Post-COVID-19 cognitive symptoms in patients assisted by a teleassistance service: a retrospective cohort study.

Introduction: Four years after the onset of the COVID-19 pandemic, the frequency of long-term post-COVID-19 cognitive symptoms is a matter of concern given the impact it may have on the work and quality of life of affected people. Objective: To evaluate the incidence of post-acute COVID-19 cognitive symptoms, as well as the associated risk factors. Methods: Retrospective cohort, including outpatients with laboratory-confirmed COVID-19 and who were assisted by a public telehealth service provided by the Telehealth Network of Minas Gerais (TNMG), during the acute phase of the disease, between December/2020 and March/2022. Data were collected through a structured questionnaire, applied via phone calls, regarding the persistence of COVID-19 symptoms after 12 weeks of the disease. Cognitive symptoms were defined as any of the following: memory loss, problems concentrating, word finding difficulties, and difficulty thinking clearly. Results: From 630 patients who responded to the questionnaire, 23.7% presented cognitive symptoms at 12 weeks after infection. These patients had a higher median age (33 [IQR 25-46] vs. 30 [IQR 24-42] years-old, p = 0.042) with a higher prevalence in the female sex (80.5% vs. 62.2%, p < 0.001) when compared to those who did not present cognitive symptoms, as well as a lower prevalence of smoking (8.7% vs. 16.2%, p = 0.024). Furthermore, patients with persistent cognitive symptoms were more likely to have been infected during the second wave of COVID-19 rather than the third (31.0% vs. 21.3%, p = 0.014). Patients who needed to seek in-person care during the acute phase of the disease were more likely to report post-acute cognitive symptoms (21.5% vs. 9.3%, p < 0,001). In multivariate logistic regression analysis, cognitive symptoms were associated with female sex (OR 2.24, CI 95% 1.41-3.57), fatigue (OR 2.33, CI 95% 1.19-4.56), depression (OR 5.37, CI 95% 2.19-13.15) and the need for seek in-person care during acute COVID-19 (OR 2.23, CI 95% 1.30-3.81). Conclusion: In this retrospective cohort of patients with mostly mild COVID-19, cognitive symptoms were present in 23.7% of patients with COVID-19 at 12 weeks after infection. Female sex, fatigue, depression and the need to seek in-person care during acute COVID-19 were the risk factors independently associated with this condition.

Myocardial protection: comparing histological effects of single-dose cardioplegic solutions-study protocol for a secondary analysis of the CARDIOPLEGIA trial.

Background: Myocardial protection is crucial for successful cardiac surgery, as it prevents heart muscle damage that can occur during the procedure. Prolonged hypoxia without proper protection can lead to adenosine triphosphate consumption, microvilli loss, blister formation, and edema. Custodiol, del Nido, and modified del Nido are single-dose cardioplegic solutions with proven safety and significance in modern surgery. While each has been independently assessed for patient outcomes, limited research directly compares them. This study aims to compare their myocardial protection using histological analysis. Methods: In a double-blind clinical trial, at least 90 patients will be randomly assigned to receive one of the three cardioplegic solutions. Myocardial biopsies will be collected before cardiopulmonary bypass and 15 minutes after reperfusion. The surgical, anesthetic and perfusion techniques will be the same for all patients, following the Institution's standard protocols. Discussion: The ideal cardioplegic solution does not exist, and its selection remains challenging for surgeons. In modern surgical practice, understanding the behavior of these solutions and the ischemic tissue damage caused during induced cardiac arrest allows for safer surgical procedures. The results of this clinical trial can help in understanding the behavior of cardioplegic solutions and their tissue effects. Thus, by selecting the best cardioplegic solution, ischemic damage can be minimized, enhancing the effectiveness of this essential technique in cardiac procedures. The study may aid in implementing clinical protocols in several institutions, aiming to choose the solution with a superior myocardial protection profile, increasing safety, and reducing expenses. Trial Registration: Brazilian Clinical Trials Registry (ReBEC, http://ensaiosclinicos.gov.br/): RBR-997tqhh. Registered: January 26th, 2022.

The use of benzodiazepines and the mental health of women in prison: a cross-sectional study.

In this article we assessed the prevalence of benzodiazepine (BZD) use in women before and during imprisonment, as well as its related factors and association with symptoms of anxiety, depression, and posttraumatic stress disorder in a quantitative, cross-sectional, analytical study of regional scope. Two female prisons in the Brazilian Prison System were included. Seventy-four women participated by completing questionnaires about their sociodemographic data, BZD use and use of other substances. These questionnaires included the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Posttraumatic Stress Disorder Checklist-Civilian Version (PCL-C). Of the 46 women who reported no BZDs use before arrest, 29 (63%) began using BZDs during imprisonment (p < 0.001). Positive scores for PTSD, anxiety, and depression, as well as associations between BZD use during imprisonment and anxiety (p = 0.028), depression (p = 0.001) and comorbid anxiety and depression (p = 0.003) were found when a bivariate Poisson regression was performed. When a multivariate Poisson regression was performed for tobacco use, the PHQ-9 and GAD-7 scales, BZD use was associated with depression (p = p = 0.008), with tobacco use (p = 0.012), but not with anxiety (p = 0.325). Imprisonment increases the psychological suffering of women, consequently increasing BZD use. Nonpharmacological measures need to be considered in the health care of incarcerated women.

Lesão Miocárdica e Prognóstico em Pacientes Hospitalizados com COVID-19 no Brasil: Resultados do Registro Nacional de COVID-19 / Myocardial Injury and Prognosis in Hospitalized COVID-19 Patients in Brazil: Results From The Brazilian COVID-19 Registry

Resumo Fundamento As complicações cardiovasculares da COVID-19 são aspectos importantes da patogênese e do prognóstico da doença. Evidências do papel prognóstico da troponina e da lesão miocárdica em pacientes hospitalizados com COVID-19 na América Latina são ainda escassos. Objetivos Avaliar a lesão miocárdica como preditor independente de mortalidade hospitalar e suporte ventilatório mecânico em pacientes hospitalizados, do registro brasileiro de COVID-19. Métodos Este estudo coorte é um subestudo do registro brasileiro de COVID-19, conduzido em 31 hospitais brasileiros de 17 cidades, de março a setembro de 2020. Os desfechos primários incluíram mortalidade hospitalar e suporte ventilatório mecânico invasivo. Os modelos para os desfechos primários foram estimados por regressão de Poisson com variância robusta, com significância estatística de p<0,05. Resultados Dos 2925 pacientes [idade mediana de 60 anos (48-71), 57,1%], 27,3% apresentaram lesão miocárdica. A proporção de pacientes com comorbidades foi maior nos pacientes com lesão miocárdica [mediana 2 (1-2) vs. 1 (0-20)]. Os pacientes com lesão miocárdica apresentaram maiores valores medianos de peptídeo natriurético cerebral, lactato desidrogenase, creatina fosfoquinase, N-terminal do pró-peptídeo natriurético tipo B e proteína C reativa em comparação a pacientes sem lesão miocárdica. Como fatores independentes, proteína C reativa e contagem de plaquetas foram relacionados com o risco de morte, e neutrófilos e contagem de plaquetas foram relacionados ao risco de suporte ventilatório mecânico invasivo. Os pacientes com níveis elevados de troponina apresentaram um maior risco de morte (RR 2,03, IC95% 1,60-2,58) e suporte ventilatório mecânico (RR 1,87;IC95% 1,57-2,23), em comparação àqueles com níveis de troponina normais. Conclusão Lesão cardíaca foi um preditor independente de mortalidade hospitalar e necessidade de suporte ventilatório mecânico em pacientes hospitalizados com COVID-19.

Abstract Background Cardiovascular complications of COVID-19 are important aspects of the disease's pathogenesis and prognosis. Evidence on the prognostic role of troponin and myocardial injury in Latin American hospitalized COVID-19 patients is still scarce. Objectives To evaluate myocardial injury as independent predictor of in-hospital mortality and invasive mechanical ventilation support in hospitalized patients, from the Brazilian COVID-19 Registry. Methods This cohort study is a substudy of the Brazilian COVID-19 Registry, conducted in 31 Brazilian hospitals of 17 cities, March-September 2020. Primary outcomes included in-hospital mortality and invasive mechanical ventilation support. Models for the primary outcomes were estimated by Poisson regression with robust variance, with statistical significance of p<0.05. Results Of 2,925 patients (median age of 60 years [48-71], 57.1% men), 27.3% presented myocardial injury. The proportion of patients with comorbidities was higher among patients with cardiac injury (median 2 [1-2] vs. 1 [0-2]). Patients with myocardial injury had higher median levels of brain natriuretic peptide, lactate dehydrogenase, creatine phosphokinase, N-terminal pro-brain natriuretic peptide, and C-reactive protein than patients without myocardial injury. As independent predictors, C-reactive protein and platelet counts were related to the risk of death, and neutrophils and platelet counts were related to the risk of invasive mechanical ventilation support. Patients with high troponin levels presented a higher risk of death (RR 2.03, 95% CI 1.60-2.58) and invasive mechanical ventilation support (RR 1.87, 95% CI 1.57-2.23), when compared to those with normal troponin levels. Conclusion Cardiac injury was an independent predictor of in-hospital mortality and the need for invasive mechanical ventilation support in hospitalized COVID-19 patients.

Predictors of venous thromboembolism in COVID-19 patients: results of the COVID-19 Brazilian Registry.

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.

Comparison between Custodiol, del Nido and modified del Nido in the myocardial protection - Cardioplegia Trial: a study protocol for a randomised, double-blind clinical trial.

INTRODUCTION: Myocardial protection is essential for successful cardiac surgery, and the search for an ideal cardioplegic solution has continued since its beginning. In this context, Custodiol, del Nido and modified del Nido are single-dose cardioplegic solutions with good safety profiles and great relevance in modern surgical practice. While these solutions have all been evaluated for their impact on patient outcomes independently, limited research exists comparing them directly. Thus, the present study aims to examine the effects of these cardioplegic solutions on myocardial protection and clinical outcomes in adult patients undergoing elective cardiac surgery. The assessment of the increase in myocardial injury biomarkers in patients submitted to all treatment methods may be considered a major strength of our study. METHODS AND ANALYSIS: This is a clinical trial study protocol that will compare myocardial protection and clinical outcomes among three patient groups based on which cardioplegic solution was used. Patients will be randomised to receive del Nido (n=30), modified del Nido (n=30) or Custodiol (n=30). Myocardial injury biomarkers will be measured at the baseline and 2 hours, 12 hours and 24 hours after the cardiopulmonary bypass. Clinical outcomes will be assessed during the trans operative period and the intensive care unit stay, in addition to other haematological parameters. ETHICS AND DISSEMINATION: This protocol and its related documents were approved by the Research Ethics Committee of the Hospital Nossa Senhora da Conceição, Brazil, registered under no. 4.029.545. The findings of this study will be published in a peer-reviewed journal in the related field. TRIAL REGISTRATION NUMBER: RBR-7g5s66.

Equidade e judicialização de medicamentos: perfil das demandas à Secretaria de Saúde do Rio Grande do Sul pelos usuários de Porto Alegre / Equity and judicialization of medicines: profile of the demands made to the Health Secretariat of Rio Grande do Sul by users in Porto Alegre

O provimento de medicamentos por meio de ordens judiciais tem levado a amplas discussões em virtude de sua magnitude e de seu grande impacto na gestão dos recursos públicos. Este trabalho teve como objetivo caracterizar as demandas judiciais para a obtenção de medicamentos e comparar os quartis socioeconômicos na judicialização de medicamentos. Foi realizado um estudo observacional transversal retrospectivo das demandas judiciais por medicamentos ajuizadas por usuários de Porto Alegre contra a Secretaria Estadual de Saúde do Rio Grande do Sul no período de março de 2017 a fevereiro de 2018 e deferidas a favor dos requerentes. Dos processos analisados, 77,5% foram ajuizados pela Defensoria Pública Estadual, porém cerca de 60% foram provenientes de usuários com melhores condições socioeconômicas e mais acesso a informações sobre seus direitos, residindo em áreas com melhores Índices de Desenvolvimento Humano Municipal. Além disso, 72,1% dos usuários possuíam prescrições médicas originadas em serviço privado e misto; e 72,3% dos medicamentos solicitados foram considerados como "fora de lista". Os dados revelaram que a judicialização pode contrariar o princípio da equidade previsto nas políticas públicas de saúde relacionadas à assistência farmacêutica. A criação de uma Comissão de Farmácia e Terapêutica Estadual e o emprego da avaliação de tecnologias em saúde podem subsidiar as decisões judiciais e auxiliar na elaboração de pareceres técnicos e protocolos clínicos.

The provision of medicines through court orders has led to wide discussions due to its magnitude and its great impact on the management of public resources. The objective of this study was to characterize the judicial demands for obtaining medicines and to compare the socioeconomic quartiles in the judicialization of medicines. A retrospective cross-sectional observational study of judicial demands for medications filed by users in Porto Alegre against the State Health Secretariat of Rio Grande do Sul from March 2017 to February 2018 and granted in favor of the claimants was carried out. Of the cases analyzed, 77.5% were filed by the State Public Defender's Office, but around 60% were from users with better socioeconomic conditions and more access to information about their rights, residing in areas with better Municipal Human Development Indexes. In addition, 72.1% of the users had medical prescriptions originated from private and mixed services; and 72.3% of the requested medications were considered as "off the list". The data revealed that judicialization may contradict the principle of equity foreseen in public health policies related to pharmaceutical care. The creation of a State Pharmacy and Therapeutics Committee and the use of health technology assessment could subsidize court decisions and assist in the elaboration of technical opinions and clinical protocols.

O fortalecimento da Atenção Primária à Saúde nos municípios da Região Metropolitana de Porto Alegre, Brasil, após a inserção no Programa Mais Médicos: uma comparação intermunicipal / Strengthening Primary Health Care in the municipalities in the Metropolitan Region of Porto Alegre, Brazil, after the introduction of the Mais Médicos (More Doctors) Program: an inter-municipal comparison

Resumo Este artigo visa propor uma adaptação da metodologia utilizada por Starfield e Shy (2002) para avaliar a qualidade da atenção primária em saúde (APS) dos municípios que aderiram ao Programa Mais Médicos. Os indicadores foram adaptados para cada um dos nove critérios propostos na metodologia original e aplicados para os municípios de médio e grande porte da Região Metropolitana de Porto Alegre, antes e depois destes integrarem o Programa Mais Médicos. Em 2014, os municípios foram agregados em três grupos, conforme seus escores. As análises de correlações entre diferentes grupos de escores dos municípios e os indicadores de saúde avaliados não se mostraram significativas, porém, as médias dos indicadores avaliados são melhores no grupo de municípios caracterizados com os melhores escores da APS. Em relação aos indicadores de renda, os maiores gastos per capita em saúde estão relacionados à melhor performance da APS nesses municípios. A adaptação desta metodologia pode indicar melhor compreensão das políticas relacionadas à determinação da saúde.

Abstract This article aims to propose an adaptation of the methodology used by Starfield and Shy (2002) to assess the quality of health care in the municipalities which joined the Mais Médicos (More Doctors) Program. The indicators were adapted for each one of the nine criteria proposed in the methodology and were applied to medium and large municipalities in the Metropolitan Region of Porto Alegre before and after they were integrated in the Mais Médicos Program. In 2014, the municipalities were grouped into three groups according to their scores. An analysis concerning any correlations between the different group scores for the municipalities and the health indicators that were evaluated, did not reveal anything significant. However the averages of the evaluated indicators were better in the group of municipalities characterized through having the best APS scores. In relation to the income indicator, the highest amount of money spent per capita in health is related to the best APS performance in the municipalities. An adaption of this methodology may be able to provide a better understanding of the policies related to health care.

Adesão ao tratamento com psicofármacos: fatores de proteção e motivos de não adesão ao tratamento farmacológico / Adherence to psychotropic treatment: protection factors and reasons for non adherence to pharmacologic treatment

A não adesão ao tratamento farmacológico de pacientes com agravos comuns de saúde mental traz grande comprometimento da qualidade de vida do paciente, além de influenciar em outros fragmentos importantes da vida. Intervenções na adesão ao tratamento por profissionais da atenção primária, além de custo-efetivas, reduzem a morbidade, melhoram a qualidade de vida e fortalecem o vínculo do paciente com a atenção primária. Este estudo tem como objetivo buscar as barreiras e os motivos para a adesão medicamentosa. Foram selecionados seis pacientes pertencentes à área de uma unidade de saúde, com uso de psicofármacos, e realizada entrevista para investigação de motivos de barreira e proteção ao uso desses medicamentos. Os motivos de não adesão referidos foram os efeitos adversos, a vontade de não depender do medicamento e a precária comunicação com o prescritor. Como fatores de adesão, a motivação pelo resultado, a confiança no prescritor, uma boa comunicação com o prescritor e a família. Sendo assim, percebe-se a necessidade de uma boa relação dos profissionais de saúde com os usuários, por meio da comunicação, vínculo e educação em saúde.

Non-adherence to pharmacological treatment of patients with common mental health illnesses brings great prejudice to the patient´s quality of life of as well as influencing other important fragments of life. Interventions in treatment adherence for primary care professionals not only are cost effective but also reduce morbidity, improve quality of life and strengthen the bond with the primary health care services. This study aims to search the barriers and protective factors for to medication adherence. Six patients belonging to the area of a health care facility and with current use of psychotropic drugs were selected for a interview in order to investigate barriers and protective factors to the use of these medications. The reasons for non adherence brought by the interviewee were adverse effects, willing not to depend on medication and poor communication with the prescriber. As for the protective factors were indentified motivation by the results, family, confidence in the prescriber and good communication with the prescriber. Thus, we see the need for a good relationship of health professionals with users, through a good communication, bond and health education.

Potential drug-drug interactions in hospitalized patients undergoing systemic chemotherapy: a prospective cohort study.

BACKGROUND: Adverse drug-drug interactions (DDI) are a major cause of morbidity and mortality in susceptible populations. Cancer patients are a population at high risk for DDI especially because they commonly receive several drugs concomitantly. The knowledge about the most common interactions between drugs used in oncology inpatients is essential to reduce drug-related problems and increase the safety and efficacy of the therapy. OBJECTIVE: To assess the frequency of potential DDI throughout the hospital stay of cancer patients undergoing systemic chemotherapy, describe their epidemiology, and identify risk factors for major DDI. Setting An oncology-hematology inpatient unit of a public hospital in southern Brazil. METHOD: Drug prescriptions were prospectively reviewed throughout the hospital stay of patients admitted for systemic chemotherapy. Descriptive statistics and Poisson regression were used for data analysis. MAIN OUTCOME MEASURE: Potential DDI and their characteristics. RESULTS: The cohort consisted of 113 patients, who used a mean of 8.9 ± 2.7 drugs/day. All patients had at least one potential DDI (median, 7.0/patient; 25th-75th percentile, 3.5-12.0), and 46 % of the patients had at least one DDI classified as major, i.e. that it may result in death, hospitalization, permanent injury, or therapeutic failure. Only 13.7 % of all interactions involved antineoplastic agents, identified in 62.8 % of patients. Most interactions were of moderate severity, 6.4 % were major, and 8.5 % had a recommendation for therapy modification. Multivariate analysis revealed mean number of drugs prescribed [relative risk (RR) for each additional drug: 1.12; 95 % confidence interval (CI) 1.07-1.17; P < 0.01] and age ≥60 years (RR 1.48; 95 % CI 1.03-2.14; P < 0.01) as independent risk factors for major DDI. CONCLUSION: Potential DDI were highly frequent in this cohort. Older age and number of drugs prescribed were more likely to lead to major interactions. Prospective surveillance is required to detect adverse DDI, aiming primarily at reducing the risk of toxicity or treatment failure.

Tendências na utilizaçäo de antimicrobianos em um hospital universitário, 1990-1996 / Trends in antimicrobial utilization in a university hospital, 1990-1996

OBJETIVO: Uma das principais preocupaçöes mundiais quanto ao uso de medicamentos está relacionada à utilizaçäo de antimicrobianos. Nos países em desenvolvimento, poucos recursos säo empregados na monitorizaçäo de açöes sobre o uso racional de medicamentos. Säo, também, limitados os dados sobre o uso daqueles agentes em hospitais. Assim realizou-se estudo para determinar os padröes de uso de antimicrobianos em hospital num período de sete anos (1990 a 1996). MÉTODOS: O estudo foi realizado em um hospital universitário, terciário, com 690 leitos, localizado em Porto Alegre, RS. Os registros hospitalares foram revisados visando identificar o consumo de antimicrobianos por pacientes internados, sendo os resultados expressos em dose diária definida (DDD) por 100 leitos-dia. A análise de conglomerados foi realizada para determinar as tendências de consumo dos agentes individuais. RESULTADOS: O consumo de antimicrobianos aumentou com o correr dos anos, passando de 83,8 DDD por 100 leitos-dia, em 1990, a 124,58 DDD por 100 leitos-dia em 1996. O grupo de medicamentos mais utilizado foi de penicilinas (39,6 por cento), seguido por cefalosporinas (15,0 por cento), aminoglicosídeos (14,4 por cento), sulfonamidas (12,8 por cento), glicopeptídeos (3,6 por cento) e lincosaminas (3,1 por cento). Estes grupos foram responsáveis por cerca de 90 por cento do consumo. A análise de conglomerados do uso de antimicrobianos mostrou 13 grupos principais de tendência de consumo. CONCLUSOES: O consumo de antimicrobianos cresceu no período avaliado, sendo expressivamente mais alto em comparaçäo com o relatado em outros estudos. Quando novas alternativas terapêuticas foram disponibilizadas no hospital, o uso de medicamentos antigos decresceu e, em alguns casos, existiu manutençäo dos níveis de consumo. Quando foi realizada intervençäo específica como uma campanha para o uso correto de cefoxitina, as mudanças esperadas ocorreram