Manejo da hanseníase na atenção primária: diagnóstico e tratamento / Leprosy management in primary care: diagnosis and treatment

A Hanseníase é uma patologia de evolução alongada, e seu agente causador é o Mycobacterium leprae. Seus sinais e sintomas são no nível dermatoneurológico. Nesse contexto, esse estudo tem por objetivo geral analisar por meio da pesquisa baseada em evidências - PBE- achados da literatura, sobre estigmas que envolvem pacientes com hanseníase e praticas da educação em saude durante o tratamento na atenção básica. Pesquisa baseada em evidências, utilizando os indexadores Pubmed, Scielo e Cohcrane com os seguintes filtros: resumo abstract, textos open access, idioma português e inglês, período 2016 a 2021. Também foram utilizados manuais e boletins epidemiológicos disponíveis na página do Ministério da Saúde. O material foi selecionado de modo a buscar responder os objetivos dessa pesquisa e portanto utilizou os descritores em saúde: hanseníase, atenção básica, diagnóstico, tratamento. Foram abordadas práticas de educação em saude que envolvem orientações e estigmas em saude. Entende-se que o manejo da hanseníase envolve sensibilidade, consciência e sobretudo conhecimento embasado para consubstanciar a prática clínica

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Efeito da fonte de fibra e uso de xilanase sobre desempenho, qualidade de ovos e biometria dos órgãos gastrointestinais de poedeiras leves

Exportado OPUSMade available in DSpace on 2019-08-14T04:51:52Z (GMT). No. of bitstreams: 1 efeito_da_fonte_de_fibra_e_uso_de_xilanase_sobre_desempenho__qualidade_de__ovos_e_biometria_dos__rg_os_gastrointestinais_de_poedeiras_leves_lorena_salim__de_sousa.pdf: 1161111 bytes, checksum: 04d01b0298e733d931a5451b1042da02 (MD5) Previous issue date: 15Objetivou-se avaliar o efeito de diferentes fontes de fibras com inclusão ou não de enzima em rações para poedeiras de 25 a 45 semanas de idade. Foram utilizadas 864 aves da linhagem comercial Lohmann®, distribuídas em delineamento inteiramente casualizado em esquema fatorial 3x2, compreendendo três fontes de fibras (farelo de trigo, casca de soja e casca de café) e a inclusão ou não de uma xilanase, totalizando seis tratamentos e seis repetições/tratamento. No período experimental que teve duração de 20 semanas foram avaliados os parâmetros de desempenho das aves, qualidade dos ovos e biometria dos órgãos intestinais. Não houve interação entre os fatores sobre as características avaliadas. A inclusão de enzima não influenciou os parâmetros avaliados. As fontes de fibras tiveram efeito sobre ganho de peso, viabilidade, peso do ovo, parâmetros de qualidade da casca, cor da gema e peso relativo do fígado e moela. As cascas de café, de soja e o farelo de trigo podem ser utilizadas na ração de poedeiras sem prejudicar o desempenho. A enzima avaliada não se mostrou eficiente em melhorar o desempenho e a qualidade da casca de ovos de poedeiras.This study aimed to evaluate the effect of different dietary fiber sources varying in xylanase inclusion on productive performance, egg quality and digestive organ biometry of laying hens. A total of 864 Lohmann White hens were fed diets with 3 fiber sources (wheat bran, soybean hull and coffee hull) with or without xylanase inclusion in a 3x2 factorial arrangement from 25 to 44 weeks of age. Each treatment was replicated 6 times (6 hens per replicate). There were no interactions (P > 0.05) between dietary fiber and xylanase inclusion. The enzyme supplementation did not influence any parameters evaluated (P > 0.05). There were dietary fiber effects (P<0,05) on body weight gain, viability, egg weight, eggshell quality, yolk pigmentation and liver and gizzard relative weights. The wheat bran, soybean hull and coffee hull can be used in laying hen diets without cause any detrimental effect on productive performance. The enzyme used in this experiment did not show any improvement in hen´s performance and eggshell quality

Fiber source and xylanase on performance, egg quality, and gastrointestinal tract of laying hens

ABSTRACT The objective of this study was to ascertain the influence of different dietary fiber sources and the usage of xylanase on diet of commercial layers and their influence on productive performance, egg quality, and digestive organ biometry. A total of 864 Lohmann® White hens was fed diets with three different fiber sources (wheat bran, soybean hull, or coffee husk) with or without xylanase inclusion (concentration of 160,000 BXU/g) in a 3×2 factorial arrangement, with six replicates of 24 birds each, from 25 to 44 weeks of age. There were no interactions between dietary fiber and xylanase inclusion. The enzyme supplementation did not influence any parameters evaluated. There were dietary fiber effects on body weight gain, viability, egg weight, eggshell quality, yolk pigmentation, and liver and gizzard relative weights. Wheat bran, soybean hull, and coffee husk can be used in laying hen diets without detrimental effect on productive performance. The enzyme used had no effect on the performance and eggshell quality of laying hens

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

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

AimThe 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.MethodsThis 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.ResultsOverall, 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 ConclusionOne 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

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

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