Thoracic lymphadenopathy in benign diseases: A state of the art review

Lymphadenopathy is a common radiological finding in many thoracic diseases and may be caused by a variety of infectious, inflammatory, and neoplastic conditions. This review aims to describe the patterns of mediastinal and hilar lymphadenopathy found in benign diseases in immunocompetent patients. Computed tomography is the method of choice for the evaluation of lymphadenopathy, as it is able to demonstrate increased size of individual nodes, abnormalities of the interface between the mediastinum and lung, invasion of surrounding fat, coalescence of adjacent nodes, obliteration of the mediastinal fat, and hypo- and hyperdensity in lymph nodes. Intravenous contrast enhancement may be needed to help distinguish nodes from vessels. The most frequent infections resulting in this finding are tuberculosis and fungal disease (particularly histoplasmosis and coccidioidomycosis). Sarcoidosis is a relatively frequent cause of lymphadenopathy in young adults, and can be distinguished from other diseases - especially when enlarged lymph nodes are found to be multiple and symmetrical. Other conditions discussed in this review are silicosis, drug reactions, amyloidosis, heart failure, Castleman's disease, viral infections, and chronic obstructive pulmonary disease. (C) 2016 Elsevier Ltd. All rights reserved.Fed Univ Hlth Sci Porto Alegre, Porto Alegre, RS, BrazilUniv Fed Rio de Janeiro, Rio De Janeiro, BrazilLiverpool Heart & Chest Hosp, Liverpool, Merseyside, EnglandFleury Med Diagnost, Sao Paulo, SP, BrazilHosp Sao Joaquim Beneficencia Portuguesa, Sao Paulo, SP, BrazilLABIMED, Lab Pesquisas Imagens Med, Irmandade Santa Casa Misercordia Porto Alegre, Rua Prof Annes Dias,28 Ctr, BR-9002009 Porto Alegre, RS, BrazilUniv Fed Rio de Janeiro, Rua Thomaz Cameron 43, BR-25685120 Rio De Janeiro, BrazilNHS Fdn Trust, Dept Radiol, Liverpool Heart & Chest Hosp, Thomas Dr Broadgreen, Liverpool L14 3PE, Merseyside, EnglandUniv Fed Sao Paulo, Dept Diagnost Imagem, Rua Napoleao Barros 800, BR-04024002 Sao Paulo, SP, BrazilHop Sao Joaquim Beneficencia Portugues, Dept Radiol & Diagnost Imagem, Rua Maestro Cardim 769, BR-01323001 Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Diagnost Imagem, Rua Napoleao Barros 800, BR-04024002 Sao Paulo, SP, BrazilWeb of Scienc

ASSISTÊNCIA DE ENFERMAGEM AOS FATORES DE RISCO PARA O TRAUMA MAMILAR CAUSADO NA AMAMENTAÇÃO

Introduction: Adequate breastfeeding reduces the rate of infection up to six months of age, and it is considered that the child is free from diseases, being observed that the introduction complemented by other foods is contraindicated since breastfeeding is the method of excellent nutrition for the baby, for its efficient contribution to health and for being considered the most sensitive, economical and effective method of intervention to reduce infant morbidity and mortality. Objective: To describe nurses' knowledge related to risk factors for nipple trauma caused by breastfeeding. Methodology: This is an integrative literature review, where a survey was carried out in the national literature, published between 2013 and 2018. Results: Nurses play an important role in welcoming pregnant women and postpartum women, as it is in this environment of cooperation that we realize the importance of nurses to direct their actions of competence, improving and mobilizing knowledge, demonstrating that breast milk is part of the life cycle of all women. Conclusion: The main risk factors for nipple trauma are: inadequate grip, stretch marks, fissure, nipple pain, absence of a partner, being primiparous, turgid and engorged breasts, semi-protruded and/or malformed, depigmented nipples, lack of complementary feeding mother, cesarean delivery and lack of prenatal guidance.Introducción: La lactancia materna adecuada reduce la tasa de infección hasta los seis meses de edad, y se considera que el niño está libre de enfermedades, observándose que la introducción complementada con otros alimentos está contraindicada ya que la lactancia materna es el método de nutrición por excelencia para el bebé. , por su eficiente contribución a la salud y por ser considerado el método de intervención más sensible, económico y eficaz para reducir la morbimortalidad infantil. Objetivo: Describir el conocimiento de los enfermeros en relación a los factores de riesgo de trauma del pezón causado por la lactancia. Metodología: Se trata de una revisión integrativa de la literatura, donde se realizó una encuesta en la literatura nacional, publicada entre 2013 y 2018. Resultados: Las enfermeras juegan un papel importante en la acogida de las gestantes y puérperas, ya que es en este ambiente de cooperación que nos damos cuenta de la importancia de que las enfermeras orienten sus acciones de competencia, mejorando y movilizando conocimientos, demostrando que la leche materna es parte del ciclo de vida de todas las mujeres. Conclusión: Los principales factores de riesgo para traumatismo en el pezón son: agarre inadecuado, estrías, fisura, dolor en el pezón, ausencia de pareja, ser primípara, mamas turgentes y congestionadas, pezones semiprotruidos y/o malformados, despigmentados, falta de alimentación complementaria. madre, parto por cesárea y falta de orientación prenatal.Introdução: O aleitamento materno adequado reduz o índice de infecção até os seis meses de vida, e é considerado que a criança fica livre de doenças, sendo observado que a introdução complementada por outros alimentos é contra indicado já que o aleitamento materno é o método de alimentação de excelência para o bebê, por sua eficiente contribuição para a saúde e por ser considerado o método mais sensível, econômico e eficaz de intervenção para redução da morbimortalidade infantil. Objetivo: Descrever o conhecimento do enfermeiro relacionado aos fatores de risco para o trauma mamilar causado na amamentação. Metodologia: Trata-se de uma revisão integrativa de literatura, onde se realizou uma pesquisa, na literatura nacional, publicada no período entre 2013 a 2018. Resultados: Os enfermeiros têm um papel importante no acolhimento à gestante e puérperas, pois é neste ambiente de cooperação que percebemos a importância do enfermeiro para dirigir suas ações de competência, aprimorando e mobilizando os conhecimentos, demonstrando que o leite materno é parte do ciclo da vida de todas as mulheres. Conclusão: Os principais fatores de risco para o trauma mamilar são: pega inadequada, estrias, fissura, dor mamilar, ausência do companheiro, ser primípara, mamas túrgidas e ingurgitadas, mamilos semi protusos e/ou malformados, despigmentados, ausência de alimentação complementar da mãe, parto cesáreo e falta de orientações no pré natal.Introdução: O aleitamento materno adequado reduz o índice de infecção até os seis meses de vida, e é considerado que a criança fica livre de doenças, sendo observado que a introdução complementada por outros alimentos é contra indicado já que o aleitamento materno é o método de alimentação de excelência para o bebê, por sua eficiente contribuição para a saúde e por ser considerado o método mais sensível, econômico e eficaz de intervenção para redução da morbimortalidade infantil. Objetivo: Descrever o conhecimento do enfermeiro relacionado aos fatores de risco para o trauma mamilar causado na amamentação. Metodologia: Trata-se de uma revisão integrativa de literatura, onde se realizou uma pesquisa, na literatura nacional, publicada no período entre 2013 a 2018. Resultados: Os enfermeiros têm um papel importante no acolhimento à gestante e puérperas, pois é neste ambiente de cooperação que percebemos a importância do enfermeiro para dirigir suas ações de competência, aprimorando e mobilizando os conhecimentos, demonstrando que o leite materno é parte do ciclo da vida de todas as mulheres. Conclusão: Os principais fatores de risco para o trauma mamilar são: pega inadequada, estrias, fissura, dor mamilar, ausência do companheiro, ser primípara, mamas túrgidas e ingurgitadas, mamilos semi protusos e/ou malformados, despigmentados, ausência de alimentação complementar da mãe, parto cesáreo e falta de orientações no pré natal

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

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions

Adolpho Lutz and controversies over the transmission of leprosy by mosquitoes Adolpho Lutz e as controvérsias sobre a transmissão da lepra por mosquitos

During his years of study in Switzerland and Germany, Adolpho Lutz published his first articles on zoology, clinical practice, and therapeutics. In Limeira, São Paulo, he began studies on animal and human diseases caused by germs and parasites. In 1885-86, Lutz traveled to Hamburg to study the morphology of germs related to skin diseases, in conjunction with Paul Gerson Unna, one of Germany's foremost dermatologists. He proposed the inclusion of Hansen's and Koch's bacilli in a new genus. In 1889, Unna nominated his student as physician-in-chief of the Leper Settlement on Molokai Island, Hawaii. From then on, Lutz sustained the theory that the disease was transmitted by mosquitoes. He conducted research to prove this theory when he was head of the Instituto Bacteriológico de São Paulo (1893-1908) and, later, after he moved to the Instituto Oswaldo Cruz (1908-1940). Although this research was not successful, on commissions and at congresses in which he participated until his death in October 1940, he still held to his conviction that leprosy was transmitted by mosquitoes.<br>Quando estudava na Suíça e Alemanha, Adolpho Lutz publicou os primeiros trabalhos sobre zoologia, clínica e terapêutica. Em Limeira, São Paulo, iniciou estudos sobre doenças humanas e animais causadas por germes e parasitas. Em 1885-86, viajou para Hamburgo para estudar microrganismos relacionados a doenças de pele sob a orientação de Paul Gerson Unna, um dos mais renomados dermatologistas alemães. Propôs a inclusão dos bacilos de Hansen e Koch num novo gênero. Em 1889, Unna indicou seu discípulo como chefe dos serviços médicos do Leprosário de Molokai, no Havaí. Lutz passou a defender a transmissão da doença por mosquitos. Realizou pesquisas para provar esta teoria depois que assumiu a chefia do Instituto Bacteriológico de São Paulo (1893-1908) e, sobretudo, após a transferência para o Instituto Oswaldo Cruz (1908-1940). Apesar de não terem sido bem-sucedidas estas pesquisas, sustentou a transmissão da lepra por mosquitos nas comissões e congressos de que participou, até sua morte em outubro de 1940