Ellas por ellos

La equidad de género es un asunto que nos involucra a todas y todos, pues los efectos de las relaciones de desigualdad, que inciden en la sana evolución de las mujeres, alcanzan también a los hombres, cuya masculinidad, construida bajo los cánones de una cultura patriarcal, les ha vetado el acceso a las emociones y el goce de placeres asignados en exclusiva al mundo de lo privado, al femenino. El Consejo Nacional para Prevenir la Discriminación ha convocado a una pléyade de voces masculinas para que incursionen en el mundo femenino con este libro inspirado en la edición española Ellas. Catorce hombres dan la cara… Dieciséis hombres aceptaron el reto emocional, intelectual y profesional de aportar su visión de Ellas –nombradas así, genéricamente, sin más calificativos–, con la única premisa de escribir a partir de aquello que despierte en su imaginario masculino el simple hecho de pronunciar ese vocablo. … Ellas son aquí mujeres de carne y hueso, actrices, modelos, futbolistas, vendedoras, activistas, amantes y políticas, musas y ejemplos de vida, mundos interpretados desde lo que se sabe y lo que se intuye, acciones y pasiones estocadas indefectiblemente por la inspección masculina, la visión de género, el machismo y la misoginia, miradas injustas que revelan, también, el mundo de Ellos. … Ellas... por ellos es la oportunidad de mirar el imaginario de los Otros. Es atreverse a correr la cortina y aprender de la desnudez de las almas y conciencias masculinas. Es abrazar la frescura de un despertar de los hombres a una nueva era de comprensión y tolerancia, de respeto a lo diferente, de inclusión e integralidad. Valorar lo aquí expuesto por Ellos será para Ellas, definitivamente, un aliento para seguir construyendo una sociedad en igualdad, sin discriminación ni violencia

Atualizações e abordagens clínicas da neuropatia diabética dolorosa no âmbito atual

A Neuropatia Diabética (ND) representa um grupo heterogêneo de manifestações clínicas ou subclínicas mais prevalentes em que há o comprometimento do Sistema Nervoso Periférico (SNP), sendo uma das formas de complicações. Sendo assim, estima-se que pelo menos metade dos pacientes com Diabetes irá desenvolver a neuropatia em alguma fase da evolução clínica da doença. Dessa forma, este estudo configura-se como uma revisão integrativa realizada por meio do levantamento bibliográfico nos diretórios: Google Scholare Scientific Eletronic LibraryOn-line (SciELO), com uso dos descritores DeCs (Descritores em Saúde) e o Medical Subject Headings (MeSH), nos idiomas português e inglês, com os seguintes termos:  Diabetes”(diabetes), “neuropatia” (neuropathy), “tratamento” (treatment). Desta busca, foram encontrados 150 artigos, posteriormente submetidos aos critérios de seleção. A seleção resultou em 8 artigos que foram submetidos à análise seletiva, exploratória e interpretativa no contexto do presente estudo. A partir da revisão bibliográfica dos estudos analisados, conclui-se que, de fato, a neuropatia diabética é complexa e precisa ser estudada constantemente

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

EXPERIMENTAL GUINEA-PIG OCULAR INFECTION BY SALMONELLA-TYPHIMURIUM

ESCOLA PAULISTA MED,DISCIPLINA MICROBIOL,BR-04023 SAO PAULO,SP,BRAZILESCOLA PAULISTA MED,DISCIPLINA ANAT PATOL,BR-04023 SAO PAULO,SP,BRAZILESCOLA PAULISTA MED,DISCIPLINA ANAT DESCRITIVA,BR-04023 SAO PAULO,SP,BRAZILESCOLA PAULISTA MED,DISCIPLINA MICROBIOL,BR-04023 SAO PAULO,SP,BRAZILESCOLA PAULISTA MED,DISCIPLINA ANAT PATOL,BR-04023 SAO PAULO,SP,BRAZILESCOLA PAULISTA MED,DISCIPLINA ANAT DESCRITIVA,BR-04023 SAO PAULO,SP,BRAZILWeb of Scienc

Clinical practice guidelines for the diagnosis and treatment of patients with soft tissue sarcoma by the Spanish group for research in sarcomas (GEIS)

Soft tissue sarcomas (STS) constitute an uncommon and heterogeneous group of tumours, which require a complex and specialized multidisciplinary management. The diagnostic approach should include imaging studies and core needle biopsy performed prior to undertaking surgery. Wide excision is the mainstay of treatment for localized sarcoma, and associated preoperative or postoperative radiotherapy should be administered in high-risk patients. Adjuvant chemotherapy was associated with a modest improvement in survival in a meta-analysis and constitutes a standard option in selected patients with high-risk STS. In metastatic patients, surgery must be evaluated in selected cases. In the rest of patients, chemotherapy and, in some subtypes, targeted therapy often used in a sequential strategy constitutes the treatment of election. Despite important advances in the understanding of the pathophysiology of the disease, the advances achieved in therapeutic results may be deemed still insufficient. Moreover, due to the rarity and complexity of the disease, the results in clinical practice are not always optimal. For this reason, the Spanish Group for Research on Sarcoma (GEIS) has developed a multidisciplinary clinical practice guidelines document, with the aim of facilitating the diagnosis and treatment of these patients in Spain. In the document, each practical recommendation is accompanied by level of evidence and grade of recommendation on the basis of the available data

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