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BACKGROUND: COVID-19 vaccines effectively prevent infection and hospitalization. However, few population-based studies have compared the clinical characteristics and outcomes of patients hospitalized for COVID-19 using advanced statistical methods. Our objective is to address this evidence gap by comparing vaccinated and unvaccinated patients hospitalized for COVID-19. METHODS: This retrospective cohort included adult COVID-19 patients admitted from March 2021 to August 2022 from 27 hospitals. Clinical characteristics, vaccination status, and outcomes were extracted from medical records. Vaccinated and unvaccinated patients were compared using propensity score analyses, calculated based on variables associated with vaccination status and/or outcomes, including waves. The vaccination effect was also assessed by covariate adjustment and feature importance by permutation. RESULTS: From the 3,188 patients, 1,963 (61.6%) were unvaccinated and 1,225 (38.4%) were fully vaccinated. Among these, 558 vaccinated individuals were matched with 558 unvaccinated ones. Vaccinated patients had lower rates of mortality (19.4% vs. 33.3%), invasive mechanical ventilation (IMV-18.3% vs. 34.6%), noninvasive mechanical ventilation (NIMV-10.6% vs. 22.0%), intensive care unit admission (ICU-32.0% vs. 44.1%) vasoactive drug use (21.1% vs. 32.6%), dialysis (8.2% vs. 14.7%) hospital length of stay (7.0 vs. 9.0 days), and thromboembolic events (3.9% vs.7.7%), p < 0.05 for all. Risk-adjusted multivariate analysis demonstrated a significant inverse association between vaccination and in-hospital mortality (adjusted odds ratio [aOR] = 0.42, 95% confidence interval [CI]: 0.31-0.56; p < 0.001) as well as IMV (aOR = 0.40, 95% CI: 0.30-0.53; p < 0.001). These results were consistent in all analyses, including feature importance by permutation. CONCLUSION: Vaccinated patients admitted to hospital with COVID-19 had significantly lower mortality and other severe outcomes than unvaccinated ones during the Delta and Omicron waves. These findings have important implications for public health strategies and support the critical importance of vaccination efforts, particularly in low-income countries, where vaccination coverage remains suboptimal.

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Patients with chronic kidney disease (CKD), especially those on dialysis or who have received a kidney transplant (KT), are considered more vulnerable to severe COVID-19. This susceptibility is attributed to advanced age, a higher frequency of comorbidities, and the chronic immunosuppressed state, which may exacerbate their susceptibility to severe outcomes. Therefore, our study aimed to compare the clinical characteristics and outcomes of COVID-19 in KT patients with those on chronic dialysis and non-CKD patients in a propensity score-matched cohort study. This multicentric retrospective cohort included adult COVID-19 laboratory-confirmed patients admitted from March/2020 to July/2022, from 43 Brazilian hospitals. The primary outcome was in-hospital mortality. Propensity score analysis matched KT recipients with controls - patients on chronic dialysis and those without CKD (within 0.25 standard deviations of the logit of the propensity score) - according to age, sex, number of comorbidities, and admission year. This study included 555 patients: 163 KT, 146 on chronic dialysis, and 249 non-CKD patients (median age 57 years, 55.2% women). With regards to clinical outcomes, chronic dialysis patients had a higher prevalence of acute heart failure, compared to KT recipients, furthermore, both groups presented high in-hospital mortality, 34.0 and 28.1%, for KT and chronic dialysis patients, respectively. When comparing KT and non-CKD patients, the first group had a higher incidence of in-hospital dialysis (26.4% vs. 8.8%, p < 0.001), septic shock (24.1% vs. 12.0%, p = 0.002), and mortality (32.5% vs. 23.3%, p = 0.039), in addition to longer time spent in the intensive care unit (ICU). In this study, chronic dialysis patients presented a higher prevalence of acute heart failure, compared to KT recipients, whereas KT patients had a higher frequency of complications than those without CKD, including septic shock, dialysis during hospitalization, and in-hospital mortality as well as longer time spent in the ICU.

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PURPOSE: To develop a mortality risk score for COVID-19 patients admitted to intensive care units (ICU), and to compare it with other existing scores. MATERIALS AND METHODS: This retrospective observational study included consecutive adult patients with laboratory-confirmed COVID-19 admitted to ICUs of 18 hospitals from nine Brazilian cities, from September 2021 to July 2022. Potential predictors were selected based on the literature review. Generalized Additive Models were used to examine outcomes and predictors. LASSO regression was used to derive the mortality score. RESULTS: From 558 patients, median age was 69 years (IQR 58-78), 56.3 % were men, 19.7 % required mechanical ventilation (MV), and 44.8 % died. The final model comprised six variables: age, pO2/FiO2, respiratory function (respiratory rate or if in MV), chronic obstructive pulmonary disease, and obesity. The AB2CO had an AUROC of 0.781 (95 % CI 0.744 to 0.819), good overall performance (Brier score = 0.191) and an excellent calibration (slope = 1.063, intercept = 0.015, p-value = 0.834). The model was compared with other scores and displayed better discrimination ability than the majority of them. CONCLUSIONS: The AB2CO score is a fast and easy tool to be used upon ICU admission.

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Background: Predicting the need for invasive mechanical ventilation (IMV) is important for the allocation of human and technological resources, improvement of surveillance, and use of effective therapeutic measures. This study aimed (i) to assess whether the ABC2-SPH score is able to predict the receipt of IMV in COVID-19 patients; (ii) to compare its performance with other existing scores; (iii) to perform score recalibration, and to assess whether recalibration improved prediction. Methods: Retrospective observational cohort, which included adult laboratory-confirmed COVID-19 patients admitted in 32 hospitals, from 14 Brazilian cities. This study was conducted in two stages: (i) for the assessment of the ABC2-SPH score and comparison with other available scores, patients hospitalized from July 31, 2020, to March 31, 2022, were included; (ii) for ABC2-SPH score recalibration and also comparison with other existing scores, patients admitted from January 1, 2021, to March 31, 2022, were enrolled. For both steps, the area under the receiving operator characteristic score (AUROC) was calculated for all scores, while a calibration plot was assessed only for the ABC2-SPH score. Comparisons between ABC2-SPH and the other scores followed the Delong Test recommendations. Logistic recalibration methods were used to improve results and adapt to the studied sample. Results: Overall, 9,350 patients were included in the study, the median age was 58.5 (IQR 47.0-69.0) years old, and 45.4% were women. Of those, 33.5% were admitted to the ICU, 25.2% received IMV, and 17.8% died. The ABC2-SPH score showed a significantly greater discriminatory capacity, than the CURB-65, STSS, and SUM scores, with potentialized results when we consider only patients younger than 80 years old (AUROC 0.714 [95% CI 0.698-0.731]). Thus, after the ABC2-SPH score recalibration, we observed improvements in calibration (slope = 1.135, intercept = 0.242) and overall performance (Brier score = 0.127). Conclusion: The ABC2-SPHr risk score demonstrated a good performance to predict the need for mechanical ventilation in COVID-19 hospitalized patients under 80 years of age.

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Purpose: This work was designed to identify the pharmacogenetic profile of Brazilian psychiatric patients receiving psychoactive drug treatment according to ethnicity. Methods: Based on the GnTech® database, this cross-sectional study analyzed data from self-reported sociodemographic and genetic results from the next-generation sequencing panel composed of 26 pharmacogenes from 359 psychotropic drug users. Results: Variant frequencies of multiple pharmacogenes presented differences between ethnicities (CYP3A5, CYP2D6, CYP1A2, CYP2B6, CYP3A4, UGT1A4, UGT2B15, ABCB1 rs1045642, ADRA2A rs1800544, COMT rs4680, GRIK4 rs1954787, GSK3B rs334558, GSK3B rs6438552, HTR1A rs6295, HTR2A rs7997012, HTR2C rs1414334, MTHFR rs1801131, OPRM1 rs1799971 and 5-HTTLPR), endorsing the necessity of individual-level analyses in drug treatment. Conclusion: A discussion of pharmacogenomic test implementation in psychiatric clinical practice is needed to improve treatment choices, especially in Brazil, a multiethnic country.

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BACKGROUND: Scientific data regarding the prevalence of COVID-19 neurological manifestations and prognosis in Latin America countries is still lacking. Therefore, the study aims to understand neurological manifestations of SARS-CoV 2 infection and outcomes in the Brazilian population. METHODS: This study is part of the Brazilian COVID-19 Registry, a multicentric cohort, including data from 37 hospitals. For the present analysis, patients were grouped according to the presence of reported symptoms (i.e., headache; anosmia and ageusia; syncope and dizziness) vs. clinically-diagnosed neurological manifestations (clinically-defined neurological syndrome: neurological signs or diagnoses captured by clinical evaluation) and matched with patients without neurological manifestations by age, sex, number of comorbidities, hospital of admission, and whether or not patients had underlying neurological disease. RESULTS: From 6,635 hospitalized patients with COVID-19, 30.8% presented reported neurological manifestations, 10.3% were diagnosed with a neurological syndrome and 60.1% did not show any neurological manifestations. In patients with reported symptoms, the most common ones were headache (20.7%), ageusia (11.1%) and anosmia (8.0%). In patients with neurological syndromes, acute encephalopathy was the most common diagnosis (9.7%). In the matched analysis, patients with neurological syndromes presented more cases of septic shock (17.0 vs. 13.0%, p = 0.045), intensive care unit admission (45.3 vs. 38.9%, p = 0.023), and mortality (38.7 vs. 32.6%, p = 0.026; and 39.2 vs. 30.3%, p < 0.001) when compared to controls. CONCLUSION: COVID-19 in-hospital patients with clinically defined neurological syndromes presented a higher incidence of septic shock, ICU admission and death when compared to controls.

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BACKGROUND: Acute kidney injury (AKI) is frequently associated with COVID-19, and the need for kidney replacement therapy (KRT) is considered an indicator of disease severity. This study aimed to develop a prognostic score for predicting the need for KRT in hospitalised COVID-19 patients, and to assess the incidence of AKI and KRT requirement. METHODS: This study is part of a multicentre cohort, the Brazilian COVID-19 Registry. A total of 5212 adult COVID-19 patients were included between March/2020 and September/2020. Variable selection was performed using generalised additive models (GAM), and least absolute shrinkage and selection operator (LASSO) regression was used for score derivation. Accuracy was assessed using the area under the receiver operating characteristic curve (AUC-ROC). RESULTS: The median age of the model-derivation cohort was 59 (IQR 47-70) years, 54.5% were men, 34.3% required ICU admission, 20.9% evolved with AKI, 9.3% required KRT, and 15.1% died during hospitalisation. The temporal validation cohort had similar age, sex, ICU admission, AKI, required KRT distribution and in-hospital mortality. The geographic validation cohort had similar age and sex; however, this cohort had higher rates of ICU admission, AKI, need for KRT and in-hospital mortality. Four predictors of the need for KRT were identified using GAM: need for mechanical ventilation, male sex, higher creatinine at hospital presentation and diabetes. The MMCD score had excellent discrimination in derivation (AUROC 0.929, 95% CI 0.918-0.939) and validation (temporal AUROC 0.927, 95% CI 0.911-0.941; geographic AUROC 0.819, 95% CI 0.792-0.845) cohorts and good overall performance (Brier score: 0.057, 0.056 and 0.122, respectively). The score is implemented in a freely available online risk calculator ( https://www.mmcdscore.com/ ). CONCLUSIONS: The use of the MMCD score to predict the need for KRT may assist healthcare workers in identifying hospitalised COVID-19 patients who may require more intensive monitoring, and can be useful for resource allocation.

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The COVID-19 pandemic caused unprecedented pressure over health care systems worldwide. Hospital-level data that may influence the prognosis in COVID-19 patients still needs to be better investigated. Therefore, this study analyzed regional socioeconomic, hospital, and intensive care units (ICU) characteristics associated with in-hospital mortality in COVID-19 patients admitted to Brazilian institutions. This multicenter retrospective cohort study is part of the Brazilian COVID-19 Registry. We enrolled patients ≥ 18 years old with laboratory-confirmed COVID-19 admitted to the participating hospitals from March to September 2020. Patients' data were obtained through hospital records. Hospitals' data were collected through forms filled in loco and through open national databases. Generalized linear mixed models with logit link function were used for pooling mortality and to assess the association between hospital characteristics and mortality estimates. We built two models, one tested general hospital characteristics while the other tested ICU characteristics. All analyses were adjusted for the proportion of high-risk patients at admission. Thirty-one hospitals were included. The mean number of beds was 320.4 ± 186.6. These hospitals had eligible 6556 COVID-19 admissions during the study period. Estimated in-hospital mortality ranged from 9.0 to 48.0%. The first model included all 31 hospitals and showed that a private source of funding (ß = - 0.37; 95% CI - 0.71 to - 0.04; p = 0.029) and location in areas with a high gross domestic product (GDP) per capita (ß = - 0.40; 95% CI - 0.72 to - 0.08; p = 0.014) were independently associated with a lower mortality. The second model included 23 hospitals and showed that hospitals with an ICU work shift composed of more than 50% of intensivists (ß = - 0.59; 95% CI - 0.98 to - 0.20; p = 0.003) had lower mortality while hospitals with a higher proportion of less experienced medical professionals had higher mortality (ß = 0.40; 95% CI 0.11-0.68; p = 0.006). The impact of those association increased according to the proportion of high-risk patients at admission. In-hospital mortality varied significantly among Brazilian hospitals. Private-funded hospitals and those located in municipalities with a high GDP had a lower mortality. When analyzing ICU-specific characteristics, hospitals with more experienced ICU teams had a reduced mortality.

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Previous studies that assessed risk factors for venous thromboembolism (VTE) in COVID-19 patients have shown inconsistent results. Our aim was to investigate VTE predictors by both logistic regression (LR) and machine learning (ML) approaches, due to their potential complementarity. This cohort study of a large Brazilian COVID-19 Registry included 4120 COVID-19 adult patients from 16 hospitals. Symptomatic VTE was confirmed by objective imaging. LR analysis, tree-based boosting, and bagging were used to investigate the association of variables upon hospital presentation with VTE. Among 4,120 patients (55.5% men, 39.3% critical patients), VTE was confirmed in 6.7%. In multivariate LR analysis, obesity (OR 1.50, 95% CI 1.11-2.02); being an ex-smoker (OR 1.44, 95% CI 1.03-2.01); surgery ≤ 90 days (OR 2.20, 95% CI 1.14-4.23); axillary temperature (OR 1.41, 95% CI 1.22-1.63); D-dimer ≥ 4 times above the upper limit of reference value (OR 2.16, 95% CI 1.26-3.67), lactate (OR 1.10, 95% CI 1.02-1.19), C-reactive protein levels (CRP, OR 1.09, 95% CI 1.01-1.18); and neutrophil count (OR 1.04, 95% CI 1.005-1.075) were independent predictors of VTE. Atrial fibrillation, peripheral oxygen saturation/inspired oxygen fraction (SF) ratio and prophylactic use of anticoagulants were protective. Temperature at admission, SF ratio, neutrophil count, D-dimer, CRP and lactate levels were also identified as predictors by ML methods. By using ML and LR analyses, we showed that D-dimer, axillary temperature, neutrophil count, CRP and lactate levels are risk factors for VTE in COVID-19 patients.

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BACKGROUND: It is not clear whether previous thyroid diseases influence the course and outcomes of COVID-19. METHODS: The study is a part of a multicentric cohort of patients with confirmed COVID-19 diagnosis from 37 hospitals. Matching for age, sex, number of comorbidities, and hospital was performed for the paired analysis. RESULTS: Of 7,762 patients with COVID-19, 526 had previously diagnosed hypothyroidism and 526 were matched controls. The median age was 70 years, and 68.3% were females. The prevalence of comorbidities was similar, except for coronary and chronic kidney diseases that were higher in the hypothyroidism group (p=0.015 and p=0.001). D-dimer levels were lower in patients with hypothyroid (p=0.037). In-hospital management was similar, but hospital length-of-stay (p=0.029) and mechanical ventilation requirement (p=0.006) were lower for patients with hypothyroidism. There was a trend of lower in-hospital mortality in patients with hypothyroidism (22.1% vs 27.0%; p=0.062). CONCLUSION: Patients with hypothyroidism had a lower requirement of mechanical ventilation and showed a trend of lower in-hospital mortality. Therefore, hypothyroidism does not seem to be associated with a worse prognosis.

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Objetivo: Avaliar a tendência temporal das Internações por Condições Sensíveis à Atenção Primária (ICSAP), em idosos, segundo sua estrutura, magnitude e causas, no Brasil, entre 2000 e 2018. Métodos: Estudo ecológico realizado com base em dados do Sistema de Informação Hospitalar do Sistema Único de Saúde (SUS) e Sistema de Informação da Atenção Básica (SIAB), entre 2000 e 2018, referentes a indivíduos com 60 anos ou mais, sendo incluídas 20.695.407 internações. Calcularam-se os coeficientes brutos e específicos de hospitalizações segundo sexo, faixa etária e região e estimaram-se a cobertura da Estratégia de Saúde da Família e o número de consultas médicas na atenção primária. Para análise da série temporal utilizou-se o método de regressão linear simples, sendo testada a correlação pelo Coeficiente de Correlação de Pearson (p<0,05). Resultados: Observou-se tendência de redução nas taxas de ICSAP em idosos no Brasil, de 2000 a 2018, para ambos os sexos, todas as faixas etárias e regiões (p<0,001). As principais causas de ICSAP concentraram-se nas doenças do aparelho circulatório (14,42%); respiratório (11,52%); e endócrinas, metabólicas e nutricionais (4,42%). Ocorreu diminuição de 61,50% de internações por insuficiência cardíaca e um aumento de 27,29% nas internações por pneumonia. Constatou-se tendência de aumento da cobertura da Estratégia de Saúde da Família (ESF) e do número médio de consultas (p<0,001), em idosos, no Brasil, de 2000 a 2015. Houve correlação negativa entre internações e indicadores de acesso à atenção primária (p<0,001). Conclusão: Há tendência de redução nas taxas gerais de ICSAP em idosos no Brasil, em função de melhorias na cobertura da atenção primária.

Objective: To evaluate the temporal trend of hospitalizations for Ambulatory Care Sensitive Conditions (ACSC) in the elderly, according to their structure, magnitude, and causes, in Brazil, between 2000 and 2018. Methods: An ecological study based on data from the Hospital Information System of the Unified Health System (Sistema Único de Saúde - SUS) and the Primary Care Information System (Sistema de Informações sobr à Atenção Básica - SIAB), between 2000 and 2018, referring to individualsaged 60 years or older, including 20,695,407 hospitalizations. Gross and specific coefficients of hospitalizations were calculated according to sex, age group, and region, and the coverage of the Family Health Strategy (Estratégia Saúde da Família ­ ESF), and the number of medical consultations in primary care were estimated. For the time series analysis, the simple linear regression method was used, and the correlation was tested by Pearson's Correlation Coefficient (p<0.05). Results: There was a trend of reduction in the rates of hospitalizations for ACSC in the elderly in Brazil, from 2000 to 2018, for both sexes, all age groups, and regions (p<0.001). The main causes of ACSC were concentrated in diseases of the circulatory system (14.42%), respiratory (11.52%), and endocrine, metabolic and nutritional (4.42%). There was a 61.50% decrease in hospitalizations for heart failure and a 27.29% increase in hospitalizations for pneumonia. There was a tendency to increase the coverage of the ESF and the average number of consultations (p<0.001) in the elderly in Brazil from 2000 to 2015. There was a negative correlation between hospitalizations and indicators of access to primary care (p<0.001). Conclusion: There is a trend of a reduction in the general rates of hospitalizations for ACSC in the elderly in Brazil due to improvements in primary care coverage.

Objetivo: Evaluar la tendencia temporal de las Hospitalizaciones por Condiciones Sensible de la Atención Primaria (HCSAP), de mayores, según la estructura, la magnitud y sus causas, en Brasil, entre 2000 y 2018. Métodos: Estudio ecológico realizado en la base de datos del Sistema de Información Hospitalaria del Sistema Único de Salud (SUS) y del Sistema de Información de la Atención Básica (SIAB), entre 2000 y 2018, referentes a los individuos de 60 años o más, con la inclusión de 20.695.407 hospitalizaciones. Se ha calculado los coeficientes brutos y específicos de las hospitalizaciones según el sexo, la franja de edad y la región y se ha estimado la cobertura de la Estrategia Salud de la Familia y el número de citas médicas de la atención primaria. Para el análisis de la serie temporal se ha utilizado el método de regresión linear simple y se ha testada la correlación por el Coeficiente de Correlación de Pearson (p<0,05). Resultados: Se observó la tendencia para la reducción de las tasas de HCSAP de mayores en Brasil entre 2000 y 2018, para ambos sexos, todas las franjas de edad y regiones (p<0,001). Las principales causas de HCSAP se han concentrado en las enfermedades del aparato circulatorio (14,42%); del respiratorio (11,52%); y las endocrinas, las metabólicas y las nutricionales (4,42%). Hubo una disminución del 61,50% de ingresos por insuficiencia cardiaca y el aumento del 27,29% de los ingresos por neumonía. Se ha constatado la tendencia de aumento de la cobertura de la Estrategia Salud de la Familia (ESF) y del número medio de citas (p<0,001) de mayores en Brasil entre 2000 y 2015. Hubo correlación negativa entre los ingresos y los indicadores de acceso a la atención primaria (p<0,001). Conclusión: Hay una tendencia para la reducción de las tasas generales de HCSAP de mayores en Brasil debido las mejorías de la cobertura de la atención primaria.

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Around 5% of coronavirus disease 2019 (COVID-19) patients develop critical disease, with severe pneumonia and acute respiratory distress syndrome (ARDS). In these cases, extracorporeal membrane oxygenation (ECMO) may be considered when conventional therapy fails. This study aimed to describe the clinical characteristics and in-hospital outcomes of COVID-19 patients with ARDS refractory to lung-protective ventilation and prone positioning on ECMO support, as well as to review the available literature on ECMO use and COVID-19 patients' outcome. Patients from this case series were selected from the Brazilian COVID-19 Registry. From the 7646 patients included in the registry, only eight received ECMO support (0.1%), in four hospitals. The median age of the entire sample was 59 (interquartile range 54.2-64.4) years old and 87.5% were male. Hypertension (50.0%), diabetes mellitus (50.0%) and obesity (37.5%) were the most frequent comorbidities. The indications for ECMO were PaO2 /FiO2 ratio <80 mm Hg for more than 6 h or PaO2 /FiO2 ratio <60 mm Hg for more than 3 h. The mortality rate was 87.5%. In conclusion, in this case series of COVID-19 patients with ARDS refractory to conventional therapy who received ECMO support, a very high mortality was observed. Our findings are not different from previous studies including a small number of patients; however, there is a huge difference from Extracorporeal Life Support Organization results, which encourages us to keep looking for improvement.

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There is a consensus regarding the efficacy of physical exercise in maintaining or improving human health; however, there are few studies examining the effect of physical exercise on the expression levels of microRNAs (miRNA/miRs) in Parkinson's disease (PD). The aim of the present study was to investigate the effects of an interval training program on a cycle ergometer on the expression levels of miR­106a­5p, miR­103a­3p and miR­29a­3p in serum samples from men with PD. This was a quasi­experimental study with pre­ and post­testing and with a non­equivalent group design. The participants were selected based on the eligibility criteria and subsequently classified into two groups: Experimental group and control group. The evaluations were performed at the beginning of the study (week 0) and after 8 weeks of the intervention program (week 9). The interval training program was performed on a cycle ergometer for 30 min, three times a week during an 8­week period. The expression levels of miR­106a­5p, miR­103a­3p and miR­29a­3p in the experimental group were increased after physical exercise and were associated with cognitive improvement in men with PD. However, further studies are required to clarify the potential use of these circulating miRNAs as markers of adaptation to physical exercise. Collectively, the present results indicated that these three miRNAs may be associated with the exercise response and cognitive improvement in men with PD.

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Introdução: Atualmente o bypass gástrico em Y de Roux (BGYR) é o método cirúrgico de escolha no tratamento da obesidade. Todavia, pode ocorrer reganho de peso após a cirurgia. A aplicação do plasma de argônio por via endoscópica constitui uma opção terapêutica que visa redução do calibre da anastomose gastrojejunal, com consequente perda de peso. Objetivo: Avaliar a relação da redução do calibre da anastomose gastrojejunal com a perda de peso e sensação de saciedade nos pacientes que readquiriram peso após BGYR. Métodos: Estudo observacional transversal, que incluiu 34 pacientes submetidos à aplicação do plasma de argônio entre 2014 e 2018, na Usuy Clínica Médica em Florianopólis. As diferenças entre as médias de peso, IMC e diâmetro da anastomose gastrojejunal frente a aplicação do plasma de argônio e saciedade referida foram estabelecidas pelo teste de Wilcoxon (p≤0,05). Resultados: Observou-se redução de 6,26% do peso, 6,21% do IMC e 43,04% do diâmetro anastomótico comparando as médias pré e pós seis meses do procedimento. 53,3% dos pacientes sentiram-se mais saciados. Conclusão: A aplicação do plasma de argônio mostrou-se eficaz na redução do diâmetro da anastomose gastrojejunal, perda de peso corporal e diminuição do IMC.

Introduction: Nowadays the Roux-en-Y Gastric Bypass (RYGB) is the surgical choice method in obesity treatment. However, weight regain may occur after the surgery. The endoscopy applied argon plasma constitutes one therapeutic option in order to reduce the gastrojejunal anastomosis caliber and consequently weight loss. Objective: To evaluate the relation between the gastrojejunal anastomosis caliber reduction, weight loss and sensation of satiety in patients who regained weight after RYGB. Methods: Observational cross-sectional study that includes 34 patients submitted to argon plasma application between 2014 and 2018 at the Usuy Medical Center in Florianopolis. Weight averages, Body Mass Index (BMI) and gastrojejunal anastomosis diameter differences regarding argon plasma application and referred satiety were established by the Wilcoxon Test (p ≤ 0,05). Results: A reduction of 6.26 % of the weight, 6.21 % of the BMI and 43.04 % of the anastomotic diameter was observed upon comparing the average rate six months before and after the procedure. 53.3 % of the patients felt more satiated. Conclusion: The argon plasma application was effective in reducing gastrojejunal anastomosis diameter, body weight and BMI.

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Sepse é uma disfunção de órgãos decorrente à infecção, sendo importante causa de morte nas Unidades de Terapia Intensiva (UTI). O estudo objetivou conhecer o desfecho clínico e os fatores associados ao óbito em pacientes com sepse internados na Unidade de Terapia Intensiva. Estudo transversal analítico, envolvendo 99 prontuários de pacientes com sepse internados em uma UTI, na Grande Florianópolis, em 2016. Identificada prevalência de sepse de 18,4% e mortalidade de 37,4%. O principal foco de infecção foi o pulmonar (39.4%), pelo microrganismo Staphylococcos coagulase negativa (55%). O tempo médio de internação foi de 20 dias. 55.6% dos pacientes internaram por motivos clínicos, 60,6% do sexo masculino, com idade inferior a 60 anos (56.6%). 60% apresentavam alguma comorbidade, sendo as principais a hipertensão (27.3%) e o diabetes Mellitus (15.2%). Os procedimentos invasivos mais utilizados foram, sonda vesical de demora (100%), intubação orotraqueal (64.6%) e acesso venoso central (64.4%) e periférico (100%). Observada associação com significância estatística entre óbito e o motivo clínico de internação (RP: 1,89; IC: 1,056 ­ 3,387; p= 0,023). Encontrada importante prevalência de sepse e incidência de mortalidade, estando associados ao óbito o motivo clínico de internação e a presença de comorbidades.

Objetive: Sepsis is an organ dysfunction due to infection and is an important cause of death in intensive care units (ICU). The objective of this study was to identify the clinical correlation and the factors associated with death in patients with sepsis in Intensive Care. Method: A cross-sectional analytical study with 99 records of patients with sepsis hospitalized in an ICU of Florianópolis in 2016. Results: A prevalence of of 18.4% of sepsis, 37.4% of mortality was identified. Main focus of respiratory infection was pulmonary (39.4%), by the coagulase negative Staphylococcos (55%). An average of 20 days of hospitalization, and 55.6% of patients hospitalized for clinical reasons, 60.6% were male, under 60 years old (56.6%). 60% had comorbidities (hypertension - 27.3% and diabetes - 15.2%). Intravenous catheters (100%), orotracheal intubation (64.6%), central venous access (64.4%) and peripheral (100%) venous access were the most prevalent procedure. There was a significant association between death and clinical reason for hospitalization (PR: 1.89; CI: 1.056 - 3.387; p = 0.023). Important prevalence of sepsis and incidence of mortality were found, being associated with death evolution for hospitalization and the presence of comorbidities.

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O Diabetes Mellitus é uma doença crônica não transmissível com alta prevalência global. Para evitar complicações e tratar corretamente, é necessário que os pacientes tenham o conhecimento sobre sua doença e atitudes positivas, para que seja possível a prevenção do sofrimento e uma melhor qualidade de vida. O presente estudo objetivou avaliar conhecimento, atitude, sofrimento e qualidade de vida de indivíduos diabéticos de uma Unidade Básica de Saúde (UBS) de Palhoça, Santa Catarina, Brasil. Trata-se de um estudo transversal realizado com 80 pacientes diabéticos. Foram avaliadas variáveis sociodemográficas, clínicas, conhecimento (DKN-A), atitude (ATT-19), nível de sofrimento emocional (PAID) e qualidade de vida (SF-36). Os dados foram descritos na forma de frequências (absoluta/relativa), média e desvio padrão. A diferença entre médias foi estabelecida pelo teste T de student para amostras independentes (p≤0,05), a partir do SPSS 18.0. Observou-se 81,3% da população com baixo conhecimento sobre a doença, 97,5% com atitudes negativas e 32,5% com alto nível de sofrimento emocional. Em relação à qualidade de vida, os menores escores foram observados no sumário mental, com diferenças estatisticamente significativas nos domínios vitalidade, limitação por aspectos emocionais e saúde mental (p<0,05). Assim, o estudo demonstrou que os pacientes diabéticos apresentaram baixo conhecimento, atitudes negativas frente a doença, alto nível de sofrimento emocional e baixa qualidade de vida.

Diabetes Mellitus is a chronic, non-communicable disease with high global prevalence. To avoid complications and treat correctly, patients need to be knowledgeable about their illness and positive attitudes, so that suffering can be prevented and a better quality of life is possible. The present study aimed to evaluate the knowledge, attitude, suffering and quality of life of diabetic individuals of a Basic Health Unit (BHU) in Palhoça, Santa Catarina, Brazil. It is a cross-sectional study with 80 diabetic patients. Sociodemographic, clinical, knowledge (DKN-A), attitude (ATT-19), emotional distress level (PAID) and quality of life (SF-36) were evaluated. Data were described in the form of frequencies (absolute / relative), mean and standard deviation. The difference between means was established by the student T test for independent samples (p≤0.05), from SPSS 18.0. It was observed 81.3% of the population with low knowledge about the disease, 97.5% with negative attitudes and 32.5% with high level of emotional suffering. Regarding quality of life, the lowest scores were observed in the mental summary, with statistically significant differences in the domains of vitality, limitation by emotional aspects and mental health (p <0.05). Thus, the study demonstrated that diabetic patients presented low knowledge, negative attitudes towards the disease, high level of emotional suffering and low quality of life.

RESUMEN

Introdução: A fratura de calcâneo é muito grave e de difícil tratamento, sendo considerada um grande desafio à ortopedia devido aos inúmeros maus resultados, frequentemente apresentando complicações. Objetivos: Analisar os fatores envolvidos na prevalência de complicações após uma fratura de calcâneo. Métodos: Estudo transversal que incluiu 99 pacientes vítimas de fratura de calcâneo atendidos em um hospital público de referência da Grande Florianópolis. A coleta de dados foi realizada através de prontuário eletrônico. Foi utilizado Qui-quadrado ou Prova Exata de Fisher, p ≤ 0,05, Razão de Prevalência com IC 95%. Trabalho aprovado pelo Comitê de Ética da UNISUL. Resultados: Observou-se que 84,8% dos pacientes eram do sexo masculino e 69,2% exerciam profissões de risco para traumas, com prevalência de complicações em 54,4% dos pacientes, sendo os principais fatores preditivos envolvidos o tempo até o tratamento ≥ 7 dias com 1,8 vezes maior risco, o tratamento cirúrgico com 66,7% de complicações e o tempo de internação ≥ 15 dias em 70,2% de casos. Conclusão: Foi identificada alta prevalência de complicações, principalmente entre o sexo masculino e entre trabalhadores envolvidos com a construção civil, sendo a dor crônica residual a principal sequela encontrada. Como fatores preditivos, foram identificados aspectos relacionados ao tempo tardio para diagnóstico da fratura e posterior definição da conduta, ao tratamento cirúrgico e ao tempo de internação prolongado, superior a 2 semanas. Não foram encontradas associações entre existência de comorbidades, etilismo e tabagismo com a prevalência de complicações.

Introduction: The calcaneal fracture is very serious and difficult to handle, being considered a great orthopedic challenge due to its numerous poor results, frequently presenting complications. Objectives: To analyze the factors involved in the prevalence of complications following a calcaneal fracture. Methods: A cross-sectional study involving 99 patients with calcaneal fracture treated at a reference hospital in Greater Florianópolis. Data collection was done through an electronic medical record. Chi-square and Fisher's exact test were used, p ≤ 0.05, Prevalence Ratio with 95% CI. Work approved by the Ethics Committee of UNISUL. Results: It was observed that 84.8% of the patients were males and 69.2% had professions of risk for trauma, with a prevalence of complications in 54.4% of the patients, with the main predictive factors being the time to treatment ≥ 7 days with 1.8 times greater risk, surgical treatment with 66.7% of complications and the hospitalization time ≥ 15 days in 70.2%. Conclusion: A high prevalence of complications was identified, mainly among males and among workers involved in construction, with residual chronic pain being the main sequel found. As predictive factors were identified aspects related to late diagnosis of the fracture and subsequent definition of the conduct, surgical treatment and length of stay longer than 2 weeks. No associations were found between pre-existence comorbidities, alcoholism or smoking and the prevalence of complications.

RESUMEN

Avaliar as características da demanda e os determinantes de procura pelo SE por pacientes classificados como pouco urgentes e não-urgentes em hospital geral, Sul do Brasil. Estudo epidemiológico, transversal. A coleta de dados foi realizada por entrevista, com duração aproximada de 15 minutos, em 2017, por pesquisadores treinados. Desfecho do estudo: determinantes de procura. Variáveis independentes: demográficas, socioeconômicas e características gerais de procura. Também coletou-se dados sobre a auto percepção do paciente (urgência e preocupação) e escolha do local para atendimento (Escala Likert 0-10). Os dados qualitativos apresentados na forma de frequências simples e relativa, os quantitativos como média e desvio padrão. Foram analisadas associações entre variáveis independentes e o desfecho, através do teste qui-quadrado de Pearson, seguido de Razão de Prevalência e Intervalo Confiança 95%. Participaram do estudo 290 pacientes: 50 (17%) pouco urgentes e 240 (83,0%) não urgentes, sexo feminino (57,2%), faixa etária entre 15-29 anos (39,0%), sem companheiro (51,0%), ensino superior/médio (69,3%), em atividade ocupacional (61,2%). Sobre características gerais da demanda: 77,9% oriundos de suas residências e 39,3% utilizou veículo próprio para o deslocamento. Distância média deslocamento (12,47±15,8 Km) e tempo médio deslocamento (25,98±23,55 minutos). Tempo médio triagem (17,69min.±15,36) e de espera atendimento médico (1h13min±1h10min). Não houve associação com significância estatística entre características demográficas, socioeconômicas e motivos de procura pelo SE. Conclui-se que os critérios determinantes de procura pelo SE foram resolutividade (40,9%) e funcionamento inadequado das UBS (24,7%), seguidos de procura por especialista e agudização da doença crônica.

To evaluate the demand and the determinants of the search for the Emergency service by patients classified as not very urgent and not-urgent in a general hospital, South of Brazil. Cross epidemiological study. Data collect was performed by interview, with an approximated duration of 15 minutes, in 2017, by trained researchers. Study outcome: Search determinants. Independent variables: demographic, socioeconomic and general demand characteristics. It was also collected data on the patient self-perception (urgency and concern) and the choice of the medical care (Likert Scale 0-10). The qualitative data presented by simple and relative way frequencies, the quantitative ones as average and standard deviation. Associations between independent variables and the outcome were analyzed using Pearson's chi-square test, followed by a Prevalence Ratio and 95% Confidence Interval. The study included 290 patients: 50 (17%) were not very urgent and 240 (83.0%) female not-urgent were (57.2%), 15-29 years old (39.0%), without partner (51.0%), higher /college degree (69.3%) in occupational activity (61.2%). On general demand characteristics: 77.9% come from their homes and 39.3% used their own vehicle for the trip. Average displacement distance (12.47 ± 15.8 Km) and average displacement time (25.98 ± 23.55 minutes). Average screening time (17.69min ± 15.36) and waiting for medical care (1h13min ± 1h10min). There was no association with statistical significance between demographic, socioeconomic and reasons for Emergency Service search. The determinant criteria of the search for ES were resolutiveness (40.9%) and inadequate working of the BHU (24.7%), followed by specialist search and chronic disease exacerbation.

RESUMEN

Objetivo: Avaliar a tendência temporal de internação por queimadura no Sul do Brasil, no período de 2008 a 2016. Método: Estudo ecológico de séries temporais, realizado a partir do Banco de Dados do SIH-SUS, com internações de residentes do Sul do Brasil, de 2008 a 2016. As taxas de internações foram padronizadas pelos estados do Sul, sexo e faixa etária e foi realizada regressão linear simples para estimar as tendências de internação. Resultados: No período estudado ocorreram 37.571 internações. A taxa de internação por queimadura em 2008, início do período, foi 13,11 internações por 100.000 habitantes, finalizando em 2016 com taxa de 14,60/100.000 habitantes, mantendo-se constante no período. No sexo masculino as taxas foram superiores, iniciando o período com 15,87/100.000, finalizando a série histórica com 19,76/100.000. No feminino, a taxa manteve-se linear durante o período. Verificou-se que o Paraná apresentou as maiores taxas em relação a Santa Catarina e Rio Grande do Sul. A faixa etária mais acometida foi de 0-19 anos. Conclusão: Há tendência de estabilidade na taxa geral de internação. O sexo masculino e a faixa etária de 0-19 anos são os mais acometidos por queimaduras no Sul do Brasil. O Paraná tem maiores taxas de internação quando comparado aos outros dois estados.

Objective: To evaluate the temporal trend of hospitalization for burns in the South of Brazil, from 2008 to 2016. Methods: Ecological study of time series, carried out from the Database of the SIH-SUS, with hospitalizations of residents of the South of Brazil, from 2008 to 2016. The hospitalization rates were standardized by the southern states, sex and age group and a simple linear regression was performed to estimate the hospitalization trends. Results: During the study period, 37,571 hospitalizations occurred. The hospitalization rate for burns in 2008, beginning of the period, was 13.11 hospitalizations per 100,000 inhabitants, ending the period (2016) with a rate of 14.60 / 100,000 inhabitants, remaining constant in the period. In males the rates were higher, starting the period with 15.87 / 100,000, finishing the historical series with 19.76 / 100,000. In the female, the rate remained linear during the period. It was verified that Paraná presented the highest rates in relation to Santa Catarina and Rio Grande do Sul. The most affected age group was 0-19 years. Conclusion: There was a trend towards stability in the general hospitalization rate. The male gender and age group of 0-19 years were the most affected by burns in the South of Brazil. Paraná has the highest hospitalization rates when compared to the other two states.

Objetivo: Evaluar la tendencia temporal de internación por quemadura en el Sur de Brasil, en el período de 2008 a 2016. Metodos: Estudio ecológico de series temporales, realizado a partir del Banco de Datos del SIH-SUS, con internaciones de residentes del Sur de Brasil, de 2008 a 2016. Las tasas de internaciones fueron estandarizadas por los estados del Sur, sexo y grupo de edad y se realizó una regresión lineal simple para estimar las tendencias de internación. Resultados: En el período estudiado ocurrieron 37.571 internaciones. La tasa de internación por quemadura en 2008, inicio del período, fue 13,11 internaciones por 100.000 habitantes, finalizando el período (2016) con tasa de 14,60 / 100.000 habitantes, manteniendo constante en el período. En el sexo masculino las tasas fueron superiores, iniciando el período con 15,87 / 100.000, finalizando la serie histórica con 19,76 / 100.000. En el femenino, la tasa se ha mantenido lineal durante el período. Se verificó que el Paraná presentó las mayores tasas en relación a Santa Catarina y Rio Grande do Sul. El grupo de edad más afectado fue de 0-19 años. Conclusión: Hubo tendencia de estabilidad en la tasa general de internación. El sexo masculino y el grupo de edad de 0-19 años fueron los más afectados por quemaduras en el sur de Brasil. El Paraná se quedó siendo el estado con mayores tasas de internación cuando comparado a los otros dos estados.

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