Cross-bordering processes on the triple border Argentina / Brazil/ Uruguay – ARBRUY: territorial actors and their actions in the cities of Monte Caseros (Arg), Barra do Quarai (Br) And Bella Union (Uy)

Este artigo apresenta o caso específico de uma microrregião transfronteiriça denominada, localmente, como ARBRUY. Ela se localiza na Macrorregião da Bacia do Rio da Prata junto à tríplice fronteira mais meridional da América do Sul entre Argentina, Brasil e Uruguai, em posição periférica em relação aos seus respectivos estados nacionais. A Microrregião Transfronteiriça ARBRUY, principalmente rural e dependente do comércio de lojas free shops terrestres, abrange as cidades trigêmeas de Barra do Quaraí (na região de planejamento do Conselho Regional de Desenvolvimento - Corede Fronteira Oeste do Estado do Rio Grande do Sul); Monte Caseros (no Departamento de Monte Caseros da Província de Corrientes, Argentina) e Bella Unión (no Departamento de Artigas, Uruguai). As principais atividades de cooperação internacional têm sido promovidas por organizações civis (ONGs), com apoio dos governos locais nos eixos ambiental e educacional, principalmente. A conquista recente do Comitê de Fronteira Trinacional em 2019, reconhecido pelos respectivos três estados nacionais, é uma das principais repercussões territoriais alcançadas pelos atores locais / regionais na Microrregião, já que se trata do primeiro a reunir três países no Mercosul.This article presents the specific case of a cross-border micro-region named, locally, ARBRUY. It is located in the macro-region of the La Plata River Basin, on the southernmost triple border in South America between Argentina, Brazil, and Uruguay, in a peripheral position concerning its respective national states. The cross-border micro-region is mainly rural and dependent on the trade of land-based duty-free stores. It encompasses the triple cities of Barra do Quaraí (in the planning region of the Regional Development Council - Corede Fronteira Oeste of the State of Rio Grande do Sul, Brazil), Monte Caseros (in the Monte Caseros Department, Corrientes Province, Argentina) and Bella Unión (in the Artigas Department, Uruguay). The main activities of international cooperation have been promoted by civil organizations (NGOs), with the support of the three local governments in the environmental and educational axes, mainly. The recent achievement of the Trinational Border Committee in 2019, recognized by the three respective national states, is one of the main territorial repercussions obtained by local/regional actors in the Micro-region ARBRUY because it is the first to bring together three countries in Mercosur

CT pulmonary angiography appropriateness in a single emergency department: does the use of revised Geneva score matter?

Purpose: To assess the percentage of computed tomography pulmonary angiography (CTPA) procedures that could have been avoided by methodical application of the Revised Geneva Score (RGS) coupled with age-adjusted D-dimer cut-offs rather than only clinical judgment in Emergency Department patients with suspected pulmonary embolism (PE). Material and methods: Between November 2019 and May 2020, 437 patients with suspected PE based on symptoms and D-dimer test were included in this study. All patients underwent to CTPA. For each patient, we retrospectively calculated the age-adjusted D-dimer cut-offs and the RGS in the original version. Finally, CT images were retrospectively reviewed, and the presence of PE was recorded. Results: In total, 43 (9.84%) CTPA could have been avoided by use of RGS coupled with age-adjusted D-dimer cut-offs. Prevalence of PE was 14.87%. From the analysis of 43 inappropriate CTPA, 24 (55.81%) of patients did not show any thoracic signs, two (4.65%) of patients had PE, and the remaining patients had alternative thoracic findings. Conclusion: The study showed good prevalence of PE diagnoses in our department using only physician assessment, although 9.84% CTPA could have been avoided by methodical application of RGS coupled with age-adjusted D-dimer cut-offs

Impact of the COVID-19 Outbreak on Anesthesiologist Assistance for Endoscopic Procedures

Background/Aims: The coronavirus disease 2019 (COVID-19) outbreak has modified the activities of endoscopy units worldwide. Herein, we investigated the impact of the COVID-19 outbreak on anesthesiologist assistance for endoscopic procedures in Lombardy, Italy. Methods: A questionnaire concerning anesthesiologist assistance provided from October 26 to December 6, 2020, in comparison with the same period in 2019, was sent to endoscopic units in Lombardy. Results: Approximately 54% (34/63) of the units responded. A reduction in the number of all endoscopies (-33.5%; 18792 in 2020 vs. 28264 in 2019) and anesthesiologist-assisted endoscopies (-15.3%; 2652 in 2020 vs. 3132 in 2019) was reported. A greater reduction in anesthesiologist assistance was observed in government community units (-29.5%) than in academic (-14%) and private community units (-4.6%). Among all units, 85% reported a reduction in anesthesiologist assistance; 65% observed a delay/cancellation of procedures; 59%, a restricted patient selection; 17%, the need to transfer some patients to other hospitals; and 32%, a related worsening of procedure quality. Conclusion: The COVID-19 pandemic compromised the anesthesiologist assistance for endoscopic procedures in Lombardy, which worsened the procedure quality mainly in government community units. The COVID-19 “stress test” suggests a more balanced allocation of anesthesiologic resources in the future

Unsedated colonoscopy: A neverending story

Although sedation and analgesia for patients undergoing colonoscopy is the standard practice in Western countries, unsedated colonoscopy is still routinely provided in Europe and the Far East. This variation in sedation practice relies on the different cultural attitudes of both patients and endoscopists across these countries. Data from the literature consistently report that, in unsedated patients, the use of alternative techniques, such as warm water irrigation or carbon dioxide insufflation, can allow a high quality and well tolerated examination