Assuntos
Estenose das Carótidas , Endarterectomia das Carótidas , Ensaios Clínicos Controlados Aleatórios como Assunto , Stents , Humanos , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas/métodos , Metanálise como Assunto , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/epidemiologiaAssuntos
Neoplasias da Mama , Neoplasias Colorretais , Detecção Precoce de Câncer , Disparidades em Assistência à Saúde , Neoplasias do Colo do Útero , Humanos , Feminino , Neoplasias da Mama/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/prevenção & controle , Neoplasias do Colo do Útero/epidemiologia , Detecção Precoce de Câncer/economia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/prevenção & controle , Neoplasias Colorretais/economia , Neoplasias Colorretais/epidemiologia , Fatores Socioeconômicos , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Masculino , Estados Unidos/epidemiologia , Disparidades Socioeconômicas em SaúdeRESUMO
BACKGROUND: The unexpected virulence of the COVID19 pandemic brought to significant changes of generally accepted therapeutic approaches. The consequences of these changes were difficult to define during the pandemic period. METHODS: We analyzed the National Registries including 97% of hospital admissions in Italy, regarding data describing number of operations for aortic valve implantation or repair, carotid and coronary revascularization, AAA repair, and lower limb arterial reconstruction performed in the period 2015 to 2019 and in the pandemic years 2020, 2021, and 2022. Primary outcomes were number and type of surgical procedures, 30-days operative mortality. RESULTS: During the three years of the pandemic there was a statistically significant increase of the number of all-causes deaths in comparison with the mean of the previous five years (2015-2019). In Italy there was a total increase of all causes-deaths of 251.911 (+105900 in 2020; +66929 in 2021; and +79082 in 2022), and 73% of the excess of deaths was related with COVID19 infection and 27% occurred in COVID 19 negative patients. During the first year of the pandemic, worse clinical outcomes for hospitalized patients with CVD were registered. The medical system responded adequately and in the following two pandemic years clinical outcomes for hospitalized patients were similar with those of the pre-pandemic period. CONCLUSIONS: The unexpected virulence of COVID19 pandemic determined worse clinical outcomes for patients with CVD during the first year. The adopted preventive measures allowed in the following two pandemic years improved clinical outcomes, similar with those of the pre-pandemic period.
Assuntos
COVID-19 , Doenças Cardiovasculares , Humanos , COVID-19/epidemiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/terapia , Itália/epidemiologia , Sistema de Registros , SARS-CoV-2 , Masculino , Feminino , Idoso , Hospitalização/estatística & dados numéricos , Mortalidade HospitalarAssuntos
Detecção Precoce de Câncer , Cooperação do Paciente , Neoplasias do Colo do Útero , Humanos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/prevenção & controle , Feminino , Detecção Precoce de Câncer/métodos , Cooperação do Paciente/estatística & dados numéricos , Pobreza , Escolaridade , Educação de Pacientes como Assunto/métodos , Adulto , Pessoa de Meia-Idade , Programas de Rastreamento/métodosRESUMO
In this editorial we comment on the article published in the recent issue of the World Journal of Gastrointestinal Endoscopy 2023; 15 (11): 634-680. Gastric cancer (GC) remains the fifth most common malignancy and the fourth leading cause of cancer-related death worldwide. The overall prevalence of GC has declined, although that of proximal GC has increased over time. Thus, a significant proportion of GC cases and deaths can be avoided if preventive interventions are taken. Early GC (EGC) is defined as GC confined to the mucosa or submucosa. Endoscopic resection is considered the most appropriate treatment for precancerous gastrointestinal lesions improving patient quality of life, with reduced rates of complications, shorter hospitalization period, and lower costs when compared to surgical resection. Endoscopic mucosal resection (EMR) and endoscopic sub-mucosal dissection (ESD) are representative endoscopic treatments for EGC and precancerous gastric lesions. Standard EMR implies injection of a saline solution into the sub-mucosal space, followed by excision of the lesion using a snare. Complete resection rates vary depending on the size and severity of the lesion. When using conventional EMR methods for lesions less than 1 cm in size, the complete resection rate is approximately 60%, whereas for lesions larger than 2 cm, the complete resection rate is low (20%-30%). ESD can be used to remove tumors exceeding 2 cm in diameter and lesions associated with ulcers or submucosal fibrosis. Compared with EMR, ESD has higher en bloc resection rates (90.2% vs 51.7%), higher complete resection rates (82.1 vs 42.2%), and lower recurrence rates (0.65% vs 6.05%). Thus, innovative techniques have been introduced.
Assuntos
Síndrome Coronariana Aguda , Intervenção Coronária Percutânea , Humanos , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/cirurgia , Inibidores da Agregação Plaquetária , Fatores de Risco , Resultado do Tratamento , Fatores SexuaisRESUMO
BACKGROUND: the aim of our study was to analyze exposure of the general population to established risk factors for cardiovascular disease (CVD), which might have determined the trend towards increased mortality rates related with CVD from 2015 to 2019 in USA. MATERIAL AND METHODS: We Analyzed epidemiological of data from the US National Health and Nutrition Examination Survey and from the European Health Interview Survey to determine trends for exposure to several established risk factors for CVD from 2000 to 2018-2019. Trends of prevalence of obesity, arterial hypertension, cigarettes smoking, high cholesterol level, diabetes in the period 2000 to 2018-2019 in USA were correlated with age adjusted mortality and burden related with CVD. We correlated these trends also with educational attainment, family income and national expenditure for preventive care. RESULTS: Cardiovascular Diseases Related Mortality And Burden Decreased Significantly In Usa In The Period 2000-2015; In The Period 2015-2019 there was a trend towards increasing mortality rates. The trend in the period 2015-2019 was associated with increased exposure to several established risk factors for CVD: obesity, diabetes, cigarettes smoking and arterial hypertension. Level of education attainment and family income, and national health expenditure for information, education and counseling were statistically correlated with reduced exposure to established risk factors. Similar trends were present in Western European countries. CONCLUSIONS: Attention is required to improve education and communication, health access and care for people with poor economic conditions, homeless, minorities, to reduce CVD related mortality and burden.