Emprego de guia introdutor (bougie) artesanal para intubação em situação de emergência em pacientes que se apresentam com via aérea de difícil intubação: série de casos

ResumoJustificativa e objetivosA incidência de via aérea difícil chega a 10% das intubações de emergência. Ainda que poucos estudos abordem o emprego de guia introdutor artesanal no ambiente de emergência e terapia intensiva, há descrições de guias produzidas de forma artesanal disponíveis na internet. Nosso objetivo é descrever uma série de casos sobre o uso de um guia introdutor (Bougie) artesanal para intubação de emergência em pacientes com Via Aérea Difícil.Relato de casoO guia introdutor artesanal foi utilizado em cinco pacientes consecutivos com via aérea difícil, instabilidade clínica e falta de outro método imediato para a obtenção de uma via aérea. Essa técnica proporcionou sucesso na intubação e não houve complicações.ConclusõesA utilização do guia introdutor artesanal pode ser uma opção útil para o manejo de via aérea difícil.AbstractBackground and objectivesThe incidence of difficult airway reaches 10% of emergency intubations. Although few studies address the use of handmade introducer guides in emergency and intensive care environment, there are descriptions of handmade guides available on the Internet. We describe a case series on the use of a handmade introducer guide (bougie) for emergency intubation in patients with difficult airway.Case reportThe handmade introducer guide was used in five consecutive patients with difficult airways, and clinical instability and in the absence of another immediate method to obtain an airway. This technique provided successful intubation and there were no complications.ConclusionsThe use of the handmade introducer guide can be a useful option for the management of difficult airways

Responsible AI governance: A response to UN interim report on governing AI for humanity

A response to UN interim report on governing AI for humanit

SARS-CoV-2 omicron (B.1.1.529)-related COVID-19 sequelae in vaccinated and unvaccinated patients with cancer: results from the OnCovid registry

Background COVID-19 sequelae can affect about 15% of patients with cancer who survive the acute phase of SARS-CoV-2 infection and can substantially impair their survival and continuity of oncological care. We aimed to investigate whether previous immunisation affects long-term sequelae in the context of evolving variants of concern of SARS-CoV-2. Methods OnCovid is an active registry that includes patients aged 18 years or older from 37 institutions across Belgium, France, Germany, Italy, Spain, and the UK with a laboratory-confirmed diagnosis of COVID-19 and a history of solid or haematological malignancy, either active or in remission, followed up from COVID-19 diagnosis until death. We evaluated the prevalence of COVID-19 sequelae in patients who survived COVID-19 and underwent a formal clinical reassessment, categorising infection according to the date of diagnosis as the omicron (B.1.1.529) phase from Dec 15, 2021, to Jan 31, 2022; the alpha (B.1.1.7)-delta (B.1.617.2) phase from Dec 1, 2020, to Dec 14, 2021; and the pre-vaccination phase from Feb 27 to Nov 30, 2020. The prevalence of overall COVID-19 sequelae was compared according to SARS-CoV-2 immunisation status and in relation to post-COVID-19 survival and resumption of systemic anticancer therapy. This study is registered with ClinicalTrials.gov, NCT04393974. Findings At the follow-up update on June 20, 2022, 1909 eligible patients, evaluated after a median of 39 days (IQR 24-68) from COVID-19 diagnosis, were included (964 [ 50 center dot 7%] of 1902 patients with sex data were female and 938 [49 center dot 3%] were male). Overall, 317 (16 center dot 6%; 95% CI 14 center dot 8-18 center dot 5) of 1909 patients had at least one sequela from COVID-19 at the first oncological reassessment. The prevalence of COVID-19 sequelae was highest in the prevaccination phase (191 [19 center dot 1%; 95% CI 16 center dot 4-22 center dot 0] of 1000 patients). The prevalence was similar in the alpha-delta phase (110 [16 center dot 8%; 13 center dot 8- 20 center dot 3] of 653 patients, p=0 center dot 24), but significantly lower in the omicron phase (16 [6 center dot 2%; 3 center dot 5-10 center dot 2] of 256 patients, p<0 center dot 0001). In the alpha- delta phase, 84 (18 center dot 3%; 95% CI 14 center dot 6-22 center dot 7) of 458 unvaccinated patients and three (9 center dot 4%; 1 center dot 9- 27 center dot 3) of 32 unvaccinated patients in the omicron phase had sequelae. Patients who received a booster and those who received two vaccine doses had a significantly lower prevalence of overall COVID-19 sequelae than unvaccinated or partially vaccinated patients (ten [7 center dot 4%; 95% CI 3 center dot 5-13 center dot 5] of 136 boosted patients, 18 [9 center dot 8%; 5 center dot 8-15 center dot 5] of 183 patients who had two vaccine doses vs 277 [ 18 center dot 5%; 16 center dot 5-20 center dot 9] of 1489 unvaccinated patients, p=0 center dot 0001), respiratory sequelae (six [4 center dot 4%; 1 center dot 6-9 center dot 6], 11 [6 center dot 0%; 3 center dot 0-10 center dot 7] vs 148 [9 center dot 9%; 8 center dot 4- 11 center dot 6], p= 0 center dot 030), and prolonged fatigue (three [2 center dot 2%; 0 center dot 1-6 center dot 4], ten [5 center dot 4%; 2 center dot 6-10 center dot 0] vs 115 [7 center dot 7%; 6 center dot 3-9 center dot 3], p=0 center dot 037)

Confiabilidade e validade de uma escala de mensuração da mobilidade do tronco na doença de Parkinson : escala de mobilidade de tronco

Rigidez axial é importante manifestação motora na doença de Parkinson (DP). Prejuízos na mobilidade do tronco podem ocasionar problemas na marcha, equilíbrio e postura. No entanto, poucos instrumentos analisam a mobilidade do tronco em pacientes com DP. O objetivo deste estudo é apresentar uma nova Escala de Mobilidade do Tronco (TMS) e sua validação na DP. A TMS é constituída de provas dinâmicas que envolvem os movimentos do tronco no plano sagital, transversal e coronal. Noventa e oito pacientes com DP e 31 controles normais foram analisados. Uma forte correlação foi encontrada entre os escores do TMS e os do Hoehn & Yahr Staging Scale (r: 0,72; p <0,01), Unified Parkinson’s Disease Rating Scale (r: 0,84; p<0,01) e Schwab and England England Activities of Daily Living (r: –0,72, p <0,01). A escala mostrou uma taxa de confiabilidade satisfatória (αCronbach: 0,85; ICC: 099). TMS é um instrumento simples e confiável para avaliar comprometimentos da mobilidade de tronco em pacientes com DP.Axial rigidity is an important motor manifestation in Parkinson’s disease (PD). Trunk mobility impairment can cause gait, balance and postural problems. However, only few instruments analyze the trunk mobility in PD patients. The aim of this study is to present a new Trunk Mobility Scale (TMS) and its validation in PD. The TMS constituted of dynamic tests involving trunk movements in sagittal, transversal and coronal planes. Ninety eight PD patients and 31 normal controls were analyzed. A strong correlation was found between the TMS scores and the Hoehn & Yahr staging scale (r: 0.72; p<0.01), motor Unified Parkinson’s Disease Rating Scale (r: 0.84; p<0.01) and Schwab and England Activities of Daily Living (r: –0.72; p<0.01). The scale showed a satisfactory reliability rate (αCronbach: 0.85, ICC: 099). TMS is a simple and reliable instrument to evaluate trunk mobility impairment in patients with PD

Platypnea-orthodeoxia syndrome in patients presenting enlarged aortic root: case report and literature review

Descrevemos aqui o caso de um paciente que, ao assumir posi&#231;&#245;es de ortostatismo, apresentava hipoxemia e disfun&#231;&#227;o ventilat&#243;ria grave. Embora a gravidade dos sintomas tenha determinado a necessidade de interna&#231;&#227;o em ambiente de terapia intensiva, os exames iniciais identificaram apenas a presen&#231;a de ectasia da aorta, sem, no entanto, justificar o quadro. A associa&#231;&#227;o dessas manifesta&#231;&#245;es a uma etiologia incomum, o shunt intracard&#237;aco, caracterizou o diagn&#243;stico da s&#237;ndrome de platipneia-ortode&#243;xia. A revis&#227;o da literatura demonstra que, com o avan&#231;o dos m&#233;todos de investiga&#231;&#227;o, houve progressivo aumento na identifica&#231;&#227;o desse quadro, devendo essa associa&#231;&#227;o fazer parte do diagn&#243;stico diferencial de dispneia em pacientes com aorta ect&#225;sica