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1.
Breast Dis ; 41(1): 1-3, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34219707

RESUMO

During the first hit of SARS-COVID pandemic, an important reorganization of Healthcare Services has been done, and new protocols and pathways to protect frail patients like oncological patients were designed. The second hit of pandemic had stressed these new pathways and suggests to health-workers some improvements for safer management of patents.We reported our experience in organizing the clinical pathway of neoadjuvant therapy candidate patients based on the execution of sentinel lympho-node biopsy and the placement of implantable venous access port in the same access to operating room before neoadjuvant chemotherapy suggesting a possible organizational model. In the period October-December 2020 we have included in this new type of path twelve patients and we have not registered any cases of COVID among the patients included. We think this new path, adopted amid the second hit, will be useful for all Breast Units that are facing the challenge of guaranteeing the highest standards of care in a historical moment where the health emergency occupies the efforts of health workers and the economic resources of health systems.


Assuntos
Antineoplásicos/administração & dosagem , Neoplasias da Mama/tratamento farmacológico , COVID-19/prevenção & controle , Cateterismo Venoso Central/métodos , Controle de Infecções/métodos , Segurança do Paciente , Biópsia de Linfonodo Sentinela/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Cateterismo Venoso Central/instrumentação , Cateterismo Venoso Central/normas , Cateteres Venosos Centrais , Quimioterapia Adjuvante , Procedimentos Clínicos , Feminino , Humanos , Controle de Infecções/normas , Mastectomia , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estadiamento de Neoplasias , Biópsia de Linfonodo Sentinela/normas
2.
Urol Clin North Am ; 49(1): 153-159, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34776048

RESUMO

Ureteroscopy is the most common surgical modality for stone treatment. Reusable flexible ureteroscopes are delicate instruments that require expensive maintenance and repairs. Multiple single use ureteroscopes have been developed recently to combat the expensive and time-intensive sterilization and repair of ureteroscopes. Although multiple studies have looked at different aspects of reusable and single use ureteroscopes, there is significant heterogeneity in performance measures and cost between the 2 categories, and neither has a clear advantage. Both can be used successfully, and individual and institution level factors should be considered when deciding which ureteroscope to use.


Assuntos
Equipamentos Descartáveis , Meio Ambiente , Contaminação de Equipamentos , Ureteroscópios , Equipamentos Descartáveis/economia , Equipamentos Descartáveis/normas , Humanos , Manutenção/economia , Ureteroscópios/economia , Ureteroscópios/normas , Urolitíase/cirurgia
3.
Meat Sci ; 183: 108654, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34419789

RESUMO

In the European Community, conformation and fat cover of bovine carcasses is assessed using the SEUROP grading system. In this study we pursued the development of an application software (App) based on Visual Image Analysis, useful for SEUROP and Fat Cover grading of bovine carcasses using a smartphone. The App was trained using 500 bovine carcasses. Carcass conformation and Fat Cover classes were assessed in parallel by expert evaluators and by App. Overall, a high correspondence was found between the measurements of carcasses parameters by operators and by the App, as high as 84.2% for SEUROP and 86.4% for the Fat Cover. In the 15.8% of samples with discordant SEUROP evaluation, and in the 13.6% of samples with discordant Fat Cover evaluation, the operators' and App measurements deviated by only one class. All values also aligned with the requirements expected by the current legislation for the use of automated and/or semi-automated systems able to determine the market value of carcasses.


Assuntos
Tecido Adiposo/anatomia & histologia , Processamento de Imagem Assistida por Computador/métodos , Carne Vermelha/análise , Animais , Composição Corporal , Bovinos , União Europeia , Carne Vermelha/normas
6.
Pan Afr Med J ; 40: 25, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34733393

RESUMO

Introduction: infants in the first six months of life are relatively protected from malaria. Emerging reports from endemic regions however are showing increasing malaria susceptibility in this age group. This study set out to determine the prevalence, parasite density and predictive factors for malaria parasitaemia in ill young infants at the Wesley Guild Hospital (WGH), Ilesa, Nigeria. Methods: ill infants aged one to six months were consecutively recruited over an 11-month period in a hospital based cross-sectional study. History of illness, sociodemographic and perinatal history were obtained; clinical examination and results of venous blood for thick and thin film malaria parasite examinations were recorded and analyzed. Results: the mean (SD) age of the 350 infants was 3.4 (1.6) months with male: female (M: F) of 1.2: 1. The prevalence of malaria parasitaemia (all plasmodium falciparum) was 19.1% while parasite density ranged from 24.0 to 400,000 parasites/µl, median (IQR) 900 (250-4,588)/µl. Sixteen (4.6%) had heavy malaria parasitaemia (>5000/µl). Low social class (OR=2.457; 95%CI 1.404-4.300; p=0.002), suboptimal antenatal care (OR=2.226; 95%CI 1.096-4.522; p=0.027), low birth weight infants (OR=4.818; 95%CI 2.317-10.018; p=<0.001) and injudicious use of haematinics (OR=3.192; 95%CI1.731-5.886; p=<0.001) were predictors of malaria parasitaemia among the infants. Conclusion: one-in-five ill young infants had malaria parasitaemia with heavy parasitaemia in 23.8% of infected infants. Malaria parasitaemia was associated with modifiable factors, high index of suspicion in endemic region and optimal maternal and child care services may assist to reduce the burden of malaria in this age group.


Assuntos
Malária Falciparum/epidemiologia , Parasitemia/epidemiologia , Plasmodium falciparum/isolamento & purificação , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Nigéria/epidemiologia , Parasitemia/parasitologia , Gravidez , Cuidado Pré-Natal/normas , Prevalência , Fatores de Risco
7.
Medicine (Baltimore) ; 100(41): e27103, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34731101

RESUMO

BACKGROUND: Comparison between endosonographic ultrasonography (EUS)-guided celiac ganglia neurolysis (CGN) and EUS-guided celiac plexus neurolysis (CPN) in pain management for pancreatic cancer has engendered controversy. To analyze the effectiveness and safety of EUS-CGN and figure out whether EUS-CGN is better than EUS-CPN, a qualitative systematic review was conducted. METHODS: Studies were searched from Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE up to April 2020. We only included studies with full-text and in English and assessed study quality with Newcastle-Ottawa Scale or Cochrane risk-of-bias tool. We recorded details of study design, participants, procedure performed, protocol of follow-up, pain response, quality of life, survival, and adverse events. The study was conducted under Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement 2009. RESULTS: Five studies involving 319 patients were included. Short-term pain response rates ranged from 65.0% to 88.46% in EUS-CGN group and most studies reported its superiority over EUS-CPN. As for adverse events, the incidence of transient hypotension and gastrointestinal symptoms seemed comparable, while results of initial pain exacerbation varied among studies. Besides, EUS-CGN might provide a shorter survival. CONCLUSION: EUS-CGN can be safely performed while it may shorten survival. In terms of short-term pain response, EUS-CGN is better than EUS-CPN while no conclusion of long-term pain control can be drawn.


Assuntos
Bloqueio Nervoso Autônomo/métodos , Carcinoma Ductal Pancreático/terapia , Endossonografia/métodos , Manejo da Dor/métodos , Neoplasias Pancreáticas/terapia , Bloqueio Nervoso Autônomo/normas , Carcinoma Ductal Pancreático/complicações , Plexo Celíaco/diagnóstico por imagem , Endossonografia/efeitos adversos , Gânglios Simpáticos/diagnóstico por imagem , Humanos , Neoplasias Pancreáticas/complicações , Pesquisa Qualitativa , Qualidade de Vida , Ultrassonografia de Intervenção/efeitos adversos , Ultrassonografia de Intervenção/métodos
8.
Medicine (Baltimore) ; 100(41): e27478, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34731126

RESUMO

ABSTRACT: The COVID-19 pandemic has challenged institutions' diagnostic processes worldwide. The aim of this study was to assess the feasibility of an artificial intelligence (AI)-based software tool that automatically evaluates chest computed tomography for findings of suspected COVID-19.Two groups were retrospectively evaluated for COVID-19-associated ground glass opacities of the lungs (group A: real-time polymerase chain reaction positive COVID patients, n = 108; group B: asymptomatic pre-operative group, n = 88). The performance of an AI-based software assessment tool for detection of COVID-associated abnormalities was compared with human evaluation based on COVID-19 reporting and data system (CO-RADS) scores performed by 3 readers.All evaluated variables of the AI-based assessment showed significant differences between the 2 groups (P < .01). The inter-reader reliability of CO-RADS scoring was 0.87. The CO-RADS scores were substantially higher in group A (mean 4.28) than group B (mean 1.50). The difference between CO-RADS scoring and AI assessment was statistically significant for all variables but showed good correlation with the clinical context of the CO-RADS score. AI allowed to predict COVID positive cases with an accuracy of 0.94.The evaluated AI-based algorithm detects COVID-19-associated findings with high sensitivity and may support radiologic workflows during the pandemic.


Assuntos
Inteligência Artificial/normas , COVID-19/diagnóstico , Pulmão/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , Teste de Ácido Nucleico para COVID-19/normas , Estudos de Viabilidade , Feminino , Humanos , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , SARS-CoV-2 , Tomografia Computadorizada por Raios X
9.
BMC Res Notes ; 14(1): 405, 2021 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-34727971

RESUMO

There has been an important global interest in Open Science, which include open data and methods, in addition to open access publications. It has been proposed that public availability of raw data increases the value and the possibility of confirmation of scientific findings, in addition to the potential of reducing research waste. Availability of raw data in open repositories facilitates the adequate development of meta-analysis and the cumulative evaluation of evidence for specific topics. In this commentary, we discuss key elements about data sharing in open repositories and we invite researchers around the world to deposit their data in them.


Assuntos
Acesso à Informação , Pesquisa Biomédica , Ciência , Humanos , Pesquisadores , Ciência/normas
11.
Infect Dis Clin North Am ; 35(4): 1027-1053, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34752219

RESUMO

Invasive fungal infections are an important cause of morbidity and mortality in hospitalized patients and in the immunocompromised population. This article reviews the current epidemiology of nosocomial fungal infections in adult patients, with an emphasis on invasive candidiasis (IC) and invasive aspergillosis (IA). Included are descriptions of nosocomial infections caused by Candida auris, an emerging pathogen, and IC- and IA-associated with coronavirus disease 2019. The characteristics and availability of newer nonculture-based tests for identification of nosocomial fungal pathogens are discussed. Recently published recommendations and guidelines for the control and prevention of these nosocomial fungal infections are summarized.


Assuntos
Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Micoses/epidemiologia , Micoses/prevenção & controle , Antifúngicos/uso terapêutico , COVID-19/complicações , COVID-19/epidemiologia , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/etiologia , Fungos/classificação , Fungos/patogenicidade , Humanos , Hospedeiro Imunocomprometido , Controle de Infecções/normas , Micoses/diagnóstico , Micoses/etiologia , Fatores de Risco , SARS-CoV-2
12.
Infect Dis Clin North Am ; 35(4): 1055-1075, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34752220

RESUMO

Health care-acquired viral respiratory infections are common and cause increased patient morbidity and mortality. Although the threat of viral respiratory infection has been underscored by the coronavirus disease 2019 (COVID-19) pandemic, respiratory viruses have a significant impact in health care settings even under normal circumstances. Studies report decreased nosocomial transmission when aggressive infection control measures are implemented, with more success noted when using a multicomponent approach. Influenza vaccination of health care personnel furthers decrease rates of transmission; thus, mandatory vaccination is becoming more common. This article discusses the epidemiology, transmission, and control of health care-associated respiratory viral infections.


Assuntos
Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/virologia , Infecções Respiratórias/prevenção & controle , Infecções Respiratórias/virologia , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/transmissão , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/transmissão , Fidelidade a Diretrizes , Pessoal de Saúde/normas , Humanos , Controle de Infecções/normas , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/transmissão , SARS-CoV-2/patogenicidade , Vacinação , Vírus/classificação , Vírus/patogenicidade
13.
Infect Dis Clin North Am ; 35(4): 841-856, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34752222

RESUMO

Despite a large volume of research in prevention, central line-associated bloodstream infections and catheter-related bloodstream infections continue to cause significant morbidity, mortality, and increased health care costs. Strategies in prevention, including decision about catheter placement, insertion bundles, adherence to standard of care guidelines, and technologic innovations, shown to decrease rates of catheter-related bloodstream infections and central line-associated bloodstream infections are described in this update. The coronavirus disease 2019 pandemic has resulted in increased health care-acquired infections, including central line-associated bloodstream infections.


Assuntos
Bacteriemia/prevenção & controle , Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/efeitos adversos , Bacteriemia/epidemiologia , Bacteriemia/etiologia , COVID-19/epidemiologia , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/etiologia , Cateterismo Venoso Central/normas , Tomada de Decisão Clínica , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/etiologia , Humanos , Pacotes de Assistência ao Paciente/normas , Guias de Prática Clínica como Assunto , SARS-CoV-2
14.
Can J Surg ; 64(6): E609-E612, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34759046

RESUMO

Trauma care delivery is a complex team-based task that requires deliberate practice. The COVID-19 pandemic has not diminished the importance of excellent trauma team dynamics. However, the pandemic hampers our ability to gather safely and train together. A mitigating solution is the provision of high-fidelity simulation training in a virtual setting. The Simulated Trauma and Resuscitation Team Training (S.T.A.R.T.T.) course has provided multidisciplinary trauma team members with skills in crisis resource management (CRM) for nearly 10 years. It has promoted collaborative learning from coast to coast, as the course typically runs at our national surgical and trauma meetings. In response to COVID-19 challenges, the course content has been modified to virtually connect 2 centres in different provinces simultaneously. High participant satisfaction suggests that the new virtual E-S.T.A.R.T.T course is able to continue to help providers develop important CRM skills in a multidisciplinary setting while remaining compliant with COVID-19 safety precautions.


Assuntos
COVID-19 , Educação à Distância , Treinamento com Simulação de Alta Fidelidade , Traumatologia/educação , Ferimentos e Lesões/terapia , Canadá , Competência Clínica , Gestão de Recursos da Equipe de Assistência à Saúde , Currículo , Treinamento com Simulação de Alta Fidelidade/métodos , Treinamento com Simulação de Alta Fidelidade/normas , Humanos , Pandemias , Equipe de Assistência ao Paciente , SARS-CoV-2 , Traumatologia/normas
20.
Am Fam Physician ; 104(5): 476-483, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34783493

RESUMO

Medical consultations before dental procedures present opportunities to integrate cross-disciplinary preventive care and improve patient health. This article presents recommendations related to patients with certain medical conditions who are planning to undergo common dental procedures, such as cleanings, extractions, restorations, endodontic procedures, abscess drainage, and mucosal biopsies. Specifically, prophylactic antibiotics are not recommended for preventing prosthetic joint infections or infectious endocarditis except in certain circumstances. Anticoagulation and antiplatelet therapies typically should not be suspended for common dental treatments. Elective dental care should be avoided for six weeks after myocardial infarction or bare-metal stent placement or for six months after drug-eluting stent placement. It is important that any history of antiresorptive or antiangiogenic therapies be communicated to the dentist. Ascites is not an indication for initiating prophylactic antibiotics before dental treatment, and acetaminophen is the analgesic of choice for patients with liver dysfunction or cirrhosis who abstain from alcohol. Nephrotoxic medications should be avoided in patients with chronic kidney disease, and the consultation should include the patient's glomerular filtration rate. Although patients undergoing chemotherapy may receive routine dental care, it should be postponed when possible in those currently undergoing head and neck radiation therapy. A detailed history of head and neck radiation therapy should be provided to the dentist. Multimodal, nonnarcotic analgesia is recommended for managing acute dental pain.


Assuntos
Analgésicos não Narcóticos/uso terapêutico , Odontologia , Procedimentos Cirúrgicos Bucais , Serviços Preventivos de Saúde , Liberação de Cirurgia/métodos , Antibioticoprofilaxia/métodos , Contraindicações , Odontologia/métodos , Odontologia/normas , Humanos , Procedimentos Cirúrgicos Bucais/efeitos adversos , Procedimentos Cirúrgicos Bucais/métodos , Planejamento de Assistência ao Paciente/organização & administração , Exame Físico/métodos , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde/normas
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