scholarly journals DIAPHRAGMATIC ULTRASONOGRAPHY AS A PREDICTOR OF VENTILATORY WEANING: A SYSTEMATIC REVIEW

2021 ◽  
Author(s):  
André Luiz Lisboa Cordeiro ◽  
Lucas Soares ◽  
Késsia Oliveira ◽  
Amanda Maria Jesus
Keyword(s):  
Artificial Respiration ◽  
Case Reports ◽  
Ventilatory Support ◽  
Ventilator Weaning ◽  
Inclusion Criteria ◽  
Cutoff Value ◽  
Predicting Success ◽  
Literature Reviews ◽  
Predictor Of Success ◽  
Definition Of

Objectives: To review the evidence on Diaphragmatic Ultrasonography as a predictor of success in ventilatory weaning. Methodology:Systematically review using the PICO methodology and keywords: Ultrasound, Ultrasound, Diagnostic imaging, Diaphragm, Weaning, Intensive Care Unit, Artificial Respiration, Mechanical Ventilation, Ventilator Weaning. Published cohort studies were used without language and year restrictions that addressed the use of ultrasound to predict success in weaning and ventilatory extubation. Studies with patients under 18 years of age, case reports, literature reviews, results that do not bring a cutoff value for thickness and diaphragmatic excursion and the definition of failure in the weaning and extubation process were excluded. In addition, the Boolean operators “and” and “or” were used. Results:459 were found, which after exclusion due to duplication and reading of titles and abstract, only 11 were selected by the inclusion criteria. The samples ranged from 34 to 193 individuals. We can evidence that the use of USG to assess the thickness and excursion of the diaphragm in patients undergoing invasive ventilatory support is effective in predicting success in the weaning and extubation process. Conclusion: It is concluded that Diaphragmatic Ultrasonography has great applicability to assess the ability to predict success or failure in removing invasive ventilatory support.

scholarly journals Provisórios em prótese fixa: revisão integrativa da literatura e técnicas para confecção

2021 ◽  
Vol 12 (1) ◽  
pp. 48
Author(s):  
Andressa Cristina Da Silva Queiroz ◽  
Robson De Lima Gomes ◽  
Gregorio Marcio De Figueiredo Rodrigues ◽  
Viviane Figueiredo
Keyword(s):  
Intermediate Phase ◽  
Case Reports ◽  
Laboratory Research ◽  
Inclusion Criteria ◽  
Exclusion Criteria ◽  
Literature Reviews ◽  
Cad Cam ◽  
Endodontically Treated Tooth ◽  
Dental Polishing ◽  
Fixed Prosthesis

INTRODUCTION: The temporary fixed denture is an important part of the treatment, being an intermediate phase necessary for the manufacture of the definitive denture. OBJECTIVE: Present materials and their properties; as well as the techniques for making provisionals in Fixed Prosthesis, through an integrative literature review. MATERIAL AND METHOD: Search for the articles took place in the BVS and PubMed, published in portuguese and english, between 2000 and 2020. The search strategy used was: (Denture, Partial, Temporary) AND (Polymers) AND (Denture, Partial, Fixed) AND ("Dental Prosthesis" OR "Flexural Strength" OR "Dental Polishing"). The inclusion criteria were complete studies and available; studies of temporary fixed denture on teeth. The exclusion criteria were studies of provisional prostheses on implants. The complete data of the selected texts were extracted by the reviewers. Techniques for temporary fixed denture were presented regarding the stages of preparation, literature reviews and case reports. RESULTS: The studies addressed the application of different materials and techniques, in addition to laboratory research being prevalent. There was a heterogeneity between study objects and variables, with emphasis on the use of different polymers, techniques and adding reinforcement. CONCLUSION: The revised literature presented several of temporary materials. The techniques reported were the use of silicone mold, acetate matrix and CAD / CAM. And the most common techniques to be performed in the daily clinic were adaptation of the stock facet (on the preparation tooth and endodontically treated tooth), adapted resin or ball and silicone mold or matrix.

Exercise in intensive care units, safety and hemodynamic monitoring

2020 ◽  
Vol 19 (1) ◽  
pp. 3
Author(s):  
Giulliano Gardenghi
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Hemodynamic Monitoring ◽  
Artificial Respiration ◽  
Exercise Physiology ◽  
Ventilatory Support ◽  
Early Mobilization ◽  
Cycle Ergometer ◽  
Search Terms

Introduction: Patients in the intensive care unit (ICU) have several deleterious effects of immobilization, including weakness acquired in the ICU. Exercise appears as an alternative for early mobilization in these patients. Objective: This work aims to highlight the hemodynamic repercussions and the applicability of exercise in the ICU. Methods: An integrative literature review was carried out, with articles published between 2010 and 2018, in the Lilacs, PubMed and Scielo databases, using the following search terms: exercise, cycle ergometer, intensive care units, early mobilization, mechanical ventilation, artificial respiration. Results: 13 articles were included, addressing hemodynamic monitoring and the role of exercise as early mobilization, with or without ventilatory support. The exercise sessions were feasible and safe within the ICU environment. Conclusion: Physical exercise can be performed safely in an ICU environment, if respecting a series of criteria such as those presented here. It is important that the assistant professional seeks to prescribe interventions based on Exercise Physiology that can positively intervene in the functional prognosis in critically ill patients.Keywords: exercise, intensive care units, patient safety.

Reference Conundrum: The Broad Definition of Peer-Review

2018 ◽  
Author(s):  
Cody Fullerton
Keyword(s):  
Peer Review ◽  
Gold Standard ◽  
Review Process ◽  
Peer Review Process ◽  
Academic Publishing ◽  
Inaccurate Information ◽  
The Core ◽  
Literature Reviews ◽  
Reference Interactions ◽  
Definition Of

For years, the gold-standard in academic publishing has been the peer-review process, and for the most part, peer-review remains a safeguard to authors publishing intentionally biased, misleading, and inaccurate information. Its purpose is to hold researchers accountable to the publishing standards of that field, including proper methodology, accurate literature reviews, etc. This presentation will establish the core tenants of peer-review, discuss if certain types of publications should be able to qualify as such, offer possible solutions, and discuss how this affects a librarian's reference interactions.

Terson sign:

2020 ◽  
Vol 2 (1) ◽  
pp. 38-43
Author(s):  
Luiz Severo Bem Junior ◽  
Gustavo De Souza Andrade ◽  
Joao Ribeiro Memória Júnior ◽  
Hildo Rocha Cirne de Azevedo Filho
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Early Recognition ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Case Reports ◽  
Clinical Status ◽  
Vitreous Hemorrhage ◽  
Anterior Communicating Artery ◽  
Inclusion Criteria ◽  
Relationship Of ◽  
The Relationship

Terson's sign (TS) is classically defined as vitreous hemorrhage associated with subarachnoid hemorrhage of aneurysmal origin, being an important predictor of severity, indicating greater morbidity and mortality when compared to patients without the sign. The objective of this study is to review the relationship of Terson syndrome/Terson sign with the prognosis of aneurysmal subarachnoid hemorrhage. A search for original articles, research and case reports was performed on the PubMed, Scielo, Cochrane and ScienceDirect platform, with the following descriptors: Terson sign and subarachnoid hemorrhage. Retrospective, prospective articles and case reports published in the last 5 years and which were in accordance with the established objective and inclusion criteria were selected. Ten (10) articles were selected, in which the available results show an unfavorable prognostic relationship of TS and subarachnoid hemorrhage, because these patients had a worse clinical status assessed on the Glasgow scales ≤ 8, Hunt & Hess > III, Fisher > 3, in addition to intracranial hypertension and location of the aneurysm in the anterior communicating artery complex. The early recognition of this condition described by Albert Terson in 1900 brought an important contribution to neurosurgery, being recognized until nowadays.

scholarly journals AB0677 REVISING THE DEFINITION OF REACTIVE ARTHRITIS AND DIFFERENTIATION FROM UNDIFFERENTIATED SPONDYLOARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1633.2-1634
Author(s):  
F. Cosan ◽  
O. M. Gedar
Keyword(s):  
Causative Agent ◽  
Reactive Arthritis ◽  
Case Reports ◽  
Experimental Studies ◽  
Classification Criteria ◽  
General Definition ◽  
Parasitic Infections ◽  
Undifferentiated Spondyloarthritis ◽  
Classical Definition ◽  
Definition Of

Background:Reactive arthritis (ReA) is defined by 1999 ACR criteria as arthritis preceding a bacterial genitourinary (GUS) or gastrointestinal (GIS) infection in 3 days-6 weeks and evidence of triggering infection. Recently, ReA is classified as SpA and patients who do not fulfill SpA criteria are classified as undifferentiated spondyloarthritis (USpA) according to ASAS/EULAR SpA classification criteria.Objectives:In several case reports which are associated with other infective agents are reported and the definition is extended for some clinicians so that SpA which is occurred after any infection is called as ReA. On the other hand, some researchers still accept the classical definition of ReA. The problem with the heterogeneity of opinions and unstandardized definition of ReA hinders studies about pathogenesis and standardization of treatments. In this study, we aimed to determine the spectrum of the use of the definition of reactive arthritis in publications in PubMed between 2009-2019.Methods:The ReA keyword is searched in PubMed for the years between 2009-2019. 248 different publications have been identified and included in this research. 89 articles, 47 reviews, 108 case reports, 2 guidelines, and 2 editorials reviewed for the definition of ReA.Results:Only 42.7% (106 patients) of these publications meet the classical definition which suggests ReA after only GIS and GUS infections. In 4 (1.6%) of the publications ReA was defined after GIS, GUS and oropharyngeal infections; in 3 (1,2%) of the publications after any bacterial infection; in 9 (3.6%) of the publications after any infection. In 8 (3.2%) of the publications, ReA and USPA was used correspondingly. In 39 (15,7%) of the publications the term agent related, ReA was used without making a general definition for ReA. 79 publications (31,9%) have not defined ReA.According to causative agent and ReA relationship, in 64 (24,6%) general infective agents, in 75 (30,2%) classical agents, in 22 (8,9%) other bacterial agents, in 23 (9,3%) streptococcus, in 10(4%) intravesical BCG, in 6 (2.4%) HIV, in 6 (2.4%) tuberculosis, in 12 (4,8%) clostrudium difficle, in 2 (0.8%) parasites were reported. In 31 (12,5%) of the publications the causative agent for the ReA was unknown, the diagnosis was made clinically.Conclusion:In this study, it is aimed to draw attention terminology intricacy and the need for the standardization of the definition of ReA and USpA. It is clear that to standardize the definition of Rea and USpA is necessary. Between 2009-2019 there are reported cases diagnosed as ReA associated with bacterial infections (especially with Clostridium difficile, streptococcus and tuberculosis infections), and viral infections (by a majority with HIV), and parasitic infections. It is not clear if we need to define them classically or define them as USPA. Another important consideration is the necessity of extended laboratory investigations to find out the real causative agent even if the patient is clinically diagnosed with ReA. The requirement of the differentiation between ReA and USpA must be revealed for therapeutic researches.References:[1]A proposal for the classification of patients for clinical and experimental studies on reactive arthritis. Pacheco-Tena C, Burgos-Vargas R, Vázquez-Mellado J, Cazarín J, Pérez-Díaz JA. J Rheumatol. 1999 Jun;26(6):1338-46.[2]The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Rudwaleit M, van der Heijde D, Landewé R, Akkoc N, Brandt J, Chou CT, Dougados M, Huang F, Gu J, Kirazli Y, et al. Ann Rheum Dis. 2011;70:25–31.Disclosure of Interests:None declared

scholarly journals Haemostatic and thrombo-embolic complications in pregnant women with COVID-19: a systematic review and critical analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Juliette Servante ◽  
Gill Swallow ◽  
Jim G. Thornton ◽  
Bethan Myers ◽  
Sandhya Munireddy ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Pregnant Women ◽  
Clinical Evidence ◽  
Case Reports ◽  
Standard Form ◽  
Test Results ◽  
Maternal Deaths ◽  
High Clinical Suspicion ◽  
Increased Risk ◽  
Definition Of

Abstract Background As pregnancy is a physiological prothrombotic state, pregnant women may be at increased risk of developing coagulopathic and/or thromboembolic complications associated with COVID-19. Methods Two biomedical databases were searched between September 2019 and June 2020 for case reports and series of pregnant women with a diagnosis of COVID-19 based either on a positive swab or high clinical suspicion where no swab had been performed. Additional registry cases known to the authors were included. Steps were taken to minimise duplicate patients. Information on coagulopathy based on abnormal coagulation test results or clinical evidence of disseminated intravascular coagulation (DIC), and on arterial or venous thrombosis, were extracted using a standard form. If available, detailed laboratory results and information on maternal outcomes were analysed. Results One thousand sixty-three women met the inclusion criteria, of which three (0.28, 95% CI 0.0 to 0.6) had arterial and/or venous thrombosis, seven (0.66, 95% CI 0.17 to 1.1) had DIC, and a further three (0.28, 95% CI 0.0 to 0.6) had coagulopathy without meeting the definition of DIC. Five hundred and thirty-seven women (56%) had been reported as having given birth and 426 (40%) as having an ongoing pregnancy. There were 17 (1.6, 95% CI 0.85 to 2.3) maternal deaths in which DIC was reported as a factor in two. Conclusions Our data suggests that coagulopathy and thromboembolism are both increased in pregnancies affected by COVID-19. Detection of the former may be useful in the identification of women at risk of deterioration.

scholarly journals Applicability of Moyers analysis in mixed dentition: A systematic review

2013 ◽  
Vol 18 (6) ◽  
pp. 100-105 ◽  
Author(s):  
Mariana de Aguiar Bulhões Galvão ◽  
Gladys Cristina Dominguez ◽  
Sérgio Thomaz Tormin ◽  
Alex Akamine ◽  
André Tortamano ◽  
...  
Keyword(s):  
Systematic Review ◽  
Literature Review ◽  
Clinical Case ◽  
Case Reports ◽  
Mixed Dentition ◽  
Inclusion Criteria ◽  
Exclusion Criteria ◽  
Theoretical Probability ◽  
Study Population ◽  
Mixed Dentition Analysis

INTRODUCTION: Moyers analysis is widely used for analyzing mixed dentition, however, the accuracy of its theoretical probability tables has been recently questioned. Taking into consideration the fact the mixed dentition analysis is of paramount importance to precisely determine the space needed for alignment of canines and premolars, this research aimed at objectively assessing in the literature such an important step for orthodontic diagnosis. METHODS: A computerized search involving articles published on PubMed and Lilacs between 1990 and September, 2011 was conducted in accordance with the method described in the Cochrane 5.1.0 handbook. RESULTS: The research resulted in a sample composed of 629 articles. The inclusion criteria were: Articles using the Moyers analysis with a sample greater or equal to 40 patients. Conversely, the exclusion criteria were: Dental casts of patients with syndromes or oral cleft, researches conducted with a literature review, only, or clinical case reports and researches conducted before 1990. For this systematic review, 19 articles were selected. CONCLUSION: Based on the literature available, we can conclude that the Moyers mixed dentition analysis must be carefully used, since the majority of the articles analyzed showed that the probability of 75% was not as accurate as expected, leading to the need of adapting the probability levels depending on the study population.

scholarly journals 247. Validation of the Use of Oral Vancomycin Following Positive Admission Screening Testing for C. difficile

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S123-S123
Author(s):  
Preethi Yeturu ◽  
Jorge P Parada ◽  
Maressa Santarossa ◽  
Laurie Labuszewski ◽  
Jenna Lopez ◽  
...  
Keyword(s):  
Clinical History ◽  
Inclusion Criteria ◽  
Infectious Colitis ◽  
First Line Therapy ◽  
Clostridioides Difficile ◽  
Admission Screening ◽  
Positive Stool ◽  
Number Of Patients ◽  
Polymerase Chain ◽  
Definition Of

Abstract Background Clostridioides difficile can cause a severe infectious colitis and is often associated with significant morbidity and mortality. C. difficile infection (CDI) is defined as the presence of diarrhea plus a positive stool test, whereas C. difficile colonization is defined as a positive stool test in the absence of diarrhea or the presence of diarrhea attributable to causes other than CDI. Widespread use of stool polymerase chain reaction (PCR) testing, especially within the first 3 days of admission, has become common at our institution and has been associated with increased number of positive C. difficile tests results. However, C. difficile colonization rates may be 15% or higher. Oral (PO) vancomycin (vanc) is first line therapy for the treatment of CDI. We sought to evaluate the appropriateness of use of PO vanc in patients who tested positive for C. difficile via stool PCR within 3 days of admission. Methods We reviewed the clinical history, presence of diarrhea, risk factors for diarrhea, treatment and use of an infectious disease (ID) consultation for all patients 18 years of age or older found to test positive for C. difficile by PCR on stool assays during the first 3 days of admission from 07/01/18 to 12/31/18. Results A total of 228 patients met inclusion criteria. 183 (80%) received PO vanc while 45 (20%) did not. 131 (71.6%) of patients who received PO vanc had diarrhea, 39 (21.3%) did not have diarrhea, 13 (7.1%) the presence of diarrhea was unknown. 41 of 143 (28.7%) of patients without ID consults received PO vanc despite not having diarrhea, while 11 of 40 (27.5%) patients seen by ID received PO vanc despite not having diarrhea (p=0.888). Conclusion Most patients who tested positive for C. difficile received PO vanc had documented diarrhea, meeting the definition of CDI. However, over 1 in 5 (21.3%) of patients who received PO vanc did not have diarrhea and may have been colonized rather than have true CDI. ID consultation did not decrease the number of patients without diarrhea who received PO vanc or prevent treatment of colonized patients. This work reveals there may be an opportunity for improvement regarding management of CDI vs. C. difficile colonization which may enhance antibiotic stewardship and the appropriate use of PO vanc. Disclosures All Authors: No reported disclosures

Abstract P563: Prognosis Driven Definition of Carotid Near-Occlusion With Full Collapse

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Charith Cooray ◽  
Thomas Gu ◽  
Allan J Fox ◽  
Elias Johansson
Keyword(s):  
Ischemic Stroke ◽  
Carotid Stenosis ◽  
Risk Markers ◽  
Inclusion Criteria ◽  
Short Term ◽  
Residual Stenosis ◽  
Kaplan Meier ◽  
Near Occlusion ◽  
Definition Of ◽  
Distal Artery

Introduction: Carotid near-occlusion is a severe carotid stenosis causing distal artery collapse of varying degree. Near-occlusion is often divided into a “full collapse” group with a threadlike distal lumen, and the often overlooked “without full collapse” group with a normal-appearing, albeit small, distal lumen. By this division by appearance, symptomatic near-occlusion with full collapse has been reported to have worse short-term prognosis than those without full collapse, no other division has been assessed for prognosis. The aim of this study was to assess if a measurement based definition of full collapse might improve prognostic discrimination. Methods: 99 consecutive patients with symptomatic near-occlusion diagnosed on CT-angiography were included. The risk of preoperative recurrent ipsilateral ischemic stroke within 28 days of presenting event was assessed with Kaplan-Meier analysis, censoring at revascularization. We assessed residual stenosis diameter, distal ICA diameter, ICA-ratio (side-to-side), and ICA-ECA ratio as risk markers. Results: By appearance, the 28-day risk of stroke tended to be higher for full collapse (27%, 11/42) than without full collapse (11%, 6/57), p=0.054 (figure). The best new definition of full collapse was distal ICA diameter ≤2.0 mm and/or ICA ratio ≤0.47. 10 patients were reclassified by this new definition compared to appearance definition, 5 in each direction. By the new definition, 28-day risk of stroke was higher in full collapse (34%, 14/42) than without full collapse (5%, 3/57), p<0.001 (fig 1B). Conclusions: Compared to the appearance based definition, our new definition of separating near-occlusions into with and without full collapse yields similar groups sizes but better prognostic discrimination. This new definition could be used as inclusion criteria in future treatment trials.

scholarly journals Video-assisted thoracoscopic extended thymectomy in myasthenic children

2013 ◽  
Vol 5 (1) ◽  
pp. 4 ◽  
Author(s):  
Rita Sonzogni ◽  
Lorenzo Novellino ◽  
Alberto Benigni ◽  
Ilaria Busi ◽  
Magda Khotcholava ◽  
...  
Keyword(s):  
Case Reports ◽  
Preoperative Evaluation ◽  
Surgical Techniques ◽  
Length Of Hospital Stay ◽  
Ventilator Weaning ◽  
New Drugs ◽  
Extended Thymectomy ◽  
Myasthenic Patient ◽  
Surgical Department ◽  
Video Assisted

Myasthenia gravis (MG) is an autoimmune disease marked by weakness of voluntary musculature. Medical and surgical therapy of adult myasthenia is well documented. There is little pediatric surgical evidence, only a few case reports being available. The aim of this paper is to verify whether the surgical and anesthesiological techniques can warrant an early and safe discharge from the operating room. The secondary aim is to assess the presence of perioperative indicators that can eventually be used as predictors of postoperative care. During the years 2006-2009, 10 pediatric patients were treated according to a surgical approach based on video assisted thoracoscopic extended thymectomy (VATET). Standard preoperative evaluation is integrated with functional respiratory tests. Anesthetic induction was made with propofol and fentanyl/remifentanyl and maintenance was obtained with sevoflurane/desflurane/propofol ± remifentanyl. A muscle relaxant was used in only one patient. Right or left double-lumen bronchial tube (Ruesch Bronchopart® Carlens) placement was performed. Six patients were transferred directly to the surgical ward while 4 were discharged to the intensive care unit (ICU); ICU stay was no longer than 24 h. Length of hospital stay was 4.4±0.51 days. No patient was readmitted to the hospital and no surgical complications were reported. Volatile and intravenous anesthetics do not affect ventilator weaning, extubation or the postoperative course. Paralyzing agents are not totally contraindicated, especially if short-lasting agents are used with neuromuscular monitoring devices and new reversal drugs. Perioperative evaluation of the myasthenic patient is mandatory to assess the need for postoperative respiratory support and also predict timely extubation with early transfer to the surgical department. Availability of new drugs and of reversal drugs, the current practice of mini-invasive surgical techniques, and the availability of post anesthesia care units are the keys to the safety and successful prognosis of patients affected by MG who undergo thymectomy.

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