55 research outputs found

    Cegueira silenciosa: revisĂŁo narrativa e estudo epidemiolĂłgico do glaucoma no Brasil entre 2017 e 2022: Silent blindness: narrative review and study epidemiology of glaucoma in Brazil between 2017 and 2022

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    Considerado um problema de saĂșde pĂșblica por representar importante causa de cegueira irreversĂ­vel, alĂ©m de demandar altos gastos ao Sistema Único de SaĂșde, o glaucoma urge atenção especializada no Brasil. Objetivou-se, primeiramente, alcançar perspectivas especĂ­ficas no que tange ao glaucoma, abrangendo questĂ”es etiolĂłgicas, fisiopatolĂłgicas, clĂ­nico-sintomatolĂłgicas, comportamentais, diagnĂłsticas, tĂ©cnicas terapĂȘuticas, alĂ©m de levantar dados epidemiolĂłgicos acerca da prevalĂȘncia do glaucoma. As tabulaçÔes de dados advindas do DATASUS-TabNet evidenciam as seguintes variĂĄveis atreladas Ă  doença: histĂłria familiar positiva, faixa etĂĄria acima de 45 anos, acometimento majoritĂĄrio em indivĂ­duos do sexo masculino, etnia negra, preponderĂąncia na regiĂŁo Sudeste do Brasil, escolaridade limitada e recorrĂȘncia alinhada a fatores de risco comportamentais presentes ao longo da vida. O diagnĂłstico perfaz a realização de exame oftalmolĂłgico atrelado a exames complementares. Em relação ao acompanhamento e ao tratamento, Ă© fundamental uma postura individualizada para o direcionamento de condutas especializadas para cada paciente

    A INCIDÊNCIA DA HEMORRAGIA DIGESTIVA ALTA EM PACIENTES PEDIÁTRICOS APÓS USO DE ANTI-INFLAMATÓRIOS NÃO ESTEROIDAIS

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    INTRODUCTION: Upper Gastrointestinal Bleeding (OGH) in children is a clinical condition in which its causes are rarely reported in the literature, but studies demonstrate a correlation between prolonged or continuous use of non-steroidal anti-inflammatory drugs (NSAIDs) and the incidence of cases in pediatrics. OBJECTIVES: The present study seeks to analyze, through a bibliographic review, more in-depth studies and analyzes on the prolonged use of NSAIDs and the incidence of HGA in underage patients. METHODOLOGY: Bibliographic review carried out from June to July 2023. Literature searches were carried out in the PubMed and Scientific Electronic Library Online (SciELO) databases. 238 articles were found and after applying inclusion and exclusion criteria, 18 articles were selected to form the collection. RESULTS: The different studies analyzed demonstrate that although NSAIDs are predictors of damage to the gastric mucosa, they tend to play an indirect role in causing Upper Gastrointestinal hemorrhage. In this sense, in the majority of cases studied, patients have another risk factor for this complication - given a pre-existing intestinal injury, correlated with self-medication, especially medication administration without the correct dosage by parents/guardians. CONCLUSION: The mechanism of injury caused by NSAIDs is already known, however, there are still disagreements on the subject in question. It is essential that parents or guardians pay attention to the ideal dosage prescribed by doctors, respecting the medication administration interval, thus avoiding its irregular use and, therefore, its more vigorous consequences on the NSAID and HGA correlation in children, since which are highly complex cases and may require urgent care and hospitalization.INTRODUÇÃO: Hemorragia Gastrointestinal Alta (HGA) em crianças Ă© uma condição clĂ­nica na qual suas causas sĂŁo pouco relatadas na literatura, porĂ©m estudos demonstram correlação entre uso prolongado ou contĂ­nuo de anti-inflamatĂłrios nĂŁo esteroidais (AINES) com a incidĂȘncia de casos na pediatria. OBJETIVOS: O presente estudo busca analisar por meio de uma revisĂŁo bibliogrĂĄfica estudos e anĂĄlises mais aprofundados sobre o uso prolongado de AINES e a incidĂȘncia de HGA em pacientes menores de idade. METODOLOGIA: RevisĂŁo BibliogrĂĄfica realizada no perĂ­odo de junho a julho de 2023. As buscas da literatura foram feitas nas bases de dados PubMed e Scientific Electronic Library Online (SciELO). Foram encontrados 238 artigos e apĂłs aplicação de critĂ©rios de inclusĂŁo e exclusĂŁo, 18 artigos foram selecionados para a composição da coletĂąnea. RESULTADOS: Os diferentes estudos analisados demonstram que apesar dos AINES serem preditores de lesĂŁo na mucosa gĂĄstrica, tendem a exercer papel indireto na causa de hemorragia Gastrointestinal Alta. Nesse sentido, a maioria dos casos estudados os pacientes possuem outro fator de risco para referida complicação- haja vista uma lesĂŁo intestinal prĂ©-existente, correlacionado a automedicação, sobretudo, a administração medicamentosa sem a posologia correta por pais/responsĂĄveis. CONCLUSÃO: O mecanismo de lesĂŁo pelo de AINES jĂĄ Ă© conhecido, porĂ©m, ainda existem divergĂȘncias sobre o assunto em questĂŁo. É imprescindĂ­vel que os pais ou responsĂĄveis atentem-se Ă  posologia ideal prescrita por mĂ©dicos, respeitando o intervalo de administração do medicamento, evitando assim o seu uso irregular e, portanto, suas consequĂȘncias mais vigorosas sobre a correlação AINES e HGA em crianças, uma vez que sĂŁo casos de alta complexidade podendo precisar de atendimento e internação de urgĂȘncia

    ANÁLISE COMPARATIVA DO EIXO INTESTINO-CÉREBRO: RELAÇÃO ENTRE DISBIOSE E DEPRESSÃO.

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    OBJECTIVE: The present study seeks to analyze the intestine-brain axis through scientific literature, focusing on the transition of nutritional patterns, seeking a relationship between dysbiosis and depression. METHODOLOGY: Bibliographic review carried out from June to July 2023. Literature searches were carried out in the PubMed and Scientific Electronic Library Online (SciELO) databases. 209 articles were found and, after the inclusion criteria, 21 studies were selected to be included. RESULTS: The different studies analyzed indicate that the microbiota can be affected by several factors, such as probiotics, diet, antibiotics and dietary factors. As a result, changes in the microbiota, known as dysbiosis, can lead to dysregulation of the gut-brain axis and cause changes in mood, as well as depression. Therefore, it is necessary to carry out studies to better understand the gut-brain axis, with an emphasis on the relationship between dysbiosis and depression, in order to provide a better quality of life for such patients. CONCLUSION: It is necessary to balance care in the face of daily hyperactivity, associated with a reduction in negligence regarding diet, sleep quality and regular exercise, in order to control bacterial proliferation. In this sense, there is evidence that the microbiota directly interferes with the CNS, both in the prevention of diseases such as colorectal cancer, but being a causal factor in chronic inflammatory diseases, ulcerative colitis and Crohn's disease. Thus, the microbiome is a system that is evolving and maturing through the different stratifications of life.OBJETIVO: O presente estudo busca analisar por meio da literatura cientĂ­fica o eixo intestino-cĂ©rebro, com foco na transição dos padrĂ”es nutricionais, buscando relação da disbiose e depressĂŁo. METODOLOGIA: RevisĂŁo BibliogrĂĄfica realizada no perĂ­odo de junho a julho de 2023. As buscas da literatura foram feitas nas bases de dados PubMed e Scientific Electronic Library Online (SciELO). Foram encontrados 209 artigos e selecionados, apĂłs os critĂ©rios de inclusĂŁo, 21  estudos para compor. RESULTADOS: Os diferentes estudos analisados apontam que a microbiota pode ser afetada por diversos fatores, tais como, probiĂłticos, dieta, antibiĂłticos e fatores alimentares. Com isso, a alteração da microbiota, a disbiose, pode levar Ă  desregulação do eixo intestino-cĂ©rebro e causar mudanças no humor, alĂ©m de quadros depressivos. Assim, Ă© necessĂĄrio que se tenha estudos para melhor compreender o eixo intestino-cĂ©rebro, com ĂȘnfase na relação da disbiose com a depressĂŁo, a fim de proporcionar uma melhor qualidade de vida a tais pacientes. CONCLUSÃO: Faz-se necessĂĄrio, equilibrar o cuidado perante a hiperatividade diĂĄria, associando-se a diminuição das negligĂȘncias com relação a dieta, qualidade do sono e prĂĄtica de exercĂ­cios regulares, a fim de controlar a proliferação bacteriana. Nesse sentido, hĂĄ evidencias que a microbiĂłta interfere diretamente o SNC, tanto na prevenção de doenças como o Cancer colorretal, mas sendo fator causal nas Doenças InflamatĂłrias crĂŽnicas, Colite Ulcerativa e Doença de Crohn. Dessa forma, o microbioma Ă© um sistema que estĂĄ em evolução e amadurecimento por meio das diferentes estratificaçÔes da vida

    PERFIL EPIDEMIOLÓGICO DAS CRIANÇAS COM PNEUMONIA NO ESPÍRITO SANTO ENTRE 2018 E 2023

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    INTRODUCTION: Pneumonia is a clinical syndrome characterized by inflammation of the lung parenchyma, being the main infectious cause of death in children worldwide. In Brazil, pneumonia is considered the third cause of infant mortality. Coordination of care for children with pneumonia is essential, enabling early diagnosis and treatment, as well as continuity of care. OBJECTIVE: To identify socioeconomic, environmental and clinical factors of pediatric patients affected by pneumonia, focusing on the state of EspĂ­rito Santo. METHOD: Cross-sectional research, with a qualitative and quantitative approach, with data from January 2018 to August 2023. Data collection was carried out through the SUS Hospital Information System (SIH/SUS), hosted at DATASUS). The research participants were children from EspĂ­rito Santo with pneumonia, aged 0 to 9 years. RESULTS: In relation to the number of hospitalizations, black and brown race/color lead hospitalizations with a total of 65.20% of hospitalizations. In relation to hospitalizations by sex, in a total of 18,883 hospitalizations, 53.22% were male and 46.78% female. Assessing age, of the total of 18,883 hospitalizations, it was noticed that the majority were patients aged 1 to 4 years old with 54.52% of hospitalizations, under one year old 30.73% and 5 to 9 years old were 14.75%. of hospitalizations. CONCLUSION: The vast majority of cases were urgent. Of these, more than half of the hospitalizations occurred in the age group of 1 to 4 years. Furthermore, the highest number of deaths also occurred in this age group. Therefore, it is important to highlight the need for early diagnosis, identifying signs and symptoms in children, in order to reduce emergency hospitalizations and, concomitantly, the number of deaths from this disease.INTRODUÇÃO: A pneumonia Ă© uma sĂ­ndrome clĂ­nica caracterizada pela inflamação do parĂȘnquima pulmonar, sendo a principal causa infecciosa de morte em crianças no mundo. No Brasil,  a pneumonia Ă© considerada a terceira causa de mortalidade infantil. A coordenação do cuidado da criança com pneumonia Ă© fundamental, possibilitando o diagnĂłstico e o tratamento precoces, bem como a continuidade do cuidado. OBJETIVO: Identificar fatores socioeconĂŽmicos, ambientais e clĂ­nicos dos pacientes pediĂĄtricos acometidos pela pneumonia, com foco no estado do EspĂ­rito Santo. MÉTODO: Pesquisa transversal, de abordagem qualitativa e quantitativa, com dados referentes a janeiro de 2018 a agosto de 2023. A coleta dos dados foi feita atravĂ©s do Sistema de InformaçÔes Hospitalares do SUS (SIH/SUS), hospedado no DATASUS). Os componentes da pesquisa foram crianças capixabas com quadro de pneumonia, na faixa etĂĄria de 0 a 9 anos. RESULTADOS: Com relação ao nĂșmero de internaçÔes, a raça/cor preta e parda lideram as internaçÔes com um total 65,20% das internaçÔes. Em relação Ă s internaçÔes por sexo, em um total de 18.883 internaçÔes, 53,22% foram do sexo masculino e 46,78% do sexo feminino. Avaliando a idade, do total de 18.883 internaçÔes, percebeu-se que a maioria foram pacientes de 1 a 4 anos com 54,52% das internaçÔes, menores de um ano 30,73% e de 5 a 9 anos foram 14,75% das  internaçÔes. CONCLUSÃO: A grande maioria dos casos foi em carĂĄter de urgĂȘncia. Destes, mais da metade das internaçÔes ocorreu na faixa etĂĄria de 1-4 anos. AlĂ©m disso, o maior nĂșmero de Ăłbitos tambĂ©m acompanhou esta faixa etĂĄria. Assim, Ă© importante ressaltar a necessidade de diagnĂłstico precoce pela identificação de sinais e sintomas dos infantos, a fim de reduzir as internaçÔes em carĂĄter de urgĂȘncia e, concomitantemente, o nĂșmero de Ăłbitos por essa doença

    PERFIL EPIDEMIOLÓGICO DE CRIANÇAS COM INFECÇÃO DE TRATO URINÁRIO NO ESPÍRITO SANTO ENTRE 2018 E 2023

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    INTRODUCTION: urinary tract infection (UTI) occurs due to the invasion and proliferation of microorganisms in the urinary system, which can compromise any segment of it, such as kidneys, ureters, bladder and urethra. UTI is a very common condition in pediatric patients and infants, considered one of the most common bacterial infections in pediatrics, which mostly affects girls. OBJECTIVE: To analyze the number of children with urinary tract infections and their respective epidemiological profile, in the last five years, focusing on the state of EspĂ­rito Santo. METHOD: Cross-sectional research, with a qualitative and quantitative approach, with data from January 2018 to August 2023. Data collection was carried out through the SUS Hospital Information System (SIH/SUS), hosted at DATASUS. The research participants were children from EspĂ­rito Santo with urinary tract infections, aged 0 to 9 years. RESULTS: Regarding the number of hospitalizations by race/color, brown ethnicities proved to be relevant with 65% of occurrences, followed by white ethnicities with 17.15%, in third place uninformed ethnicities with 16.25%, as well as to a lesser extent scale, black ethnicity with 64 cases 1.44%. Regarding the number of hospitalizations by sex, there was a greater predominance in females with 61.61% compared to males with 38.38% compared to the total. CONCLUSION: From data collection, it is concluded that UTI is a very common disease in children and breastfeeding women in EspĂ­rito Santo, with the majority of cases being female patients (61.61%), while ranges 0 to 4 years obtained the vast majority of cases (68.93%), with 98% of hospitalizations being urgent. Therefore, it is necessary to implement state prevention measures and early diagnosis of this disease, for better care for parents with their children, depending on their age, since in younger children there is a more non-specific clinical condition than in older children.INTRODUÇÃO: infecção do trato urinĂĄrio (ITU) ocorre devido Ă  invasĂŁo e a proliferação de microrganismos no sistema urinĂĄrio, podendo comprometer qualquer segmento do mesmo, como rins, ureteres, bexiga e uretra. A ITU Ă© uma condição muito comum em pacientes pediĂĄtricos e lactentes, considerada uma das infecçÔes bacterianas mais frequentes na pediatria, na qual afeta majoritariamente as meninas. OBJETIVO: Analisar o nĂșmero de crianças com infecção do trato urinĂĄrio e seu respectivo perfil epidemiolĂłgico, nos Ășltimos cinco anos, com foco no estado do EspĂ­rito Santo. MÉTODO: Pesquisa transversal, de abordagem qualitativa e quantitativa, com dados referentes a janeiro de 2018 a agosto de 2023. A coleta dos dados foi feita atravĂ©s do Sistema de InformaçÔes Hospitalares do SUS (SIH/SUS), hospedado no DATASUS. Os componentes da pesquisa foram crianças capixabas com quadro de infecção do trato urinĂĄrio, na faixa etĂĄria de 0 a 9 anos. RESULTADOS: Com relação ao nĂșmero de internaçÔes por raça/cor, etnias pardas mostrou-se relevante com 65% de ocorrĂȘncias, seguido de etnia branca 17,15%, em terceiro lugar etnias nĂŁo informadas com 16,25%, assim como em menor escala, etnia preta com 64 casos 1,44%. Referente ao nĂșmero de internaçÔes por sexo, verificou-se maior predomĂ­nio no sexo feminino com 61,61% quando comparado ao sexo masculino de 38,38% contraposto a totalidade. CONCLUSÃO: A partir da coleta de dados, conclui-se que a ITU Ă© uma doença muito comum em crianças e lactantes capixabas, sendo a maioria dos casos entre os pacientes de sexo feminino (61,61%), enquanto as faixas 0 a 4 anos obtiveram a grande maioria dos casos (68,93%), sendo que 98% das internaçÔes foram em carĂĄter de urgĂȘncia. Assim, faz-se necessĂĄrio a implementação de medidas estatais de prevenção, e diagnĂłstico precoce dessa doença, para melhor atenção dos pais com seus filhos, conforme a idade, jĂĄ que em crianças menores hĂĄ uma clĂ­nica mais inespecĂ­fica do que a das crianças maiores

    ABORDAGEM DO DIAGNÓSTICO DIFERENCIAL DE DOR TORÁCICA NA EMERGÊNCIA

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    Chest pain is one of the main causes of emergency hospitalizations, with 4 million visits being made annually. The causes of this condition range from muscle contractures to myocardial infarction and non-cardiogenic causes, such as disorders of the digestive tract. The subjectivity of chest pain becomes the main difficulty in the accurate diagnosis and necessary management for the patient. OBJECTIVE: Find ways to optimize the diagnosis of chest pain in emergency care, aiming to cause less cardiogenic damage to patients. METHODOLOGY: The present study consists of a literary review with a bibliographic survey in databases such as PubMed and Scielo. As an inclusion criterion, articles published in the last 16 years (2007 to 2023) that addressed the researched topic and that were available in digital format were considered. RESULTS: In the first consultation, the reception with the patient's risk classification enabled better flexibility, specification of the severity and risk factors that could be aggravating the patient's life. The most important initial exam is the ECG, which must be performed within 10 minutes, together with biomarkers and the history taken, which are important for the patient's differential diagnosis. FINAL CONSIDERATIONS: it was noticed that time is very important in the differential diagnosis of chest pain. However, speed is hampered by the subjectivity of patients' pain. Therefore, an adequate approach by healthcare professionals in this situation is necessary, in addition to new studies that can optimize emergency protocols.A dor torĂĄcica Ă© uma das principais causas de internaçÔes de emergĂȘncia, sendo realizados anualmente 4 milhĂ”es de atendimentos. As causas desse quadro tĂȘm origem desde contraturas musculares a infarto do miocĂĄrdio e causas nĂŁo cardiogĂȘnicas, como acometimentos do trato digestivo. A subjetividade da dor torĂĄcica se torna a principal dificuldade para o diagnĂłstico preciso e a conduta necessĂĄria para o paciente.   OBJETIVO: Encontrar formas que otimizem o diagnĂłstico da dor torĂĄcica nos atendimentos de emergĂȘncia, visando causar menores danos cardiogĂȘnicos aos pacientes. METODOLOGIA: O presente estudo consiste em uma revisĂŁo literĂĄria com  levantamento bibliogrĂĄfico em bases de dados como o PubMed e Scielo. Como critĂ©rio de inclusĂŁo, foram considerados artigos publicados nos Ășltimos 16 anos (2007 a 2023), que abordassem o tema pesquisado e que estivessem disponĂ­veis em formato digital. RESULTADOS: No primeiro atendimento, a realização do acolhimento com classificação de risco do paciente, possibilitou uma melhor flexibilidade, especificação da gravidade e dos fatores de risco que possam ser agravantes para a vida do paciente. O exame inicial mais importante Ă© o ECG, devendo ser realizado em atĂ© 10 minutos, junto aos biomarcadores e a histĂłria colhida, sendo importantes para o diagnĂłstico diferencial do paciente. CONSIDERAÇÕES FINAIS: percebeu-se que o tempo Ă© muito importante no diagnĂłstico diferencial da dor torĂĄcica. PorĂ©m, a rapidez Ă© dificultada pela subjetividade das dores dos pacientes. Assim, Ă© necessĂĄrio uma adequada abordagem do profissional da saĂșde nessa situação, alĂ©m de novos estudos que possam otimizar os protocolos na emergĂȘncia

    ANÁLISE DO PERFIL EPIDEMIOLÓGICO DE PACIENTES INTERNADOS POR LEPTOSPIROSE NO BRASIL ENTRE 2017 A 2022

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    Human leptospirosis is a disease caused by a bacteria of the genus Leptospira, infection of people occurs mainly through the urine of infected animals or contaminated water, with wounds on the skin, ocular mucous membranes, oral and nasal cavities being the main entry points for the human body. In the past, it was said that this disease predominated in rural areas, but today it is known that the majority of those infected are in urban areas. OBJECTIVE: To describe the epidemiological aspects of leptospirosis in Brazil METHODS: Cross-sectional research, with a quantitative and qualitative approach, with data from January 2018 to December 2022. The selected participants were Brazilians infected by the leptospira bacteria. Data collection was done through the SUS Hospital Information System (SIH/SUS), hosted at DATASUS. RESULTS: According to the data obtained, it was found that the total number of people infected by leptospirosis in these 5 years was 9,742. Of those infected in Brazil, 3,298 (34.81%) live in the southern region, 2,685 (28 .34%) live in the southeast region, 1,086 (11.46%) in the north region, 2,257 (23.82%) in the northeast region and 146 (1.54%) in the central-west region. It is also important to highlight the total number of deaths due to reported conditions, which was 580, corresponding to a fatality rate of 5,95% of infected citizens. CONCLUSION: Leptospira infection is more common in places where floods frequently occur, especially in urban locations, and transmission is increased by the lack of prevention and awareness actions among the population.A leptospirose humana Ă© uma doença causada por uma bactĂ©ria do gĂȘnero Leptospira, a infecção de pessoas acontece principalmente atravĂ©s da urina de animais contagiados ou por ĂĄgua contaminada, sendo feridas na pele, mucosas oculares, cavidade bucal e nasal as principais portas de entrada para o corpo humano. Antigamente, dizia-se que essa doença predominava na ĂĄrea rural, mas sabe-se, hoje, que na ĂĄrea urbana Ă© onde estĂĄ a maior parte dos infectados. OBJETIVO: Descrever os aspectos epidemiolĂłgico da leptospirose no Brasil MÉTODOS: Pesquisa transversal, de abordagem quantitativa e qualitativa, com dados de janeiro de 2018 a dezembro de 2022. Os participantes selecionados foram brasileiros infectados pela bactĂ©ria leptospira. A coleta dos dados foi feita por meio do Sistema de InformaçÔes Hospitalares do SUS (SIH/SUS), hospedado no DATASUS. RESULTADOS: De acordo com os dados obtidos, Ă© constatado que o nĂșmero total de pessoas infectadas pela leptospirose nesses 5 anos foi de 9742. Sendo que, desses infectados no Brasil, 3.298 (34,81%) habitam na regiĂŁo sul, 2.685 (28,34%) habitam na regiĂŁo sudeste, 1.086 (11,46%)na regiĂŁo norte, 2.257 (23,82%) na regiĂŁo nordeste e 146 (1,54%) na regiĂŁo centro-oeste. É importante destacar tambĂ©m o total de Ăłbitos por agravo notificado, que foi de 580, correspondendo a um Ă­ndice de letalidade de 5,95% dos cidadĂŁos infectados. CONCLUSÃO: A infecção pela leptospira Ă© mais frequente em locais que frequentemente ocorrem enchentes, principalmente em localidades urbanas, e a transmissĂŁo Ă© potencializada pela falta de açÔes de prevenção e conscientização da população

    Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

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    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

    The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

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    AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

    Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

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    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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