Embracing the future-is artificial intelligence already better? A comparative study of artificial intelligence performance in diagnostic accuracy and decision-making.

BACKGROUND AND PURPOSE: The integration of artificial intelligence (AI) in healthcare has the potential to revolutionize patient care and clinical decision-making. This study aimed to explore the reliability of large language models in neurology by comparing the performance of an AI chatbot with neurologists in diagnostic accuracy and decision-making. METHODS: A cross-sectional observational study was conducted. A pool of clinical cases from the American Academy of Neurology's Question of the Day application was used as the basis for the study. The AI chatbot used was ChatGPT, based on GPT-3.5. The results were then compared to neurology peers who also answered the questions-a mean of 1500 neurologists/neurology residents. RESULTS: The study included 188 questions across 22 different categories. The AI chatbot demonstrated a mean success rate of 71.3% in providing correct answers, with varying levels of proficiency across different neurology categories. Compared to neurology peers, the AI chatbot performed at a similar level, with a mean success rate of 69.2% amongst peers. Additionally, the AI chatbot achieved a correct diagnosis in 85.0% of cases and it provided an adequate justification for its correct responses in 96.1%. CONCLUSIONS: The study highlights the potential of AI, particularly large language models, in assisting with clinical reasoning and decision-making in neurology and emphasizes the importance of AI as a complementary tool to human expertise. Future advancements and refinements are needed to enhance the AI chatbot's performance and broaden its application across various medical specialties.

"Submarine-Shaped" Radial Forearm Flap for Simultaneous Reconstruction of Oral and Lower Lip Defects".

BACKGROUND: Reconstruction of the oral cavity commonly results in trismus and lip incompetence. AIM AND OBJECTIVES: In this study, we aim to describe an innovative design of a radial forearm free flap for resurfacing bilateral buccal defects and simultaneous functional lower lip reconstruction in a single stage. MATERIALS AND METHODS: Between January 2010 and December 2019, 6 males underwent simultaneous buccal and lower lip reconstruction with a radial forearm free flap. The mean age of the patients was 57.3 years (range, 50-68 years). The defects were caused by trismus release and due to previous treatments. The mean size of the defects was 17.9 cm in length and 3.25 cm in width. Flaps were harvested, including the proximal perforators of the radial vessels, and the inset began in the buccal area opposite the anastomosis side. RESULTS: Flap size ranged from 16 to 21 × 2 to 4 cm. The recipient vessels used were the superficial temporal (4) and facial (2). All flaps survived. Lip infection was seen in 2 cases and managed conservatively. The mean follow-up was 19.2 months (range, 12-28 months). The mean increase in the interincisal distance was 10.7 mm. Oral continence was good in all patients. Speech intelligibility was considered total in 4 patients and partial in the remaining 2. CONCLUSION: The radial forearm flap constitutes an option for simultaneous lower lip reconstruction and resurfacing of bilateral buccal areas after trismus release. The procedure provides a thin and pliable reconstruction using only 1 donor site and 1 set of recipient vessels.

Ultrasonographic Evaluation of the Patellar Tendon in Cyclists, Volleyball Players, and Non-Practitioners of Sports-The Influence of Gender, Age, Height, Dominant Limb, and Level of Physical Activity.

This study was based on the ultrasound evaluation of the patellar tendon dimensions in the anteroposterior and transversal approaches in sports practitioners (cyclists and volleyball players) and non-sports practitioners. Relationships between the patellar tendon length, width, and thickness with gender, age, height, the dominant limb, and level of physical activity were evaluated. The samples included cyclists, volleyball players, and non-sports practitioners between 15 and 25 years old. Individuals were positioned supine with 30 degrees of knee flexion for bilateral measurements. Sports practitioners presented with an increased patellar tendon length and thickness. There were significant differences bilaterally between sports and non-sports practitioners (p < 0.003). The three dimensions of the patellar tendon of both limbs presented correlations with the male gender (0.336 < r < 0.601), and values of moderate-to-strong intensity in the length of the patellar tendon was directly proportional to height (0.520 < r < 0.601). There was a significant difference between the patellar tendon width and age (p < 0.025). Regarding the level of physical activity, significant differences were found between low and high levels in the three dimensions bilaterally (p < 0.004). The study results indicate that gender, age, height, and level of physical activity impact patellar tendon dimensions. However, there are no associations with the dominant limb.

Cranioplasty is not required in the reconstruction of small combined scalp and calvarial defects.

BACKGROUND: Treatment of scalp malignancies may include the need for craniectomy. The decision to perform cranioplasty is not straightforward and is frequently subjective. The purpose of this study was to assess the clinical outcomes after reconstruction of complex scalp and calvarial defects by comparing patients with and without cranioplasty. METHODS: Retrospective review of the clinical records of a consecutive series of patients who underwent scalp soft tissue reconstruction after craniectomy for malignancy or osteoradionecrosis between 2014 and 2022 at Royal Melbourne Hospital was conducted. Demographics, previous treatments, surgical details, and post-operative complications were assessed. Traumatic injuries and decompressive craniectomies were excluded. Minimum follow-up of 6 months. RESULTS: Thirty-seven patients were included in the study. Indications for surgery included skin malignancies, osteoradionecrosis, or both. There was one reconstructive failure (in the non-cranioplasty group). Infection and metalware exposure were common complications in patients who underwent cranioplasty (38.5%). No patient developed neurological symptoms subsequent to craniectomy. One patient needed revision surgery due to esthetic reasons (cranioplasty group). Transposition flaps were associated with more complications and revision procedures. CONCLUSION: Combined scalp and calvarial defects pose a difficult reconstructive challenge. Stable soft tissue coverage is more reliably achieved with free flap reconstruction. Cranioplasty is not always mandatory and should be reserved for cases with a very large bony defect or when the defect is located in a cosmetically sensitive area.

Neuroleptic Malignant Syndrome: An Intensive Care Unit Case of Exceptionally High Creatinine Kinase and Myoglobin Levels.

Neuroleptic Malignant Syndrome (NMS) is a rare, life-threatening neurologic emergency known to be related to the administration or sudden withdrawal of dopaminergic medications. The clinical course, symptoms, and bloodwork are very heterogeneous, making this syndrome difficult to identify. Thus, NMS is a diagnosis of exclusion. We present a case of severe NMS with exceptionally high creatinine kinase (CK) and myoglobin levels with unclear etiology and a challenging differential diagnosis. Also, our case stands out because it was serious, unique, and had a favorable outcome, which could contribute to the management of future similar cases.

Nephelometry vs. Immunoturbidimetry assay: Analytical performance on IgG subclasses.

Interest in measuring immunoglobulin G Subclasses (IgG Subclasses) is increasing as more information is gathered and understanding regarding conditions associated with deficiencies of each IgG Subclass grows. Different methodologies are available for the measurement of IgG Subclasses, but their specificities vary. As a result, laboratories choose the methodology that better suits their routine, but which may not necessarily align with the needs of their population. In addition, the lack of standardization for the quantification of IgG Subclasses causes diagnostic gaps when comparing results provided by different methodologies. Thus, the purpose of our research is to compare the analytical performance of The Binding Site's (TBS) Optilite® human Immunoglobulin G (IgG) and IgG Subclasses Immunoturbidimetry assay, with the Nephelometry method routinely used in our clinical laboratory, Siemens BNII®. Our results show that the Immunoturbidimetry assay appears to be the most reliable to evaluate IgG Subclasses: the sum of IgG Subclasses and Total IgG correlate better than by Nephelometry. Although these methodologies share a similar principle, the comparison of results appears to be compromised. Therefore, prior to switching methodologies, further studies should be conducted to assess which methodology could be better applied to specific populations. It is also essential to standardise IgG Subclasses assays to reduce discrepancies that arise from comparing results.

Structured light for touchless 3D registration in video-based surgical navigation.

PURPOSE: Arthroscopic surgery, with its inherent difficulties on visibility and maneuverability inside the joint, poses significant challenges to surgeons. Video-based surgical navigation (VBSN) has proven to have clinical benefits in arthroscopy but relies on a time-consuming and challenging surface digitization using a touch probe to accomplish registration of intraoperative data with preoperative anatomical models. This paper presents an off-the-shelf laser scanner for noninvasive registration that enables an increased area of reachable region. METHODS: Our solution uses a standard arthroscope and a light projector with visual markers for real-time extrinsic calibration. Nevertheless, the shift from a touch probe to a laser scanner introduces a new challenge-the presence of a significant amount of outliers resulting from the reconstruction of nonrigid structures. To address this issue, we propose to identify the structures of interest prior to reconstruction using a deep learning-based semantic segmentation technique. RESULTS: Experimental validation using knee and hip phantoms, as well as ex-vivo data, assesses the laser scanner's effectiveness. The integration of the segmentation model improves results in ex-vivo experiments by mitigating outliers. Specifically, the laser scanner with the segmentation model achieves registration errors below 2.2 mm, with the intercondylar region exhibiting errors below 1 mm. In experiments with phantoms, the errors are always below 1 mm. CONCLUSION: The results show the viability of integrating the laser scanner with VBSN as a noninvasive and potential alternative to traditional methods by overcoming surface digitization challenges and expanding the reachable region. Future efforts aim to improve hardware to further optimize performance and applicability in complex procedures.

Winemaking: Advanced Technology and Flavor Research.

Beginning in ancient times, human societies around the world continue to produce fermented beverages from locally available sugar sources [...].

Exploring factors influencing the levels of biogenic amines in wine and microbiological strategies for controlling their occurrence in winemaking.

Fermented beverages, including wine, can accumulate high concentrations of biogenic amines (BAs), which can pose potential health risks. BAs are produced by various yeasts and lactic acid bacteria (LAB) during winemaking. LAB are the main contributors to the formation of histamine and tyramine, the most toxic and food safety relevant biogenic amines. Numerous factors, ranging from agricultural and oenological practices to sanitation conditions, can contribute to the formation of BAs in wines. Moreover, organic and biodynamic wines impose limitations on the use of common food additives employed to control the proliferation of native and spoilage microorganisms during vinification and storage. To mitigate histamine production, commercial starter cultures incapable of synthesising histamine have been effectively utilised to reduce wine histamine content. Alternative fermentative microorganisms are currently under investigation to enhance the safety, quality, and typicity of wines, including indigenous LAB, non-Saccharomyces yeasts, and BAs degrading strains. Furthermore, exploration of extracts from BAs-degrading microorganisms and their purified enzymes has been undertaken to reduce BAs levels in wines. This review highlights microbial contributors to BAs in wines, factors affecting their growth and BA production, and alternative microorganisms that can degrade or avoid BAs. The aim is to lessen reliance on additives, providing consumers with safer wine choices.

Efficiency of Alginic Acid, Sodium Carboxymethylcellulose, and Potassium Polyaspartate as Calcium Tartrate Stabilizers in Wines.

The instability of calcium tartrate (CaT) in wines occurs when the effective concentration of ions surpasses the solubility product, leading to the formation of CaT crystals. Unlike potassium hydrogen tartrate (KHT), temperature has little effect on the rate of CaT precipitation, making cold stabilization ineffective. Additives like metatartaric acid and carboxymethylcellulose (CMC) have been used to mitigate this problem, but metatartaric acid's effectiveness is limited due to hydrolysis. Additionally, potassium polyaspartate (KPA), commonly used as a KHT stabilizer, has been reported to reduce wine stability regarding CaT instability. Therefore, exploring alternative stabilization methods is crucial. Alginic acid, permitted as a processing aid in winemaking, can be an alternative to CMC and metatartaric acid due to its strong negative charge and ability to bind calcium ions. This study aimed to assess alginic acid's efficacy as a CaT stabilizer compared to CMC and investigate the impact of KPA on CaT instability. The results showed that KPA did not increase CaT instability and even improved its stability in some wines. Alginic acid outperformed both CMC and KPA in mitigating CaT instability, possibly due to its higher zeta potential and calcium ion complexation ability. This study is the first to investigate the use of alginic acid for CaT stability in wine.

REM and NREM Sleep Parasomnia in Anti-NMDA Receptor Encephalitis.

OBJECTIVES: Encephalitis with anti-N-methyl-d-aspartate receptor antibodies (anti-NMDARe) is a rare disorder characterized by cognitive impairment, psychosis, seizures, and abnormal movements. Abnormal behaviors during REM sleep have not been described in anti-NMDARe. METHODS: Patients were monitored by video-polysomnography on a first night followed by multiple sleep latency tests and 18 hours of bed rest. RESULTS: Two patients with anti-NMDARe developed during the acute and postacute phase parasomnias including REM sleep behavior disorder and continuous finalistic quiet gesturing during a mixed N2/R sleep. The parasomnia disorder was improved by gabapentin and clonazepam. DISCUSSION: Video-polysomnography avoids misdiagnosing these parasomnia behaviors for seizure or movement disorders and allows adequate treatment.

Traumatic atlanto-occipital dislocation with improvement of neurological deficit: case report / Luxação traumática atlanto-occipital com melhora do déficit neurológico: relato de caso / Luxación atlanto-occipital traumática con mejoría del déficit neurológico: informe de un caso

ABSTRACT: Traumatic atlanto-occipital dislocation is a rare, severe, and usually fatal injury. In this paper, we report the case of a 28-year-old patient with multiple trauma, who suffered an atlanto-occipital dislocation (AOD) associated with rotatory dislocation at C1-C2, condyle fracture and traumatic brain injury resulting from a car accident, with a cardiopulmonary arrest at the accident site. The patient had motor and sensory deficits, suffering other complications of clinical severity during hospitalization. After two years of surgical treatment follow-up, the patient had a complete recovery of neuromotor and sensory functions. This case demonstrates that neurological recovery with minimal sequelae is possible, even after an unfavorable prognosis resulting from a severe injury with a high risk of death as this kind of trauma. It is essential for health professionals to have the ability to identify and treat AOD, ensuring improved clinical outcomes, reducing mortality and morbidity, and providing a better life to affected patients. Level of Evidence IV; Cases Series.

RESUMO: A luxação traumática atlanto-occipital (LTAO) é uma lesão rara, grave e com alto índice de mortalidade. Neste artigo relatamos o caso de um paciente de 28 anos, politraumatizado, que sofreu uma LTAO associada à luxação rotatória em C1-C2, à avulsão de côndilo e ao traumatismo crânio encefálico decorrente de acidente automobilístico, com relato de uma parada cardiorrespiratória no local do acidente. O paciente deu entrada no serviço com déficit motor e sensitivo, sofrendo outras intercorrências de gravidade clínica durante a internação. Após dois anos do tratamento cirúrgico, o paciente evoluiu favoravelmente com completa recuperação das alterações neuromotoras e sensitivas. O caso apresentado demonstra que é possível a recuperação neurológica com sequelas mínimas, mesmo após um prognóstico desfavorável decorrente de uma lesão grave e o elevado risco de morte decorrente desse tipo de trauma. É essencial que os profissionais de saúde estejam aptos a identificar e tratar a LTAO, garantindo uma melhorar dos resultados clínicos, redução da mortalidade e morbidade, além de proporcionar uma melhor qualidade de vida aos pacientes afetados. Nível de Evidência IV; Série de casos.

RESUMEN: La luxación traumática atlanto-occipital (LTAO) es una lesión grave, poco frecuente y con una elevada tasa de mortalidad. En este artículo presentamos el caso de un paciente politraumatizado de 28 años que sufrió una LTAO asociada a luxación rotatoria en C1-C2, a la avulsión de cóndilos y traumatismo craneoencefálico como consecuencia de un accidente de tráfico, con parada cardiorrespiratoria en el lugar del accidente. El paciente presentaba déficits motores y sensoriales y sufrió otras complicaciones clínicas graves durante su hospitalización. Luego de dos años de tratamiento quirúrgico, el paciente evoluciona favorablemente con recuperación completa de las alteraciones neuromotoras y sensitivas. El caso presentado demuestra que la recuperación neurológica con mínimas secuelas es posible, incluso después de un pronóstico desfavorable debido a una lesión grave y al alto riesgo de muerte derivado de este tipo de traumatismos. Es esencial que los profesionales sanitarios sean capaces de identificar y tratar la LTAO, garantizando mejores resultados clínicos, una reducción de la mortalidad y la morbilidad, y una mejor calidad de vida para los pacientes afectados. Nivel de Evidencia IV; Series de casos.

A saúde promovida por redes sociais e comunitárias de mulheres de baixa renda / Health promoted by social and community networks of low-income women / La salud promovida por las redes sociales y comunitarias de mujeres de bajos ingresos

Resumo: As redes sociais e comunitárias constituem um importante determinante social de saúde, especialmente nos segmentos populares da sociedade civil e em suas lutas para garantir o direito à saúde. Esta pesquisa buscou compreender quais são as redes sociais e comunitárias constituídas por mulheres residentes em uma comunidade de baixa renda e sua relação com a produção da saúde nesse grupo social. Foram realizadas entrevistas semiestruturadas com 11 mulheres participantes de uma organização não governamental (ONG) da comunidade, e os dados foram submetidos à análise de conteúdo. A análise destacou quatro categorias: a comunidade como uma grande rede - formada por múltiplas redes dinâmicas interligadas; a rede das "tias" - mulheres com papel importante no cuidado da comunidade, tratadas como parte da família; as rodas de conversa - como o rito de encontro periódico nas calçadas, apontado como importante espaço garantidor de estabilidade emocional e qualidade de vida; e as benzedeiras e o uso de plantas medicinais - referências de cuidado na comunidade, que proporcionam prevenção/tratamento à saúde e encaminhamento para a unidade de saúde quando necessário. Conclui-se que as redes sociais e comunitárias formadas pelas participantes são determinantes sociais importantes. Assim, é necessária a valorização de tais redes pelos equipamentos de saúde inscritos no território.

Abstract: Social and community networks constitute an important social determinant of health, especially in the poorer segments of civil society and in their struggles to guarantee the right to health care. This study sought to understand the social and community networks created by women living in a low-income community and their relationship with the development of health care in this social group. Semi-structured interviews were conducted with 11 women participating in a nongovernmental organization in the community, and the data were subjected to content analysis. The analysis highlighted four categories: the community as a large network, formed by multiple interconnected dynamic networks; the network of "aunts", women with an important role in the care of the community, treated as part of the family; the conversation circles, such as the rite of periodic meeting on the sidewalks, indicated as an important space that guarantees emotional stability and quality of life; and the benzedeiras with the use of medicinal plants, they are reference care within the community, providing disease prevention, health treatment, and referral to the health care unit when necessary. We concluded that the social and community networks created by the participants are important social determinants, and health facilities registered in the territory should value such networks.

Resumen: Las redes sociales y comunitarias constituyen un importante determinante social de salud, especialmente en los segmentos populares de la sociedad civil y en sus luchas para garantizar el derecho a la salud. La presente investigación buscó comprender cuáles son las redes sociales y comunitarias tejidas por las mujeres residentes en una comunidad de bajos ingresos y su relación con la producción de la salud en este grupo social. Se realizaron entrevistas semiestructuradas con 11 mujeres participantes de una organización no gubernamental de la comunidad, y los datos se sometieron a análisis de contenido. El análisis destacó cuatro categorías: la comunidad como una gran red - formada por múltiples redes dinámicas interconectadas; la red de las "tías" - mujeres con papel importante en el cuidado de la comunidad, tratadas como parte de la familia; las ruedas de conversación - como el rito de encuentro periódico en las aceras, señalado como un espacio importante que garantiza la estabilidad emocional y la calidad de vida, y las curanderas y el uso de plantas medicinales - referencias de cuidado en la comunidad; que proporcionan prevención/tratamiento a la salud y el encaminamiento para la unidad de salud cuando sea necesario. Se concluye que las redes sociales y comunitarias tejidas por las participantes son determinantes sociales importantes, siendo necesaria la valorización de tales redes por los equipos de salud inscritos en el territorio.

Intervenções de enfermagem no serviço de urgência: Perspetivas dos enfermeiros / Nursing interventions in emergency departments: Nurses' perspectives / Intervenciones de enfermería en el servicio de urgencias: Perspectivas de los enfermeros

Resumo Enquadramento: A evolução dos serviços de urgência tornou complexo o enquadramento das intervenções realizadas pelos enfermeiros. Compreender esta evolução é essencial para gerir eficientemente estes recursos e garantir cuidados seguros às pessoas. Objetivo: Descrever as intervenções de enfermagem implementadas aos clientes no serviço de urgência. Metodologia: Estudo qualitativo com uma abordagem descritiva e exploratória, que ocorreu em duas etapas sequenciais - (1) identificação das intervenções de enfermagem através da observação não participante, entrevista semiestruturada e questionário e (2) análise de conteúdo às intervenções identificadas. Resultados: Identificaram-se 1429 intervenções que foram categorizadas em 24 dimensões. As mais comuns incluíram a Administração de fármacos, a Avaliação clínica, a Colheita de amostras biológicas, a Gestão da informação clínica e a Manutenção do funcionamento das unidades. Conclusão: As intervenções identificadas revelam uma ampla gama de práticas que vão além do cuidado direto à pessoa, incluindo a gestão do fluxo de trabalho e da informação clínica. Os resultados do estudo destacam a importância de uma melhor compreensão dessas intervenções para a otimização dos serviços de urgência.

Abstract Background: The evolution of emergency departments added further complexity to the framework of nursing interventions. Understanding this evolution is vital to efficiently manage resources and ensure patients the provision of safe care. Objective: The objective of this study is to describe nursing interventions provided to patients in emergency departments. Methodology: A qualitative approach using a descriptive and exploratory methodology was employed by this study, involving two consecutive stages - (1) identification of nursing interventions using non-participant observation, semi-structured interviews, and a questionnaire, and (2) content analysis of the identified interventions. Results: A total of 1,429 interventions were identified and categorized into 24 dimensions. The most commonly observed interventions were Administration of medication, Clinical assessment, Collection of biological specimens, Management of clinical information, and Maintaining the department's functioning. Conclusion: The identified interventions show nurses' broad range of practices that surpass direct patient care, encompassing the management of workflows and clinical information. The study findings emphasize the significance of further understanding nursing interventions for the optimal management of emergency departments.

Resumen Marco contextual: La evolución de los servicios de urgencias ha complicado el marco de las intervenciones realizadas por el personal de enfermería. Comprender esta evolución es esencial para gestionar de forma eficiente estos recursos y garantizar unos cuidados seguros para las personas. Objetivo: Describir las intervenciones de enfermería aplicadas a los pacientes del servicio de urgencias. Metodología: Estudio cualitativo con enfoque descriptivo y exploratorio, que se desarrolló en dos etapas secuenciales - (1) identificación de las intervenciones de enfermería mediante observación no participante, entrevista semiestructurada y cuestionario, y (2) análisis de contenido de las intervenciones identificadas. Resultados: Se identificaron un total de 1429 intervenciones, clasificadas en 24 dimensiones. Las más comunes incluían la Administración de fármacos, la Evaluación clínica, la Recogida de muestras biológicas, la Gestión de la información clínica y el Mantenimiento del funcionamiento de la unidad. Conclusión: Las intervenciones identificadas muestran un amplio abanico de prácticas que van más allá de la atención directa a la persona, incluida la gestión del flujo de trabajo y de la información clínica. Los resultados del estudio destacan la importancia de comprender mejor estas intervenciones para optimizar los servicios de urgencias.

Enfermedad de motoneurona asociada a procesos neoplásicos: una revisión de casos / Motor Neuron Disease associated with a neoplastic procesess: a review of cases

Introduction: Association between Motor Neuron Disease (MND) and neoplastic processes is rarely described. It is unclear whether MND occurs as a paraneoplastic syndrome. Methods: We retrospectively analysed 35 patients with MND followed in our Hospital from January 2013 to December 2016. Results: A neoplastic process was found in four patients. All of them had definite clinical and electromyographic criteria supporting MND according to standard Awaji criteria. Results: Onconeuronal antibodies were positive in two patients (anti-Yo and anti-PNMA2). The types of tumour were variable: two breast cancers, one lung cancer and one thyroid Hürthle cell neoplasm. Discussion: In our cohort, 11.4% of MND patients were diagnosed with a neoplastic process being a rather high frequency of co-occurrence. Treating the neoplastic process may potentially halt or reverse the progression of MND. (AU)

Desigualdade, situação geográfica e sentidos da ação na pandemia da COVID-19 no Brasil / Desigualdad, situación geográfica y sentidos de la acción sanitaria durante la pandemia de COVID-19 en Brasil / Inequality, geographic situation, and meanings of action in the COVID-19 pandemic in Brazil

Resumo: Este Ensaio traz uma reflexão sobre como as desigualdades socioespaciais e as situações geográficas são condicionantes da pandemia da COVID-19 no Brasil, assim como das ações para o seu enfrentamento. A bibliografia de apoio fundamenta os argumentos. Compreende-se a desigualdade socioespacial como processo e condição estrutural de um território marcado por vulnerabilidades herdadas e atualizadas, resultante da relação de exploração, espoliação e opressão no atual período da globalização. Argumenta-se que a pandemia da COVID-19 pode ter repercussões mais graves em contextos de maior desigualdade socioespacial, com aprofundamento sistêmico e duradouro das crises econômica e social nos lugares. Contudo, as ações importam, incluindo as articulações entre diversos grupos, instituições e setores. A análise da situação geográfica contribui para a compreensão do território herdado e das diferentes experiências da COVID-19 indissociavelmente das condições e dos sentidos da ação frente à pandemia, em cada lugar. A situação expressa a tensão entre a liberdade e a condição para a ação. A crise não é apenas sanitária, é um dado do período atual, e a desigualdade se revela como a maior emergência do século XXI.

Resumen: Este Ensayo plantea una reflexión sobre cómo las desigualdades socioespaciales y las situaciones geográficas son condicionantes de la pandemia de COVID-19 en Brasil, así como sobre las acciones para luchar contra ella. La bibliografía de apoyo fundamenta los argumentos. Se entiende la desigualdad socioespacial como un proceso y condición estructural de un territorio, marcado por vulnerabilidades heredadas y actualizadas, resultantes de la relación de explotación, expolio y opresión en el marco del actual período de globalización. Se argumenta que la pandemia de COVID-19 puede tener repercusiones más graves en contextos de mayor desigualdad socioespacial, con una profundización sistémica y duradera de las crisis económicas y sociales en diferentes espacios. No obstante, las acciones importan, incluyendo la coordinación entre diversos grupos, instituciones y sectores. El análisis de situación geográfica contribuye a la comprensión del territorio heredado y de las diferentes experiencias de la COVID-19, indisociablemente de las condiciones y de los sentidos de la acción frente a la pandemia, en cada lugar. La situación expresa la tensión entre la libertad y la condición para la acción. La crisis no es solamente sanitaria, es un hecho propio de la era actual en la que nos encontramos, y la desigualdad se revela como la mayor emergencia del siglo XXI.

Abstract: This Essay reflects on how socio-spatial inequalities and geographic situations condition the COVID-19 pandemic in Brazil, as well as actions to deal with the pandemic, with arguments backed by the literature. Socio-spatial inequality is defined as a process and structural condition of a territory marked by inherited and updated vulnerabilities, resulting from a relationship of exploitation, spoliation, and oppression in the current period of globalization. The authors argue that the COVID-19 pandemic can have more serious repercussions in contexts of greater socio-spatial inequality, with systemic and chronic deepening of the economic and social crises in places. Still, actions matter, including collaboration between different groups, institutions, and sectors. The analysis of geographic situation contributes to understanding the inherited territory and different experiences with COVID-19, inextricably linked to the conditions and meanings of action in the face of the pandemic in each place. Geographic situation expresses the tension between freedom and the condition for action. The crisis is not only a health crisis, but a manifestation of the current time, and inequality proves to be the most serious emergency of the 21st century.

Análise dos programas de plantas medicinais e fitoterápicos no Sistema Único de Saúde (SUS) sob a perspectiva territorial / Analysis of medicinal plant and herbal medicine programs in the Unified Health System (SUS) from the territorial perspective

Resumo É expressivo o crescimento do número de programas de fitoterapia no SUS desde 2006, quando lançada a Política Nacional de Plantas Medicinais e Fitoterápicos. Como esses programas se distribuem no território e como expressam diversidades regionais? A pesquisa analisou como os usos do território condicionam a existência desses programas e como estes promovem maior sinergia técnica (saber local e saber universalizado) e política (estratégias e atores) na produção, circulação, distribuição e dispensação de plantas medicinais e fitoterápicos no sistema público de saúde. A análise envolveu referencial teórico da geografia crítica e saúde coletiva, revisão bibliográfica conceitual e temática, análise documental, levantamento de dados primários e secundários, destacando-se extenso trabalho de campo. Os resultados apontam que o crescimento dos programas foi acompanhado pela opção por fitoterápicos industrializados, concentrando-se espacialmente no Sul e Sudeste. Foram identificadas duas fases nesse processo: 1980-2008, caracterizada por ações mais horizontais ligadas a diversidades regionais; e 2008-atual, caracterizada por ações mais verticalizadas na escala nacional. Conclui-se: a Política Nacional possibilitou aumento do número de programas, mas pouco fomentou suas expressões regionais.

Abstract There has been significant growth in the number of municipal phytotherapy programs in the Unified Health System since the launch of the National Policy of Medicinal Plants in 2006. The aim of the research was to analyze how these programs are distributed throughout Brazil, how they express regional diversity and how land use can influence these programs and promote broad technical synergy (local knowledge and universal knowledge) and policy (strategy and actors) in the production, circulation, distribution and dispe sation of medicinal plants in the public health system. The analysis involved a theoretical framework of critical geography and public health, conceptual and thematic literature review, document analysis, survey of primary and secondary data along with extensive fieldwork. The results show that the growth of programs was accompanied by the choice of industrialized herbal medicines, spatially concentrated in the South and Southeast. Two phases were identified in this process: 1980-2008 characterized by horizontal actions linked to regional diversities; 2008 to the present characterized by verticalized actions on a national scale. The National Policy made it possible to increase the number of programs but did little to promote greater regional diversity.

Complete axillary dissection without drainage for the surgical treatment of breast cancer: a randomized clinical trial

OBJECTIVE: This randomized clinical trial evaluated the possibility of not draining the axilla following axillary dissection. METHODS: The study included 240 breast cancer patients who underwent axillary dissection as part of conservative treatment. The patients were divided into two groups depending on whether or not they were subjected to axillary drainage. ClinicalTrials.gov: NCT01267552. RESULTS: The median volume of fluid aspirated was significantly lower in the axillary drainage group (0.00 ml; 0.00 - 270.00) compared to the no drain group (522.50 ml; 130.00 - 1148.75). The median number of aspirations performed during conservative breast cancer treatment was significantly lower in the drainage group (0.5; 0.0 - 4.0) compared to the no drain group (5.0; 3.0 - 7.0). The total volume of serous fluid produced (the volume of fluid obtained from drainage added to the volume of aspirated fluid) was similar in the two groups. Regarding complications, two cases (2.4%) of wound dehiscence occurred in the drainage group compared to 13 cases (13.5%) in the group in which drainage was not performed, with this difference being statistically significant. Rates of infection, necrosis and hematoma were similar in both groups. CONCLUSION: Safety rates were similar in both study groups; hence, axillary dissection can feasibly be performed without drainage. However, more needle aspirations could be required, and there could be more cases of wound dehiscence in patients who do not undergo auxiliary drainage.