72 research outputs found
Protocols and complications in the reconstruction of major scalp defects
Introduction: This study aimed to analyze the protocols and complications in four unusual cases of large and complex scalp defects, in which conventional, non-microsurgical flaps were used.
Methods: This was a critical and retrospective analysis of four cases. Three immunosuppressed patients had squamous cell carcinomas (SCC) (one underwent liver transplant, one underwent renal transplant, and one had rheumatoid arthritis). The other patient had sequelae of head trauma and multiple neurosurgeries using self-polymerizing acrylic, followed by osteomyelitis and fistula.
Results: The cases of large carcinoma were reconstructed with rotation large scalp flaps. Two of them had epidermolysis/necrosis in a small distal portion of the flaps, which were treated, with excellent aesthetic results. The case of sequelae of trauma was reconstructed with expanded advancement scalp flap over cranioplasty using ribs. Despite the extrusion of one osteosynthesis, the patient healed without recurrence of the fistula, with na excellent aesthetic result.
Conclusion: The analysis of these complex and unusual cases indicates that temporal pedicles are preferred in the planning of flaps for the conventional reconstruction of large scalp defects. The treatment employed for the possible epidermolyses and distal necroses in these flaps led to satisfying aesthetic and functional results
Practical criteria for a safer liposuction: a multidisciplinary approach
In 2012, the Research Group on Body Contouring Surgery of the Brazilian Society of Plastic Surgery conducted an extensive study on the safety of liposuction before the initiation of the course of the Group, held in 2013 in Rio de Janeiro during the 50th Brazilian Congress of Plastic Surgery, with the presence of the illustrious Dr. Yves GĂ©rard Illouz and a large number of participants. The authors performed a review and update of the safety parameters, incorporating recent advances and systematizing relevant information for the execution of a safer liposuction. With the collaboration of anesthesiologist, intensive care physician, and vascular surgeon, all with extensive experience in supporting the procedure, new practical guidelines were presented for a safer liposuction on the preoperative, transoperative, and postoperative periods
Futebol: um meio de educar
Introdução: Atualmente, podemos classificar o esporte nas dimensĂ”es de alto rendimento, educacional, de participação-lazer e esporte âsocialâ. Devido Ă sua grande popularidade no Brasil, o futebol/futsal Ă© um esporte de grande aceitação pelas crianças e jovens e pode ser um meio de educar atravĂ©s de sua prĂĄtica. Objetivo: verificar a evolução da aprendizagem do futsal e se Ă© possĂvel melhorar o comportamento de crianças atravĂ©s da prĂĄtica do futsal. MĂ©todos: Foi feita uma avaliação qualitativa da evolução do comportamento e das habilidades do futsal, atravĂ©s da tĂ©cnica de observação participante, feita pelos estagiĂĄrios/bolsistas do Projeto (n=7), atravĂ©s das observaçÔes das aulas e os relatos foram discutidos em reuniĂ”es semanais. Fizeram parte da amostra todos os inscritos (6-8 anos, n=42; 9-10 anos, n=30; 11-12 anos, n=86; 13-14 anos, n=48) no Projeto âFutebol Escolaâ do Departamento de Educação FĂsica da Faculdade de CiĂȘncias/UNESP â Bauru, independente do gĂȘnero e da habilidade de jogar. As aulas foram realizadas aos sĂĄbados, com duração de 1h30, durante o ano de 2009, em quadras de futsal. A metodologia de ensino utilizada nas aulas combinou os mĂ©todos de ensino parcial, global, situacional e jogos prĂ©-desportivos. A estrutura das aulas foi subdividida em cinco partes: i-) conversa inicial; ii-) atividade recreativa sobre o tema da aula; iii-) jogo prĂ©-desportivo ou exercĂcios de fundamentos tĂ©cnicos do tema da aula; iv) jogo de futsal propriamente dito com regras adaptadas Ă s respectivas faixas etĂĄrias; v-) conversa final. Resultados: No inĂcio das aulas foi constatado mau comportamento de grande parte dos alunos: indisciplina (nas aulas e no ĂŽnibus), desrespeito aos colegas (agressĂ”es verbais e corporais) e aos estagiĂĄrios/bolsistas (nĂŁo aceitação e nĂŁo cumprimento de normas das aulas e regras dos jogos) e indisposição dos meninos em jogar junto com as meninas, alĂ©m da falta de habilidade e do conhecimento das regras do futsal, principalmente entre os menores (7-10 anos). Ao final do Projeto foi observada melhora da tĂ©cnica, do comportamento tĂĄtico e a aprendizagem das regras do futsal, principalmente entre os menores de 10 anos. Houve melhora considerĂĄvel no comportamento dos alunos, pois os meninos passaram a ceder o lugar no ĂŽnibus para as meninas e as mĂŁes, maior aceitação da substituição durante o jogo, maior aceitação em jogar com alunos que nĂŁo tinham amizade, anteriormente, cuidado com o material do Projeto (bolas e coletes), aceitação do comando dos estagiĂĄrios/bolsistas, aceitação dos menos habilidosos e da diferença entre os gĂȘneros, para jogar. O ambiente externo Ă escola, a estrutura fĂsica (quadras e ginĂĄsio coberto), material adequado (bolas, cones, coletes), a realização de um âFestival de Futsalâ e a atuação dos estagiĂĄrios, em nosso entendimento, foram os fatores que contribuĂram para os resultados positivos. ConclusĂŁo: Ao final do Projeto verificamos que atravĂ©s da prĂĄtica do futebol/futsal foi possĂvel melhorar, alĂ©m das habilidades especĂficas do jogo e aprendizagem das regras, melhorar do comportamento geral dos alunos, o espĂrito esportivo e a aceitação das diferenças (habilidade de jogar e gĂȘnero).</span
Futebol: um meio de educar
Introdução: Atualmente, podemos classificar o esporte nas dimensĂ”es de alto rendimento, educacional, de participação-lazer e esporte âsocialâ. Devido Ă sua grande popularidade no Brasil, o futebol/futsal Ă© um esporte de grande aceitação pelas crianças e jovens e pode ser um meio de educar atravĂ©s de sua prĂĄtica. Objetivo: verificar a evolução da aprendizagem do futsal e se Ă© possĂvel melhorar o comportamento de crianças atravĂ©s da prĂĄtica do futsal. MĂ©todos: Foi feita uma avaliação qualitativa da evolução do comportamento e das habilidades do futsal, atravĂ©s da tĂ©cnica de observação participante, feita pelos estagiĂĄrios/bolsistas do Projeto (n=7), atravĂ©s das observaçÔes das aulas e os relatos foram discutidos em reuniĂ”es semanais. Fizeram parte da amostra todos os inscritos (6-8 anos, n=42; 9-10 anos, n=30; 11-12 anos, n=86; 13-14 anos, n=48) no Projeto âFutebol Escolaâ do Departamento de Educação FĂsica da Faculdade de CiĂȘncias/UNESP â Bauru, independente do gĂȘnero e da habilidade de jogar. As aulas foram realizadas aos sĂĄbados, com duração de 1h30, durante o ano de 2009, em quadras de futsal. A metodologia de ensino utilizada nas aulas combinou os mĂ©todos de ensino parcial, global, situacional e jogos prĂ©-desportivos. A estrutura das aulas foi subdividida em cinco partes: i-) conversa inicial; ii-) atividade recreativa sobre o tema da aula; iii-) jogo prĂ©-desportivo ou exercĂcios de fundamentos tĂ©cnicos do tema da aula; iv) jogo de futsal propriamente dito com regras adaptadas Ă s respectivas faixas etĂĄrias; v-) conversa final. Resultados: No inĂcio das aulas foi constatado mau comportamento de grande parte dos alunos: indisciplina (nas aulas e no ĂŽnibus), desrespeito aos colegas (agressĂ”es verbais e corporais) e aos estagiĂĄrios/bolsistas (nĂŁo aceitação e nĂŁo cumprimento de normas das aulas e regras dos jogos) e indisposição dos meninos em jogar junto com as meninas, alĂ©m da falta de habilidade e do conhecimento das regras do futsal, principalmente entre os menores (7-10 anos). Ao final do Projeto foi observada melhora da tĂ©cnica, do comportamento tĂĄtico e a aprendizagem das regras do futsal, principalmente entre os menores de 10 anos. Houve melhora considerĂĄvel no comportamento dos alunos, pois os meninos passaram a ceder o lugar no ĂŽnibus para as meninas e as mĂŁes, maior aceitação da substituição durante o jogo, maior aceitação em jogar com alunos que nĂŁo tinham amizade, anteriormente, cuidado com o material do Projeto (bolas e coletes), aceitação do comando dos estagiĂĄrios/bolsistas, aceitação dos menos habilidosos e da diferença entre os gĂȘneros, para jogar. O ambiente externo Ă escola, a estrutura fĂsica (quadras e ginĂĄsio coberto), material adequado (bolas, cones, coletes), a realização de um âFestival de Futsalâ e a atuação dos estagiĂĄrios, em nosso entendimento, foram os fatores que contribuĂram para os resultados positivos. ConclusĂŁo: Ao final do Projeto verificamos que atravĂ©s da prĂĄtica do futebol/futsal foi possĂvel melhorar, alĂ©m das habilidades especĂficas do jogo e aprendizagem das regras, melhorar do comportamento geral dos alunos, o espĂrito esportivo e a aceitação das diferenças (habilidade de jogar e gĂȘnero)
Futebol: um meio de educar
Introdução: Atualmente, podemos classificar o esporte nas dimensĂ”es de alto rendimento, educacional, de participação-lazer e esporte âsocialâ. Devido Ă sua grande popularidade no Brasil, o futebol/futsal Ă© um esporte de grande aceitação pelas crianças e jovens e pode ser um meio de educar atravĂ©s de sua prĂĄtica. Objetivo: verificar a evolução da aprendizagem do futsal e se Ă© possĂvel melhorar o comportamento de crianças atravĂ©s da prĂĄtica do futsal. MĂ©todos: Foi feita uma avaliação qualitativa da evolução do comportamento e das habilidades do futsal, atravĂ©s da tĂ©cnica de observação participante, feita pelos estagiĂĄrios/bolsistas do Projeto (n=7), atravĂ©s das observaçÔes das aulas e os relatos foram discutidos em reuniĂ”es semanais. Fizeram parte da amostra todos os inscritos (6-8 anos, n=42; 9-10 anos, n=30; 11-12 anos, n=86; 13-14 anos, n=48) no Projeto âFutebol Escolaâ do Departamento de Educação FĂsica da Faculdade de CiĂȘncias/UNESP â Bauru, independente do gĂȘnero e da habilidade de jogar. As aulas foram realizadas aos sĂĄbados, com duração de 1h30, durante o ano de 2009, em quadras de futsal. A metodologia de ensino utilizada nas aulas combinou os mĂ©todos de ensino parcial, global, situacional e jogos prĂ©-desportivos. A estrutura das aulas foi subdividida em cinco partes: i-) conversa inicial; ii-) atividade recreativa sobre o tema da aula; iii-) jogo prĂ©-desportivo ou exercĂcios de fundamentos tĂ©cnicos do tema da aula; iv) jogo de futsal propriamente dito com regras adaptadas Ă s respectivas faixas etĂĄrias; v-) conversa final. Resultados: No inĂcio das aulas foi constatado mau comportamento de grande parte dos alunos: indisciplina (nas aulas e no ĂŽnibus), desrespeito aos colegas (agressĂ”es verbais e corporais) e aos estagiĂĄrios/bolsistas (nĂŁo aceitação e nĂŁo cumprimento de normas das aulas e regras dos jogos) e indisposição dos meninos em jogar junto com as meninas, alĂ©m da falta de habilidade e do conhecimento das regras do futsal, principalmente entre os menores (7-10 anos). Ao final do Projeto foi observada melhora da tĂ©cnica, do comportamento tĂĄtico e a aprendizagem das regras do futsal, principalmente entre os menores de 10 anos. Houve melhora considerĂĄvel no comportamento dos alunos, pois os meninos passaram a ceder o lugar no ĂŽnibus para as meninas e as mĂŁes, maior aceitação da substituição durante o jogo, maior aceitação em jogar com alunos que nĂŁo tinham amizade, anteriormente, cuidado com o material do Projeto (bolas e coletes), aceitação do comando dos estagiĂĄrios/bolsistas, aceitação dos menos habilidosos e da diferença entre os gĂȘneros, para jogar. O ambiente externo Ă escola, a estrutura fĂsica (quadras e ginĂĄsio coberto), material adequado (bolas, cones, coletes), a realização de um âFestival de Futsalâ e a atuação dos estagiĂĄrios, em nosso entendimento, foram os fatores que contribuĂram para os resultados positivos. ConclusĂŁo: Ao final do Projeto verificamos que atravĂ©s da prĂĄtica do futebol/futsal foi possĂvel melhorar, alĂ©m das habilidades especĂficas do jogo e aprendizagem das regras, melhorar do comportamento geral dos alunos, o espĂrito esportivo e a aceitação das diferenças (habilidade de jogar e gĂȘnero)
Development of novel adenoviral vectors to overcome challenges observed with HAdV-5 based constructs
Recombinant vectors based on human adenovirus serotype 5 (HAdV-5) have been extensively studied in pre-clinical models and clinical trials over the last two decades. However, the thorough understanding of the HAdV-5 interaction with human subjects has uncovered major concerns about its product applicability. High vector-associated toxicity and widespread pre-existing immunity have been shown to significantly impede the effectiveness of HAdV-5 mediated gene transfer. It is therefore that the in depth knowledge attained working on HAdV-5 is currently being used to develop alternative vectors. Here, we provide a comprehensive overview of data obtained in recent years disqualifying the HAdV-5 vector for systemic gene delivery as well as novel strategies being pursued to overcome the limitations observed with particular emphasis on the ongoing vectorization efforts to obtain vectors based on alternative serotypes
Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world
Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic.
Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality.
Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States.
Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis.
Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection
Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.
How long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted life-years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years. Methods We used data for age-specific mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Socio-demographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males. Findings Globally, from 1990 to 2017, life expectancy at birth increased by 7·4 years (95% uncertainty interval 7·1-7·8), from 65·6 years (65·3-65·8) in 1990 to 73·0 years (72·7-73·3) in 2017. The increase in years of life varied from 5·1 years (5·0-5·3) in high SDI countries to 12·0 years (11·3-12·8) in low SDI countries. Of the additional years of life expected at birth, 26·3% (20·1-33·1) were expected to be spent in poor health in high SDI countries compared with 11·7% (8·8-15·1) in low-middle SDI countries. HALE at birth increased by 6·3 years (5·9-6·7), from 57·0 years (54·6-59·1) in 1990 to 63·3 years (60·5-65·7) in 2017. The increase varied from 3·8 years (3·4-4·1) in high SDI countries to 10·5 years (9·8-11·2) in low SDI countries. Even larger variations in HALE than these were observed between countries, ranging from 1·0 year (0·4-1·7) in Saint Vincent and the Grenadines (62·4 years [59·9-64·7] in 1990 to 63·5 years [60·9-65·8] in 2017) to 23·7 years (21·9-25·6) in Eritrea (30·7 years [28·9-32·2] in 1990 to 54·4 years [51·5-57·1] in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males in 2017, with extra years lived varying from 1·4 years (0·6-2·3) in Algeria to 11·9 years (10·9-12·9) in Ukraine. Of the extra years gained, the proportion spent in poor health varied largely across countries, with less than 20% of additional years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75·8 years [72·4-78·7]) and males (72·6 years [69·8-75·0]) and the lowest estimates were in Central African Republic (47·0 years [43·7-50·2] for females and 42·8 years [40·1-45·6] for males). Globally, in 2017, the five leading causes of DALYs were neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41·3% (38·8-43·5) for communicable diseases and by 49·8% (47·9-51·6) for neonatal disorders. For non-communicable diseases, global DALYs increased by 40·1% (36·8-43·0), although age-standardised DALY rates decreased by 18·1% (16·0-20·2)
Global burden of 369 diseases and injuries in 204 countries and territories, 1990â2019: a systematic analysis for the Global Burden of Disease Study 2019
Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990â2010 time period, with the greatest annualised rate of decline occurring in the 0â9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10â24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10â24 years were also in the top ten in the 25â49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50â74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens
Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic
This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic
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