35 research outputs found
Manoel Ferreira de AraĂșjo GuimarĂŁes, a Academia Real Militar do Rio de Janeiro e a definição de um gĂȘnero cientĂfico no Brasil em inĂcios do sĂ©culo XIX
The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study
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 4âweeks 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 4âweeks. 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%, PÂ =Â 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, Pâ<â0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, PÂ =Â 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, PÂ =Â 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
Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study
Background
Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave.
Methods
This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs.
Results
Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; pâ=â0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; pââ€â0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; pâ=â0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; pâ=â0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; pâ=â0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI â 0.47, 1.37, pâ=â0.34) and hospital (adj. difference 1.4 days; 95% CI â 0.62, 2.35, pâ=â0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, pâ=â0.24) when adjusted for covariates.
Conclusions
Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility.
Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021)
Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTICâHF: baseline characteristics and comparison with contemporary clinical trials
Aims:
The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTICâHF) trial. Here we describe the baseline characteristics of participants in GALACTICâHF and how these compare with other contemporary trials.
Methods and Results:
Adults with established HFrEF, New York Heart Association functional class (NYHA)ââ„âII, EF â€35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokineticâguided dosing: 25, 37.5 or 50âmg bid). 8256 patients [male (79%), nonâwhite (22%), mean age 65âyears] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NTâproBNP 1971âpg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTICâHF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressureâ<â100âmmHg (n = 1127), estimated glomerular filtration rate <â30âmL/min/1.73 m2 (n = 528), and treated with sacubitrilâvalsartan at baseline (n = 1594).
Conclusions:
GALACTICâHF enrolled a wellâtreated, highârisk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation
Brincando com a fĂsica: ensino lĂșdico na forma de teatro em espaço nĂŁo formal
Physics teaching, using different tools combined with environments outside the classroom, can become widely pleasant and efficient, both for the teacher and for the students. Thus, it has been developed a project named Brincando com a FĂsica (Playing with Physics), in which a series of experiments presented in a dynamic and entertaining plot of a theater, is explored. Besides developing the artistic potential of students, theater allows to know physical concepts of non-mandatory way in non-formal spaces and also approach the biography and contributions of several scientists. The development of Brincando com a FĂsica theater, maintains a continuous and immersive interaction with the public. Thus, this public does not behave as a mere spectator, it constantly participates in the moments presented by "actors", either individually, selected randomly, sometimes collectively. It is part of the theater, a synchronized soundtrack and also a series of images and videos that help explain the physical concepts involved in each of the experiments presented by the team. In this context, the project Brincando com a FĂsica has with the main objective, arouse the curiosity of the students of the schools of primary and secondary education, about the concepts of physics involved in experiments and / or actual situations of non-classical form everyday life, that is, present contents in different situations, complementing what is covered in the classroom for these students.O ensino de FĂsica, utilizando ferramentas diferenciadas aliadas a ambientes extraclasse, pode se tornar amplamente prazeroso e eficiente, tanto para o educador, como para os estudantes. Neste sentido, tem sido desenvolvido um projeto denominado Brincando com a FĂsica, no qual Ă© explorada uma sĂ©rie de experimentos apresentados em um enredo dinĂąmico e divertido de uma peça teatral. AlĂ©m de desenvolver o potencial artĂstico dos estudantes, as peças teatrais permitem conhecer conceitos fĂsicos de forma nĂŁo obrigatĂłria em espaços nĂŁo formais, alĂ©m de abordar a biografia e contribuiçÔes de vĂĄrios cientistas. O desenvolvimento da peça teatral mantĂ©m uma interação contĂnua e envolvente com pĂșblico. Dessa forma, este pĂșblico nĂŁo se comporta apenas como mero espectador, pois participa constantemente dos quadros apresentados pelos âatoresâ, ora individualmente, selecionados de forma aleatĂłria, ora coletivamente. Faz parte da peça teatral, uma trilha sonora sincronizada e tambĂ©m uma sĂ©rie de imagens e vĂdeos que auxiliam na explicação dos conceitos fĂsicos envolvidos em cada um dos experimentos apresentados pela equipe. Neste contexto, o projeto Brincando com a FĂsica tem com objetivo principal, despertar a curiosidade dos estudantes das escolas de ensino fundamental e mĂ©dio, quanto aos conceitos de FĂsica envolvidos em experimentos e/ou situaçÔes reais do cotidiano de forma nĂŁo clĂĄssica, ou seja, abordar conteĂșdos dentro de situaçÔes diferenciadas, complementando o que Ă© abordado em sala de aula por estes estudantes.Fundação de Amparo Ă Pesquisa do Estado de SĂŁo Paulo (FAPESP
NĂșcleos de Ensino da Unesp: artigos 2014: volume 2: metodologias de ensino e a apropriação de conhecimento pelos alunos
Mandioca, a rainha do Brasil? AscensĂŁo e queda da Manihot esculenta no estado de SĂŁo Paulo
Co-infection and ICU-acquired infection in COIVD-19 ICU patients: a secondary analysis of the UNITE-COVID data set
Background: The COVID-19 pandemic presented major challenges for critical care facilities worldwide. Infections which develop alongside or subsequent to viral pneumonitis are a challenge under sporadic and pandemic conditions; however, data have suggested that patterns of these differ between COVID-19 and other viral pneumonitides. This secondary analysis aimed to explore patterns of co-infection and intensive care unit-acquired infections (ICU-AI) and the relationship to use of corticosteroids in a large, international cohort of critically ill COVID-19 patients.Methods: This is a multicenter, international, observational study, including adult patients with PCR-confirmed COVID-19 diagnosis admitted to ICUs at the peak of wave one of COVID-19 (February 15th to May 15th, 2020). Data collected included investigator-assessed co-infection at ICU admission, infection acquired in ICU, infection with multi-drug resistant organisms (MDRO) and antibiotic use. Frequencies were compared by Pearson's Chi-squared and continuous variables by Mann-Whitney U test. Propensity score matching for variables associated with ICU-acquired infection was undertaken using R library MatchIT using the "full" matching method.Results: Data were available from 4994 patients. Bacterial co-infection at admission was detected in 716 patients (14%), whilst 85% of patients received antibiotics at that stage. ICU-AI developed in 2715 (54%). The most common ICU-AI was bacterial pneumonia (44% of infections), whilst 9% of patients developed fungal pneumonia; 25% of infections involved MDRO. Patients developing infections in ICU had greater antimicrobial exposure than those without such infections. Incident density (ICU-AI per 1000 ICU days) was in considerable excess of reports from pre-pandemic surveillance. Corticosteroid use was heterogenous between ICUs. In univariate analysis, 58% of patients receiving corticosteroids and 43% of those not receiving steroids developed ICU-AI. Adjusting for potential confounders in the propensity-matched cohort, 71% of patients receiving corticosteroids developed ICU-AI vs 52% of those not receiving corticosteroids. Duration of corticosteroid therapy was also associated with development of ICU-AI and infection with an MDRO.Conclusions: In patients with severe COVID-19 in the first wave, co-infection at admission to ICU was relatively rare but antibiotic use was in substantial excess to that indication. ICU-AI were common and were significantly associated with use of corticosteroids