General Approach to Acute Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): A Systematic Review

Abstract Background Acute myocardial infarction (AMI) without obstructive coronary arteries (MINOCA) is a medical condition of great relevance, with clinical characteristics of AMI, but without evidence of coronary artery obstruction. The mechanism involved in the pathophysiology of the disease and its possible etiologies are important objects of study due to their impact on the morbidity and mortality of affected patients. Objectives The aim of this study was to systematically review MINOCA and its characteristics, with emphasis on the clinical profile of patients, etiology, pathophysiology, diagnosis, and treatment of the syndrome. Methods Relevant articles related to MINOCA were analyzed in the PubMed and LILACS databases. In the initial search stage, 619 eligible articles were obtained, with final inclusion criteria being: original systematic reviews with clinical, epidemiological, diagnostic, or treatment data on MINOCA, published in Portuguese or English, with an abstract, and a publication date limit of September 2020. Results A total of 10 articles classified as systematic reviews that considered clinical data on MINOCA were included in this review. Conclusion After analyzing various literature, the present study provided a tool to better understand MINOCA, not only regarding its casuistry but also in grouping parameters and information that contribute to a healthy approach to this clinical situation. It was possible to identify and better outline the clinical profile of patients who presented this condition and the use of appropriate tools for correct diagnosis and ideal treatment.

Impact of the COVID-19 Pandemic on Elective and Emergency Surgical Procedures in a University Hospital.

OBJECTIVE: to assess the impact of the COVID-19 pandemic on abdominal wall hernia repair surgeries and cholecystectomy in a referral center hospital. METHODS: a retrospective, observational, cross-sectional study carried out at Hospital Universitário Evangélico Mackenzie (HUEM), in Curitiba, Paraná, Brazil. Data obtained through electronic medical records of patients who underwent cholecystectomy and abdominal wall hernia repair from March to December 2019 and 2020 at HUEM were included. Data were analyzed using Pearsons Chi-Square test and analysis of variance (ANOVA). RESULTS: a total of 743 medical records were analyzed, with a 63.16% drop in the total number of surgeries in 2020. There was a 91.67% increase in the number of ICU admissions in 2020, as well as a 70% increase in average length of stay. A greater number of complications was observed (in 2020, 27% had complications, while in 2019 this figure was 18.8%) and an increase in mortality (in 2019, this rate was 1.3% and in 2020, 6.5%). There were 6 cases of COVID-19 in 2020, so that of these, 5 patients died. CONCLUSION: during the COVID-19 pandemic, an important reduction in the number of abdominal wall hernia repair surgeries and cholecystectomy was observed. In addition, there was a statistically significant increase in postoperative complications, mortality rate and length of stay in 2020.

Impact of the COVID-19 Pandemic on Elective and Emergency Surgical Procedures in a University Hospital / Impacto da Pandemia por COVID-19 nos Procedimentos Cirúrgicos Eletivos e Emergenciais em Hospital Universitário

ABSTRACT Objective: to assess the impact of the COVID-19 pandemic on abdominal wall hernia repair surgeries and cholecystectomy in a referral center hospital. Methods: a retrospective, observational, cross-sectional study carried out at Hospital Universitário Evangélico Mackenzie (HUEM), in Curitiba, Paraná, Brazil. Data obtained through electronic medical records of patients who underwent cholecystectomy and abdominal wall hernia repair from March to December 2019 and 2020 at HUEM were included. Data were analyzed using Pearsons Chi-Square test and analysis of variance (ANOVA). Results: a total of 743 medical records were analyzed, with a 63.16% drop in the total number of surgeries in 2020. There was a 91.67% increase in the number of ICU admissions in 2020, as well as a 70% increase in average length of stay. A greater number of complications was observed (in 2020, 27% had complications, while in 2019 this figure was 18.8%) and an increase in mortality (in 2019, this rate was 1.3% and in 2020, 6.5%). There were 6 cases of COVID-19 in 2020, so that of these, 5 patients died. Conclusion: during the COVID-19 pandemic, an important reduction in the number of abdominal wall hernia repair surgeries and cholecystectomy was observed. In addition, there was a statistically significant increase in postoperative complications, mortality rate and length of stay in 2020.

RESUMO Objetivo: avaliar o impacto da pandemia da COVID-19 em cirurgias de reparo de hérnias de parede abdominal e colecistectomia em hospital centro de referência. Métodos: estudo transversal retrospectivo observacional realizado no Hospital Universitário Evangélico Mackenzie (HUEM), em Curitiba, Paraná, Brasil. Foram incluídos os dados obtidos através de prontuários eletrônicos de pacientes que realizaram colecistectomia e reparo de hérnias de parede abdominal no período de março a dezembro de 2019 e 2020 no HUEM. Os dados foram analisados por meio do teste Qui-Quadrado de Pearson e aplicação da Análise de Variância (ANOVA). Resultados: Foram analisados 743 prontuários ao todo, sendo constatada uma queda de 63,16% no número total de cirurgias no ano de 2020. Verificou-se um aumento de 91,67% no número de internações em UTI em 2020, bem como um aumento de 70% no tempo médio de internação. Foi observado um maior número de complicações (em 2020, 27% apresentaram complicações, enquanto em 2019 este valor foi de 18,8%) e um aumento em relação à mortalidade (em 2019, esta taxa foi de 1,3% e em 2020, 6,5%). Observaram-se 6 casos de COVID-19 em 2020, de modo que destes, 5 pacientes vieram a óbito. Conclusão: durante a pandemia da COVID-19, observou-se uma importante redução na quantidade de cirurgias de reparo de hérnia de parede abdominal e colecistectomia. Além disso, houve aumento estatisticamente relevante quanto às complicações pós-operatórias, taxa de mortalidade e tempo de internamento em 2020.