Maldita COVID, hérnia laparoscópica, castigos físicos, mindfulness no bloco

1. Foi portanto inevitável voltar ao tema maldito. Como sabem, nos EUA já iniciaram a vacinação contra a COVID-19 de crianças acima dos 5 anos com a vacina Pfizer no início de Novembro e até recomendam fazê-la em conjunto com a vacina da gripe. Em Portugal, a DGS aguardava então o parecer da Associação Europeia do Medicamento (EMA) e dos pediatras. Daí, recomendar-vos a leitura do documento do Advisory Commitee da FDA sobre o tema ou a as FAQs do website da AAP.

2. Foi publicado um estudo que remete para uma luta antiga minha na defesa da laparoscopia para a correção da hérnia inguinal. O estudo compara resultados a longo prazo de 1697 crianças e as evidências são claras: a acuidade diagnóstica e a possibilidade de correção da hérnia contralateral ‘silenciosa’ permitem afirmar que a laparoscopia é e melhor opção. Long-term follow-up of pediatric open and laparoscopic inguinal hernia repair. Follow-up averaged 3.6 years after open (N = 1156) and 2.6 years after laparoscopic (N = 541) surgery. Metachronous contralateral repair was performed in 3.8% (26/683) of patients with open unilateral surgery without contralateral exploration, 0.7% (2/275) of open+explore patients, and 0.9% (3/336) of laparoscopic unilateral patients (p < 0.01). Ipsilateral repair was performed in 0.8% (10/1156) of open repairs and 0.3% (2/541) of laparoscopic repairs. Chart review confirmed 5 postoperative infections in 1156 patients with open surgery (0.43%) and 6 infections in 541 patients with laparoscopic surgery (1.11%) (p = 0.11). Conclusion Our study’s laparoscopic and open approaches have similar low ipsilateral reoperation rates, incision times, and complications. The use of laparoscopy to visualize the contralateral side resulted in a significantly lower rate of metachronous contralateral repair.

3. Já que estamos numa de controvérsias/lutas pessoais, gostaria de vos sugerir esta revisão da literatura publicada no The Lancet. Tem a força e a credibilidade desta revista, pelo que escuso-me de comentar. Physical punishment and child outcomes: a narrative review of prospective studies. This narrative review summarises the findings of 69 prospective longitudinal studies to inform practitioners and policy makers about physical punishment’s outcomes. Our review identified seven key themes. First, physical punishment consistently predicts increases in child behaviour problems over time. Second, physical punishment is not associated with positive outcomes over time. Third, physical punishment increases the risk of involvement with child protective services. Fourth, the only evidence of children eliciting physical punishment is for externalising behaviour. Fifth, physical punishment predicts worsening behaviour over time in quasi-experimental studies. Sixth, associations between physical punishment and detrimental child outcomes are robust across child and parent characteristics. Finally, there is some evidence of a dose–response relationship. The consistency of these findings indicates that physical punishment is harmful to children and that policy remedies are warranted.

4. Finalizo com um trabalho exploratório interessante e que pode até ser útil para os cirurgiões aqui presentes. Mindfulness in the OR: A Pilot Study Investigating the Efficacy of an Abbreviated Mindfulness Intervention on Improving Performance in the Operating Room. Highlights: Mindfulness for surgeons to increase focus and decrease stress. Mindfulness can increase flow state for surgeons. A brief mindfulness intervention is compatible with busy schedule of OR physicians.

Abraço,
João

Por João Moreira Pinto, MD PhD, Cirurgião Pediátrico
Linked in  | Facebook | e-Mail: moreirapinto@gmail.com
Cirurgia Pediátrica, Centro Hospitalar Universitário do Porto | Hospital da Luz Arrábida/Guimarães | Hospital-Escola Fernando Pessoa

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