Modern Management of Esophageal Cancer: Radio-Oncology in Neoadjuvancy, Adjuvancy and Palliation

The modern management of esophageal cancer is crucially based on a multidisciplinary and multimodal approach. Radiotherapy is involved in neoadjuvant and adjuvant settings; moreover, it includes radical and palliative treatment intention (with a focus on the use of a stent and its potential integration with radiotherapy). In this review, the above-mentioned settings and approaches will be described. Referring to available international guidelines, the background evidence bases will be reviewed, and the ongoing, more relevant trials will be outlined. Target definitions and radiotherapy doses to administer will be mentioned. Peculiar applications such as brachytherapy (interventional radiation oncology), and data regarding innovative approaches including MRI-guided-RT and radiomic analysis will be reported. A focus on the avoidance of surgery for major clinical responses (particularly for SCC) is detailed.

Ageing societies and the first and second waves of the COVID-19 pandemic – Statements of the European Geriatric Medicine Society and measures of the Hungarian Government concerning older people

Purpose Ageing of the societies is a demographic phenomenon in the developed world. SARS-CoV-2 is a novel human coronavirus responsible for a pandemic of coronavirus disease 2019 (COVID-19). World Health Organization (WHO) data demonstrated that the first two waves of the pandemic had the most severe impact on older people and that is why new guidelines and protocols were necessary in geriatric medicine to protect senior citizens. Materials and methods In our publication, we summarise the three statements of EuGMS concerning the first and second waves of COVID-19 pandemic in Europe. Besides following the European recommendations, a proper local response was necessary in each country. Results The Hungarian Government has successfully completed the necessary measures during the first two waves, which are summarised in our publication. Those measures took into consideration not only the international guidelines, but the capacities of the healthcare system, as well as the sociodemographic and economic characteristics of the country. Conclusions Successful local defence against COVID-19 required adequate and optimised interpretation of the international guidelines to save the life of thousands of older adults in Hungary.

O Fenômeno das Fake News: Implicações para a Política Externa do Governo Bolsonaro durante a Pandemia do COVID-19 | The Fake News Phenomenon: Implications for the Foreign Policy of the Bolsonaro Government during the COVID-19 Pandemic

O uso de plataformas como o Twitter por políticos, como Bolsonaro, tem mudado a comunicação política. Associado a isso, a rapidez com que a informação circula por tais ambientes proporciona a disseminação de desinformação e fake news, especialmente durante a pandemia do COVID-19 a partir de 2020. Diante disso, o artigo busca entender como o presidente Jair Bolsonaro utilizou o fenômeno das fake news como base da sua comunicação política durante a pandemia do COVID-19 e qual a influência desse fenômeno para a política externa brasileira. A hipótese inicial é de que a propagação de informações sem conteúdo confiáveis é utilizada como ferramenta política por Jair Bolsonaro. Nesse cenário, a política externa brasileira sofre influências diretas devido a ocorrência de tal fenômeno, com novas diretrizes internacionais e posicionamentos, acarretando a perda de credibilidade internacional brasileira e, ainda, colocando em risco a aquisição de vacinas pelo país.Palavras-chave: Fake News; Jair Bolsonaro; Política ExternaABSTRACTThe usage of social media, like Twitter, by politicians, such as Jair Bolsonaro, have changed the political communication. That said, the information has circulated quickly and provides a favorable environment for disinformation and fake news, especially during the COVID-19 pandemic from 2020. Based on that, the article aims to understand how the Brazilian president, Jair Bolsonaro, has used fake News as the ground for your political communication during the COVID-19 pandemic. It also aims to understand which is the influence of this phenomena to the Brazilian foreign policy. The initial hypothesis is that the dissemination of information without reliable content is used as political tool by Bolsonaro. In this scenario, the Brazilian foreign policy is under direct influence of this phenomena, with new international guidelines and positioning, resulting in the loss of the Brazilian international credibility and risking the vaccines acquisition by the country.Keywords: Fake News; Jair Bolsonaro; Foreign Policy. Recebido em: 14/04/2021 | Aceito em: 29/10/2021.

Evaluation of Peripheral Electrostimulation Thresholds in Human Model for Uniform Magnetic Field Exposure

The external field strength according to the international guidelines and standards for human protection are derived to prevent peripheral nerve system pain at frequencies from 300–750 Hz to 1 MHz. In this frequency range, the stimulation is attributable to axon electrostimulation. One limitation in the current international guidelines is the lack of respective stimulation thresholds in the brain and peripheral nervous system from in vivo human measurements over a wide frequency range. This study investigates peripheral stimulation thresholds using a multi-scale computation based on a human anatomical model for uniform exposure. The nerve parameters are first adjusted from the measured data to fit the peripheral nerve in the trunk. From the parameters, the external magnetic field strength to stimulate the nerve was estimated. Here, the conservativeness of protection limits of the international guidelines and standards for peripheral stimulation was confirmed. The results showed a margin factor of 4–6 and 10–24 times between internal and external protection limits of Institute of Electrical and Electronics Engineers standard (IEEE C95.1) and International Commission on Non-Ionizing Radiation Protection guidelines, with the computed pain thresholds.

Premenarche bilateral giant juvenile fibroadenoma of breast: literature review with a case report

Fibroadenoma is a common abnormality which every surgeon has been exposed to, and there are several international guidelines regarding its management. However giant fibroadenomas, especially in the premenarche setting has been a rare occurrence, even for the experienced surgeon. Various reports have shown that we need to treat this condition more aggressively than the normal fibroadenoma, and issues of cosmesis in a developing breast along with the aim to preserve lactation functionality becomes an issue. Since these cases remain a single life time experience for most surgeons, there is a sparsity of treatment protocols even in literature. Through this paper we hope to shed some valuable insight to this rare disorder and help surgeon colleagues, when dealing with similar cases.

Fever Among Preschool Aged Children: A Cross-Sectional Study Assessing Lebanese Parents’ Knowledge, Attitudes and Practices on Pediatric Fever Assessment and Management

Background The existing literature demonstrates insufficient parental knowledge around fever, and international guidelines suggest studying parents’ perceptions and practices in treating febrile sickness. This study investigated parental knowledge, attitudes and practices toward fever in preschool children to help address all pointed gaps and provide information with the aim of supporting clinical reports for parental education. Methods A cross-sectional study design was used to explore parental experiences with fever. Participants were recruited randomly from schools all over Lebanon targeting the preschool divisions to include parents of children aged 5 years or less. An electronic self-administered questionnaire was sent to the parents through the schools’ emails and e-learning mobile applications, with a separate message encouraging parents to take time to fill carefully the survey. Results A total of 733 parents were included in the study. Only 44% identified fever correctly according to the recognized definition by international guidelines. A significant association between parents’ knowledge of antibiotics and years of parenting experience was found (ORa = 4.23, 95% CI 1.41-12.68, P=0.01). Other sociodemographic factors that were significantly associated with parents’ knowledge of antibiotics were age (ORa = 3.42, 95% CI 1.09-10.73, P=0.036) and education level (ORa = 7.99, 95% CI 3.71-17.23, P<0.001). Greater than 75% usually give their children antipyretics without consulting a doctor. Approximately one-quarter of parents (26.3%) consulted different doctors at the same time, of which more than half (58.4%) had received different medical information. Conclusions This research determines deficiencies in parents’ knowledge of fever with some malpractices in its management. It provides insight for healthcare providers to empower parental experiences by offering the necessary information to enhance general outcomes of febrile sickness.

Challenges of implementing the Paediatric Surviving Sepsis Campaign International Guidelines 2020 in resource-limited settings: A real-world view beyond the academia

Las Guías Internacionales de la Campaña Sobreviviendo a la Sepsis para el Manejo del Shock Séptico y la Disfunción de Órganos Asociada a la Sepsis en Niños, fueron publicadas en 2020 y están desti- nadas a ser utilizadas en todos los lugares que atienden a niños. Sin embargo, los profesionales que atienden a los niños con sepsis en entornos con recursos limitados se enfrentan a una serie de desafíos y perfiles de enfermedad distintos a los que se encuentran en entornos ricos en recursos. Basándonos en nuestra experiencia colectiva en entornos con recursos limitados, nos propusimos reflexionar so- bre las dificultades de aplicar las directrices internacionales. Creemos que hay una necesidad urgente de más evidencia de entornos con recursos limitados en enfoques factibles y eficaces para el trata- miento de la sepsis y el shock séptico que podrían incluirse en las futuras directrices para situaciones y contextos específicos.

Negotiating without the victim state: the exclusiveness of anticorruption settlements

Purpose Corporate foreign bribery can have devastating consequences on communities and states. Over the past decade, there have been several promising developments, both national and international, that might increase the chances of victim states to receive remediation for the harm they suffered from foreign bribery. In particular, awareness has risen that victim states must be considered and new innovative items have been added to the toolbox of prosecutors in the fight against corruption that is assumed to also improve victim states’ standing in these procedures. This study aims to assess whether indeed victim states receive compensation through these novel procedures. Design/methodology/approach This study uses the three case studies of Switzerland, France and England and Wales for a comprehensive empirical and normative analysis of settlement agreements between defendants and prosecution authorities and of court jurisprudence. Findings This study shows that although de jure, it seems warranted to order the payment of remedies to victim states within domestic criminal proceedings, in practice, this rarely happens. A number of legal and practical obstacles account for this situation. This study, therefore, calls for the formulation of international guidelines containing the obligation to inform victim states of ongoing criminal proceedings on corporate foreign bribery, and guidance on how to identify the victim of this crime, as well as the damage caused. Originality/value This is the first contribution to verify whether claims that settlement agreements, recently introduced in England and Wales and France (and similar procedures are available in Switzerland), are beneficial for victim states in their quest to receive compensation. As this study shows that this is – not yet – the case in practice, this study proposes solutions that could lead the way for remediation of the harm caused by corporate corruption – and thereby, ultimately, to a more just outcome.

Use of high-sensitivity cardiac troponins in the emergency department for the early rule-in and rule-out of acute myocardial infarction without persistent ST-segment elevation (NSTEMI) in Italy

Serial measurements of cardiac troponin are recommended by international guidelines to diagnose myocardial infarction (MI) since 2000. However, some relevant differences exist between the three different international guidelines published between 2020 and 2021 for the management of patients with chest pain and no ST-segment elevation. In particular, there is no agreement on the cut-offs or absolute change values to diagnose non-ST-segment elevation MI (NSTEMI). Other controversial issues concern the diagnostic accuracy and cost-effectiveness of cut-off values for the most rapid algorithms (0 h/1 h or 0 h/2 h) to rule-in and rule-out NSTEMI. Finally, another important point is the possible differences between demographic and clinical characteristics of patients enrolled in multicenter trials compared to those routinely admitted to the Emergency Department in Italy. The Study Group of Cardiac Biomarkers, supported by the Italian Scientific Societies Società Italiana di Biochimica Clinica, Italian Society of the European Ligand Assay Society, and Società Italiana di Patolgia Clinica e Medicina di Laboratorio decided to revise the document previously published in 2013 about the management of patients with suspected NSTEMI, and to provide some suggestions for the use of these biomarkers in clinical practice, with a particular focus on the Italian setting.