12 research outputs found

    Autoimmune/inflammatory syndrome induced by adjuvants: a review

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    The autoimmune/inflammatory syndrome induced by adjuvants (ASIA) includes several autoimmune conditions and phenomena that occur after exposure to substances with adjuvant activity. The spectrum of the disease is heterogeneous with respect to the clinical presentation as well as the severity of the clinical manifestations. Different substances and medical devices with adjuvant activity are currently known, such as vaccines, oils, silicones, mineral salts, lipopolysaccharides, peptidoglycans, among others. These adjuvants are immunological molecules that function through potentiation of antigen-specific immune responses. Thus, the etiopathogenesis of ASIA syndrome involves a multifactorial interaction between environmental factors and genetic predisposition, and secondary activation of the adaptive and innate arms of the immune system through various mechanisms. Although in some reported cases the ASIA syndrome improves considerably when removing the implants, there are no conclusive results for the clinical benefit of removing the implants, so it is necessary to carry out further basic, clinical and surgical investigations in order to determine the best therapeutic decision

    Breast reconstruction: a review

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    Surgeons in the late 19th - 20th century performed radical mastectomies as the only possible treatment for breast cancers. Since then, the medical-surgical/scientific community has been constantly encouraged to develop and study different less invasive alternatives in breast reconstruction. Over time, locoregional perforator flap options have served as practical alternatives to implant-based reconstruction and abdominal flaps, especially in the setting of patients who have received radiation therapy or have a history of failed reconstruction, as they effectively fill the missing volume and respect the musculature of the donor site. Breast reconstruction using strategies with one of the different locoregional flaps can preserve the musculature and innervation of the post-mastectomy site, which manages to reduce possible adverse events. In addition to evaluating the anatomical characteristics of the defect and affected quadrant, it is essential to assess the patient's body constitution and the skills of the surgical team as well as microsurgery training when designing a reconstructive plan. Different research protocols should be developed in the study and development of new medical-surgical therapeutic alternatives; we suggest joint development with tissue engineering

    Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

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    Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

    Discovering HIV related information by means of association rules and machine learning

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    Acquired immunodeficiency syndrome (AIDS) is still one of the main health problems worldwide. It is therefore essential to keep making progress in improving the prognosis and quality of life of affected patients. One way to advance along this pathway is to uncover connections between other disorders associated with HIV/AIDS-so that they can be anticipated and possibly mitigated. We propose to achieve this by using Association Rules (ARs). They allow us to represent the dependencies between a number of diseases and other specific diseases. However, classical techniques systematically generate every AR meeting some minimal conditions on data frequency, hence generating a vast amount of uninteresting ARs, which need to be filtered out. The lack of manually annotated ARs has favored unsupervised filtering, even though they produce limited results. In this paper, we propose a semi-supervised system, able to identify relevant ARs among HIV-related diseases with a minimal amount of annotated training data. Our system has been able to extract a good number of relationships between HIV-related diseases that have been previously detected in the literature but are scattered and are often little known. Furthermore, a number of plausible new relationships have shown up which deserve further investigation by qualified medical experts

    Consenso brasileiro para o diagnóstico e tratamento do hipertireoidismo: recomendações do Departamento de Tireoide da Sociedade Brasileira de Endocrinologia e Metabologia

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    Delaying surgery for patients with a previous SARS-CoV-2 infection

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    Elective Cancer Surgery in COVID-19–Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study

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