed a prospective database, including 40 admission variables of 1255 patients admitted with the acute coronary syndrome in a community hospital. Individual predictors included in GRACE score were used to train and test three NN algorithm-based models (guided models), namely: one- and two-hidden layer multilayer perceptron and a radial basis function network. Three extra NNs were built using the 40 admission variables of the entire database (unguided models). Expected mortality according to GRACE score was calculated using the logistic regression equation. Results: In terms of receiver operating characteristic area and negative predictive value (NPV), almost all NN algorithms outperformed logistic regression. Only radial basis function models obtained a better accuracy level based on NPV improvement, at the expense of positive predictive value (PPV) reduction. The independent normalized importance of variables for the best unguided NN was: creatinine 100%, Killip class 61%, ejection fraction 52%, age 44%, maximum creatine-kinase level 41%, glycemia 40%, left bundle branch block 35%, and weight 33%, among the top 8 predictors. Conclusions: Treatment of individual predictors of GRACE score with NN algorithms improved accuracy and discrimination power in all models with respect to the traditional logistic regression approach; nevertheless, PPV was only marginally enhanced. Unguided variable selection would be able to achieve better results in PPV terms.


Resumen Objetivo: El objetivo fue desarrollar, entrenar y probar diferentes modelos basados en algoritmos de redes neuronales (RN) para mejorar el rendimiento del score del Registro Global de Eventos Coronarios Agudos (GRACE) para predecir la mortalidad hospitalaria después de un síndrome coronario agudo. Métodos: Analizamos una base de datos prospectiva que incluía 40 variables de ingreso de 1255 pacientes con síndrome coronario agudo en un hospital comunitario. Las variables incluidas en la puntuación GRACE se usaron para entrenar y probar tres algoritmos basados en RN (modelos guiados), a saber: perceptrones multicapa de una y dos capas ocultas y una red de función de base radial. Se construyeron tres RN adicionales utilizando las 40 variables de admisión de toda la base de datos (modelos no guiados). La mortalidad esperada según el GRACE se calculó usando la ecuación de regresión logística. Resultados: En términos del área ROC y valor predictivo negativo (VPN), casi todos los algoritmos RN superaron la regresión logística. Solo los modelos de función de base radial obtuvieron un mejor nivel de precisión basado en la mejora del VPN, pero a expensas de la reducción del valor predictivo positivo (VPP). La importancia normalizada de las variables incluidas en la mejor RN no guiada fue: creatinina 100%, clase Killip 61%, fracción de eyección 52%, edad 44%, nivel máximo de creatina quinasa 41%, glucemia 40%, bloqueo de rama izquierda 35%, y peso 33%, entre los 8 predictores principales. Conclusiones: El tratamiento de las variables del score GRACE mediante algoritmos de RN mejoró la precisión y la discriminación en todos los modelos con respecto al enfoque tradicional de regresión logística; sin embargo, el VPP solo mejoró marginalmente. La selección no guiada de variables podría mejorar los resultados en términos de PPV.

19.
Med. U.P.B ; 40(1): 46-54, 03/03/2021. tab
Article in Spanish | LILACS, COLNAL | ID: biblio-1177497

ABSTRACT

El trauma sigue siendo una de las principales causas de morbimortalidad mundial. Entre las causas de muerte de estos pacientes cabe destacar el paro cardiaco traumático (PCT). Múltiples autores afirman que, a pesar de los avances médicos, los esfuerzos de resucitación de estos pacientes pueden llevar a malos desenlaces, ya que aquellos que sufren PCT tienen gran mortalidad y pronóstico neurológico poco alentador. Este artículo hace una recopilación de la evidencia disponible, que, a pesar de ser poca, señala los avances recientes en el enfoque y manejo de estos pacientes. Se busca que con esta revisión se logre un consenso sobre el abordaje de los pacientes en paro en el contexto de trauma, basado en la literatura y evidencia más reciente.


Trauma is still one of the main causes of morbidity and mortality worldwide. Traumatic cardiac arrest (TCA) stands out among the causes of death of these patients. Multiple authors claim that, despite medical advances, resuscitation efforts in these patients may lead to poor outcomes, since those suffering from TCA have high mortality rates and poor neurological prognosis. This article compiles the available evidence, which despite being limited, points to recent advances in the management and approach of these patients. The aim of this review is to reach a consensus on the approach to patients in cardiac arrest in the context of trauma, based on the most recent literature and evidence.


O trauma continua sendo uma das principais causas de morbimortalidade em todo o mundo. Dentre as causas de óbito nesses pacientes, vale destacar a parada cardíaca traumática (PCT). Vários autores afirmam que, apesar dos avanços médicos, os esforços de ressuscitação nesses pacientes podem levar a resultados ruins, uma vez que aqueles que sofrem de PCT apresentam alta mortalidade e prognóstico neurológico ruim. Este artigo faz uma compilação das evidências disponíveis, que, apesar de poucas, apontam para avanços recentes na abordagem e manejo desses pacientes. O objetivo desta revisão é chegar a um consenso sobre a abordagem do PCT com base na literatura e nas evidências mais recentes.


Subject(s)
Heart Arrest , Resuscitation , Wounds and Injuries , Indicators of Morbidity and Mortality , Cause of Death , Death , Consensus , Emergencies
20.
Washington; Organización Panamericana de la Salud; mar. 02, 2021. 28 p. ilus.
Non-conventional in English, Spanish, Portuguese | LILACS | ID: biblio-1150961

ABSTRACT

Todos os países do mundo formularam planos de resposta para enfrentar a pandemia da COVID-19. No entanto, os desafios impostos pela doença os obrigam a aprender e adaptar-se constantemente. Cada vez mais é necessário reforçar o componente de comunicação de riscos como uma ferramenta essencial para transmitir à população, da devida forma, todas as informações sobre o processo de imunização, desde os testes clínicos e a produção de novas vacinas, até a adoção, distribuição e priorização dos grupos aos quais serão administradas uma ou mais vacinas ­ dependendo da definição e disponibilidade de cada país ­, bem como sobre o acesso universal às vacinas, após os grupos prioritários terem sido imunizados. A Organização Pan-Americana da Saúde, em seu esforço constante e permanente para apoiar os países das Américas, apresenta este documento para facilitar a formulação de uma estratégia de comunicação de riscos e participação comunitária (CRPC) para a vacinação contra o SARS-CoV-2. O intuito é contribuir para o fortalecimento das capacidades de comunicação e planejamento dos ministérios e secretarias de saúde, bem como de outros órgãos responsáveis pela comunicação na área das novas vacinas contra a COVID-19 nas Américas.


Todos los países del mundo han desarrollado planes de respuesta para enfrentar la pandemia de COVID-19; sin embargo, los desafíos que presenta la enfermedad los obliga a un aprendizaje y a una adaptación constantes. Cada vez es más necesario reforzar el componente de comunicación de riesgos como herramienta esencial para transmitir de forma adecuada a la población toda la información sobre el proceso de inmunización, desde los ensayos clínicos y la producción de nuevas vacunas, hasta la introducción, distribución y priorización de grupos a los que hay que administrar una o varias vacunas ­según la definición y la disponibilidad de cada país­ así como el acceso universal a ellas, una vez inmunizados los grupos prioritarios. La OPS, dentro de su empeño constante por apoyar a los países de las Américas, publica el presente documento con ánimo de facilitar la elaboración de una estrategia de comunicación de riesgos y participación comunitaria para la vacunación contra la COVID-19. Su finalidad es contribuir a fortalecer las capacidades y la planificación de la comunicación de los ministerios o secretarías de salud, así como de otros organismos encargados de comunicar en el área de las nuevas vacunas contra la COVID-19 en las Américas.


All countries around the world have developed response plans to tackle the COVID-19 pandemic. However, the challenges presented by the disease require constant learning and adaptation. It is increasingly necessary to strengthen the risk communication component as an essential tool for providing the population with all of the necessary information about the immunization process. This ranges from clinical trials and the production of new vaccines to the introduction, distribution, and prioritization of groups that need one or more vaccines­according to each country's definitions and vaccine availability. It also includes universal access to vaccines, once the priority groups have been immunized. PAHO, in its constant, ongoing effort to support the countries of the Americas, is making this document available to facilitate the preparation of a risk communication and community engagement strategy for vaccination against COVID-19. Its goal is to help to strengthen the communication and planning capacities of the ministries or secretariats of health and other agencies in charge of communicating about new COVID-19 vaccines in the Americas.


Subject(s)
Humans , Pneumonia, Viral/immunology , Viral Vaccines/immunology , Immunization Programs/organization & administration , Coronavirus Infections/immunology , Health Communication , Pandemics/prevention & control , Betacoronavirus/immunology
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