RESUMEN

OBJECTIVES: to assess the operationalization of Primary Health Care in the COVID-19 pandemic, according to Primary Care Assessment Tool: PCATool-Brasil attributes, from physicians' and nurses' perspective. METHODS: a cross-sectional study, carried out with 99 physicians and nurses from Basic Health Units in a state in northeastern Brazil, with the aid of the adapted instrument PCATool-Brasil. RESULTS: Essential Score was classified as high performance (6.6) and General Score as low performance (6.5). First Contact Access, Care Integration, and Community Guidance scores were <6.6. The best performances were attributed to the Longitudinality, Comprehensiveness and Family Guidance services (scores>6.6). CONCLUSIONS: the attributes of Primary Health Care, in general, showed values above or close to the cut-off point in the assessment. These data can support strategies for local and national managers to strengthen Primary Health Care in the COVID-19 pandemic and future public health emergencies.

Asunto(s)

COVID-19 , Enfermeras y Enfermeros , Médicos , Humanos , Atención Primaria de Salud , Estudios Transversales , Pandemias , COVID-19/epidemiología

RESUMEN

The pandemic caused by coronavirus has resonated throughout different levels of health care in Brazil and, in this context, the present research aimed to evaluate this impact on tertiary dental care provided by the Unified Health System (SUS). Therefore, an ecological study was conducted with data obtained from the Hospital Information System processed by the Portal of the Department of Informatics of SUS. The sample consisted of patients of all sexes and age groups, whose Hospital Admission Authorizations (AIHs) were approved for dental tertiary care procedures from January 2015 to December 2020. Descriptive analyses and the ANOVA test with a significance level set at p < 0.05 were used. When the annual mean numbers of AIHs approved were evaluated, findings showed that on an average, the Southeast region authorized a higher number of procedures (p-value < 0.001), however, in the pandemic year (2020), a reduction of approximately 24.5% of these hospitalizations occurred throughout Brazil, with the Midwest being the region most affected (32.12%). A percentage increase occurred in the Surgical Treatment of Oral sinus/Oral nasal Fistula (16.1%), in addition to a significant decrease in performing procedures for Resection of Mouth Lesion (33.4%). In the pandemic year, there was a reduction of 14% in expenditures related to hospital services and 23.26% related to professional services. It was concluded that the data presented demonstrated a significant reduction in AIHs for tertiary dental care in the pandemic year.

Asunto(s)

COVID-19 , Humanos , Pandemias , Atención Terciaria de Salud , Brasil , Atención Odontológica

RESUMEN

Abstract The pandemic caused by coronavirus has resonated throughout different levels of health care in Brazil and, in this context, the present research aimed to evaluate this impact on tertiary dental care provided by the Unified Health System (SUS). Therefore, an ecological study was conducted with data obtained from the Hospital Information System processed by the Portal of the Department of Informatics of SUS. The sample consisted of patients of all sexes and age groups, whose Hospital Admission Authorizations (AIHs) were approved for dental tertiary care procedures from January 2015 to December 2020. Descriptive analyses and the ANOVA test with a significance level set at p < 0.05 were used. When the annual mean numbers of AIHs approved were evaluated, findings showed that on an average, the Southeast region authorized a higher number of procedures (p-value < 0.001), however, in the pandemic year (2020), a reduction of approximately 24.5% of these hospitalizations occurred throughout Brazil, with the Midwest being the region most affected (32.12%). A percentage increase occurred in the Surgical Treatment of Oral sinus/Oral nasal Fistula (16.1%), in addition to a significant decrease in performing procedures for Resection of Mouth Lesion (33.4%). In the pandemic year, there was a reduction of 14% in expenditures related to hospital services and 23.26% related to professional services. It was concluded that the data presented demonstrated a significant reduction in AIHs for tertiary dental care in the pandemic year.

RESUMEN

ABSTRACT Objectives: to assess the operationalization of Primary Health Care in the COVID-19 pandemic, according to Primary Care Assessment Tool: PCATool-Brasil attributes, from physicians' and nurses' perspective. Methods: a cross-sectional study, carried out with 99 physicians and nurses from Basic Health Units in a state in northeastern Brazil, with the aid of the adapted instrument PCATool-Brasil. Results: Essential Score was classified as high performance (6.6) and General Score as low performance (6.5). First Contact Access, Care Integration, and Community Guidance scores were <6.6. The best performances were attributed to the Longitudinality, Comprehensiveness and Family Guidance services (scores>6.6). Conclusions: the attributes of Primary Health Care, in general, showed values above or close to the cut-off point in the assessment. These data can support strategies for local and national managers to strengthen Primary Health Care in the COVID-19 pandemic and future public health emergencies.

---

RESUMEN Objetivos: evaluar la operacionalización de la Atención Primaria de Salud en la pandemia de la COVID-19, según los atributos del Instrumento de Evaluación de la Atención Primaria: PCATool-Brasil, en la perspectiva de médicos y enfermeros. Métodos: estudo transversal, realizado com 99 médicos e enfermeiros de Unidades Básicas de Saúde de um estado do Nordeste do Brasil, com auxílio do instrumento adaptado PCATool-Brasil. Resultados: Escore Essencial foi classificado como alto desempenho (6,6), e Escore Geral, como baixo desempenho (6,5). Las puntuaciones de acceso al primer contacto, integración de la atención y orientación comunitaria fueron <6,6. Los mejores desempeños fueron atribuidos a los servicios de Longitudinalidad, Integralidad y Orientación Familiar (puntuaciones > 6,6). Conclusiones: los atributos de la Atención Primaria de Salud, en general, presentaron valores superiores o cercanos al punto de corte en la evaluación. Estos datos pueden respaldar estrategias para que los administradores locales y nacionales fortalezcan la Atención Primaria de Salud en la pandemia de COVID-19 y futuras emergencias de salud pública.

---

RESUMO Objetivos: avaliar a operacionalização da Atenção Primária à Saúde na pandemia de COVID-19, segundo os atributos do Primary Care Assessment Tool: PCATool-Brasil, na perspectiva de médicos e enfermeiros. Métodos: estudo transversal, realizado com 99 médicos e enfermeiros de Unidades Básica de Saúde de um estado do Nordeste do Brasil, com auxílio do instrumento adaptado PCATool-Brasil. Resultados: Escore Essencial foi classificado como alto desempenho (6,6), e Escore Geral, como baixo desempenho (6,5). Os escores de Acesso de Primeiro Contato, Integração do Cuidado e Orientação Comunitária foram <6,6. Os melhores desempenhos foram atribuídos aos serviços Longitudinalidade, Integralidade e Orientação Familiar (escores > 6,6). Conclusões: os atributos da Atenção Primária à Saúde, em geral, apresentaram valores superiores ou próximos ao ponto de corte na avaliação. Esses dados podem subsidiar estratégias de gestores locais e nacionais para o fortalecimento da Atenção Primária à Saúde na pandemia de COVID-19 e futuras emergências de saúde pública.

RESUMEN

Abstract Background: Current pacemakers allow for the continuous recording of the occurrence of arrhythmic events. One of the most frequent arrhythmias after implantation of a device is atrial fibrillation (AF), an important risk factor for embolic events. The frequency of this arrhythmia in pacemaker patients has not been widely studied. Objectives: This study aimed to evaluate the prevalence, incidence, and predictors of the occurrence of AF in patients with double-chamber pacemakers and without a history of atrial fibrillation prior to implantation. Methods: A dynamic, retrospective, and prospective cohort study was carried out with 186 patients undergoing biannual follow-up of the double-chamber pacemaker, without previous AF, in a single service, between 2016 and 2018. Clinical data were collected from the medical records and the telemetry of the device and the prevalence, incidence rate, relative risk by univariate analysis (by chi-square), and risk ratio were calculated by multivariate analysis (by Cox regression); values of p<0.05 were considered significant. Results: There was a prevalence of 25.3% FA, with an incidence of 5.64 cases / 100 persons-year. The median time for the development of arrhythmia was 27.5 months. Multivariate analysis identified 5 statistically significant predictors: male gender, OR: 2.54 [1.04-6.15]; coronary artery disease, OR: 2.98 [1.20-7.41]; hypothyroidism, OR: 3.63 [1.46-9.07]; prior heart surgery, OR: 2.67 [1.01-7]; and left atrial enlargement, OR: 2.72 [1.25-5.92]. Conclusions: The prevalence and incidence of AF in this population are high. Risk factors for AF were: male gender, coronary artery disease, hypothyroidism, prior heart surgery, and left atrial enlargement.

Asunto(s)

Humanos , Masculino , Femenino , Marcapaso Artificial , Fibrilación Atrial/epidemiología , Nodo Atrioventricular , Estudios de Cohortes , Factores de Riesgo de Enfermedad Cardiaca , Hipertensión

RESUMEN

Abstract Cardiovascular diseases (CVD) are one of the main causes of mortality in the world. Dyslipidemia treatment can reduce the number of deaths caused by CVD, by decreasing the lipid profile. Evaluate the pharmacotherapeutic follow-up effectiveness in patients with dyslipidemia, regarding clinical and laboratory aspects. A quasi-experimental trial was performed in 12 months. The studied population was included patients with dyslipidemia who received a pharmacotherapeutic follow-up, which was evaluated according to the Pharmacotherapy Workup developed by the Brazilian Ministry of Health. Clinical and laboratory evaluations were performed at the baseline, after a 6 and 12-months period. The statistical analyzes were performed with the normality test of Lilliefors, Cramer Von Misses, and Anderson Darling, later the t-paired test. This study demonstrated that after 6-months of intervention, statistically significant results were verified in the reduction of LDL-cholesterol, total cholesterol, increase in HDL-cholesterol, and reduction in the blood pressure. It was observed that for high-risk patients, the achievement of targets in the lipid profile and HbA1C occurred only after 12-months, because, this population needs more aggressive targets and expressive interventions. Pharmacotherapeutic follow-up in patients with dyslipidemia reduced lipid blood levels and promoted positive clinical and laboratory outcomes.

Asunto(s)

Pacientes/clasificación , Sistema Único de Salud , Atención a la Salud , Quimioterapia , Dislipidemias/diagnóstico , Necesidades y Demandas de Servicios de Salud

RESUMEN

The use of saline water is one of the major challenges of agriculture, as it can cause nutritional imbalances and thus reduce crop yield. This study proposes to examine the efficiency of potassium nutrition asa salt stress-mitigating agent in melon grown in a protected environment. The experiment was laid outin a randomized-block design with ten treatments in a 2 × 4 factorial arrangement represented by two melon cultivars (McLaren and SV1044MF) and four nutrient solutions (S1 - standard nutrient solution, 2.5 dS m-¹; S2 - nutrient solution salinized with NaCl, 5.0 dS m-¹; S3 - nutrient solution salinized with NaCl + 50% K, 6.5 dS m-¹; and S4 - nutrient solution salinized with NaCl + 100% K, 7.5 dS m-¹). Yield (average fruit weight, production, fruit diameter, internal cavity, and pulp thickness), quality (pulp firmness, total sugars, soluble solids [SS], vitamin C, pH, titratable acidity [TA] and SS/TA ratio) and nutritional (K, Na and K/Na ratio) variables were evaluated. Plants fertigated with standard nutrient solution showed the highest values for fruit weight (1,190.6 g), production (2,381.3 g per plant), fruit diameter (13.6 cm) and pulp thickness (2.6 cm) Cultivar McLaren produced heavier fruits (931.4 g) with larger diameter (12.4 cm) and pulp thickness (2.4cm). The addition of NaCl to nutrient solution induced a reduction in the yield variables but did not influence fruit quality. The addition of extra K to salinized nutrient solution did not mitigate the deleterious effect of salinity on the yield of melon.

---

O uso de água salina é um dos principais desafios na produção agrícola, pois pode provocar desbalanço nutricional e, consequentemente, reduzir o rendimento das culturas. Este trabalho teve como objetivo avaliar a eficiência da nutrição potássica como agente atenuador do estresse salino no meloeiro cultivado em ambiente protegido. O delineamento experimental utilizado foi em blocos casualizados, com dez tratamentos arranjados em esquema fatorial 2 × 4, sendo dois cultivares de meloeiro (McLarene SV1044MF) e quatro soluções nutritivas (S1- solução nutritiva padrão, 2,5 dS m-¹; S2 – solução nutritiva salinizada com NaCl, 5,0 dS m-¹; S3 – solução nutritiva salinizada com NaCl + 50% K, 6,5 dS m-¹; S4 - solução nutritiva salinizada com NaCl + 100% K, 7,5 dS m-¹). As variáveis de rendimento (peso médio de fruto, produção, diâmetro de fruto, cavidade interna e espessura de polpa), qualidade (firmeza de polpa, açúcares totais, sólidos solúveis, vitamina C, pH, acidez titulável e razão SS/AT) e nutrição (K, Na e razão K/Na) foram avaliadas. Plantas fertirrigadas com solução nutritiva padrão apresentaram maiores valores para peso de frutos (1.190,6 g), produção (2.381,3 g planta-¹), diâmetro de fruto (13,6 cm) e espessura de polpa (2,6 cm). O cv. McLaren apresentou frutos mais pesados (931,4 g), com maior diâmetro (12,4 cm) e espessura de polpa (2,4 cm). A adição de NaCl na solução nutritiva provocou redução nas variáveis de rendimento, mas não influenciou a qualidade dos frutos. A adição extra de K em solução nutritiva salinizada não atenuou o efeito deletério da salinidade sobre o rendimento do meloeiro.

Asunto(s)

Cucumis melo/química , Estrés Salino , Minerales/análisis , Potasio/administración & dosificación

RESUMEN

The use of saline water is one of the major challenges of agriculture, as it can cause nutritional imbalances and thus reduce crop yield. This study proposes to examine the efficiency of potassium nutrition asa salt stress-mitigating agent in melon grown in a protected environment. The experiment was laid outin a randomized-block design with ten treatments in a 2 × 4 factorial arrangement represented by two melon cultivars (McLaren and SV1044MF) and four nutrient solutions (S1 - standard nutrient solution, 2.5 dS m-¹; S2 - nutrient solution salinized with NaCl, 5.0 dS m-¹; S3 - nutrient solution salinized with NaCl + 50% K, 6.5 dS m-¹; and S4 - nutrient solution salinized with NaCl + 100% K, 7.5 dS m-¹). Yield (average fruit weight, production, fruit diameter, internal cavity, and pulp thickness), quality (pulp firmness, total sugars, soluble solids [SS], vitamin C, pH, titratable acidity [TA] and SS/TA ratio) and nutritional (K, Na and K/Na ratio) variables were evaluated. Plants fertigated with standard nutrient solution showed the highest values for fruit weight (1,190.6 g), production (2,381.3 g per plant), fruit diameter (13.6 cm) and pulp thickness (2.6 cm) Cultivar McLaren produced heavier fruits (931.4 g) with larger diameter (12.4 cm) and pulp thickness (2.4cm). The addition of NaCl to nutrient solution induced a reduction in the yield variables but did not influence fruit quality. The addition of extra K to salinized nutrient solution did not mitigate the deleterious effect of salinity on the yield of melon.(AU)

---

O uso de água salina é um dos principais desafios na produção agrícola, pois pode provocar desbalanço nutricional e, consequentemente, reduzir o rendimento das culturas. Este trabalho teve como objetivo avaliar a eficiência da nutrição potássica como agente atenuador do estresse salino no meloeiro cultivado em ambiente protegido. O delineamento experimental utilizado foi em blocos casualizados, com dez tratamentos arranjados em esquema fatorial 2 × 4, sendo dois cultivares de meloeiro (McLarene SV1044MF) e quatro soluções nutritivas (S1- solução nutritiva padrão, 2,5 dS m-¹; S2 solução nutritiva salinizada com NaCl, 5,0 dS m-¹; S3 solução nutritiva salinizada com NaCl + 50% K, 6,5 dS m-¹; S4 - solução nutritiva salinizada com NaCl + 100% K, 7,5 dS m-¹). As variáveis de rendimento (peso médio de fruto, produção, diâmetro de fruto, cavidade interna e espessura de polpa), qualidade (firmeza de polpa, açúcares totais, sólidos solúveis, vitamina C, pH, acidez titulável e razão SS/AT) e nutrição (K, Na e razão K/Na) foram avaliadas. Plantas fertirrigadas com solução nutritiva padrão apresentaram maiores valores para peso de frutos (1.190,6 g), produção (2.381,3 g planta-¹), diâmetro de fruto (13,6 cm) e espessura de polpa (2,6 cm). O cv. McLaren apresentou frutos mais pesados (931,4 g), com maior diâmetro (12,4 cm) e espessura de polpa (2,4 cm). A adição de NaCl na solução nutritiva provocou redução nas variáveis de rendimento, mas não influenciou a qualidade dos frutos. A adição extra de K em solução nutritiva salinizada não atenuou o efeito deletério da salinidade sobre o rendimento do meloeiro.(AU)

Asunto(s)

Cucumis melo/química , Estrés Salino , Potasio/administración & dosificación , Minerales/análisis

RESUMEN

INTRODUCCIÓN: A pesar de las políticas y programas puestos en marcha, las estadísticas argentinas registran un alto número de nacimientos provenientes de embarazos en la población adolescente. Para explorar la relación entre los condicionantes de género, la conducta y la salud sexual adolescente, el presente estudio buscó validar un cuestionario de condicionantes de género y anticoncepción (Cogant) desarrollado en España. MÉTODOS: Se realizó un estudio observacional de corte transversal para evaluar la validez y las propiedades psicométricas del Cogant en adolescentes argentinas. RESULTADOS: Se incluyó a 657 mujeres menores de 20 años, que participaron de talleres educativos en el ámbito público de las provincias de Chaco, Corrientes y Buenos Aires. La consistencia interna global del instrumento mostró una alta confiabilidad (alfa de Cronbach 0,857). El análisis de factores sugirió la retención de 7 factores subyacentes, que explican un 61,6% de la varianza del cuestionario. DISCUSIÓN: La evaluación de las medidas psicométricas del Cogant en Argentina mostró resultados similares a los encontrados en las adolescentes españolas, aunque se retuvieron menor cantidad de factores que en el estudio original. El Cogant podría ayudar a identificar las características de los comportamientos vinculados a la sexualidad, al embarazo no planificado y a la maternidad, a fin de que el personal de salud priorice las estrategias de educación y de cuidados para las adolescentes argentinas.

Asunto(s)

Adolescente , Anticoncepción , Identidad de Género

RESUMEN

The use of saline water is one of the major challenges of agriculture, as it can cause nutritional imbalances and thus reduce crop yield. This study proposes to examine the efficiency of potassium nutrition as a salt stress-mitigating agent in melon grown in a protected environment. The experiment was laid out in a randomized-block design with ten treatments in a 2 × 4 factorial arrangement represented by two melon cultivars (McLaren and SV1044MF) and four nutrient solutions (S1 - standard nutrient solution, 2.5 dS m-1; S2 - nutrient solution salinized with NaCl, 5.0 dS m-1; S3 - nutrient solution salinized with NaCl + 50% K, 6.5 dS m-1; and S4 - nutrient solution salinized with NaCl + 100% K, 7.5 dS m-1). Yield (average fruit weight, production, fruit diameter, internal cavity, and pulp thickness), quality (pulp firmness, total sugars, soluble solids [SS], vitamin C, pH, titratable acidity [TA] and SS/TA ratio) and nutritional (K, Na and K/Na ratio) variables were evaluated. Plants fertigated with standard nutrient solution showed the highest values for fruit weight (1,190.6 g), production (2,381.3 g per plant), fruit diameter (13.6 cm) and pulp thickness (2.6 cm). Cultivar McLaren produced heavier fruits (931.4 g) with larger diameter (12.4 cm) and pulp thickness (2.4 cm). The addition of NaCl to nutrient solution induced a reduction in the yield variables but did not influence fruit quality. The addition of extra K to salinized nutrient solution did not mitigate the deleterious effect of salinity on the yield of melon.(AU)

---

O uso de água salina é um dos principais desafios na produção agrícola, pois pode provocar desbalanço nutricional e, consequentemente, reduzir o rendimento das culturas. Este trabalho teve como objetivo avaliar a eficiência da nutrição potássica como agente atenuador do estresse salino no meloeiro cultivado em ambiente protegido. O delineamento experimental utilizado foi em blocos casualizados, com dez tratamentos arranjados em esquema fatorial 2 × 4, sendo dois cultivares de meloeiro (McLaren e SV1044MF) e quatro soluções nutritivas (S1- solução nutritiva padrão, 2,5 dS m-1; S2 ­ solução nutritiva salinizada com NaCl, 5,0 dS m-1; S3 ­ solução nutritiva salinizada com NaCl + 50% K, 6,5 dS m-1; S4 - solução nutritiva salinizada com NaCl + 100% K, 7,5 dS m-1). As variáveis de rendimento (peso médio de fruto, produção, diâmetro de fruto, cavidade interna e espessura de polpa), qualidade (firmeza de polpa, açúcares totais, sólidos solúveis, vitamina C, pH, acidez titulável e razão SS/AT) e nutrição (K, Na e razão K/Na) foram avaliadas. Plantas fertirrigadas com solução nutritiva padrão apresentaram maiores valores para peso de frutos (1.190,6 g), produção (2.381,3 g planta-1), diâmetro de fruto (13,6 cm) e espessura de polpa (2,6 cm). O cv. McLaren apresentou frutos mais pesados (931,4 g), com maior diâmetro (12,4 cm) e espessura de polpa (2,4 cm). A adição de NaCl na solução nutritiva provocou redução nas variáveis de rendimento, mas não influenciou a qualidade dos frutos. A adição extra de K em solução nutritiva salinizada não atenuou o efeito deletério da salinidade sobre o rendimento do meloeiro.(AU)

Asunto(s)

Potasio , Ácido Ascórbico , Cucurbitaceae , Estrés Salino , Ciencias de la Nutrición , Producción de Cultivos

RESUMEN

OBJECTIVE: To compare two groups of patients - the coronary endarterectomy group, with patients undergoing coronary artery bypass grafting (CABG) with coronary endarterectomy (CE), and the control group, with patients undergoing CABG without CE. We analyzed the rate of major outcomes (perioperative acute myocardial infarction [AMI], stroke, and mortality) and minor outcomes (time of cardiopulmonary bypass [CPB], time of aortic clamp, and postoperative length of hospital stay). We also determined the rates of early graft patency in patients undergoing CE. METHODS: We reviewed a database of patients submitted to CABG, with or without associated CE, between January 2011 and June 2017. Twenty-five patients submitted to CE were compared with 201 patients submitted only to conventional surgery; the two groups presented similar preoperative characteristics and all the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II variables did not presented statistically significant difference. We considered statistically significant values of P< 0.05. RESULTS: There was no statistically significant difference in relation to time of post-surgical hospitalization (P=0.8139), incidence of perioperative AMI (P=0.2976), stroke (P=0,2976), and mortality rate (P=1.0000), but endarterectomy was associated with longer aortic clamping time (P=0.0004) and CPB time (P=0.0030). The rate of patency evaluated in patients submitted to endarterectomy (78,95%) was compatible with that described in the literature. CONCLUSION: In this sample, coronary endarterectomy was associated with the rate of early graft patency similar to that of the literature, with morbidity and mortality rates similar to those of conventional surgery.

Asunto(s)

Endarterectomía , Estudios de Casos y Controles , Puente de Arteria Coronaria , Vasos Coronarios , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Resultado del Tratamiento

RESUMEN

Abstract Objective: To compare two groups of patients - the coronary endarterectomy group, with patients undergoing coronary artery bypass grafting (CABG) with coronary endarterectomy (CE), and the control group, with patients undergoing CABG without CE. We analyzed the rate of major outcomes (perioperative acute myocardial infarction [AMI], stroke, and mortality) and minor outcomes (time of cardiopulmonary bypass [CPB], time of aortic clamp, and postoperative length of hospital stay). We also determined the rates of early graft patency in patients undergoing CE. Methods: We reviewed a database of patients submitted to CABG, with or without associated CE, between January 2011 and June 2017. Twenty-five patients submitted to CE were compared with 201 patients submitted only to conventional surgery; the two groups presented similar preoperative characteristics and all the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II variables did not presented statistically significant difference. We considered statistically significant values of P< 0.05. Results: There was no statistically significant difference in relation to time of post-surgical hospitalization (P=0.8139), incidence of perioperative AMI (P=0.2976), stroke (P=0,2976), and mortality rate (P=1.0000), but endarterectomy was associated with longer aortic clamping time (P=0.0004) and CPB time (P=0.0030). The rate of patency evaluated in patients submitted to endarterectomy (78,95%) was compatible with that described in the literature. Conclusion: In this sample, coronary endarterectomy was associated with the rate of early graft patency similar to that of the literature, with morbidity and mortality rates similar to those of conventional surgery.

Asunto(s)

Humanos , Masculino , Femenino , Persona de Mediana Edad , Endarterectomía , Complicaciones Posoperatorias , Estudios de Casos y Controles , Puente de Arteria Coronaria , Resultado del Tratamiento , Vasos Coronarios

RESUMEN

Abstract Introduction: Many publications on coronary surgery and carotid stenosis (CS) can be found, but we do not have enough information about the relationship between ischemic stroke, CS and non-coronary cardiac surgery. Objectives: To evaluate the incidence and risk factors associated with the stroke and CS ≥50% in patients undergoing non-coronary surgeries. Objectives: We assessed 241 patients, aged 40 years or older, between 2009 and 2016, operated in Santa Casa de Misericórdia de Ponta Grossa-PR, Brazil. We perform carotid Doppler in patients 40 years of age or older before any cardiac surgery as a routine. The incidence and possible risk factors for CS ≥50% and perioperative stroke were analyzed by univariate statistical analysis. Results: 11 patients (4.56%) presented perioperative stroke. The risk factor for stroke was CS ≥50%: OR=5.3750 (1.2909-22.3805), P=0.0208. Eighteen patients (7.46%) had CS ≥50% and their risk factors were extracardiac arteriopathy: OR=18.6607 (6.3644-54.7143), P<0.0001; COPD: OR=3.9040 (1.4491-10.5179), P=0.0071; diabetes mellitus: OR=2.9844 (1.0453-8.5204), P=0.0411; recent myocardial infarction: OR=13.8125 (1.8239-104.6052), P=0.0110; EuroSCORE II higher P=0.0056. Conclusion: The incidences of stroke and CS ≥50% were 4.56% and 7.46%, respectively. The risk factor for stroke was CS ≥50% and for CS ≥50% were extracardiac arteriopathy, COPD, diabetes mellitus, recent myocardial infarction and higher EuroSCORE II.

Asunto(s)

Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Isquemia Encefálica/etiología , Isquemia Encefálica/epidemiología , Estenosis Carotídea/etiología , Estenosis Carotídea/epidemiología , Accidente Cerebrovascular/epidemiología , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Valores de Referencia , Brasil/epidemiología , Incidencia , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Distribución por Edad , Medición de Riesgo , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Complicaciones de la Diabetes/epidemiología , Enfermedad Arterial Periférica/complicaciones , Enfermedad Arterial Periférica/epidemiología , Infarto del Miocardio/complicaciones , Infarto del Miocardio/epidemiología

RESUMEN

INTRODUCTION: Many publications on coronary surgery and carotid stenosis (CS) can be found, but we do not have enough information about the relationship between ischemic stroke, CS and non-coronary cardiac surgery. OBJECTIVES: To evaluate the incidence and risk factors associated with the stroke and CS ≥50% in patients undergoing non-coronary surgeries. OBJECTIVES: We assessed 241 patients, aged 40 years or older, between 2009 and 2016, operated in Santa Casa de Misericórdia de Ponta Grossa-PR, Brazil. We perform carotid Doppler in patients 40 years of age or older before any cardiac surgery as a routine. The incidence and possible risk factors for CS ≥50% and perioperative stroke were analyzed by univariate statistical analysis. RESULTS: 11 patients (4.56%) presented perioperative stroke. The risk factor for stroke was CS ≥50%: OR=5.3750 (1.2909-22.3805), P=0.0208. Eighteen patients (7.46%) had CS ≥50% and their risk factors were extracardiac arteriopathy: OR=18.6607 (6.3644-54.7143), P<0.0001; COPD: OR=3.9040 (1.4491-10.5179), P=0.0071; diabetes mellitus: OR=2.9844 (1.0453-8.5204), P=0.0411; recent myocardial infarction: OR=13.8125 (1.8239-104.6052), P=0.0110; EuroSCORE II higher P=0.0056. CONCLUSION: The incidences of stroke and CS ≥50% were 4.56% and 7.46%, respectively. The risk factor for stroke was CS ≥50% and for CS ≥50% were extracardiac arteriopathy, COPD, diabetes mellitus, recent myocardial infarction and higher EuroSCORE II.

Asunto(s)

Isquemia Encefálica/epidemiología , Isquemia Encefálica/etiología , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Estenosis Carotídea/epidemiología , Estenosis Carotídea/etiología , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Adulto , Distribución por Edad , Brasil/epidemiología , Complicaciones de la Diabetes/epidemiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Infarto del Miocardio/complicaciones , Infarto del Miocardio/epidemiología , Enfermedad Arterial Periférica/complicaciones , Enfermedad Arterial Periférica/epidemiología , Prevalencia , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Valores de Referencia , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Distribución por Sexo

RESUMEN

Abstract This paper presents a case study of a 30-year-old male patient with dyspnea on exertion had echocardiographic diagnosis of aortic subvalvar stenosis. Discrete mitral regurgitation and aortic valve dysplasia with mild to moderate insufficiency and hypertrophic cardiomyopathy were also noted. During surgery, a rare condition was identified: presence of papillary muscle anomaly associated with the subaortic membrane as a cause of obstruction of the left ventricular outflow tract. With the resection of these structures and a mitral valve annuloplasty, the patient evolved with a significant improvement of clinical condition and heart failure, with no residual mitral insufficiency.

Asunto(s)

Humanos , Masculino , Adulto , Músculos Papilares/anomalías , Obstrucción del Flujo Ventricular Externo/cirugía , Estenosis Subaórtica Fija/complicaciones , Cardiopatías Congénitas/complicaciones , Músculos Papilares/cirugía , Obstrucción del Flujo Ventricular Externo/etiología , Ecocardiografía , Estenosis Subaórtica Fija/cirugía , Estenosis Subaórtica Fija/diagnóstico por imagen , Anuloplastia de la Válvula Mitral , Cardiopatías Congénitas/cirugía , Cardiopatías Congénitas/diagnóstico por imagen

RESUMEN

PURPOSE: To compare wound healing performed with cold blade (CSB) and ultrasonic harmonic scalpel (UHS) in the abdominal aponeurosis of rats. METHODS: Eighty Wistar rats divided into two groups and underwent midline incision in the linea alba with cold blade and harmonic ultrasonic scalpel. Analysis were performed in subgroups of 10 animals after 3, 7, 14 and 21 days. Macroscopically was observed the presence of hematoma, infection, wound dehiscence, fistula and adherences. Microscopically were used collagen and immunohistochemical staining methods. RESULTS: Macroscopic, complications showed no statistical difference. Immunohistochemical analysis for MMP-9 was more intense in UHS group (p<0.05). TGF ß presented its lower expression in UHS group at 14 and 21 days, with no statistical difference at 3 and 7 days (p<0.05). α-AML expression appeared higher in UHS group after 14 days and remained similar in others (p<0.05). Collagen deposition had no change in type I, and increased in type III in UHS; at 7th day the deposition was higher in CSB group; at 14th was similar in both groups (p<0.001). CONCLUSION: UHS compared to the CSB has higher lesion area at the time of the incision; as well as it led to the delay of regeneration and scar maturation process.

Asunto(s)

Pared Abdominal/cirugía , Colágeno/fisiología , Herida Quirúrgica/patología , Cicatrización de Heridas/fisiología , Pared Abdominal/patología , Animales , Inmunohistoquímica , Masculino , Modelos Animales , Ratas , Ratas Wistar , Instrumentos Quirúrgicos , Herida Quirúrgica/fisiopatología , Análisis de Matrices Tisulares , Procedimientos Quirúrgicos Ultrasónicos

RESUMEN

Purpose: To compare wound healing performed with cold blade (CSB) and ultrasonic harmonic scalpel (UHS) in the abdominal aponeurosis of rats. Methods: Eighty Wistar rats divided into two groups and underwent midline incision in the linea alba with cold blade and harmonic ultrasonic scalpel. Analysis were performed in subgroups of 10 animals after 3, 7, 14 and 21 days. Macroscopically was observed the presence of hematoma, infection, wound dehiscence, fistula and adherences. Microscopically were used collagen and immunohistochemical staining methods. Results: Macroscopic, complications showed no statistical difference. Immunohistochemical analysis for MMP-9 was more intense in UHS group (p 0.05). TGF presented its lower expression in UHS group at 14 and 21 days, with no statistical difference at 3 and 7 days (p 0.05). -AML expression appeared higher in UHS group after 14 days and remained similar in others (p 0.05). Collagen deposition had no change in type I, and increased in type III in UHS; at 7th day the deposition was higher in CSB group; at 14th was similar in both groups (p 0.001). Conclusion: UHS compared to the CSB has higher lesion area at the time of the incision; as well as it led to the delay of regeneration and scar maturation process.(AU)

Asunto(s)

Animales , Masculino , Adulto , Ratas , Cicatrización de Heridas/fisiología , Herida Quirúrgica/terapia , Instrumentos Quirúrgicos , Colágeno/análisis , Aponeurosis/cirugía , Ratas Wistar , Modelos Animales

RESUMEN

Abstract Purpose: To compare wound healing performed with cold blade (CSB) and ultrasonic harmonic scalpel (UHS) in the abdominal aponeurosis of rats. Methods: Eighty Wistar rats divided into two groups and underwent midline incision in the linea alba with cold blade and harmonic ultrasonic scalpel. Analysis were performed in subgroups of 10 animals after 3, 7, 14 and 21 days. Macroscopically was observed the presence of hematoma, infection, wound dehiscence, fistula and adherences. Microscopically were used collagen and immunohistochemical staining methods. Results: Macroscopic, complications showed no statistical difference. Immunohistochemical analysis for MMP-9 was more intense in UHS group (p<0.05). TGF β presented its lower expression in UHS group at 14 and 21 days, with no statistical difference at 3 and 7 days (p<0.05). α-AML expression appeared higher in UHS group after 14 days and remained similar in others (p<0.05). Collagen deposition had no change in type I, and increased in type III in UHS; at 7th day the deposition was higher in CSB group; at 14th was similar in both groups (p<0.001). Conclusion: UHS compared to the CSB has higher lesion area at the time of the incision; as well as it led to the delay of regeneration and scar maturation process.

Asunto(s)

Animales , Masculino , Ratas , Cicatrización de Heridas/fisiología , Colágeno/fisiología , Pared Abdominal/cirugía , Herida Quirúrgica/patología , Instrumentos Quirúrgicos , Inmunohistoquímica , Ratas Wistar , Modelos Animales , Pared Abdominal/patología , Análisis de Matrices Tisulares , Procedimientos Quirúrgicos Ultrasónicos , Herida Quirúrgica/fisiopatología

RESUMEN

This paper presents a case study of a 30-year-old male patient with dyspnea on exertion had echocardiographic diagnosis of aortic subvalvar stenosis. Discrete mitral regurgitation and aortic valve dysplasia with mild to moderate insufficiency and hypertrophic cardiomyopathy were also noted. During surgery, a rare condition was identified: presence of papillary muscle anomaly associated with the subaortic membrane as a cause of obstruction of the left ventricular outflow tract. With the resection of these structures and a mitral valve annuloplasty, the patient evolved with a significant improvement of clinical condition and heart failure, with no residual mitral insufficiency.

Asunto(s)

Estenosis Subaórtica Fija/complicaciones , Cardiopatías Congénitas/complicaciones , Músculos Papilares/anomalías , Obstrucción del Flujo Ventricular Externo/cirugía , Adulto , Estenosis Subaórtica Fija/diagnóstico por imagen , Estenosis Subaórtica Fija/cirugía , Ecocardiografía , Cardiopatías Congénitas/diagnóstico por imagen , Cardiopatías Congénitas/cirugía , Humanos , Masculino , Anuloplastia de la Válvula Mitral , Músculos Papilares/cirugía , Obstrucción del Flujo Ventricular Externo/etiología

RESUMEN

Avaliar se uma intervenção educacional interfere na adesão ao tratamento, meta terapêutica e frequência de eventos hemorrágicos de pacientes em uso de antagonistas de vitamina K e se características socioeconômicas/clínicas possuem efeito sobre os resultados encontrados. Método: Estudo analítico intervencionista não controlado qualitativo. Foram incluídos 49 pacientes e aplicados os questionários de medida de adesão ao tratamento (MAT) e socioeconômico. Posteriormente foram realizadas ligações mensais educativas sobre anticoagulação e foram coletadas informações sobre eventos hemorrágicos e valores de RNI. Ao termino da intervenção foi aplicado mais um questionário MAT. Foram comparados os dados antes e após a intervenção. Resultados: Os pacientes foram considerados mais aderentes após a intervenção (p=0,04) e houve diminuição na frequência de eventos hemorrágicos (p=0,01), existindo nenhuma relação com as variáveis socioeconômicas ou clínicas. Não houve melhora significativa em relação à meta de RNI (p=0,06), porém o estado civil desses pacientes teve associação com a estabilidade terapêutica (p=0,04). Conclusões: A intervenção melhorou a aderência e diminuiu os eventos hemorrágicos dos pacientes, não tendo influência sobre a meta terapêutica. Pacientes com cônjuge apresentaram melhores metas terapêuticas se comparados aos solteiros. Não houve interferência de outras variáveis socioeconômicas ou clínicas sobre os desfechos encontrados

---

Objectives: To evaluate if an educational intervention interfere in treatment adherence, therapeutic ranges and hemorrhagic.events of patients on vitamin K antagonists; and if social, economic and clinical.characteristics are associated with the ending points. Methods: It's an interventionist analytic study. 49 patients were included.and an adherence.and social/economic questionnaires were applied. Then, monthly educative phone calls.were performed about anticoagulation and information about hemorrhagic,events and INR were collected. When intervention,were done, another adherence questionnaire was applied. Data before and after intervention were compared. Results: Patients had their adherence improved (p=0,04) and there was a fall on the prevalence,of hemorrhagic events (p=0,01) with,no,social/clinical variables association. There were no significant,changes,on the therapeutic ranges (p=0,06), although there was a relationship,between marital state and INR,stability (p=0,04). Conclusions: Educational intervention increased adherence,and decreased hemorrhagic events. Marital state has been associated with better therapeutic,ranges. No other social, economic.or clinical.variable has been associated with the ending points