Rabdomioma cardíaco associado a Esclerose Tuberosa e tratamento a base de ImTOR: uma revisão narrativa

O rabdomioma cardíaco se destaca sendo o principal tumor primário benigno do coração. Quando múltiplos, estão fortemente correlacionados a esclerose tuberosa, uma condição genética de alteração dos genes TSC-1 e TSC-2. Essas mutações influenciam diretamente no cresciemento celular e por fim acabam produzindo tumorações pelo organismo, estando assim fortemente correlacionada aos rabdomiomas cardíacos multiplos. Com isso, essa revisão literária tem como objetivo esclarecer como essas patologias se associam, suas consequências, seu diagnóstico e tratamento. Levando em consideração o caratér maléfico das patologias associadas, destaca-se a importância do conhecimento acerca do assunto para melhor compreensão dessas condições raras, para que se possa fazer o manejo desses pacientes corretamente. Principalmente quanto ao seu diagnóstico, que deve ser realizado precocemente com ecocardiogramas na vida intra-uterina a partir da 17ª semana e seu tratamento de acordo com o comprometimento cardíaco fetal, sendo por muitas vezes necessária a utilização de tratamento cirúrgico, mesmo sendo uma patologia que pode regredir de forma expontânea. Ademais, novas estratégias terapeuticas vem sendo estudadas para o tratamento do rabdomioma associada a esclerose tuberosa com a utilização de Everolimus e Sirulimus, com expectativas otimistas acerca do desfecho desses pacientes

Benefícios de procedimentos minimamente invasivos em cirurgias ortopédicas: revisão de literatura: Benefits of minimally invasive procedures in orthopedic surgeries: literature review

Este estudo analisou artigos de revisão sistemática, estudos de meta-análises e  ensaios clínicos randomizados e observou os aspectos comparativos entre os procedimento cirúrgicos convencionais e minimamente invasivos. O tratamento cirúrgico visto como o modelo mais invasivo de resolução de infecções ortopédicas, atualmente encontra- se em expansão tanto em na alta demanda de pacientes quanto em relação a introdução de avanços tecnológicos nas diversas técnicas previamente preconizadas. Nesse sentido, a necessidade de promover melhores resultados clínicos e funcionais para os pacientes ortopédicos colabora para a inovação contínua dos equipamentos cirúrgicos, assim como é fomentado a importância da educação continuada entre os cirurgiões. Destacando as principais cirurgias ortopédicas realizadas como fratura de fêmur e artroplastia do joelho visto a incidência relevante, constata-se que a prática das técnicas minimamente invasivas promove inúmeros benefícios ao paciente quando comparadas aos padrões de cirurgia aberta

Ocorrência de fratura por estresse em atletas: revisão de literatura / Occurrence of stress in athletes: literature review

Este estudo analisou artigos de revisão sistemática e relatos de casos e observou os diversos fatores que interferem na saúde óssea e na propensão de maior risco da ocorrência de fraturas por estresse. O índice crescente de práticas esportivas para manutenção da saúde e o aumento da expectativa de vida no século 21, acarretam em um aumento no número de casos de fraturas por estresse em diversos ossos do corpo, principalmente os longos dos membros inferiores. Além disso, o aumento do número de casos de osteoporose, advindos do crescimento populacional de idosos, colabora para a ocorrência dessas fraturas. As lesões de tíbia, fíbula e úmero passaram a ter incidência relevante, quando falamos de fraturas por estresse, tornando essencial o relato precoce dos casos, principalmente o atleta, visando diminuir o tempo de recuperação

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research