RESUMO
A comunicação buco-sinusal, uma conexão direta entre boca e seios maxilares, ocorre comumente pela extração de dentes próximos ao seio maxilar e outros procedimentos. O diagnóstico precoce é crucial para prevenir complicações graves. A abordagem terapêutica varia conforme o tamanho do defeito, presença de infecção e localização específica. Realizou-se uma breve revisão de literatura qualitativa abordando as principais complicações da comunicação buco sinusal na cirurgia bucal e como intervi-las. Buscou-se artigos científicos indexados nas seguintes bases de dados: Google Scholar, Pubmed e Biblioteca Scielo com lapso temporal de 2013 a 2023. Foram utilizados para esta busca os seguintes descritores: Comunicação buco-sinusal; Complicações; Seio maxilar. Os critérios de inclusão desta pesquisa foram artigos em inglês, português e espanhol, sendo selecionados 26 trabalhos. Os principais critérios de exclusão foram artigos com mais de 10 anos de publicação. A prevenção e gestão eficaz das complicações na comunicação oral em cirurgias são essenciais. Identificar fatores de risco, usar técnicas cirúrgicas precisas e agir imediatamente diante de sinais de comunicação com os seios da face são medidas cruciais para garantir a segurança do paciente e aprimorar os resultados cirúrgicos.
Oral-sinusal communication, a direct connection between the mouth and maxillary sinuses, commonly occurs due to the extraction of teeth close to the maxillary sinus and other procedures. Early diagnosis is crucial to prevent serious complications. The therapeutic approach varies according to the size of the defect, presence of infection and specific location. A brief qualitative literature review was carried out looking at the main complications of oral sinus communication in oral surgery and how to intervene. We searched for scientific articles indexed in the following databases: Google Scholar, Pubmed and Scielo Library with a time span from 2013 to 2023. The following descriptors were used for this search: Oral-sinus communication; Complications; Maxillary sinus. The inclusion criteria for this study were articles in English, Portuguese and Spanish, and 26 papers were selected. The main exclusion criteria were articles published more than 10 years ago. The prevention and effective management of oral communication complications during surgery are essential. Identifying risk factors, using precise surgical techniques and acting immediately in the event of signs of communication with the sinuses are crucial measures to ensure patient safety and improve surgical outcomes.
Assuntos
Cirurgia Bucal , Fatores de Risco , Diagnóstico Precoce , Segurança do Paciente , Seio MaxilarRESUMO
A dermatofitose é uma infecção micótica superficial dos tecidos queratinizados como pelos, unhas e o estrato córneo da epiderme. Nos cães e gatos, esta enfermidade é comumente causada por fungos dermatófitos dos gêneros Microsporum, Nannizzia e Trichophyton que podem acometer quaisquer pacientes, sendo os filhotes, os animais idosos e imunocomprometidos os mais propensos. Embora seja uma doença altamente contagiosa, sua mortalidade é baixa e, em alguns casos, pode haver remissão espontânea. A dermatofitose afeta cerca de 4-15% dos caninos e 20% dos felinos, sendo a principal infecção fúngica das espécies citadas. Além disso, a dermatofitose é uma antropozoonose que afeta cerca de 25% da população humana e está amplamente difundida pelos centros urbanos. Sabe-se que os cães e gatos são importantes carreadores da doença e que tanto os animais sintomáticos, quanto os assintomáticos, são capazes de transmitir os agentes entre si e para os seres humanos. Os portadores assintomáticos têm grande importância para disseminação da zoonose, devido à falta de informação e ao fato de não apresentarem lesões, o que aumenta os riscos de exposição em decorrência do estreito contato dos tutores com seus animais.(AU)
Dermatophytosis is a superficial mycotic infection of keratinized tissues such as hair, nails, and the stratum corneum of the epidermis. In dogs and cats, this disease is commonly caused by dermatophyte fungi of the genera Microsporum, Nannizzia, and Trichophyton, that can affect any patient, with puppies, and elderly, and immunocompromised animals being the most prone. Although it is a highly contagious disease, its mortality is low and in some cases, there can be spontaneous remission. It is estimated that it affects about 4-15% of canines and 20% of felines, being the most common fungal infection in the mentioned species. In addition, dermatophytosis is an anthropozoonosis that affects about 40% of the human population and is widespread in urban centers. It is known that dogs and cats are important carriers of the disease and that both symptomatic and asymptomatic animals are capable of transmitting the agents to each other and humans. Asymptomatic carriers are of great importance for the dissemination of the zoonosis, due to the lack of information and the fact that they do not present lesions, which increases the risks of exposure due to the close contact between tutors and their animals. (AU)
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Animais , Gatos , Cães , Tinha , Gatos , Saúde Pública , Fatores de Risco , Revisão , Cães , Saúde ÚnicaRESUMO
Unhealthy lifestyles risk factors, such as smoking, alcohol consumption, physical inactivity, poor diet, and obesity, have been associated with a higher risk of all-cause and cause-specific mortality. However, composite score of these unhealthy behaviours has not been considered, particularly in Latin American populations. Herein, we examined the association of lifestyle risk factors score with all-cause and cause-specific mortality in Mexican adults. A total of 159,517 adults from the Mexico City Prospective Study (MCPS) were included. Data on sociodemographic, lifestyle risk factors and medical histories was collected through a self-reported baseline questionnaire in a census-style door-to-door interviews. Lifestyle risk factors assessment was based on five modifiable lifestyle risk factors and their respective cut-off points according to current health recommendations, including obesity, physical inactivity, tobacco, alcohol consumption and fruits and vegetables intake. Multivariable Cox regression models were used to estimate the associations of lifestyle risk factor score (ranging from 0 to 5) with all-cause and cause-specific mortality (cardiovascular disease, renal or hepatobiliary diseases, diabetes, respiratory diseases, cancer and all-cause mortality). We excluded the first 2, 5, 10, and 15 years of follow-up to account for reverse causation bias. We found a high prevalence (77%) of Mexican adults, with two or more lifestyle risk factors. Hazard ratio for respiratory diseases and renal or hepatobiliary diseases were 1.86 (95%CI: 1.45-2.39) and 2.00 (95%CI: 1.60-2.52) comparing participants with 4-5 lifestyle risk factors vs. those with none. For all-cause mortality, participants with 4-5 lifestyle risk factors had a 49% (HR: 1.49; 95%CI: 1.03-2.16) higher risk as compared to participants with none. The magnitude of the associations increased as the exclusion of follow-up time increased after 2, 5, 10 and 15 years. There was a positive association between the number of lifestyle risk factors and all-cause and cause-specific mortality, showing the highest rate of respiratory, renal or hepatobiliary and all-cause mortality among participants with 4-5 lifestyle risk factors. After accounting for reverse causation, associations were stronger.
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Estilo de Vida , Humanos , México/epidemiologia , Masculino , Feminino , Fatores de Risco , Estudos Prospectivos , Pessoa de Meia-Idade , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/efeitos adversos , Idoso , Fumar , Obesidade/mortalidade , Obesidade/epidemiologia , Mortalidade , Causas de MorteRESUMO
INTRODUCTION: Depression is the leading cause of mental health-related illnesses and disabilities. Physical activity (PA) has been included as part of therapeutic approaches for patients with depression. This study aimed to investigate the associations between depressive symptoms and PA levels in a large representative cohort of Brazilian adults and older individuals. METHODS: Data from 58,445 Brazilian adults (68.6 % males and 31.4 % females) aged 18 years or older (42.2 ± 10 years) who participated in health screening initiatives between 2008 and 2022 at the Center for Preventive Medicine at a quaternary hospital in Sao Paulo, Brazil were analyzed. Standardized health data (anthropometric, laboratory, clinical, and behavioral) were collected. A hierarchical regression model was used to examine the associations based on the presence and absence of depressive symptoms. RESULTS: In the final model, age, gender (female), body mass index (BMI) (each kg/m2), presence of hypertension, presence of diabetes mellitus, risk of alcohol consumption, smoking status, and perceived stress were associated with higher odds of depressive symptoms. However, PA levels were associated with lower odds of depressive symptoms. CONCLUSION: The findings revealed that any level of PA was independently and significantly associated reduced risk of depressive symptoms.
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Índice de Massa Corporal , Depressão , Exercício Físico , Humanos , Masculino , Feminino , Estudos Transversais , Adulto , Pessoa de Meia-Idade , Depressão/epidemiologia , Depressão/psicologia , Brasil/epidemiologia , Adulto Jovem , Fatores Sexuais , Idoso , Adolescente , Fatores de RiscoRESUMO
This article presents the first systematic review and meta-analysis of the prevalence and correlates of different forms of intimate partner violence (IPV) among women and men in Mexico. To identify studies, a comprehensive search strategy was developed and executed across 11 databases (Academic Search Complete, APA PsycInfo, CINAHL, Cochrane CENTRAL, Embase, International Bibliography of the Social Sciences, LILACS, MEDLINE, SciELO, Sociological Abstracts, Web of Science). From the 1,746 studies screened, 155 full-text articles were reviewed, and this systematic review included 27 studies involving 249,557 participants to determine the prevalence of physical, psychological, sexual, threats, and other forms of IPV, according to gender and other sociodemographic characteristics. Overall IPV prevalence was 16.4%, with significant differences across pregnant and non-pregnant women. Physical IPV prevalence was 14.7%, revealing higher rates in men (29.5%) compared to women (14.2%). Psychological IPV prevalence was 27.3% and sexual IPV was at 6.6%, with differences across evaluation periods. Threats and other IPV forms showed a prevalence rate of 14.2% and 21.5%. Meta-regression analyses included gender, education, marital status, rural residency, pregnancy, age, and evaluation period. This study demonstrates that IPV is a critical public health concern in Mexico, impacting both women and men. It shows the vulnerability of rural residents, youth, and pregnant women. However, understanding IPV complexities in Mexico requires nuanced considerations of demographic and situational contexts. Urgent initiatives from municipal, state, and federal governments are needed to combat IPV, focusing on prevention and support for affected individuals.
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Violência por Parceiro Íntimo , Feminino , Humanos , Masculino , Gravidez , Violência por Parceiro Íntimo/estatística & dados numéricos , Violência por Parceiro Íntimo/psicologia , México/epidemiologia , Prevalência , Fatores de RiscoRESUMO
Clubfoot is a common musculoskeletal congenital abnormality, with a prevalence of 5-20 cases per 10â 000 live births in low to middle-income countries. If left untreated, clubfoot causes severe consequences for the child: gait disturbances, reduced quality of life, and limited work opportunities. Our objective was to characterize clubfoot and determine its prevalence and associated risk factors in Bogotá and Cali, Colombia, from 2002 to 2020. A retrospective case-control study design was employed, analyzing data from birth defect reports provided by the Program for the Prevention and Follow-up of Congenital Defects and Orphan Diseases surveillance system. Cases included live births or stillbirths with clubfoot, while controls consisted of infants without congenital abnormalities, matched in terms of birth date and hospital. Prevalence was calculated considering a 95% confidence interval using Poisson distribution, and risk factors were assessed through adjusted odds ratios obtained by logistic regression model. Of 558â 255 births, 861 cases of clubfoot were identified, 48.20% were postural clubfoot, and 15 cases were syndromic clubfoot. In Bogota, prevalence rate was 15.1 per 10â 000 live births, whereas in Cali it was 17.29 per 10â 000 live births. Family history of clubfoot within first-degree relatives was identified as a risk factor for clubfoot. Investigating risk factors for clubfoot holds significant importance in terms of preventing and reducing morbidity within this population. Helping to drive government and healthcare initiatives aimed at providing timely and effective treatment.
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Pé Torto Equinovaro , Humanos , Pé Torto Equinovaro/epidemiologia , Colômbia/epidemiologia , Feminino , Masculino , Estudos Retrospectivos , Estudos de Casos e Controles , Prevalência , Fatores de Risco , Recém-Nascido , Lactente , Vigilância da População/métodosRESUMO
BACKGROUND: Chagas disease is a risk factor for ischemic stroke, which causes high mortality rates and significant disability. This study aims to determine the incidence and risk factors for ischemic strokes in a large cohort of Chagas cardiomyopathy patients, with a particular focus on the mechanisms involved in the pathophysiology of stroke in this condition. METHODS: The study enrolled 517 patients with Chagas cardiomyopathy who were referred to our institution from March 2000 to December 2021. All patients underwent systematic cardiological and neurological assessments. The primary outcome was the occurrence of ischemic stroke during the follow-up period, classified based on the SSS-TOAST and CCS criteria. Natural cubic splines functions were applied to examine the potential nonlinear association between continuous variables and stroke risk. RESULTS: The mean age of the cohort was 52 ± 13 years, and 299 (58 %) were men. During a mean follow-up period of 4.8 years (interquartile range-IQR 1.1 to 7.1 years), a total of 72 patients (14.8 %) had an ischemic stroke, being fatal in 10. The overall incidence rate of ischemic stroke was 3.0/100 patient-years (95 % confidence interval 2.4 to 3.8). The stroke subtypes were cardioembolic (n = 41), undetermined (n = 11), and other subtypes (n = 20). The predictors of stroke were age, left atrial volume, left ventricular ejection fraction (LVEF), LV thrombus and prior stroke with thrombus. There was a nonlinear relationship between stroke risk, LVEF, and left atrial volume. A bimodal distribution of stroke occurrences was observed according to the severity of LV dysfunction, with a threshold for LVEF of 45 %. The final model for stroke risk prediction showed good discrimination, with a C statistic of 0.775. CONCLUSIONS: In a contemporary cohort of Chagas disease patients with a broad spectrum of disease severity, stroke incidence remains high despite anticoagulation. Stroke risk shows a nonlinear association with ventricular dysfunction and left atrial size, highlighting a distinct bimodal pattern of stroke occurrence in Chagas disease.
Assuntos
Cardiomiopatia Chagásica , AVC Isquêmico , Índice de Gravidade de Doença , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , AVC Isquêmico/epidemiologia , AVC Isquêmico/diagnóstico , Cardiomiopatia Chagásica/epidemiologia , Cardiomiopatia Chagásica/fisiopatologia , Cardiomiopatia Chagásica/complicações , Cardiomiopatia Chagásica/diagnóstico , Adulto , Fatores de Risco , Idoso , Seguimentos , Incidência , Estudos de Coortes , Estudos Retrospectivos , Valor Preditivo dos TestesRESUMO
BACKGROUND: Globally, loneliness is a growing public health concern associated with poor mental and physical health among older adults. Therefore, we performed a meta-analysis to explore the prevalence of loneliness and associated risk factors among older adults across six continents. METHODS: Web of Science, PubMed, Embase, CINAHL, Cochrane Library, and references lists were comprehensively searched until April 2024. Data analysis was performed using Logit Transformation model in R-Software for pooled prevalence and DerSimonian-Lard random-effects model in Comprehensive Meta-Analysis for associated factors of loneliness. Heterogeneity was quantified by I2 and τ2 statistics. The funnel plot and Egger's regression test assessed publication bias. RESULTS: A total of 70 studies with 462,083 older adults were included. The pooled prevalence of loneliness was 26 % (95 %CI, 23 %-30 %) with 38 % for North America, 34 % for Africa, 32 % for Asia and South America, 23 % for Europe, and 13 % for Oceania. Cognitive impairment (2.98; 95 %CI, 1.30-6.81), poor health (2.35; 95 %CI, 1.59-3.45), female (1.92; 95 %CI, 1.53-2.41), depression (1.74; 95 %CI, 1.40-2.16), widowed (1.67; 95 %CI, 1.13-2.48), single (1.51; 95 %CI, 1.06-2.17), institutionalization (2.95; 95 %CI, 1.48-5.88), rural residency (1.18; 95 %CI, 1.04-1.34) were associated with increased risk of loneliness. Being married (0.51; 95 %CI, 0.31-0.82), male (0.55; 95 %CI, 0.43-0.70), and non-institutionalization (0.34; 95 %CI, 0.17-0.68) were associated with lower risk of loneliness. CONCLUSION: Approximately, three among ten older adults aged ≥ 60 years are lonely worldwide. Early detection, prevention, and management of loneliness among older adults should consider diverse needs using gender-specific approaches.
Assuntos
Solidão , Idoso , Feminino , Humanos , Masculino , África/epidemiologia , Ásia/epidemiologia , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/psicologia , Depressão/epidemiologia , Depressão/psicologia , Europa (Continente)/epidemiologia , Solidão/psicologia , América do Norte/epidemiologia , Oceania/epidemiologia , Prevalência , Fatores de Risco , América do Sul/epidemiologia , Pessoa de Meia-Idade , Idoso de 80 Anos ou maisRESUMO
Brazil is the fourth largest producer and exporter of pork in the world, standing out for its potential to increase pig production nationwide. Among the diseases that can severely compromise trade relations and cause significant losses in pig production in Brazil, Classical Swine Fever (CSF) is notable for being a highly contagious viral disease with high potential for spreading among domestic and wild pigs, wild boars, and peccaries. The present study aimed to identify high-risk regions for CSF in Brazil through spatial, temporal, and spatiotemporal analyses from 2000 to 2023. During this period, 3189 cases of CSF were detected, all reported exclusively in states within the CSF non-free zone. The Northeast region accounted for 90.31â¯% (2880/3189) of the total CSF cases, with Ceará reporting the highest number of cases at 1475 (46.25â¯%), of which 810 were reported in 2018 alone. The North region accounted for 9.69â¯% (309/3189) of the total cases, with the states of Pará and Amapá being the only ones to report cases of the disease. Temporal trend analysis identified an increase in Piauí (Annual Percentage Change [APC]: 25.58â¯%), Alagoas (APC: 28.01â¯%), and Ceará (APC: 17.99â¯%), a decreasing trend for Pernambuco (APC: 24.49â¯%), Paraíba (APC: 19.35â¯%), and Rio Grande do Norte (APC: 11.85â¯%), and stability in Maranhão (APC: 0.17â¯%), Pará (APC: 1.61â¯%), and Amapá (APC: 15.52â¯%). The spatiotemporal analysis identified the formation of two high-risk clusters: the primary cluster occurred in the Northeast region, specifically in the states of Ceará, Piauí, Rio Grande do Norte, Paraíba, Pernambuco, and Alagoas, between 2018 and 2019, with a total of 1556 CSF cases and Relative Risk (RRs) of 120.02. The secondary cluster was formed by the states of Rondônia, Acre, Amazônia, Roraima, Pará, Amapá, and Mato Grosso, located in the North and part of the Midwest region, for the year 2009, with a total of 309 cases and an RRs of 29.89. In conclusion, the Northeast region is considered high-risk for the emergence of new CSF cases, highlighting the states of Ceará and Piauí, which can be considered important sources of CSF virus spread to other Brazilian states, alerting authorities to the need for disease control actions.
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Peste Suína Clássica , Animais , Brasil/epidemiologia , Peste Suína Clássica/epidemiologia , Suínos , Sus scrofa , Análise Espaço-Temporal , Vírus da Febre Suína Clássica , Fatores de RiscoRESUMO
OBJECTIVE: To assess the relationship between breastfeeding and the risk of developing nephrotic syndrome using a population-based nationwide birth cohort in Korea. STUDY DESIGN: This nationwide cohort study utilized data from the National Health Information Database and the National Health Screening Program for Infants and Children. The study included all children born between January 1, 2010, and December 31, 2018, who underwent their first health screening, which included a specific questionnaire on breastfeeding between 4 and 6 months of age. Associations between nephrotic syndrome and exclusive breastfeeding were estimated using adjusted hazard ratios (aHR) derived from Cox proportional hazards models, adjusted for sociodemographic variables, with follow-up until the occurrence of nephrotic syndrome, 8 years postindex date, death, or December 31, 2022, whichever was first. RESULTS: The study population comprised 1 787 774 children (median follow-up: 7.96 years; IQR: 6.31-8.00 years), including 612 556 exclusively breastfed and 1 175 218 formula-fed children. Exclusive breastfeeding was associated with a decreased risk of developing nephrotic syndrome (aHR: 0.80; 95% CI: 0.69-0.93). Subgroup analysis stratified by sex mirrored the overall findings, although statistical significance was not observed in girls (boys: aHR, 0.75; 95% CI, 0.62-0.92; girls: aHR, 0.87; 95% CI, 0.70-1.09). Sensitivity analysis confirmed these results. CONCLUSIONS: Exclusive breastfeeding was associated with a 20% reduced risk of developing nephrotic syndrome up to 8 years of age.
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Aleitamento Materno , Síndrome Nefrótica , Humanos , Síndrome Nefrótica/epidemiologia , Aleitamento Materno/estatística & dados numéricos , Feminino , Masculino , Incidência , República da Coreia/epidemiologia , Criança , Lactente , Estudos de Coortes , Pré-Escolar , Seguimentos , Fatores de RiscoRESUMO
OBJECTIVE: To provide a comprehensive overview of the epidemiologic characteristics, outcomes, and risk factors of COVID-19-related deaths in children and adolescents in Brazil. STUDY DESIGN: We conducted a population-based, retrospective cohort study that included all patients aged <18 years with laboratory-confirmed, symptomatic SARS-CoV-2 infection as registered in official Brazilian national surveillance systems for COVID-19 between February 2020 and February 2023. The primary outcome was COVID-19-related deaths. Odds ratios (ORs) of risk factors associated with death were estimated using multivariable logistic regression. RESULTS: Over a 3-year period, 2 855 704 pediatric patients with symptomatic SARS-CoV-2 infection were registered in Brazil. Of these, 59 179 (2.1%) were hospitalized, 13 844 (0.48%) were admitted to the intensive care unit, and 4943 (0.17%) received mechanical ventilation. A total of 4740 (0.17%) patients had fatal outcomes. The case fatality rate increased to 7.9% among patients who required hospitalization; 2102 (44.3%) patients who died did not receive advanced critical support. Notably, 2 (65%, 95% CI 58-71) or 3 doses (86%, 95% CI 81-89) of the vaccine provided strong protection against death. The following adjusted covariates were significantly associated with increased odds of death: age (0-4 and 11-17 years), ethnicity (Brown and Indigenous), region (Northeast or North), dyspnea, nosocomial infection, and comorbidities. Conversely, living in the South or Central-West regions, admission in the later period of the pandemic, and receiving a vaccine were all associated with protection against death. CONCLUSIONS: Our findings suggest that a complex interplay between individual factors and social inequities has shaped the impact of COVID-19 on Brazilian children and adolescents.
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COVID-19 , Hospitalização , Humanos , COVID-19/epidemiologia , COVID-19/mortalidade , Brasil/epidemiologia , Criança , Masculino , Feminino , Pré-Escolar , Adolescente , Estudos Retrospectivos , Lactente , Fatores de Risco , Hospitalização/estatística & dados numéricos , Recém-Nascido , SARS-CoV-2 , Respiração Artificial/estatística & dados numéricosRESUMO
OBJECTIVE: To study whether prenatal and postnatal exposure to antibiotics is associated with the risk of type 1 diabetes in childhood. STUDY DESIGN: This case cohort study included 2869 children diagnosed with type 1 diabetes by the end of 2009 who were born between January 1, 1996, and December 31, 2008, in Finland and a reference cohort (n = 74â263) representing 10% of each birth cohort. Exposure to antibiotics was assessed in different time periods. The data were derived from Special Reimbursement Register, Drug Prescription Register, and Population Register and analyzed with weighted Cox proportional hazards regression models. RESULTS: Exposure to any antibiotics before or during pregnancy, in the neonatal ward, during the first year of life, or during the 2 first years of life, was not associated with the risk of type 1 diabetes in the offspring. Exposure to macrolides in the year preceding pregnancy (adjusted hazard ratio [HR], 1.17; 95% CI, 1.02-1.33) and to sulfonamides and trimethoprim during pregnancy (adjusted HR, 1.91; 95% CI, 1.07-3.41) was associated with an increased risk of type 1 diabetes in the offspring. Exposure to sulfonamides and trimethoprim during first 2 years of life was associated with a decreased risk of type 1 diabetes (adjusted HR, 0.84; 95% CI, 0.73-0.97). The number of antibiotic purchases among mothers or children was not associated with type 1 diabetes risk. CONCLUSIONS: Prenatal and postnatal exposure to antibiotics in general did not increase the risk of type 1 diabetes in the offspring. However, the type of antibiotic and timing of exposure may play a role in type 1 diabetes risk.
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Antibacterianos , Diabetes Mellitus Tipo 1 , Efeitos Tardios da Exposição Pré-Natal , Sistema de Registros , Humanos , Diabetes Mellitus Tipo 1/epidemiologia , Feminino , Gravidez , Finlândia/epidemiologia , Antibacterianos/efeitos adversos , Antibacterianos/uso terapêutico , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Masculino , Lactente , Recém-Nascido , Fatores de Risco , Estudos de Coortes , Pré-Escolar , Criança , Modelos de Riscos ProporcionaisRESUMO
BACKGROUND: Arterial trauma of the axillary subclavian segment carries considerable morbidity and mortality risks. Surgical approaches are challenging given the hidden trajectory of these vessels, which has made the endovascular approach a valid and potentially better alternative for managing these injuries. We describe the incidence of relevant outcomes for patients with traumatic axillary and/or subclavian artery injury who underwent endovascular therapy at a tertiary care university hospital over a 15-year period in Cali, Colombia. METHODS: We conducted an incidence study based on clinical records that included patients aged 15 years or older with traumatic axillary subclavian arterial injury treated with endovascular therapy between 2008 and 2022. Vascular injuries caused by intra-arterial dialysis catheter insertion (iatrogenic) were excluded. We described clinical and imaging characteristics upon admission, perioperative findings, and the incidence of complications and in-hospital mortality, with accompanying 95% confidence intervals (CIs). RESULTS: We included 32 patients, 93.8% of whom were male, with a median (interquartile range) age of 30 (21-42) years. The type of trauma was penetrating in 75% of patients (62.5% corresponding to gunshot wounds) and blunt in 25%. Upon admission, 12 patients (37.5%) exhibited hard signs of vascular injury, and 20 patients (62.5%) exhibited soft signs. Fourteen patients (47%) had an Injury Severity Score greater than 15, and 12 (37.5%) had hemodynamic instability. All but 3 patients (90.6%) suffered subclavian artery injury (right 48.3%, left 51.7%), while 12.9% had axillary artery injury (one patient with both vessels affected). Intraoperative complications happened in one patient (3.1%, 95% CI: 0.2-18%). Pseudoaneurysms were identified in 11 patients (34.4%), thrombosis in 6 (18.8%), and dissection in 6 (18.8%). Three (9.4%) patients required hybrid management (endovascular therapy following conventional surgery). No cases of ischemia or amputation occurred. The length of hospital stay was 6 (3, 11.5) days. No cases of in-hospital mortality were reported (0%, 95% CI: 0.0-13.4%). CONCLUSIONS: Endovascular treatment in trauma is a minimally invasive technique with favorable clinical outcomes in patients with arterial trauma in the axillary-subclavian segment. This should be a viable therapeutic option for selected cases.
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Artéria Axilar , Procedimentos Endovasculares , Mortalidade Hospitalar , Artéria Subclávia , Lesões do Sistema Vascular , Humanos , Masculino , Artéria Axilar/cirurgia , Artéria Axilar/lesões , Artéria Axilar/diagnóstico por imagem , Artéria Subclávia/cirurgia , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/lesões , Feminino , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/cirurgia , Lesões do Sistema Vascular/mortalidade , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Adulto , Resultado do Tratamento , Adulto Jovem , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Colômbia , Ferimentos não Penetrantes/cirurgia , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/mortalidade , Incidência , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Pessoa de Meia-Idade , Ferimentos Penetrantes/cirurgia , Ferimentos Penetrantes/mortalidade , Ferimentos Penetrantes/diagnóstico por imagemRESUMO
BACKGROUND: Multicenter studies conducted in developed countries demonstrated that custom-made devices are safe, effective, and durable for treating complex abdominal aneurysms. However, the situation in developing countries, such as Brazil, is different. Funding and time to have the endoprosthesis delivered are the major concerns. In order to overcome these conditions, high-volume Brazilian university hospitals started gaining experience with a custom-made device produced in the country. OBJECTIVE: The present study aimed to describe the practice of 2 tertiary centers and report the early results of fenestrated and branched endovascular repair of complex aortic aneurysms with a custom-made national device available in the Brazilian public health system. METHODS: Retrospective analysis of all consecutive patients that underwent fenestrated and branched endovascular aneurysm repair (F/BEVAR) of complex aortic aneurysms using custom-made manufactured endoprosthesis in 2 tertiary centers from January 2020 to July 2022. RESULTS: Thirteen cases were included (10 male, mean age 69 ± 9 years). 70% were complex abdominal aneurysms, and 30% were type II, III, and IV thoracoabdominal aneurysms (mean aneurysm diameter 69.2 ± 8.12 mm). F/BEVAR included 33 visceral arteries. The Apolo® device was used in all cases. Technical success was achieved in 12 out of 13 patients (92.3%). Thirty-day major adverse events included one death (7.7%), 5 acute renal failure (38.4%), 2 spinal cord ischemia (15.4%). The 1-year survival rate was 92.3%. CONCLUSIONS: Fenestrated and branched endovascular repair of complex aortic aneurysms with the custom-made Apolo® device has proven safe and effective in high-volume tertiary centers in the Brazilian public health system. Considering the complexity of the cases, the early patency of vessels and low initial mortality support this device continuation and expansion to treat complex aortic aneurysms in a developing country.
Assuntos
Aneurisma da Aorta Abdominal , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Prótese Vascular , Procedimentos Endovasculares , Desenho de Prótese , Humanos , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Masculino , Estudos Retrospectivos , Idoso , Feminino , Brasil , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/mortalidade , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Resultado do Tratamento , Fatores de Tempo , Pessoa de Meia-Idade , Aneurisma da Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/mortalidade , Fatores de Risco , Complicações Pós-Operatórias/etiologia , Idoso de 80 Anos ou mais , Stents , Centros de Atenção TerciáriaRESUMO
BACKGROUND: The present study aims to describe the clinical characteristics and treatment outcomes of patients with symptomatic carotid web treated at a single institution in South America. METHODS: Retrospective study of a single-center experience of patients with carotid webs surgically treated from September 2019 to September 2023. RESULTS: Ten patients had carotid webs, 6 (60%) were females. Median age was 54.5 years (range: 35-77 years). All patients were symptomatic. Diagnosis was made in 90% (n = 9) of the patients with either computed tomography angiography or magnetic resonance alone. One (10%) patient underwent angiography for definite diagnosis. The median interval from the first neurological event to intervention was 90 months (range: 3 days-108 months). Four (40%) patients underwent surgical treatment within 1 month from symptom onset and carotid web diagnosis, with a median of 3.5 days (range: 3-9 days). Six (60%) patients underwent delayed surgical treatment since the cause of the neurological event was uncertain, with a median of 54 months (range: 6-108 months). These 6 patients had recurrent neurological events. Three (30%) patients underwent carotid endarterectomies with polyurethane patch and 3 (30%) by eversion technique. Three (30%) patients underwent segmental resection and reanastomosis of the internal carotid artery. One underwent internal carotid artery plasty with saphenous vein. At a median follow-up of 30 months (range: 6-46 months), 1 patient persists with mild aphasia, another patient has severe aphasia and right hemiparesis, both as sequelae of their initial strokes, and another patient has suffered 3 nonischemic episodes of brief transient right hemiparesis attributed to epileptic seizures. The other 7 patients remain without new neurological events. CONCLUSIONS: Neurological events of carotid distribution deserve accurate imaging work up, keeping in mind the diagnosis of carotid web. Surgical treatment for carotid web seems effective for preventing recurrences; nevertheless, further studies are warranted to define the best management for these patients.
Assuntos
Endarterectomia das Carótidas , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Estudos Retrospectivos , Idoso , Resultado do Tratamento , Adulto , Fatores de Tempo , Endarterectomia das Carótidas/efeitos adversos , Fatores de Risco , Doenças das Artérias Carótidas/cirurgia , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/terapia , Recidiva , Tempo para o TratamentoRESUMO
From January 2008 to December 2018, 1348 HIV-exposed infants were born in Porto Alegre, Brazil; 18.8% had adverse infant outcomes (AIO) including vertical transmission (1.9%), stillbirth/neonatal death (4.0%) and loss to follow-up before HIV diagnosis (12.9%). Timing of maternal HIV diagnosis was not associated with AIO but absent antiretroviral therapy use was. Lack of maternal antiretroviral therapy use is a significant risk factor for AIO.
Assuntos
Infecções por HIV , Transmissão Vertical de Doenças Infecciosas , Complicações Infecciosas na Gravidez , Humanos , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Gravidez , Feminino , Recém-Nascido , Complicações Infecciosas na Gravidez/tratamento farmacológico , Brasil/epidemiologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/transmissão , Adulto , Lactente , Soropositividade para HIV/tratamento farmacológico , Antirretrovirais/uso terapêutico , Antirretrovirais/efeitos adversos , Fármacos Anti-HIV/uso terapêutico , Fármacos Anti-HIV/efeitos adversos , Adulto Jovem , Fatores de Risco , Masculino , Estudos RetrospectivosRESUMO
BACKGROUND: Initial caries lesions in primary teeth have presented a low progression rate after 2 years, but it could be higher in longer follow-ups. AIM: To evaluate the progression rates of sound surfaces and initial and moderate caries lesions after 7 years. DESIGN: This prospective 7-year cohort study included 639 preschool children aged 1-5 years in 2010. In 2017, 449 children were reassessed (70.3% retention rate). Dental caries was collected using the International Caries Detection and Assessment System (ICDAS) in both assessments. Incidence rate (IR) per 100 surface-years estimated the progression rates of sound surfaces and initial and moderate lesions for worse conditions. Cox regression with shared frailty evaluated the possible risk factors. RESULTS: IR was 1.0% for sound surfaces, 2.8% and 4.2% for ICDAS scores 1 and 2, respectively, and about 17.0% for moderate lesions. The most significant risk factor for the progression was the presence of cavitated lesions in other teeth. The type of surface and tooth also influenced the outcome. CONCLUSION: The progression rate of initial caries lesions in primary teeth remains low even after 7 years, but cavitated caries lesions in other teeth increase this risk. Moderate lesions demonstrate a higher risk of progression when compared to sound surfaces and initial caries lesions.
Assuntos
Cárie Dentária , Progressão da Doença , Dente Decíduo , Humanos , Cárie Dentária/epidemiologia , Dente Decíduo/patologia , Pré-Escolar , Estudos Prospectivos , Masculino , Feminino , Fatores de Risco , Lactente , Incidência , CriançaRESUMO
OBJECTIVES: Early clinical prognosis and mortality reduction remains a challenge in chronic liver disease (CLD). The full potential of the Nutritional Prognostic Index (NPI) for nutritional assessment and management in CLD patients remains unexplored. The aim of this study was to establish an NPI cutoff point for the identification of nutritional risk in advanced CLD (ACLD) patients, as well as to assess the NPI's ability to predict ACLD-associated mortality. METHODS: This ethically approved prospective cohort study investigated malnutrition risk using both the NPI and the Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) in patients hospitalized for ACLD. NPI reference values were determined using a receiver operating characteristic curve. Associations between nutritional risk identified by the RFH-NPT and the NPI were assessed using Fisher's exact test, and agreement between tools was assessed using the Kappa index. The association between NPI-defined nutritional risk and 12-mo mortality was examined using Pearson Chi-square test. RESULTS: The sample population consisted of 120 adults, comprising 84 (70%) male and 57 (50.9%) of alcoholic etiology and presenting as Child-Pugh A, B, or C at admission. The identified cutoff point for NPI was <41, identifying nutritional risk in 82.5% of patients. The NPI presented a statistically significant association with the RFH-NPT, with a substantial agreement coefficient of 0.34. An association between NPI <41 cutoff and mortality were observed, with 82.1% of the sample below cutoff experiencing mortality within 12 mo. CONCLUSIONS: The NPI is a valuable nutritional marker for the identification of nutritional risk in ACLD and is a simple and effective assessment tool that can aid in early CLD prognosis assessment. Validation, however, remains necessary in other CLD populations of different etiologies.
Assuntos
Desnutrição , Avaliação Nutricional , Estado Nutricional , Humanos , Masculino , Feminino , Prognóstico , Estudos Prospectivos , Pessoa de Meia-Idade , Medição de Risco/métodos , Desnutrição/diagnóstico , Desnutrição/mortalidade , Idoso , Adulto , Hepatopatias/mortalidade , Doença Crônica , Curva ROC , Fatores de RiscoRESUMO
Leishmaniasis is a neglected tropical disease caused by protozoan parasites of the genus Leishmania. About 20 species of Leishmania are pathogenic to humans, with the specific infecting species playing a crucial role in determining clinical outcomes. There are three main forms of disease: cutaneous, mucocutaneous and visceral leishmaniasis. In addition to the infecting species, it has recently been suggested that parasite strains and genetic factors affect disease manifestation and response to treatment. This suggests that infecting parasites are a crucial risk factor for the pathology of leishmaniasis. These parasites are transmitted by sand flies, of which more than 1000 species have been recorded. However, only approximately 10 % of these species are responsible for transmitting Leishmania, with each sand fly species typically transmitting specific species of Leishmania. Most Leishmania species are zoonotically transmitted by sand flies, with reservoir animals playing a crucial role in disease transmission and endemicity. This aspect of the disease ecology highlights the importance of considering both vectors and reservoir animals in endemic areas as risk factors for leishmaniasis. Our epidemiological studies on leishmaniasis focus mainly on South American countries. This review describes the epidemiological aspects of leishmaniasis in Ecuador and Peru, with a focus on pathological and infectious risks.
Assuntos
Leishmania , Leishmaniose , Psychodidae , Fatores de Risco , Humanos , Animais , Leishmaniose/epidemiologia , Leishmaniose/transmissão , Psychodidae/parasitologia , Leishmania/genética , Leishmania/classificação , Leishmania/fisiologia , Peru/epidemiologia , Insetos Vetores/parasitologia , Reservatórios de Doenças/parasitologia , Zoonoses/epidemiologia , Zoonoses/parasitologia , Zoonoses/transmissãoRESUMO
Although affecting both sexes, loss of sex hormones and consequently increased risk for cardiovascular disease (CVD) render particular features to vascular aging in females. More importantly, although the female's vasculature is more sensitive to CVD risk factors, CVD is often underdiagnosed in women. In the present study, we investigated vascular function in the arm and leg skeletal muscle microvasculature and conduit artery in young and older females. We also applied a mixed-effect regression analysis to examine the relationship between vascular function and CVD risk factors in women. We showed that the detrimental effects of age in conduit artery vascular function, as assessed by flow-mediated dilation (%FMD), were more evident in the lower limb (older, 2.6 ± 0.5 vs. young, 7.2 ± 0.9%; P = 0.0116) compared with the upper limb (older, 5.3 ± 0.5 vs. young, 7.3 ± 0.4%; P = 0.175). In addition, we demonstrate that CVD risk factors, mainly plasma lipid levels [very low-density lipoprotein cholesterol (VLDL-c): r2 = 0.415, P = 0.007; high-density lipoprotein cholesterol (HDL-c): r2 = 0.313, P = 0.024; triglycerides: r2 = 0.422, P = 0.006] and insulin sensitivity index [homeostasis model assessment of insulin resistance (HOMA-IR): r2 = 0.635, P < 0.001; QUICKI: r2 = 0.792, P < 0.001], were exclusively associated with upper limb skeletal muscle microvascular function in older females. In aggregate, our findings provide novel evidence that impairments in conduit artery function in older females are more pronounced in the lower limb vasculature compared with the upper limb. Also, we demonstrate that older women's upper limb microvasculature function may be more susceptible to the impact of CVD risk factors than lower limb microvasculature function and both limb's conduit arteries.NEW & NOTEWORTHY Even though the vasculature of older females has been suggested to be more sensitive to the detrimental effects of traditional cardiovascular risk factors, cardiovascular disease in women is often underdiagnosed. We show that aging-associated vascular dysfunction is more evident in the lower limb conduit arteries compared with the upper limb in older women. More importantly, we demonstrate that traditional cardiovascular risk factors were exclusively associated with upper limb skeletal muscle microvascular function in older females.