ABSTRACT
A atuação como médicos e professores no enfrentamento, por mais de um ano, da pandemia de COVID-19 em diversos cenários clínicos fez-nos constatar que vivemos tempos difíceis diante de uma doença de comportamento desconhecido e, muitas vezes, imprevisível. O objetivo do presente artigo é avaliar as medidas tomadas na nossa Instituição nestes 14 meses de pandemia, e os aprendizados recorrentes, que requerem uma reflexão ponderada para sua conveniente assimilação. As medidas tomadas em 2020 incluíram a informação objetiva e regular, da situação dos nossos cenários de prática clínica, com ênfase especial nos residências de idosos sob a nossa supervisão. Informações diárias, gráficos semanais, proporcionaram uma retrato realista da situação que estávamos vivendo. As medidas tomadas, que também visavam manter alto o moral da equipe que estava na linha de frente, propiciaram ocasião para repensar nos modelos de educação médica vigente, sugerindo novas mudanças e adaptações. Finalmente, com a chegada das vacinas em 2021, as medidas que vínhamos tomando convergiram para um esforço de vacinação massiva, principalmente nos residenciais de idosos. Esse cenário que se apresentava como crítico no início da pandemia, após a vacinação transformou-se em local de alta segurança conforme os resultados apresentados. Houve também novos aprendizados nesse mesmo local -diminuição de outras afeções, piora de níveis cognitivos- que doravante serão incorporados na nossa prática clínica.
The performance as doctors and teachers in facing, for more than a year, the pandemic of COVID-19 in several clinical settings made us realize that we live in difficult times, facing a unknown disease and, often, of unpredictable behavior. The purpose of this article is to evaluate the measures taken in our Institution in these 14 months of the pandemic, and the recurrent learning, which require thoughtful reflection for its convenient assimilation. The measures taken in 2020 included objective and regular information on the situation of our clinical practice scenarios, with special emphasis on the nursing homes for elderly under our supervision. Daily information, weekly charts, provided a realistic picture of the situation we were experiencing. The measures taken, which also aimed at maintaining the morale of the team at the forefront, provided an opportunity to rethink current medical education models, suggesting new changes and adaptations. Finally, with the arrival of vaccines in 2021, the measures we had been taking converged on a massive vaccination effort, especially in nursing homes. This particular scenario, which presented itself as critical at the beginning of the pandemic, after vaccination became a place of high security, according to the results presented. There were also new learnings in that same place - reduction of other diseases, worsening of cognitive levels - which will henceforth be incorporated into our clinical practice.
ABSTRACT
BACKGROUND: Within the adult population, there exist numerous validated risk stratification tools aimed at predicting postoperative outcomes using preoperative and intraoperative parameters. However, similar tools for the pediatric population are scarce. We previously developed and reported on a scoring system to predict postoperative complications in children undergoing surgery at Boston Children's Hospital. The objective of this study was to validate our scoring system to determine its effectiveness in identifying children at risk for major complications or death within 30 days following surgery. STUDY DESIGN: A computer program randomly selected 2015 out of 11,734 patients who underwent surgery at our institution in 2009. The severity of the complications was graded based on the Clavien classification system, with major complications being a grade III or higher. The Preoperative Complication Score (PCS) and the Overall Complication Score (OCS) were calculated for all patients, and Receiver Operating Characteristic (ROC) curves were generated for each scoring system. RESULTS: The overall incidence of major complications was 3.9% (79 patients). Proportionally, cardiac surgery had the highest percentage of major complications (20% of the performed surgeries). Both PCS and OCS demonstrated excellent correlation with postoperative outcomes with c-statistic values of 0.740 (CI 0.682-0.800, p < 0.001) and 0.767 (CI 0.712-0.822, p < 0.001) respectively. CONCLUSIONS: We determined that both the PCS and OCS are effective in identifying children at risk for major complications and death following surgery. Further studies will be needed to determine if these scoring systems are applicable to children undergoing surgery at other institutions and if the use of the scoring systems would result in improved clinical outcomes and reduced costs.
Subject(s)
Decision Support Techniques , Health Status Indicators , Postoperative Complications/diagnosis , Preoperative Care/methods , Adolescent , Child , Child, Preschool , Humans , Incidence , Infant , Infant, Newborn , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Postoperative Complications/mortality , Prognosis , ROC Curve , Risk AssessmentABSTRACT
BACKGROUND: Prognosis of prostate cancer (PCa) is based mainly in histological aspects together with PSA serum levels that not always reflect the real aggressive potential of the neoplasia. The micro RNA (miRNA) mir-21 has been shown to regulate invasiveness in cancer through translational repression of the Metaloproteinase (MMP) inhibitor RECK. Our aim is to investigate the levels of expression of RECK and miR-21 in PCa comparing with classical prognostic factors and disease outcome and also test if RECK is a target of miR-21 in in vitro study using PCa cell line. MATERIALS AND METHODS: To determine if RECK is a target of miR-21 in prostate cancer we performed an in vitro assay with PCa cell line DU-145 transfected with pre-miR-21 and anti-miR-21. To determine miR-21 and RECK expression levels in PCa samples we performed quantitative real-time polymerase chain reaction (qRT-PCR). RESULTS: The in vitro assays showed a decrease in expression levels of RECK after transfection with pre-miR-21, and an increase of MMP9 that is regulated by RECK compared to PCa cells treated with anti-miR-21. We defined three profiles to compare the prognostic factors. The first was characterized by miR-21 and RECK underexpression (N = 25) the second was characterized by miR-21 overexpression and RECK underexpression (N = 12), and the third was characterized by miR-21 underexpression and RECK overexpression (N = 16). From men who presented the second profile (miR-21 overexpression and RECK underexpression) 91.7% were staged pT3. For the other two groups 48.0%, and 46.7% of patients were staged pT3 (p = 0.025). CONCLUSIONS: Our results demonstrate RECK as a target of miR-21. We believe that miR-21 may be important in PCa progression through its regulation of RECK, a known regulator of tumor cell invasion.
