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1.
Microb Cell Fact ; 21(1): 2, 2022 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-34983520

RESUMO

Epidemic diseases and antibiotic resistance are urgent threats to global health, and human is confronted with an unprecedented dilemma to conquer them by expediting development of new natural product related drugs. C-nucleoside antibiotics, a remarkable group of microbial natural products with diverse biological activities, feature a heterocycle base linked with a ribosyl moiety via an unusual C-glycosidic bond, and have played significant roles in healthcare and for plant protection. Elucidating how nature biosynthesizes such a group of antibiotics has provided the basis for engineered biosynthesis as well as targeted genome mining of more C-nucleoside antibiotics towards improved properties. In this review, we mainly summarize the recent advances on the biosynthesis of C-nucleoside antibiotics, and we also tentatively discuss the future developments on rationally accessing C-nucleoside diversities in a more efficient and economical way via synthetic biology strategies.


Assuntos
Actinobacteria/metabolismo , Antibacterianos/biossíntese , Nucleosídeos/biossíntese , Biologia Sintética/métodos , Actinobacteria/genética , Produtos Biológicos/química , Streptomyces/genética , Streptomyces/metabolismo , Biologia Sintética/tendências
3.
AAPS J ; 24(1): 19, 2022 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-34984579

RESUMO

Over the past decade, artificial intelligence (AI) and machine learning (ML) have become the breakthrough technology most anticipated to have a transformative effect on pharmaceutical research and development (R&D). This is partially driven by revolutionary advances in computational technology and the parallel dissipation of previous constraints to the collection/processing of large volumes of data. Meanwhile, the cost of bringing new drugs to market and to patients has become prohibitively expensive. Recognizing these headwinds, AI/ML techniques are appealing to the pharmaceutical industry due to their automated nature, predictive capabilities, and the consequent expected increase in efficiency. ML approaches have been used in drug discovery over the past 15-20 years with increasing sophistication. The most recent aspect of drug development where positive disruption from AI/ML is starting to occur, is in clinical trial design, conduct, and analysis. The COVID-19 pandemic may further accelerate utilization of AI/ML in clinical trials due to an increased reliance on digital technology in clinical trial conduct. As we move towards a world where there is a growing integration of AI/ML into R&D, it is critical to get past the related buzz-words and noise. It is equally important to recognize that the scientific method is not obsolete when making inferences about data. Doing so will help in separating hope from hype and lead to informed decision-making on the optimal use of AI/ML in drug development. This manuscript aims to demystify key concepts, present use-cases and finally offer insights and a balanced view on the optimal use of AI/ML methods in R&D.


Assuntos
Inteligência Artificial , Ensaios Clínicos como Assunto , Biologia Computacional , Desenvolvimento de Medicamentos , Aprendizado de Máquina , Pesquisa Farmacêutica , Projetos de Pesquisa , Animais , Inteligência Artificial/tendências , Biologia Computacional/tendências , Difusão de Inovações , Desenvolvimento de Medicamentos/tendências , Previsões , Humanos , Aprendizado de Máquina/tendências , Pesquisa Farmacêutica/tendências , Projetos de Pesquisa/tendências
4.
PLoS One ; 17(1): e0261509, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34990459

RESUMO

The COVID Pandemic may affect fertility behaviour and intentions in many ways. Restrictions on service provision reduce access to family planning services and increase fertility in the short term. By contrast, the economic uncertainty brought about by the pandemic and its impact on mental health and well-being may reduce fertility. These various pathways have been explored in the context of high income countries such as the United States and Western Europe, but little is known about middle income countries. In this paper we asses the impact of the COVID pandemic on fertility intentions and behaviour in the Republic of Moldova, a middle income country in Eastern Europe, using the Generations and Gender Survey. This survey was conducted partially before and partially after the onset of the pandemic in 2020, allowing for detailed comparisons of individual circumstances. The results indicate that the pandemic reduced the used of intrauterine devices, and increased the use of male condoms, but with no overall decrease in contraceptive use. Conversely individuals interviewed after the onset of the pandemic were 34.5% less likely to be trying to conceive, although medium term fertility intentions were unchanged. Indicators therefore suggest that in the medium term fertility intentions may not be affected by the pandemic but restricted access to contraception requiring medical consultation and a decrease in short-term fertility intentions could disrupt short term family planning.


Assuntos
COVID-19/psicologia , Fertilidade/fisiologia , Comportamento Reprodutivo/psicologia , Adulto , COVID-19/metabolismo , Preservativos/tendências , Anticoncepção/tendências , Comportamento Contraceptivo/tendências , Características da Família , Serviços de Planejamento Familiar/provisão & distribuição , Serviços de Planejamento Familiar/tendências , Feminino , Humanos , Renda , Dispositivos Intrauterinos/tendências , Masculino , Moldávia/epidemiologia , SARS-CoV-2/patogenicidade , Inquéritos e Questionários
5.
PLoS One ; 17(1): e0262347, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34990489

RESUMO

BACKGROUND: The COVID-19 pandemic, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has substantially impacted healthcare utilization worldwide. The objective of this retrospective analysis of a large hospital discharge database was to compare all-cause and cause-specific hospitalizations during the first six months of the pandemic in the United States with the same months in the previous four years. METHODS: Data were collected from all hospitals in the Premier Healthcare Database (PHD) and PHD Special Release reporting hospitalizations from January through July for each year from 2016 through 2020. Hospitalization trends were analyzed stratified by age group, major diagnostic categories (MDCs), and geographic region. RESULTS: The analysis included 286 hospitals from all 9 US Census divisions. The number of all-cause hospitalizations per month was relatively stable from 2016 through 2019 and then fell by 21% (57,281 fewer hospitalizations) between March and April 2020, particularly in hospitalizations for non-respiratory illnesses. From April onward there was a rise in the number of monthly hospitalizations per month. Hospitalizations per month, nationally and in each Census division, decreased for 20 of 25 MDCs between March and April 2020. There was also a decrease in hospitalizations per month for all age groups between March and April 2020 with the greatest decreases in hospitalizations observed for patients 50-64 and ≥65 years of age. CONCLUSIONS: Rates of hospitalization declined substantially during the first months of the COVID-19 pandemic, suggesting delayed routine, elective, and emergency care in the United States. These lapses in care for illnesses not related to COVID-19 may lead to increases in morbidity and mortality for other conditions. Thus, in the current stage of the pandemic, clinicians and public-health officials should work, not only to prevent SARS-CoV-2 transmission, but also to ensure that care for non-COVID-19 conditions is not delayed.


Assuntos
Hospitalização/tendências , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , COVID-19/epidemiologia , Atenção à Saúde/tendências , Hospitalização/estatística & dados numéricos , Hospitais , Humanos , Pandemias/prevenção & controle , Estudos Retrospectivos , SARS-CoV-2/patogenicidade , Estados Unidos/epidemiologia
6.
PLoS One ; 17(1): e0262141, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34995288

RESUMO

The deadliest coronavirus disease 2019 (COVID-19) is taking thousands of lives worldwide and presents an extraordinary challenge to mental resilience. This study assesses mental health status during the COVID-19 pandemic and its associated factors among informal waste workers in Bangladesh. A cross-sectional survey was conducted in June 2020 among 176 informal waste workers selected from nine municipalities and one city corporation in Bangladesh. General Health Questionnaire (GHQ-12) was used to assess respondents' mental health. The study found that 80.6% of the individuals were suffering from psychological distress; 67.6% reported anxiety and depression, 92.6% reported social dysfunction, and 19.9% reported loss of confidence. The likelihood of psychological distress (Risk ratio [RR]: 1.23, 95% confidence interval [CI]: 1.02-1.48) was significantly higher for female than male. Multiple COVID-19 symptoms of the family members (RR: 1.20, 95% CI: 1.03-1.41), unawareness about COVID-19 infected neighbor (RR: 1.21, 95% CI: 1.04-1.41), income reduction (RR: 1.60, 95% CI: 1.06-2.41) and daily household meal reduction (RR: 1.34; 95% CI: 1.03-1.73) were also found to be associated with psychological distress. These identified factors should be considered in policy-making and support programs for the informal waste workers to manage the pandemic situation as well as combating COVID-19 related psychological challenges.


Assuntos
COVID-19/psicologia , Saúde Mental/tendências , Trabalhadores Pobres/psicologia , Adulto , Ansiedade , Transtornos de Ansiedade , Bangladesh/epidemiologia , COVID-19/epidemiologia , Estudos Transversais , Depressão , Transtorno Depressivo , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Angústia Psicológica , SARS-CoV-2/patogenicidade , Engenharia Sanitária/métodos , Engenharia Sanitária/tendências , Inquéritos e Questionários
7.
PLoS One ; 17(1): e0261479, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34995312

RESUMO

INTRODUCTION: The Australian National COVID-19 Clinical Evidence Taskforce is producing living, evidence-based, national guidelines for treatment of people with COVID-19 which are updated each week. To continually improve the process and outputs of the Taskforce, and inform future living guideline development, we undertook a concurrent process evaluation examining Taskforce activities and experience of team members and stakeholders during the first 5 months of the project. METHODS: The mixed-methods process evaluation consisted of activity and progress audits, an online survey of all Taskforce participants; and semi-structured interviews with key contributors. Data were collected through five, prospective 4-weekly timepoints (beginning first week of May 2020) and three, fortnightly retrospective timepoints (March 23, April 6 and 20). We collected and analysed quantitative and qualitative data. RESULTS: An updated version of the guidelines was successfully published every week during the process evaluation. The Taskforce formed in March 2020, with a nominal start date of March 23. The first version of the guideline was published two weeks later and included 10 recommendations. By August 24, in the final round of the process evaluation, the team of 11 staff, working with seven guideline panels and over 200 health decision-makers, had developed 66 recommendations addressing 58 topics. The Taskforce website had received over 200,000 page views. Satisfaction with the work of the Taskforce remained very high (>90% extremely or somewhat satisfied) throughout. Several key strengths, challenges and methods questions for the work of the Taskforce were identified. CONCLUSIONS: In just over 5 months of activity, the National COVID-19 Clinical Evidence Taskforce published 20 weekly updates to the evidence-based national treatment guidelines for COVID-19. This process evaluation identified several factors that enabled this achievement (e.g. an extant skill base in evidence review and convening), along with challenges that needed to be overcome (e.g. managing workloads, structure and governance) and methods questions (pace of updating, and thresholds for inclusion of evidence) which may be useful considerations for other living guidelines projects. An impact evaluation is also being conducted separately to examine awareness, acceptance and use of the guidelines.


Assuntos
COVID-19/terapia , Avaliação de Processos e Resultados em Cuidados de Saúde/tendências , Avaliação de Processos em Cuidados de Saúde/métodos , Austrália , Política de Saúde/tendências , Humanos , SARS-CoV-2/patogenicidade , Participação dos Interessados
8.
Anaesthesia ; 77 Suppl 1: 49-58, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-35001383

RESUMO

Delirium is a common condition affecting hospital inpatients, including those having surgery and on the intensive care unit. Delirium is also common in patients with COVID-19 in hospital settings, and the occurrence is higher than expected for similar infections. The short-term outcomes of those with COVID-19 delirium are similar to that of classical delirium and include increased length of stay and increased mortality. Management of delirium in COVID-19 in the context of a global pandemic is limited by the severity of the syndrome and compounded by the environmental constraints. Practical management includes effective screening, early identification and appropriate treatment aimed at minimising complications and timely escalation decisions. The pandemic has played out on the national stage and the effect of delirium on patients, relatives and healthcare workers remains unknown but evidence from the previous SARS outbreak suggests there may be long-lasting psychological damage.


Assuntos
COVID-19/epidemiologia , COVID-19/psicologia , Delírio/epidemiologia , Delírio/psicologia , Pessoal de Saúde/psicologia , Encéfalo/metabolismo , COVID-19/metabolismo , COVID-19/terapia , Delírio/metabolismo , Delírio/terapia , Humanos , Mediadores da Inflamação/metabolismo , Unidades de Terapia Intensiva/tendências
9.
Biomed Res Int ; 2022: 1522426, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35013710

RESUMO

Several therapeutic regimens for COVID-19 have been studied, such as combination antiviral therapies. We aimed to compare outcome of two types of combination therapies atazanavir/ritonavir (ATV/r) or lopinavir/ritonavir (LPV/r) plus hydroxychloroquine among COVID-19 patients. 108 patients with moderate and severe forms of COVID-19 were divided into two groups (each group 54 patients). One group received ATV/r plus hydroxychloroquine, and the other group received hydroxychloroquine plus LPV/r. Then, both groups were evaluated and compared for clinical symptoms, recovery rates, and complications of treatment regimens. Our findings showed a significant increase in bilirubin in ATV/r-receiving group compared to LPV/r receivers. There was also a significant increase in arrhythmias in the LPV/r group compared to the ATV/r group during treatment. Other findings including length of hospital stay, outcome, and treatment complications were not statistically significant. There is no significant difference between protease inhibitor drugs including ATV/r and LPV/r in the treatment of COVID-19 regarding clinical outcomes. However, some side effects such as hyperbilirubinemia and arrhythmia were significantly different by application of atazanavir or lopinavir.


Assuntos
Sulfato de Atazanavir/uso terapêutico , COVID-19/tratamento farmacológico , Lopinavir/uso terapêutico , Ritonavir/uso terapêutico , Idoso , Antivirais/uso terapêutico , Arritmias Cardíacas/induzido quimicamente , Arritmias Cardíacas/fisiopatologia , Bilirrubina/análise , COVID-19/metabolismo , Combinação de Medicamentos , Quimioterapia Combinada/métodos , Feminino , Hospitalização/tendências , Humanos , Hidroxicloroquina/uso terapêutico , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , SARS-CoV-2/efeitos dos fármacos , SARS-CoV-2/patogenicidade , Resultado do Tratamento
10.
Med Sci Monit ; 28: e935952, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34972812

RESUMO

On 4th November 2021, the first oral antiviral drug for COVID-19, molnupiravir (Lagevrio®), received full regulatory approval from the Medicines and Healthcare Products Regulatory Agency (MHRA) in the UK. Molnupiravir is an orally bioavailable antiviral drug for use at home when a SARS-CoV-2 test is positive. On 22nd December 2022, the FDA granted emergency use authorization (EUA) for the oral antiviral drug, nirmatrelvir/ritonavir (Paxlovid®) for adults and children with mild and moderate COVID-19 at increased risk of progression to severe COVID-19. These regulatory drug approvals come at a crucial time when new variants of concern of the SARS-CoV-2 virus are spreading rapidly. Although the FDA approved remdesivir (Veklury®) on 22nd October 2020 for use in adults and children for the treatment of COVID-19 requiring hospitalization, its use has been limited by the requirement for intravenous administration in a healthcare facility. The four FDA-approved therapeutic neutralizing monoclonal antibodies, imdevimab, bamlanivimab, etesevimab, and casirivimab are costly and also require medically-supervised intravenous administration. The availability of effective, low-cost oral antiviral drugs available in a community setting that can be used at an early stage of SARS-CoV-2 infection is now a priority in controlling COVID-19. An increasing number of repurposed antiviral drugs are currently under investigation or in the early stages of regulatory approval. This Editorial aims to present an update on the current status of orally bioavailable antiviral drug treatments for SARS-CoV-2 infection.


Assuntos
Antivirais/uso terapêutico , COVID-19/tratamento farmacológico , Citidina/análogos & derivados , Hidroxilaminas/uso terapêutico , Administração Oral , Anticorpos Monoclonais/uso terapêutico , Citidina/uso terapêutico , Aprovação de Drogas , Reposicionamento de Medicamentos/tendências , Humanos , Lactamas/uso terapêutico , Leucina/uso terapêutico , Nitrilas/uso terapêutico , Prolina/uso terapêutico , Ritonavir/uso terapêutico , SARS-CoV-2/efeitos dos fármacos , SARS-CoV-2/patogenicidade , Estados Unidos , United States Food and Drug Administration
11.
PLoS One ; 17(1): e0261142, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35025917

RESUMO

BACKGROUND: The Covid-19 pandemic in the United Kingdom has seen two waves; the first starting in March 2020 and the second in late October 2020. It is not known whether outcomes for those admitted with severe Covid were different in the first and second waves. METHODS: The study population comprised all patients admitted to a 1,500-bed London Hospital Trust between March 2020 and March 2021, who tested positive for Covid-19 by PCR within 3-days of admissions. Primary outcome was death within 28-days of admission. Socio-demographics (age, sex, ethnicity), hypertension, diabetes, obesity, baseline physiological observations, CRP, neutrophil, chest x-ray abnormality, remdesivir and dexamethasone were incorporated as co-variates. Proportional subhazards models compared mortality risk between wave 1 and wave 2. Cox-proportional hazard model with propensity score adjustment were used to compare mortality in patients prescribed remdesivir and dexamethasone. RESULTS: There were 3,949 COVID-19 admissions, 3,195 hospital discharges and 733 deaths. There were notable differences in age, ethnicity, comorbidities, and admission disease severity between wave 1 and wave 2. Twenty-eight-day mortality was higher during wave 1 (26.1% versus 13.1%). Mortality risk adjusted for co-variates was significantly lower in wave 2 compared to wave 1 [adjSHR 0.49 (0.37, 0.65) p<0.001]. Analysis of treatment impact did not show statistically different effects of remdesivir [HR 0.84 (95%CI 0.65, 1.08), p = 0.17] or dexamethasone [HR 0.97 (95%CI 0.70, 1.35) p = 0.87]. CONCLUSION: There has been substantial improvements in COVID-19 mortality in the second wave, even accounting for demographics, comorbidity, and disease severity. Neither dexamethasone nor remdesivir appeared to be key explanatory factors, although there may be unmeasured confounding present.


Assuntos
COVID-19/mortalidade , Mortalidade Hospitalar/tendências , Pacientes Internados/estatística & dados numéricos , Monofosfato de Adenosina/análogos & derivados , Monofosfato de Adenosina/uso terapêutico , Idoso , Alanina/análogos & derivados , Alanina/uso terapêutico , COVID-19/tratamento farmacológico , Estudos de Coortes , Comorbidade/tendências , Dexametasona/uso terapêutico , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Londres , Masculino , Pessoa de Meia-Idade , Pandemias/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Modelos de Riscos Proporcionais
12.
MMWR Morb Mortal Wkly Rep ; 71(1): 14-18, 2022 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-34990441

RESUMO

Firearm homicides and suicides represent an ongoing public health concern in the United States. During 2018-2019, a total of 28,372 firearm homicides (including 3,612 [13%] among youths and young adults aged 10-19 years [youths]) and 48,372 firearm suicides (including 2,463 [5%] among youths) occurred among U.S. residents (1). This report is the fourth in a series* that provides statistics on firearm homicides and suicides in major metropolitan areas. As with earlier reports, this report provides a special focus on youth violence, including suicide, recognizing the magnitude of the problem and the importance of early prevention efforts. Firearm homicide and suicide rates were calculated for the 50 most populous U.S. metropolitan statistical areas (MSAs)† for the periods 2015-2016 and 2018-2019, separated by a transition year (2017), using mortality data from the National Vital Statistics System (NVSS) and population data from the U.S. Census Bureau. Following a period of decreased firearm homicide rates among persons of all ages after 2006-2007 in large metropolitan areas collectively and nationally, by 2015-2016 rates had returned to levels comparable to those observed a decade earlier and remained nearly unchanged as of 2018-2019. Firearm suicide rates among persons aged ≥10 years have continued to increase in large MSAs collectively as well as nationally. Although the youth firearm suicide rate remained much lower than the overall rate, the youth rate nationally also continued to increase, most notably outside of large MSAs. The findings in this report underscore a continued and urgent need for a comprehensive approach to prevention. This includes efforts to prevent firearm homicide and suicide in the first place and support individual persons and communities at increased risk, as well as lessening harms after firearm homicide and suicide have occurred.


Assuntos
Armas de Fogo , Violência com Arma de Fogo , Homicídio/estatística & dados numéricos , Suicídio/estatística & dados numéricos , Adolescente , Adulto , Criança , Cidades , Feminino , Homicídio/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Suicídio/tendências , Estados Unidos , Adulto Jovem
14.
Acta Neurochir Suppl ; 134: 101-108, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34862533

RESUMO

The use of predictive models within neurosurgery is increasing and many models described in published journal articles are made available to readers in formats such as nomograms and online calculators. The present chapter details a step-by-step methodology with accompanying R code that may be used to implement models both in the form of traditional nomograms and as open-access, online calculators through RStudio's Shinyapps. The chapter assumes a basic understanding of predictive modeling in R and utilizes open-access files created by the Machine Intelligence in Clinical Neuroscience (MICN) Lab (Department of Neurosurgery and the Clinical Neuroscience Center of the University Hospital Zurich). When implemented correctly, tools such as nomograms and predictive calculators have the potential to improve user understanding of the underlying statistical models, facilitate broader adoption, and to streamline the eventual use of such models in clinical settings.


Assuntos
Neurocirurgia , Nomogramas , Humanos , Neurocirurgia/tendências
15.
Med Clin North Am ; 106(1): 219-234, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34823732

RESUMO

Gender impacts substance use initiation, substance use disorder development, engagement with treatment, and harms related to drug and alcohol use. Using the biopsychosocial model of addiction, this review provides a broad summary of barriers and facilitators to addiction services among women. It also reviews substance use among pregnant and parenting women and approaches to care. Given the increasing rates of substance use among women, there is a need to implement and scale-up gender-responsive addiction programming and pursue advocacy at the policy level that addresses the root drivers of substance use inequities among women.


Assuntos
Consumo de Bebidas Alcoólicas/terapia , Comportamento Aditivo/psicologia , Papel de Gênero , Poder Familiar/psicologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/psicologia , Aleitamento Materno/psicologia , Comportamento de Escolha , Feminino , Humanos , Masculino , Modelos Biopsicossociais , Defesa do Paciente/ética , Assistência Centrada no Paciente/tendências , Gravidez , Caracteres Sexuais , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Estados Unidos/epidemiologia
17.
Urol Clin North Am ; 49(1): 129-152, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34776047

RESUMO

Organ sparing approaches for the management of localized prostate cancer were developed in part to overcome the morbidity associated with standard, whole gland treatment options. The first description of focal therapy was now over two decades ago and since that time much has changed. The evolution of patient selection, the approach to ablation, and surveillance after focal therapy have mirrored the technologic advancements in the field as well as the improved understanding of the biology of low-grade, low-risk prostate cancer. This review presents the evidence for the basis of focal therapy from the past to the present and future endeavors.


Assuntos
Técnicas de Ablação/métodos , Seleção de Pacientes , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Técnicas de Ablação/tendências , Humanos , Biópsia Guiada por Imagem/métodos , Masculino , Imagem Multimodal , Imageamento por Ressonância Magnética Multiparamétrica , Gradação de Tumores , Próstata/patologia , Neoplasias da Próstata/diagnóstico , Fatores de Risco , Ultrassonografia
19.
Anticancer Res ; 42(1): 211-216, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34969727

RESUMO

AIM: Anastomotic leakage represents the most fearful complication in colorectal surgery. Important risk factors for leakage are low anastomoses and preoperative radiotherapy. Many surgeons often unnecessarily perform a protective ileostomy, increasing costs and necessitating a second operation for recanalization. The aim of this study was to evaluate the role of indocyanine green in assessing bowel perfusion, even in cases of a low anastomosis on tissue treated with radiotherapy. PATIENTS AND METHODS: Two groups of patients were selected: Group A (risky group) with only low extraperitoneal rectal tumors (<8 cm) previously treated with neoadjuvant chemo-radiotherapy; group B (no risk group) with only intraperitoneal rectal tumors (>8 cm), not previously treated with neoadjuvant therapy. Clinical postoperative outcome, morbidity, mortality and anastomotic leakage were compared between these two groups. RESULTS: In group A, comprised of 35 patients, the overall complication rate was 8.6%, with two patients developing anastomotic leakage (5.7%). In group B, comprised of 53 patients, the overall complication rate was 17% with four cases with anastomotic leakage (7.5%). No statistical difference was observed for conversion rate, general complications, or anastomotic leakage. No statistical differences were observed in clinical variables except for American Society of Anesthesiologist score (p=0.04). Patients who developed complications during radiotherapy had no significant differences in postoperative outcomes compared with other patients. CONCLUSION: Indocyanine green appears to be safe and effective in assessing the perfusion of colorectal anastomoses, even in the highest-risk cases, potentially reducing the rate of ileostomy. The main limitation remains the lack of a universally replicable standard assessment.


Assuntos
Verde de Indocianina/administração & dosagem , Laparoscopia/métodos , Neoplasias Retais/cirurgia , Reto/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica , Quimiorradioterapia/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Protectomia , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/patologia , Neoplasias Retais/radioterapia , Reto/diagnóstico por imagem , Reto/patologia
20.
Anticancer Res ; 42(1): 217-227, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34969728

RESUMO

BACKGROUND/AIM: The potential benefits of pancreatectomy with major arterial resection have been studied in the past, but findings remain controversial. Pancreatic neck/body cancer (PNBC) involving arteries frequently requires combined resection of the pancreas, artery and portal vein. PATIENTS AND METHODS: Nine prospectively-registered consecutive patients with PNBC were enrolled, all underwent pancreatoduodenectomy with common hepatic artery en-bloc resection (PD-CHAR). We investigated the safety of PD-CHAR by blood flow evaluation with intraoperative indocyanine green fluorescence imaging in reconstructed vessels/organs. RESULTS: Among patients who underwent PD-CHAR, there was no severe morbidity. Artery/portal vein combined resection and reconstruction was performed in all patients. Four (44%) patients had pathological positivity for cancer cell invasion into the nerve plexus of artery at the site of radiographic artery involvement, although one (11%) was diagnosed with pathological artery involvement. CONCLUSION: PD-CHAR following neoadjuvant therapy might be feasible for PNBC without severe postoperative complications. Survival benefits in PNBC should be confirmed in further studies.


Assuntos
Adenocarcinoma/cirurgia , Artéria Hepática/cirurgia , Pâncreas/cirurgia , Neoplasias Pancreáticas/cirurgia , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/patologia , Adulto , Idoso , Feminino , Artéria Hepática/patologia , Humanos , Verde de Indocianina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Pâncreas/patologia , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/patologia , Pancreaticoduodenectomia/tendências , Projetos Piloto , Veia Porta/patologia , Veia Porta/cirurgia , Complicações Pós-Operatórias
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