Summary Introduction Pancreatic and perampullary neoplasms in patients aged 80 or older trouble the surgeons because of the risk of surgical treatment. We have reviewed our experience and ...literature's reports of pancreaticoduodenectomy in octogenarians, evaluating early results and long-term survival in pancreatic cancer group. Methods Three hundred eighty-five patients who underwent pancreaticoduodenectomy for neoplasms from 1998 to 2011 were included in the study, and were divided in two groups: group 1, patients younger than 80 years of age, and group 2, patients 80 years of age and older. Operative morbidity, mortality, disease-free and long-term survival were analysed. English literature was systematically searched for pancreatic resection's outcome in octogenarians. Results There were 385 pancreaticoduodenectomies: 362 patients were in group 1 and 23 patients in group 2. There was no significant difference regarding gender, and pathologic findings between the two groups. Complications’ rate (40 vs. 43%), mortality rate (4% vs. 0%), and overall median survival for pancreatic cancer patients were not statistically different in the two groups (median 21 vs. 19 months). Literature's review showed 14 reports of pancreatic resection in octogenarians. Most of the studies (particularly in centres with high-volume pancreatic surgery) showed that outcome after pancreatectomy was not different in octogenarians or in younger patients. Conclusion Pancreaticoduodenectomy is an acceptable option for elderly patients. Age alone should not be considered a contraindication to major pancreatic resection, but a careful preoperative evaluation and an accurate postoperative management are mandatory.
Purpose
The continuous discovery of new subtypes of neuromuscular disorders demands more accurate imaging analyses. We set out to establish the specific patterns of muscular involution using magnetic ...resonance imaging (MRI).
Materials and methods
A systematic clinical evaluation based on the Medical Research Council scale and MRI was completed in ten patients with calpainopathy limb-girdle muscular dystrophy (LGMD)-2A, 16 with dysferlinopathy (LGMD-2B), ten with hyaline body myopathy (HBM), six with myotonic dystrophy (MD) types 1 and 5 with MD type 2. Severity of fibroadipose degeneration was specifically staged using T1-weighted sequences. Turbo inversion recovery magnitude (TIRM) sequences were used to assess oedema-like changes.
Results
T1 scans showed recurrent patterns of fibroadipose replacement, whereas TIRM images revealed differences in oedema-like changes between the various diseases. In LGMD, the posterior compartments are more vulnerable to degeneration. In HBM, fatty muscle degeneration and oedema are allocated to muscles of the posterior compartments of the leg. In MD, fatty muscle degeneration and oedematous changes are allocated to muscles of the anterior thigh and posterior lower leg.
Conclusions
Imaging examination suggests a characteristic pattern of muscle involvement. MRI represents an important diagnostic technique useful in differential diagnosis, thanks to the distinctive patterns observed in the distribution of muscular changes between the different muscular diseases.
This article presents results of a research carried out with the objective of analyzing the participation of Social Control in the sphere of Public Health Policy of a small municipality, located in ...the Extreme West of Santa Catarina. This is a qualitative study, carried out with the participation of twelve directors, six representatives of non-governmental entities and six of governmental entities. Data were collected between August and December 2019, through interviews with open and closed questions. The research was approved by the Ethics and Research Committee. All requirements contained in the Resolution of the National Health Council - CNS 466/2012 were observed and respected. The limits for the participation of members in the Council, time and lack of knowledge in the health area were found as limits, and with regard to the possibilities, a broader view of the health services offered, and within this, the prioritization of actions and actions. It is observed that Social Control is very important and necessarily needs to be maintained and strengthened. The Federal Constitution of 1988 consolidated and predicted in its devices the participation of citizens in the formulation and implementation of Social Control, public health policies. It is hoped that the result of the research can boost proposals that are configured as responses to the strengthening of participation in Social Control, recognizing the Health Councils are deliberative and permanent collegiate organs of the SUS, existing in each sphere of government and members of the basic structure of the health system.
The aim of this study was to describe the epidemiological profile and the patients knowledge about Diabetes Mellitus (DM). About sixty-six patients answered a questionnaire like an interview. The ...predominantly females (60,6%), aged 61 years or over (68,2%), primary school (59%), white color (78,8%), non smokers (97%), retired people (77,4%), married (66,7%), low income (50%), over weight (35%), inactivity or don´t practice physical activity (60,6%), diabetes family history (79,4%), and hypertension as principal comorbidity (25,6%). In the relation to pathology`s knowledge, about 60,6% of people figure out of what is this pathology and the proper care. Of the participants, 72,5% said it was "sugar in the blood” and 86,4% related that having Diabetes Mellitus (DM) type 2. The most part of patients (78,8%) didn´t had signs and symptoms when they had diagnosed with the disease. Almost 88% of patients used oral antidiabetic treatment, and the most common medicine is metformin, used by which 86,4% of the patients. There are patients who use insulin, 87,5% use 10 to 40 IU, twice a day 63,5%, they have to inject the insulin in the abdomen and 50% have to do the self-application. Now, in relation to diet, 72,7% said they follow her adequately and 62,2% don´t have problems with this. The results also showed that patients are aware of the possible complications, and the most frequent was retinopathy, 95,4%. Then, 68,2% use dental prostheses, and 62,1% don´t search for dental care. In this way, it is possible to concluded that diabetics patients should receive individualized and multidisciplinary care in the Basic Health Units, so that together with the professionals that monitored them, then can define what kind of care is required, and also decide to follow the treatment in a correct way, delaying the complications and improving their quality of life.
This is a retrospective, cross-sectional, documentary study aimed at analyzing the behavior of health professionals who perform prenatal care in pregnant women in the basic network of the ...Municipality of Catanduvas SC, from January to December 2016. We analyzed 97 medical records. The results show that the average age of pregnant women was 28 years, and 47.4% were aged between 20 and 29 years. The onset of prenatal care occurred in the second trimester in 55.7% of pregnant women; 50.5% performed 1 to 3 nursing consultations and 45.5% performed 7 or more medical visits. It was also observed that 91.8% of the pregnant women performed laboratory tests and three rapid tests for the diagnosis of Syphilis, Viral Hepatitis, and HIV, being a test in each gestational trimester. During the analyzed period two pregnant women with syphilis were diagnose , which gives us a prevalence rate of 2.1%, which were treated properly, but one of the partners did not accept the treatment. It should be pointed out that data referring to the characteristics of the pregnant women did not have a 100% completion which leads us to suggest that the professionals involved in the prenatal care receive continuous education about the importance of correct filling of the pregnant woman's chart, emphasizing that this is a legal procedure and that the non-fulfillment can jeopardize the continuity of the assistance and the carrying out of researches in the area.
In December 2019, a new coronavirus was sparked in China, which was named the following year by the World Health Organization as Coronavirus Disease (COVID-19). The pandemic installed because to ...Covid-19 brought interference from social and governmental aspects, such as social isolation and the closing of borders, as strategies to reduce exposures of populations to the virus. In contrast, health professionals live a time of exposure and vulnerability, facing challenges on a daily basis. This paper aims to discuss the scenario of Covid-19 in Brazil and the challenges experienced by health professionals. This is a bibliographic review of complete scientific articles, published in the Scielo, BVS and WHO virtual libraries, between 2019 and 2020, in English or Portuguese languages, being articles in the Health Sciences area. Search for the keywords “coronavirus infections and healthcare personnel”, “coronavirus infections and Brazil”, and “coronavirus infections”. Were found 696 articles and 21 of relevant content were selected for the present review. Complementary official government data were also used. It is concluded that frontline health professionals in Brazil and other countries in the world face personal and professional challenges, related to degrading feelings, insufficient guidance on handling contaminated materials and practices with transitory truths and little scientific basis. It is observed the importance of professional valorization in typical days, bigger operational investments and care with the physical and mental health of the health professionals.
Malignant melanoma represents a significant and growing public health burden worldwide. Ultrasonography is the most useful diagnostic modality for regional lymph nodal staging. Because any focal ...areas of cortical lobulation or thickening-swelling should also be considered as a sign of metastases, we are going to report the usefulness of contrast-enhanced ultrasonography (CEUS) in the differential diagnosis of benign or malignant lymph nodes in patients with malignant melanoma based on blood stream patterns and investigate the diagnostic capability.
After the excision of cutaneous melanoma with positive excision margins but with negative sentinel lymph node, 540 patients underwent US of superficial lymph nodes. The inclusion criteria for CEUS consisted of both major signs (absence of the echogenic hilus, round shape, and peripheral capsular vascularity) and minor ones (the presence of focal cortical thickening). The diagnostic capability was evaluated by comparing the cytological findings with the enhancement pattern on CEUS.
US in combination with CEUS correctly classified 534/540 patients. CEUS applied to lymph nodes with focal cortical thickening on grayscale US confirmed great sensitivity (0.98) and specificity (0.99) but above all, it showed a markedly improved accuracy of 0.99. The likelihood ratios confirmed the good performance of the methods used.
CEUS increases the diagnostic accuracy of US in the differential diagnosis of benign and malignant LNs but it also allows us, when possible, to avoid unnecessary invasive operations such as LN FNAC. Moreover, CEUS may guide FNAC in the case of focal cortical thickening on the basis of hypoperfusion, with a reduction in the number of false negatives and much earlier detection of nodal metastatic foci.
This article presents part of study’s results that aims to identify the incidence rates and factors associated with STDs in the elderly population of São Miguel do Oeste – SC. A quantitative, ...analytical, descriptive and cross - sectional cohort study was performed. The information was obtained in a campaign of rapid tests for men and women over 60 years. The population in the age group from 60 to 90 years, resident in the municipality in 2018 is 4,391 people (2,432 women and 1,959 men). Four rapid tests were performed: Hepatitis B, Hepatitis C, Syphilis and HIV; 1,027 people aged over 60 years were tested. A total of 29 positive STD-related results were reported, corresponding to 2.82% of the group. The results show that there is an exposure of the elderly population to STDs in the city and, therefore, is important to emphasize the relevance of health’s professionals to develop actions focusing at the changes that happen in the aging process, highlighting the prevention of STDs as a important health factor.
Background Although both diseases are characterized by specific features the differentiation between rheumatoid arthritis (RA) and simil-rheumatoid psoriatic arthritis (srPsA) is extremely difficult ...except by hard-to-gain biopsy specimens (1). On contrast enhanced magnetic resonance imaging (CE-MRI) some extra-articular manifestations may direct diagnosis, but synovitis could not be discriminated between RA and srPsA in these studies (2-4). Contrast-enhanced ultrasound (CEUS) using “real” intravascular agents is believed to allow more accurate study of synovial vascularization. Objectives To determine the feasibility to discriminate between RA and srPsA using CEUS derived flow parameters by ad hoc developed software program for analysis of synovial vascularization. Methods 64 outclinic patients with polyarthritis of hands, 32 with RA and 32 with srPsA, were recruited. The most active joint was chosen for CEUS examination using a US device (Mylab70, Esaote) equipped with Contrast tuned Imaging (CnTI, Esaote), and as contrast agent sulfur hexafluoride microbubbles (SonoVue; Bracco International). Both the anatomical B-mode image and the CnTI cineloop video were digitally stored for subsequent software analysis. Image analysis was performed firstly applying a semi-automatic detection of synovial boundaries (5). Then, the contrast time-activity curve of all pixels belonging to the synovial and perisynovial region was analyzed fitting a gamma curve f(t) = A(t − t0)a $times$ e(t −t0)/b on the data. The statistics summarizing the distribution of the estimated kinetics parameters in the synovial and in the perisynovial tissue were computed and their difference between the two groups (RA and srPsA) analyzed, so to study the existence of different vascularization patterns. Finally, a supervised classifier (random forest) was trained to classify each patient through its CEUS-derived parameters, validating the classifier diagnostic power using a leave-one-out strategy. To further increase diagnostic power data about DAS28, CRP, ESR and autoantibodies were added. Results Vascularization pattern constituted of 40 flow parameters discriminated effectively RA from srPsA. Accuracy was 0.93 during training and 0.83 during test phase. Adding rheumatoid factor (RF) and anti-CCP increased diagnostic accuracy to 0.99 in training and 0.93 in test phase decreasing needed flow parameters to 28, whereas DAS28, CRP and ESR did not. Conclusions The Dynamic Automated Synovial Imaging (DASI) is actually the only imaging method that accurately discriminates RA from srPsA, especially in the presence of RF and anti-CCP data. References Kruithof E. Arthritis Res Ther 2005;7:569-80. Jevtic V. Handchir Mikrochir Plast Chir 2012;44:163-170. Cimmino MA. J Rheum 2012;39(89):43-8. Schoellnast H. AJR 2006;187:351-7. Veronese E. Med Eng Phys 2013; 35, 188–194. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3779
PDF
