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Endoscopic management of difficult common bile duct stones:Where are we now?A comprehensive review

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World Journal of Gastroenterology 2021年第44期27卷 7597-7611页

作者： Alberto Tringali deborah costa Alessandro Fugazza Matteo Colombo Kareem Khalaf Alessandro Repici Andrea Anderloni Gastroenterology and Endoscopy Unit Department of MedicineConegliano HospitalULSS 2 Marca TrevigianaConegliano 31015Italy Digestive Endoscopy Unit Department of GastroenterologyHumanitas Research Hospital IRCCSRozzano 20089MilanItaly Department of Biomedical Sciences Humanitas UniversityPieve Emanuele 20072MilanItaly

Endoscopic management for difficult common bile duct(CBD)stones still presents a challenge for several reasons,including anatomic anomalies,patients’individual conditions and stone *** recent years,variable methods have emerged that have attributed to higher stone removal success rates,reduced cost and lower adverse *** this review,we outline a stepwise approach in CBD stone *** first line therapy,endoscopic sphincterotomy and large balloon dilation are recommended,due to a 30%-50%reduction of the use of mechanical *** the other hand,cholangioscopy-assisted lithotripsy has been increasingly reported as an effective and safe alternative technique to mechanical lithotripsy but remains to be reserved in special settings due to limited large-scale *** discussed,findings suggest that management needs to be tailored to the patient’s characteristics and anatomical ***,we evaluate the management of CBD stones in various surgical altered anatomy(Billroth II,Roux-en-Y and Roux-en-Y gastric bypass).Moreover,we could conclude that cholangioscopy-assisted lithotripsy needs to be evaluated for primary use,rather than following a failed management *** addition,we discuss the importance of dissecting other techniques,such as the primary use of interventional endoscopic ultrasound for the management of CBD stones when other techniques have *** conclusion,we recognize that endoscopic sphincterotomy and large balloon dilation,mechanical lithotripsy and intraductal lithotripsy substantiate an indication to the management of difficult CBD stones,but emerging techniques are in rapid evolution with encouraging results.

关键词： Common bile duct stones Balloon dilation Endoscopic retrograde cholangiopancreatography Endoscopic ultrasonography Anastomoses,Roux en y Double balloon enteroscopy Mechanical lithotripsy Cholangioscopy

Physicians and Conflicts of Interest

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International Journal of Clinical Medicine 2014年第16期5卷 956-965页

作者： deborah Pimentel Maria-Jesia Vieira Joao Pedro Declerc FSNeves Manoel Juvenal da costa-Neto Lais costa Souza Oliveira Department of Medicine Universidade Federal de SergipeAracajuBrazil Universidade Tiradentes AracajuBrazil Postgraduate Program in Health Sciences Universidade Federal de SergipeAracajuBrazil Universidade Federal de Sergipe AracajuBrazil

In medical practice, the most commonly observed conflicts of interest are the ones existing in the relations between professionals and industries linked to health or between the former and health services. These relations are no longer a partnership in search of the best to be offered to patients and tend to take up a commercial role, in a seduction game where, each one, in their own manner, seeks benefits. The purpose of this study is to analyze the existence of these conflicts of interest, in an exploratory and qualitative study, with physician focal groups. The results were grouped in two categories: benefits received by physicians and the justifications provided by them for the establishment of these partnerships. The most common benefits are: percentages over orthoses and prosthetics received by the industry;discounts and credits on rent or condominium fees for exam indications and procedures;rewards offered by the pharmaceutical industry for the indication of their products. Physicians have pointed out as main determinants for ethical missteps that involve conflicts of interest, the character and family formation as well as the lack of denunciations. The fact that efficient and widespread laws for resolution of conflicts of interest do not exist makes it necessary to recognize their existence with mechanisms of management and transparency, perhaps as the only way to avoid negative interference in physician behavior.

关键词： Ethics Physicians Conflicts of Interest

Eosinophilic Granulomatosis with Polyangiitis and Bowel Perforation: Case Report

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Journal of Pharmacy and Pharmacology 2022年第11期10卷 283-287页

作者： PauloÁtila da Silva Viana Leonardo de Oliveira Cavalcante Liz Miranda Mateus Lara Farias Lustosa da costa deborah Giovanna Santana Rabelo Medical Residency in Rheumatology General Hospital Dr.Cesar CalsCeará60.015-050Brazil Service Coordinator Medical Residency in Rheumatology General Hospital Dr.Cesar CalsCeará60.015-050Brazil Medical-Academic League of Rheumatology of Fortaleza Christu University CenterFortaleza 60.160-230Brazil Medical-Academic League of Rheumatology of Fortaleza Cearástate UniversityFortaleza 60.714-903Brazil

The small and medium sized vessels vasculitis included in the group of vasculitis associated with anti-neutrophil cytoplasmic antibodies,is a rare disease characterized by the presence of vasculitis in association with asthma and *** objective of this report is to describe a case with a typical initial presentation of eosinophilic granulomatosis with polyangiitis-EGPA,that evolved with atypical clinical manifestations and findings in complementary *** the clinical evolution and comprehending the therapeutic response of the patient in question,with scientific embasement on published medical literature.

关键词： Granulomatosis with polyangiitis Vasculitis Asthma Eosinophilia Acute abdomen

Relationship between perceived social support and postpartum care attendance in three Latin American countries:a crosssectional analytic study

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Global Health Research and Policy 2021年第1期6卷 341-349页

作者： Nancy R.Cardona Cordero JoséPerez Ramos Zahira Quiñones Tavarez Scott McIntosh Esteban Avendaño Carmen DiMare deborah J.Ossip Timothy De Ver Dye University of Rochester School of Medicine and DentistryObstetrics and Gynecology Department Research Division601 Elmwood AvenueRochesterNY 14642USA Pontificia Universidad Católica Madre y Maestra Santiago De Los Caballeros 51000República Dominicana Universidad de Ciencias Médicas 400 metros oeste del M.A.G.Carr.Vieja a EscazúSan José10108Costa Rica

Background:Postpartum Care is a strategy to improve survival of women and newborns,especially in low-and middle-income *** post-partum care can promote healthy behaviors and the identification of risk factors associated with poorer pregnancy-related *** objective of this study was to assess the association of perceived social support with attendance to post-partum care in women from three Latin-American and Caribbean countries:costa Rica,Dominican Republic and ***:Women aged 18+who completed a pregnancy in the past 5 years were interviewed in local healthcare and community settings in each *** social support(PSS)was the primary explanatory variable and the primary outcome was self-reported attendance to post-partum *** Ratios(OR)with 95%confidence intervals derived from logistic regression documented the association between *** Odds Ratios(AOR)were calculated,controlling for social and pregnancy-related ***–Lemeshow’s Goodnessof-Fit statistic was computed to assess model ***:Our cohort of 1199 women across the three Latin-American and Caribbean countries showed relatively high attendance to post-partum care(82.6%,n=990).However,51.7%(n=581)of women reported lower levels of total *** were more likely to attend postpartum care if they had mean and higher levels of PSS Family subscale(OR:1.9,95%CI:1.4,2.7),Friends subscale(OR 1.3,95%CI:0.9,1.8),Significant Other subscale(OR 1.8,95%CI:1.3,2.4)and the Total PSS(OR 1.8,95%CI:1.3,2.5).All associations were statistically significant at p<0.05,with exception of the Friends *** with higher levels of total PSS were more likely to attend to post-partum care(AOR:1.40,0.97,1.92)even after controlling for confounders(education,country,and food insecurity).Conclusions:Women with higher perceived social support levels were more likely to attend to post-partum *** all countries,women from Dominican Republic had lower per

关键词： Postpartum care Social support Maternal health Latin America costa Rica Dominican Republic Honduras Social determinants

A globally networked hybrid approach to public health capacity training for maternal health professionals in low and middle income countries

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Global Health Research and Policy 2017年第1期2卷 310-323页

作者： Scott McIntosh JoséG.Pérez-Ramos Tamala David Margaret M.Demment Esteban Avendaño deborah J.Ossip Timothy De Ver Dye Department of Public Health Sciences University of Rochester Medical Center265 Crittenden Blvd.CU 420644RochesterNY 14642USA Department of Obstetrics and Gynecology University of Rochester Medical CenterRochesterUSA Department of Nursing the College at BrockportState University of New YorkRochesterNYUSA University of Rochester School of Nursing(URSON) RochesterNYUSA Department of Obstetrics&Gynecology-University of Rochester Medical Center RochesterNYUSA UCIMED San JoséCosta Rica

Background:MundoComm is a current NIH-funded project for sustainable public health capacity building in community engagement and technological advances aimed at improving maternal health *** to four teams are selected annually,each consisting of three healthcare professionals and one technical person from specific low and middle income countries(LMICs)including costa Rica,Dominican Republic,Honduras,and other *** is a course with three parts:in-person workshops,online modules,and mentored community engagement *** annual 1-week on-site“short courses”convened in costa Rica are supplemented with six monthly online training modules using the Moodle®online platform for e-learning,and mentored project *** year-long course comprises over 20 topics divided into the six modules-each module further segmented into 4 week-long assignments,with readings and assigned tasks covering different aspects of community-engaged *** content is peer reviewed by experts in the respective fields from University of Rochester,UCIMED in costa Rica,and faculty from costa Rica and the Dominican Republic who maintain regular contact with the trainees to mentor learning and project *** purpose of this paper is to report the first year results of the MundoComm ***:Both quantitative and qualitative feedback(using online data capturing forms)assess baseline and posttraining knowledge and skills in public health project ***:The course currently has one team each in costa Rica,the Dominican Republic,and Honduras for a total of 12 *** course and modules include best practices in information and communication technologies(ICTs),ethical reviews,community engagement,evidence-based community interventions,and e-Health *** maximize successful and culturally appropriate training approaches,the multi-media didactic presentations,flexible distance learning strategies,and the use of tablets for offline

关键词： income annually globally