The coronavirus disease 2019 (COVID-19) outbreak has created unprecedent challenges for healthcare systems worldwide. Oncology services have been reorganized to decrease the risk of nosocomial acquisition of SARS-CoV-2, but changes in treatment pathways and follow-up cancer care can result in patients receiving suboptimal or delayed care. Herein, we describe a cross-sectional nested cohort study conducted to evaluate delays in care for patients with head and neck cancer (HNC) in post-treatment follow-up or palliative care during the COVID-19 pandemic in Northeast Brazil and its impact on health outcomes. Information was extracted from medical records and supplemented by telephone interviews. We compared the following health outcomes: self-perception of anxiety or sadness, fear of COVID-19 infection, cancer-related complications during social isolation, self-medication, diagnosis of COVID-19, and death between patients with and without delayed cancer care. The Mann-Whitney U test was used to compare distributions of continuous variables and the Fisher exact test was used for categorical variables. Thirty-one HNC patients were included in the study, and no case of confirmed SARS-CoV-2 was found. Delayed cancer care due to restriction in health services was reported in 58.1% of cases, and there was no report of telemedicine use during the COVID-19 outbreak. Cancer-related complications during the COVID-19 pandemic were described for most patients (67.7%) and included pain or discomfort, swelling, and dyspnea. Eight (25.8%) patients reported use of prescribed morphine or codeine to manage pain and six (19.4%) patients reported self-medication with over-the-counter (OTC) non-steroidal anti-inflammatory drugs (NSAIDs). We found an association between delayed HNC care and the use of self-medication (p = 0.028). This study indicated that patients with delayed HNC care during the COVID-19 outbreak are more likely to use self-medication with NSAIDs for pain management. Better strategies to follow HNC patients in socioeconomically disadvantaged communities need to be discussed and implemented.
RESUMOObjetivo: Avaliar a qualidade da assistência pré-natal a partir do Programa de Humanização no Pré-Natal e Nascimento. Método: Estudo quantitativo, transversal, com 260 puérperas que realizaram o acompanhamento pré-natal no Sistema Único de Saúde em Lagarto, Estado de Sergipe, Brasil. As informações foram obtidas por meio de entrevistas e visualização do cartão de pré-natal. A análise estatística foi realizada no software SPSS 20.0. Resultados: Pouco mais da metade das puérperas haviam iniciado seu acompanhamento pré-natal antes da 16ª semana gestacional e também realizaram seis ou mais consultas (66,9%; n = 174, cada variável). Somente 41,5% (n = 108) das participantes receberam informações sobre a maternidade de referência para o parto e 42,7% (n = 111) sobre as atividades para facilitar o parto. Quanto aos exames, foi identificada elevada cobertura no primeiro trimestre, com discreta redução no terceiro. Conclusão: A assistência pré-natal oferecida às usuárias do SUS de Lagarto se mostrou inadequada às recomendações do Programa de Humanização no Pré-Natal e Nascimento, pois foi evidenciado o início tardio, número insuficiente de consultas, poucas orientações e cobertura insatisfatória dos exames preconizados pelo Ministério da Saúde. Descritores: Saúde Materna; Gravidez; Gestantes; Cuidado Pré-Natal; Saúde Materno-Infantil; Humanização da Assistência.ABSTRACTObjective: To evaluate the quality of prenatal care based on the Prenatal and Birth Humanization Program. Method: Quantitative and cross-sectional study conducted with 260 puerperal women who underwent prenatal care in the Unified Health System of Lagarto, State of Sergipe, Brazil. The data were obtained through interviews and prenatal records. The statistical analysis was performed using the SPSS 20.0 software. Results: A little more than half of the puerperal women had initiated prenatal care before the 16th gestational week and had also attended six or more consultations (66.9%, n = 174, each variable). Only 41.5% (n = 108) of the participants received information about reference maternities for childbirth, and 42.7% (n = 111) about activities to facilitate childbirth. Regarding the exams, there was high coverage in the first trimester, with a slight reduction in the third. Conclusion: Prenatal care provided to users of the Unified Health System of Lagarto was inadequate with respect to the recommendations of the Prenatal and Birth Humanization Program, since there was evidence of late initiation of prenatal care, insufficient number of consultations, few guidelines, and unsatisfactory performance of the exams recommended by the Ministry of Health. Descriptors: Maternal Health; Pregnancy; Pregnant Women; Prenatal Care; Maternal and Child Health; Humanization of Assistance.RESUMENObjetivo: Evaluar la calidad de la asistencia prenatal a partir del Programa de Humanización en Prenatal y Nacimiento. Método: Estudio cuantitativo y transversal conducido con 260 puérperas que realizaron cuidado prenatal en el Sistema Único de Salud en Lagarto, Estado de Sergipe, Brasil. La información fue obtenida por medio de entrevistas y expedientes de prenatal. El análisis estadístico se realizó en el software SPSS 20.0. Resultados: Poco más de la mitad de las puérperas habían iniciado cuidado prenatal antes de la 16ª semana gestacional y también realizaron seis o más consultas (66,9%, n = 174, cada variable). Sólo el 41,5% (n = 108) de las participantes recibieron información sobre la maternidad de referencia para el parto y el 42,7% (n = 111) sobre las actividades para facilitar el parto. En cuanto a los exámenes, se observó una elevada cobertura en el primer trimestre, con discreta reducción en el tercero. Conclusión: La asistencia prenatal ofrecida a las usuarias del Sistema Único de Salud de Lagarto fue inadecuada con respecto a las recomendaciones del Programa de Humanización en Prenatal y Nacimiento, pues se evidenció inicio tardío, número insuficiente de consultas, pocas orientaciones y cobertura insatisfactoria de los exámenes preconizados por el Ministerio de Salud. Descriptores: Salud Materna; Embarazo; Mujeres Embarazadas; Cuidado Prenatal; Salud Materno-Infantil; Humanización de la Asistencia.
Background There is emerging evidence that frail individuals present a decreased physiological reserve, decreased ability to maintain homeostasis, and increased vulnerability to stressors. The concept of frailty has become increasingly recognized as a valuable measure in oncological surgical patients, including those with head and neck cancer. Preoperative screening for frailty may provide an individualized risk assessment that can be used by an interdisciplinary team for preoperative counseling and to improve outcomes. The aim of this meta-analysis was to evaluate the relationship between frailty and the risk of major postoperative complications in frail individuals submitted to head and neck oncologic surgery. Material and Methods PubMed, SCOPUS, Web of Science, Google Scholar and OpenThesis were systematically searched to identify studies that evaluated the risk of major postoperative complications in frail individuals undergoing head and neck oncologic surgery. The search was performed on August 31, 2020, without language or date restrictions. Two independent investigators screened the searched studies based on each paper’s title and abstract. Relevant studies were read in full and selected according to the eligibility criteria. Frailty was assessed by modified Frailty Index (mFI-11) and major postoperative complications were measured by the Clavien-Dindo classification. We performed a categorical and dose-response meta-analysis using a random-effects model to evaluate the association between frailty and the risk of major postoperative complications in patients submitted to head and neck oncologic surgery. The results of the meta-analysis were expressed as relative risk (RR) and 95% confidence interval (95% CI). The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). Results Four studies (9,947 patients) were included in this systematic review and meta-analysis. Frail patients presented an increased risk of life-threatening complications requiring intensive care unit (ICU) admission (RR = 4.67; 95% CI 1.54–14.10) and 30-day mortality (RR = 8.10; 95% CI 2.30–28.57) compared to non-frail patients. We found evidence of dose-response trend between mFI-11 and major postoperative complications. Conclusions Higher frailty scores are associated with a significant increase in ICU-level complications and 30-day mortality after head and neck oncologic surgery. Key words: Frailty, head and neck neoplasms, postoperative complications, mortality.
Objective To examine the effects of short-term cyclic stretch on apoptosis in alveolar type II cells (A549). To study in vitro the direct influence of alveolar type II cells on mechanical stretch. Methods A549 were treated with different doses of lipopolysaccharide (LPS), 0 ng/ml, 1 ng/ml, 10 ng/ml, 100 ng/ml, 1000 ng/ml, and then A549 were lengthened 5%, 15%, 30% using a FLEXCELL tension unit 4000, a vacuum-driven device that applies strain to cells, which were cultured in six-well plates coated with collagen-I, and 12 cycles/min for 4 hours. Apoptosis was measured using the flow cytometry method that measures annexin V and propidium iodide (PI) staining. The morphological changes of apoptotic cells were observed by transmission electron microscope. Results Apoptosis could be induced in alveolar type II cells (A549) by mechanical stretch. The percentage of annexin V + PI cells increased after being treated with cyclic stretch for 4 hours by 5%, 15%, 30% in all groups. The morphological features of apoptotic cells demonstrated by transmission electron microscope were as follows: shrinkage of the cell, chromatin condensation and aggregation under the nuclear membrane as a crescent or lump, membrane-encapsulated nuclear fragment or cell organ formed by invagination of the cell membrane, and apoptotic body formation followed by vacuolization. Conclusion Apoptosis induced by mechanical stretch and LPS is dose dependent. Mechanical stretch aggravates apoptosis especially in cells treated with LPS. Annexin V and PI double staining is a specific, sensitive, and quantitative method for analyzing apoptotic cells. It is also helpful to clarify the protective mechanism of low-volume ventilation in ARDS. Acknowledgement The study was funded by the 'One Hundred People' project of Shanghai Sanitary Bureau (03-77-20). Introduction Although extrapulmonary ALI/ARDS is a common clinical entity, most animal models used to study this disease are induced by direct lung injuries. Our intention was therefore to investigate whether a condition resembling ALI/ARDS develops during the course of a fecal peritonitis in pigs; in that case experimental peritonitis would also prove as a clinically relevant ARDS model. Methods In 10 anesthetized, mechanically ventilated, and instrumented pigs fecal peritonitis was induced by inoculating autologue feces pellets suspended in saline. Mechanical ventilation was set with VT = 8 ml/kg, FiO 2 to reach a SaO 2 target of >90%, PEEP = 10 cmH 2 O if PaO 2 /FiO 2 > 300 and 12 cmH 2 O if PaO 2 /FiO 2 < 300, and respiratory rate to obtain a PaCO 2 of 35-45 mmHg. Before as well as 12 and 24 hours after peritonitis induction we measured the PaO 2 /FiO 2 ratio, the total compliance of the respiratory system (C), calculated as VT/(P plateau -PEEP) and inspiratory airway resistance (R i ) calculated as (P max -P plateau ) / mean inspiratory flow. Data are mean [range]. Results For data see Table 1. During the course of the 24-hour study period, six of 10 animals developed gas exchange deteriorations consistent w...
Introdução: O câncer de cabeça e pescoço é considerado um dos cânceres mais agressivos, com baixa sobrevida e impacto negativo na qualidade de vida dos pacientes. Objetivos: Avaliar a sobrevida e os fatores relacionados ao óbito de pacientes com câncer de cabeça e pescoço no Estado de Sergipe. Métodos: Estudo longitudinal com pacientes diagnosticados com câncer de cabeça e pescoço no período de agosto de 2017 a junho de 2020. O tamanho amostral mínimo foi estimado em 47 pacientes, baseado em análise de sobrevivência não-paramétrica de uma amostra. Os dados foram examinados quanto a perda de seguimento, outliers, normalidade e linearidade. A sobrevida foi calculada por meio do estimador produto limite Kaplan-Meier, os fatores relacionados ao óbito por regressão de Cox. Resultados: Dos 79 pacientes acompanhados, a maioria era homem, média de 55 anos, residentes do interior do estado, baixa renda e escolaridade, tabagistas e diagnosticados com lesões em estágio avançado. A sobrevida global em 12 e 24 meses de acompanhamento foi de 50.6% e 39.4%, respectivamente. O sexo masculino e não possuir companheiro, esteve associado ao óbito. Conclusão: Pacientes com câncer de cabeça e pescoço em Sergipe apresentam baixa sobrevida em 24 meses e maior risco de morte entre indivíduos do sexo masculino e solteiros, divorciados e viúvos.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
334 Leonard St
Brooklyn, NY 11211
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.