8 research outputs found

    Visualization and 3D Reconstruction of Flame Cells of Taenia solium (Cestoda)

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    BACKGROUND: Flame cells are the terminal cells of protonephridial systems, which are part of the excretory systems of invertebrates. Although the knowledge of their biological role is incomplete, there is a consensus that these cells perform excretion/secretion activities. It has been suggested that the flame cells participate in the maintenance of the osmotic environment that the cestodes require to live inside their hosts. In live Platyhelminthes, by light microscopy, the cells appear beating their flames rapidly and, at the ultrastructural, the cells have a large body enclosing a tuft of cilia. Few studies have been performed to define the localization of the cytoskeletal proteins of these cells, and it is unclear how these proteins are involved in cell function. METHODOLOGY/PRINCIPAL FINDINGS: Parasites of two different developmental stages of T. solium were used: cysticerci recovered from naturally infected pigs and intestinal adults obtained from immunosuppressed and experimentally infected golden hamsters. Hamsters were fed viable cysticerci to recover adult parasites after one month of infection. In the present studies focusing on flame cells of cysticerci tissues was performed. Using several methods such as video, confocal and electron microscopy, in addition to computational analysis for reconstruction and modeling, we have provided a 3D visual rendition of the cytoskeletal architecture of Taenia solium flame cells. CONCLUSIONS/SIGNIFICANCE: We consider that visual representations of cells open a new way for understanding the role of these cells in the excretory systems of Platyhelminths. After reconstruction, the observation of high resolution 3D images allowed for virtual observation of the interior composition of cells. A combination of microscopic images, computational reconstructions and 3D modeling of cells appears to be useful for inferring the cellular dynamics of the flame cell cytoskeleton

    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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    PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

    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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    PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

    Percepción de la Utilidad del Expediente Clínico Electrónico en un Instituto Nacional de Salud

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    INTRODUCTION: The electronic clinical record is one of the most representative development examples of the biomedical informatics in Mexico. However the idea that prevails on the advantages it entails the implementation of this strategy in health facilities, after conducting a thorough review of the Ibero-American medical literature, not found evidence sufficient to recommend it as a good practice. MATERIAL AND METHODS: 890 electronic clinical record users were invited to participate in a public opinion survey Likert-type with a range of responses ranging from anything useful to very useful, they agreed to answer it 577 users among physicians, residents, nurses, administrative staff, social workers, therapists, psychologists and nutritionists/dietitians. The 23 version of the SPSS program was used for statistical analysis. RESULTS: Frequency, internal consistency (Cronbach´s alpha) and interobserver concordance (W Kendall) was calculated for each subset of users previous identification of reagents which shared the questionnaires of different disciplines and were subsequently grouped for each item, analyzing responses through non-parametric tests in order to find differences in the distribution of scores (Kruskal Wallis test), found that the questionnaires for physicians and nutrition staff had greater reliability for internal consistency (Cronbach = α. 943). Greater interobserver agreement took place between physicians (W Kendall =. 530). The questionnaire for nursing was the least consistent and concordant. CONCLUSION: Responses in general, provide evidence to recommend as good practice the use of the electronic clinical record during patients care since health professionals prefer this mode above the traditional clinical record; they believe that it contributes to improving the safety of patients to be more available information and approve its use is widespread in other national institutes of health.INTRODUCCIÓN: El Expediente Clínico Electrónico es uno de los ejemplos más representativos del desarrollo de la Informática Biomédica en México. No obstante la idea que prevalece sobre las ventajas que conlleva la implementación de esta estrategia en los establecimientos de salud, tras realizar una revisión exhaustiva de la literatura médica iberoamericana, no se encontró evidencia suficiente para recomendarla como punto de buena práctica. METODOLOGÍA: Se invitó a 890 usuarios del expediente clínico electrónico a participar en una encuesta de opinión tipo Likert con una gama de respuestas que va desde nada útil a muy útil, accedieron a responderla 577 usuarios entre los cuales se encontraban médicos adscritos y residentes, enfermeras, personal técnico administrativo, trabajadores sociales, terapeutas, psicólogos y nutriólogos/ dietistas. Para el análisis estadístico se utilizó la versión 23 del programa SPSS. RESULTADOS: La frecuencia, consistencia interna (alpha de Cronbach) y concordancia interobservador (W de Kendall) se calculó para cada subgrupo de usuarios previa identificación de los reactivos que compartían los cuestionarios de las diferentes disciplinas y posteriormente se agruparon para cada ítem, analizando las respuestas a través de pruebas no paramétricas con el fin de encontrar diferencias en la distribución de las puntuaciones (Prueba de Kruskal Wallis o de la mediana), se encontró que los cuestionarios para médicos adscritos y para el personal de nutrición tuvieron la mayor confiabilidad por consistencia interna (α de Cronbach= .943). La mayor concordancia interobservador sucedió entre los médicos adscritos (W de Kendall= .530). El cuestionario para enfermería fue el menos consistente y concordante. CONCLUSIÓN: Las respuestas en lo general, aportan evidencia para recomendar como punto de buena práctica el uso del expediente clínico electrónico durante el proceso de atención médica de los pacientes ya que los profesionales de la salud prefieren esta modalidad que el expediente clínico tradicional; consideran que contribuye a mejorar la seguridad de los pacientes al estar más disponible y consultable la información y aprueban que su uso se generalice en otros Institutos Nacionales de Salud

    Preoperative nasopharyngeal swab testing and postoperative pulmonary complications in patients undergoing elective surgery during the SARS-CoV-2 pandemic.

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    BACKGROUND: Surgical services are preparing to scale up in areas affected by COVID-19. This study aimed to evaluate the association between preoperative SARS-CoV-2 testing and postoperative pulmonary complications in patients undergoing elective cancer surgery. METHODS: This international cohort study included adult patients undergoing elective surgery for cancer in areas affected by SARS-CoV-2 up to 19 April 2020. Patients suspected of SARS-CoV-2 infection before operation were excluded. The primary outcome measure was postoperative pulmonary complications at 30 days after surgery. Preoperative testing strategies were adjusted for confounding using mixed-effects models. RESULTS: Of 8784 patients (432 hospitals, 53 countries), 2303 patients (26.2 per cent) underwent preoperative testing: 1458 (16.6 per cent) had a swab test, 521 (5.9 per cent) CT only, and 324 (3.7 per cent) swab and CT. Pulmonary complications occurred in 3.9 per cent, whereas SARS-CoV-2 infection was confirmed in 2.6 per cent. After risk adjustment, having at least one negative preoperative nasopharyngeal swab test (adjusted odds ratio 0.68, 95 per cent confidence interval 0.68 to 0.98; P = 0.040) was associated with a lower rate of pulmonary complications. Swab testing was beneficial before major surgery and in areas with a high 14-day SARS-CoV-2 case notification rate, but not before minor surgery or in low-risk areas. To prevent one pulmonary complication, the number needed to swab test before major or minor surgery was 18 and 48 respectively in high-risk areas, and 73 and 387 in low-risk areas. CONCLUSION: Preoperative nasopharyngeal swab testing was beneficial before major surgery and in high SARS-CoV-2 risk areas. There was no proven benefit of swab testing before minor surgery in low-risk areas

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

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