Prolonged survival after thoracic metastasectomy in patients with nonseminomatous testicular cancer

Abstract Introduction Almost 20 % of patients with Non-Seminomatous Germinative Cell Tumors (NSGCT) will require intrathoracic metastasectomy after chemotherapy. The authors aim to determine their long-term survival rates. Methods Retrospective study including patients with NSGCT and intrathoracic metastasis after systemic therapy from January 2011 to June 2022. Treatment outcomes and overall survival were analyzed with the Kaplan-Meier method. Results Thirty-seven male patients were included with a median age of 31.8 years. Six presented with synchronous mediastinum and lung metastasis, nine had only lung, and 22 had mediastinal metastasis. Over half had retroperitoneal lymph node metastasis. Twenty-two had dissimilar pathologies, with a discordance rate of 62 %. Teratoma and embryonal carcinoma were the prevalent primary tumor types, 40.5 % each, while teratoma was predominant (70.3 %) in the metastasis group. Thoracotomy was the main surgical approach (39.2 %) followed by VATS (37.2 %), cervico-sternotomy (9.8 %), sternotomy (5.8 %), and clamshell (3.9 %). Lung resection was performed in 40.5 % of cases. Overall, 10-year survival rates were 94.3 % with no surgical-related mortality. Conclusion Multimodality treatment with systemic therapy followed by radical surgery offers a high cure rate to patients with intrathoracic metastatic testicular germ cell tumors.

The association of visceral pleural invasion with skip N2 metastasis on clinical stage IA NSCLC

Abstract Background Lung lymphatic drainage occurs mainly through a peribronchial path, but it is hypothesized that visceral pleural invasion could alter this path. This study aims to investigate the association between visceral pleural invasion, node upstaging, and N2 skip metastasis and the impact on survival in a population of patients with non-small cell lung cancer of 3 cm or smaller. Methods We retrospectively queried our institutional database of lung cancer resection for all patients with clinical stage IA NSCLC between June 2009 and June 2022. We collected baseline characteristics and clinical and pathological staging data. Patients were classified into two groups: The non-VPI group with negative visceral pleural invasion and the VPI group with positive. The primary results analyzed were the occurrence of nodal upstaging, skip N2 metastasis and recurrence. Results There were 320 patients analyzed. 61.3 % were women; the median age was 65.4 years. The pleural invasion occurred in 44 patients (13.7 %). VPI group had larger nodules (2.3 vs. 1.7 cm; p < 0.0001), higher 18F-FDG uptake (7.4 vs. 3.4; p < 0.0001), and lymph-vascular invasion (35.7 % vs. 13.5 %, p = 0.001). Also, the VPI group had more nodal disease (25.6 % vs. 8.7 %; p = 0.001) and skip N2 metastasis (9.3 % vs. 1.8 %; p = 0.006). VPI was a statistically independent factor for skip N2 metastasis. Recurrence occurred in 17.2 % of the population. 5-year disease-free and overall survival were worse in the VPI group. Conclusions The visceral pleural invasion was an independent factor associated with N2 skip metastasis and had worse disease-free and overall survival.

Risk Factors Associated with Ischemic Stroke in the Immediate Postoperative Period of Cardiac Surgery

ABSTRACT Introduction: Stroke remains a major complication of cardiac surgery. Despite all efforts, the incidence of postoperative stroke remains as high as 6%. We aimed to investigate risk factors for ischemic stroke in a contemporary cohort of patients undergoing cardiac surgery. Methods: This is a retrospective cohort study of 678 consecutive adult patients who underwent cardiac surgery requiring cardiopulmonary bypass in a tertiary hospital in Brazil between July 1, 2011, and December 31, 2018. The primary outcome was the rate of early (perioperative and seven-day postoperative) stroke, defined as the occurrence of the outcome during the index admission. We developed a predictive model of stroke using the Poisson regression analysis with robust variance. Results: Postoperative stroke occurred in 24 patients (3.5%), 23 (3.3%) were ischemic, and 21 (3.0%) were diagnosed in the first 72 hours after surgical procedure. After multivariate analysis, the following factors were significantly associated with stroke: previous stroke/transient ischemic attack (relative risk [RR]=2.75; 95% confidence interval [CI], 1.11-6.82), carotid artery disease (RR=4.0; 95% CI, 1.43-11.0), previous atrial fibrillation (RR=3.26, 95% CI, 1.31-8.1), and postoperative platelets > 200,000/mm3 (RR=2.26; 95% CI, 1.01-5.1). Conclusion: We developed a contemporary model to determine risk predictors for stroke after cardiac surgery. This model may help clinicians to identify patients at risk and could be useful in clinical practice.

Risk factors related to pleural empyema after talc slurry pleurodesis

Abstract Objective: Empyema is a complication of talc-pleurodesis that may lead to further surgical intervention and death. Therefore, the present study's objective was to identify the risk factors for the development of post-pleurodesis empyema after talc slurry pleurodesis in order to better select patients for this procedure and minimize its morbidity. Methods: Patients with malignant pleural effusion who underwent talc slurry pleurodesis at the present institution from January 2018 to January 2020 were retrospectively analyzed. Post-pleurodesis empyema was defined as pleural infection up to 30 days after pleurodesis. Using Cox regression analysis, significant prognostic factors for the development of empyema were examined. Results: Of the 86 patients identified for inclusion in the study, 62 were women (72%). Their mean age was 56.3±12.6 years. The median pleural drainage time was 9 days, and 20 patients (23.3%) developed empyema. In the univariate analysis, both drainage time (p = 0.038) and the use of antibiotics prior to pleurodesis (p < 0.001) were risk factors for pleural empyema. Multivariate analysis also identified the use of antibiotics as an independent risk factor (Odds Ratio [OR] 9.81; 95% Confidence Interval [95% CI] 2.87-33.54). Although the pulmonary expansion was not associated with empyema in the multivariate analysis, patients with less than 50% pulmonary expansion had a 4.5-times increased risk of empyema (95% CI 0.90-22.86; p = 0.067), and patients with 50-70% pulmonary expansion had a 3.8-times increased risk of empyema (95% CI 0.98-15; p = 0.053) after pleurodesis. Conclusion: The study suggests that antibiotic therapy prior to talc slurry pleurodesis may increase the risk of developing empyema. Furthermore, pleurodesis should be considered with caution in patients with long-duration chest tube placement and incomplete lung expansion.

Analysis of post-traumatic stress disorder in nursing professionals during the covid-19 pandemic / Análisis del trastorno de estrés post-traumático en profesionales de enfermería durante la pandemia de covid-19 / Análise do transtorno do estresse pós-traumático em profissionais de enfermagem durante a pandemia da covid-19

ABSTRACT Objective to analyze the prevalence of Post-Traumatic Stress Disorder and factors associated with its development in Nursing professionals during the COVID-19 pandemic. Method an observational, analytical and cross-sectional study conducted with 309 Nursing professionals, using a questionnaire to assess sociodemographic data and work-related information, in addition to the Impact Event Scale - Revised, which aims at collecting diverse information related to Post-Traumatic Stress Disorder symptoms. Results the study participants were 176 nurses and 133 nursing technicians: 83.82% female and 56.96% male nurses. As for the hour load, 55.66% asserted working up to 40 weekly hours 47.90% had more than one employment contract, 89.32% were active in the front line against the pandemic, and 60.19% reported an increase in workload. However, 64.40% presented symptoms or were diagnosed with COVID-19 and 43.37% indicated emotional impairment. Using the classifications of the overall Impact Event Scale - Revised score, 29 (53.40%) obtained scores of at least 33, the cutoff point for likely diagnosis of Post-Traumatic Stress Disorder. Conclusion it was evidenced that more than half of the study sample presented a high risk of developing Post-Traumatic Stress Disorder in the Impact Event Scale - Revised scale. Factors associated with the development of Post-Traumatic Stress Disorders in Nursing professionals during the COVID-19 pandemic include use of psychotropic drugs, age up to 35 years old, and occurrence of physical and emotional changes.

RESUMEN Objetivo analizar la prevalencia del Trastorno de Estrés Post-Traumático y los factores asociados al desarrollo de dicho trastorno en profesionales de Enfermería durante la pandemia de COVID-19. Método estudio observacional, analítico y transversal, realizado con 309 profesionales de Enfermería por medio de un cuestionario para evaluar datos sociodemográficos y diversa información sobre el trabajo, además de la Escala de Impacto del Evento - Revisada, que tiene como objetivo recolectar diversa información relacionada con la sintomatología del Trastorno de Estrés Post-Traumático. Resultados el estudio contó con la participación de 176 enfermeros y 133 técnicos de Enfermería: 83,82% del sexo femenino y 56,96% de enfermeros. En cuanto al trabajo, el 55,66% poseían una carga horaria de hasta 40 horas semanales, el 47,90% tenían más de un vínculo laboral, el 89,32% trabajaba en la primera línea de lucha contra la pandemia y el 60,19% señaló un aumento en la carga de trabajo. No obstante, el 64,40% presentó síntomas o fueron diagnosticados con COVID-19 y el 43,37% indicó perjuicios emocionales. Utilizando las clasificaciones de la puntuación general de la escala Escala de Impacto del Evento - Revisada, 29 (53,40%) obtuvieron un puntaje de al menos 33, punto de corte para el probable diagnóstico de Trastorno de Estrés Post-Traumático. Conclusión se hizo evidente que, en la escala Escala de Impacto del Evento - Revisada, más de la mitad de la muestra del estudio presentó alto riesgo de desarrollar el Trastorno de Estrés Post-Traumático. Como factores asociados al desarrollo del Trastorno de Estrés Post-Traumático en profesionales de Enfermería durante la pandemia de COVID-19 figuran los siguientes: uso de medicamentos psicotrópicos, edad de hasta 35 años, y cambios en estado financiero y emocional.

RESUMO Objetivo analisar a prevalência de Transtorno de Estresse Pós-Traumático e os fatores associados ao desenvolvimento do Transtorno de Estresse Pós-Traumático em profissionais de enfermagem durante a pandemia da COVID-19. Método estudo observacional, analítico e transversal, realizado com 309 profissionais de enfermagem, utilizando questionário para avaliar dados sociodemográficos e informações sobre o trabalho, além da Escala do Impacto do Evento - Revisada (IES-R), que visa coletar informações relacionadas à sintomatologia do Transtorno de Estresse Pós-Traumático. Resultados o estudo contou com 176 enfermeiros e 133 técnicos de enfermagem, sendo 83,82% do sexo feminino e 56,96% de enfermeiros. Quanto ao trabalho, 55,66% possuíam carga horária de até 40 horas semanais, 47,90% tinham mais de um vínculo, 89,32% atuaram na linha de frente da pandemia e 60,19% apontaram aumento da carga de trabalho. Não obstante, 64,40% apresentaram sintomas ou foram diagnosticados com COVID-19 e 43,37% apontaram prejuízo emocional. Utilizando as classificações do escore geral da Escala do Impacto do Evento - Revisada, 29, 53,40% atingiram pontuação maior ou igual a 33, ponto de corte para o provável diagnóstico de Transtorno do Estresse Pós-Traumático. Conclusão foi evidenciado que mais da metade da amostra do estudo apresentou na escala Escala do Impacto do Evento - Revisada alto risco de desenvolver Transtorno do Estresse Pós-Traumático. Como fatores associados ao desenvolvimento do Transtorno de Estresse Pós-Traumático em profissionais de enfermagem durante a pandemia da COVID-19, estão o uso de medicamentos psicotrópicos, idade até 35 anos, mudança financeira e emocional.

A Brazilian randomized study: Robotic-Assisted vs. Video-assisted lung lobectomy Outcomes (BRAVO trial) / Estudo brasileiro randomizado: desfechos da lobectomia pulmonar robótica vs. videoassistida (estudo BRAVO)

ABSTRACT Objective: To compare 90-day morbidity in patients undergoing lung lobectomy performed by either robotic-assisted thoracic surgery (RATS) or video-assisted thoracic surgery (VATS). Intraoperative complications, drainage time, length of hospital stay, postoperative pain, postoperative quality of life, and readmissions within 90 days were also compared. Methods: This was a two-arm randomized clinical trial including patients with lung lesions (primary lung cancer or lung metastasis) who were candidates for lung lobectomy. Patients with comorbidities that precluded surgical treatment were excluded. All patients followed the same postoperative protocol. Results: The overall sample comprised 76 patients (39 in the VATS group and 37 in the RATS group). The two groups were similar regarding gender, age, BMI, FEV1 in % of predicted, and comorbidities. Postoperative complications within 90 days tended to be more common in the VATS group than in the RATS group, but the difference was not significant (p = 0.12). However, when only major complications were analyzed, this tendency disappeared (p = 0.58). Regarding postoperative outcomes, the VATS group had a significantly higher number of readmissions within 90 days than did the RATS group (p = 0.029). No significant differences were found regarding intraoperative complications, drainage time, length of hospital stay, postoperative pain, and postoperative quality of life. Conclusions: RATS and VATS lobectomy had similar 90-day outcomes. However, RATS lobectomy was associated with a significant reduction in the 90-day hospital readmission rate. Larger studies are necessary to confirm such a finding. (ClinicalTrials.gov identifier: NCT02292914 [http://www.clinicaltrials.gov/])

RESUMO Objetivo: Comparar a morbidade em 90 dias de pacientes submetidos à lobectomia pulmonar por robotic-assisted thoracic surgery (RATS, cirurgia torácica robótica) ou por video-assisted thoracic surgery (VATS, cirurgia torácica videoassistida). Complicações intraoperatórias, tempo de drenagem, tempo de internação hospitalar, dor pós-operatória, qualidade de vida pós-operatória e reinternações em 90 dias também foram comparados. Métodos: Ensaio clínico randomizado, com dois braços, incluindo pacientes com lesões pulmonares (câncer de pulmão primário ou metástase pulmonar) candidatos à lobectomia pulmonar. Foram excluídos pacientes com comorbidades que impossibilitassem o tratamento cirúrgico. Todos os pacientes seguiram o mesmo protocolo pós-operatório. Resultados: A amostra total foi composta por 76 pacientes (39 no grupo VATS e 37 no grupo RATS). Os dois grupos foram semelhantes quanto a sexo, idade, IMC, VEF1 em % do previsto e comorbidades. Complicações pós-operatórias em 90 dias tenderam a ser mais frequentes no grupo VATS do que no grupo RATS, mas a diferença não foi significativa (p = 0,12). No entanto, quando analisadas apenas as complicações maiores, essa tendência desapareceu (p = 0,58). Quanto aos desfechos pós-operatórios, o grupo VATS apresentou um número significativamente maior de reinternações em 90 dias do que o grupo RATS (p = 0,029). Não foram encontradas diferenças significativas quanto a complicações intraoperatórias, tempo de drenagem, tempo de internação hospitalar, dor pós-operatória e qualidade de vida pós-operatória. Conclusões: A lobectomia por RATS e a lobectomia por VATS apresentaram desfechos em 90 dias semelhantes. No entanto, a lobectomia por RATS foi associada a uma redução significativa na taxa de reinternação hospitalar em 90 dias. Estudos maiores são necessários para confirmar esse achado. (Identificador ClinicalTrials.gov: NCT02292914 [http://www.clinicaltrials.gov/])

Combined Reconstruction of the Anterior Cruciate Ligament and Anterolateral Ligament Injury Compared to the Isolated Reconstruction of the Anterior Cruciate Ligament: A Meta-Analysis / Reconstrução combinada do ligamento cruzado Anterior e lesão do ligamento anterolateral comparada àreconstrução isolada do ligamento cruzado anterior: Uma metanálise

Abstract The present research aims to compare the outcomes from the combined reconstruction of the anterior cruciate ligament (ACL) and of the anterolateral ligament (ALL) with the standard isolated ACL reconstruction in patients with chronic ACL injury. To do so, a meta-analysis was carried out to determine whether the combined ACL and ALL reconstruction would lead to a significant improvement in knee function according to the International Knee Documentation Committee (IKDC), the Lysholm test and KT-2000 evaluation scores and lower graft rupture rates in comparison with isolated reconstruction. To identify randomized controlled trials (RCTs) comparing the combined ACL and ALL reconstruction with the isolated ACL reconstruction, papers published between 2010 and 2019 were searched in the MEDLINE, EMBASE, SPORTDiscus, LILACS and Cochrane Central Register of Controlled Trials databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The stability of the knee joint is only marginally improved with the combined reconstruction of ACL and ALL, and both reconstruction techniques show functional results. The main outcomes sought were patient function and graft stability and rupture rates after ACL reconstruction. Out of the 421 studies identified, 6 were included in our meta-analysis. Study quality (internal validity) was assessed using the Cochrane risk-of-bias tool; in general, the studies included presented moderate-quality evidence. The graft rupture rate was higher in patients undergoing isolated ACL reconstruction (relative risk, 0.22; 95% confidence interval, 0.12 to 0.41; p < 0.00001).

Resumo O objetivo da presentepesquisa é comparar, por meio de uma metanálise, os resultados da reconstrução combinada do ligamento cruzado anterior (LCA) e do ligamento anterolateral (LLA), comparado com a reconstrução isolada padrão, em pacientes com lesão crônica do ligamento cruzado anterior. Buscando alcançar o objetivo da pesquisa, foi realizada uma meta-análise para determinar se a combinação da reconstrução combinada LCA e LLA levaria àmelhoria significativa da função do joelho, medida pelos escores de avaliação International Knee Documentation Committee (IKDC), Lysholm, KT-2000 e menor taxa de ruptura do enxerto, em comparação com a reconstrução isolada. Para identificar ensaios clínicos randomizados (ECR) comparando a reconstrução combinada do LCA e LLA com a reconstrução isolada do LCA, foram pesquisados artigos publicados entre 2010 e 2019 nas bases MEDLINE, EMBASE, SPORTDiscus, LILACS e Cochrane Central RegisterofControlledTrials e seguiram os critérios de Itens de Relatórios Preferidos para Revisões Sistemáticas e Metanálises (PRISMA). A estabilidade da articulação do joelho é apenas marginalmente aprimorada com a reconstrução combinada de LCA e LLA, e ambas as técnicas de reconstrução mostram resultados funcionais. Os principais desfechos procurados foram a função do paciente e as taxas de estabilidade e ruptura do enxerto após a reconstrução do LCA. Dos 421 estudos identificados, 6estudos foram incluídos em nossa meta-análise. A qualidade do estudo (validade interna) foi avaliada usando o instrumento Cochrane risco-de-viés; em geral, foi encontrada uma qualidade moderada de evidências dos estudos incluídos. Os pacientes submetidos à reconstrução isolada do LCA mostraram maior taxa de ruptura do enxerto (RR 0,22; índice de confiança [IC]95%: 0,12-0,41; p< 0,00001).

Two validity evidences of the ESQUADA and Brazilians' dietary quality levels / Duas evidências de validade da ESQUADA e níveis de qualidade da dieta dos brasileiros

ABSTRACT OBJECTIVE Assess two validity evidences of the diet quality scale (ESQUADA) for the selection of items with better discrimination of the Brazilians' diet quality and propose a description in score levels. METHODS Brazilian adolescents and adults residing in the country (n = 2,059) answered an online questionnaire with 52 items, shared on social networks and email lists between March and April 2018. Statistical tests were applied to analyze the validity and reliability of the instrument's evidence. Factor analysis was applied to study the dimensionality of the questionnaire items. Item response theory was applied to identify the discrimination and location of items on the continuum, construct the scale and assess the differential item functioning in terms of sex and age. RESULTS Among the 52 items of the questionnaire, 25 had greater measurement accuracy, with adequate adjustment and reliability. The item on the habit of eating ultra-processed foods at home showed the best discrimination of diet quality. No item showed differential functioning regarding sex and age. In the construction of the ESQUADA, five diet quality levels were identified: very poor, poor, good, very good and excellent. It was observed that while breakfast cereals and/or cereal bars are more frequently consumed by individuals with "very poor" diet quality; nuts and/or walnuts are most often consumed by those individuals with "excellent" diet quality. CONCLUSION The ESQUADA consists of 25 precise items with no differential functioning to assess the quality of Brazilians' diet. The construction of the ESQUADA made it possible to recognize food consumption and dietary practices characteristic of each level of diet quality.

RESUMO OBJETIVO Avaliar duas evidências de validade da escala de qualidade da dieta (ESQUADA) para seleção dos itens com melhor discriminação da qualidade da dieta dos brasileiros e propor uma descrição em níveis de escore. MÉTODOS Adolescentes e adultos brasileiros e residentes no país (n = 2.059), responderam a um questionário on-line com 52 itens, compartilhado em redes sociais e listas de correio eletrônico entre março e abril de 2018. Foram aplicados testes estatísticos para análise de evidências de validade e confiabilidade do instrumento. A análise fatorial foi aplicada para estudo da dimensionalidade dos itens do questionário. A teoria de resposta ao item foi aplicada para identificar a discriminação e localização dos itens no continuum , construir a escala e avaliar o comportamento diferencial dos itens quanto ao sexo e idade. RESULTADOS Dentre os 52 itens do questionário, 25 apresentaram maior precisão de medida, com ajuste e confiabilidade adequados. O item sobre o costume de comer alimentos ultraprocessados em casa apresentou a melhor discriminação da qualidade da dieta. Nenhum item apresentou comportamento diferencial quanto a sexo e idade. Na construção da ESQUADA foram identificados cinco níveis de qualidade da dieta: "muito ruim", "ruim", "boa", "muito boa" e "excelente". Observou-se que enquanto cereais matinais e/ou barrinhas de cereais são consumidos com maior frequência por indivíduos com qualidade da dieta "muito ruim"; castanhas e/ou nozes são consumidos mais frequentemente por aqueles indivíduos com qualidade da dieta "excelente". CONCLUSÕES A ESQUADA é composta por 25 itens precisos e sem comportamento diferencial para avaliar a qualidade da dieta dos brasileiros. A construção da ESQUADA possibilitou reconhecer consumo e práticas alimentares característicos de cada nível de qualidade da dieta.

Robotic thoracic surgery for inflammatory and infectious lung disease: initial experience in Brazil / Cirurgia torácica robótica para doença pulmonar inflamatória e infecciosa: experiência inicial no Brasil

ABSTRACT Objective: in Latin America, especially Brazil, the use of a robotic platform for thoracic surgery is gradually increasing in recent years. However, despite tuberculosis and inflammatory pulmonary diseases are endemic in our country, there is a lack of studies describing the results of robotic surgical treatment of bronchiectasis. This study aims to evaluate the surgical outcomes of robotic surgery for inflammatory and infective diseases by determining the extent of resection, postoperative complications, operative time, and length of hospital stay. Methods: retrospective study from a database involving patients diagnosed with bronchiectasis and undergoing robotic thoracic surgery at three hospitals in Brazil between January of 2017 and January of 2020. Results: a total of 7 patients were included. The mean age was 47 + 18.3 years (range, 18-70 years). Most patients had non-cystic fibrosis bronchiectasis (n=5), followed by tuberculosis bronchiectasis (n=1) and lung abscess (n=1). The performed surgeries were lobectomy (n=3), anatomic segmentectomy (n=3), and bilobectomy (n=1). The median console time was 147 minutes (range 61-288 min.) and there was no need for conversion to open thoracotomy. There were no major complications. Postoperative complications occurred in one patient and it was a case of constipation with the need for an intestinal lavage. The median for chest tube time and hospital stay, in days, was 1 (range, 1-6 days) and 5 (range, 2-14 days) respectively. Conclusions: robotic thoracic surgery for inflammatory and infective diseases is a feasible and safe procedure, with a low risk of complications and morbidity.

RESUMO Objetivo: na América Latina, especialmente no Brasil, a adoção da plataforma robótica para cirurgia torácica está aumentando gradativamente nos últimos anos. No entanto, apesar da tuberculose e doenças pulmonares inflamatórias serem endêmicas em nosso país, faltam estudos que descrevam os resultados do tratamento cirúrgico robótico das bronquiectasias. Este estudo tem como objetivo avaliar os resultados cirúrgicos da cirurgia robótica para doenças inflamatórias e infecciosas, determinando a extensão da ressecção, complicações pós-operatórias, tempo operatório e tempo de internação hospitalar. Métodos: estudo retrospectivo a partir de um banco de dados envolvendo pacientes com diagnóstico de bronquiectasia e submetidos à cirurgia torácica robótica em três hospitais brasileiros entre janeiro de 2017 e janeiro de 2020. Resultados: foram incluídos 7 pacientes. A média de idade foi 47 + 18,3 anos (variação, 18-70 anos). A maioria dos pacientes apresentou bronquiectasia não fibrose cística (n=5), seguida de bronquiectasia tuberculosa (n=1) e abscesso pulmonar (n=1). As cirurgias realizadas foram lobectomia (n=3), segmentectomia anatômica (n=3) e bilobectomia (n=1). O tempo médio do console foi de 147 minutos (variação de 61-288 min.) e não houve necessidade de conversão para toracotomia. Complicação pós-operatória ocorreu em um paciente, tratando-se de obstipação com necessidade de lavagem intestinal. A mediana do tempo de drenagem torácica e internação hospitalar, em dias, foi de 1 (variação, 1-6 dias) e 5 (variação, 2-14 dias), respectivamente. Conclusões: a cirurgia torácica robótica para doenças inflamatórias e infecciosas é um procedimento viável e seguro, com baixo risco de complicações e morbidade.

Antidiabéticos orais no diabetes gestacional: revisão de literatura / Oral antidiabetics in gestational diabetes: literature review

O diabetes mellitus gestacional (DMG) é um distúrbio metabólico por déficit na produção e/ou ação insulínica. Tem relação direta com um constante estado catabólico associado com maior resistência à ação da insulina. Doença de difícil controle, implica risco materno-fetal elevado. O objetivo é estudar a eficácia das drogas antidiabéticas orais sobre o controle glicêmico no DMG e sua segurança quanto aos desfechos gestacionais e perinatais. Trata-se de revisão de literatura descritiva baseada em dados de artigos, livros-texto e guidelines emitidos nos últimos cinco anos. O antidiabético oral pode ser uma boa alternativa no controle do DMG em fase inicial da doença, na presença de distúrbio metabólico e como complemento da terapia com insulina. Entretanto, por causa de sua passagem placentária, há preocupações com seus efeitos fetais e perinatais. Estudos comparativos destacam a metformina no manejo do DMG, considerando principalmente a segurança materno-fetal.(AU)

Gestational diabetes mellitus (GDM) is a metabolic disorder caused by deficit in production and/or insulin action. It is directly related to a constant catabolic state associated with greater resistance to insulin action. Disease difficult to control, implies high maternal-fetal risk. To study the efficacy of oral antidiabetic drugs on glycemic control in GDM and its safety regarding gestational and perinatal outcomes. Descriptive literature review based on data from articles, textbooks and guidelines issued in the last five years. Oral antidiabetic can be a good alternative in the control of GDM in the initial phase of the disease, in the presence of metabolic disorder and as a complement to insulin therapy. However, there are concerns about its placental passage and perinatal effects. Comparative studies highlight metformin in the management of DMG considering mainly maternal-fetal safety.(AU)

Validation of the criteria matrix about the generalist's education in Dentistry Undergraduate Courses

Abstract The generalist training planned by Brazilian National Curriculum Guidelines for Dentistry undergraduate courses should provide actions for the development of health promotion in the field of public health, as well as disease prevention, diagnosis, planning, and dental treatment in the clinical field. Considering this complexity, the aim of the present study was to validate dimensions and sub-dimensions in dentistry training, allowing the identification of the main necessary competences and clinical skills for the generalist practice. For this, an evaluation study was carried out through the Delph's Method with the participation of 19 professors of Dentistry courses in Brazil working in the clinical area, considered "experts" in this theme. It was possible to identify clinical competences and skills in four dimensions and respective sub-dimensions: Transversal skills (biosafety, patient-team communication, humanization, ethical principles, dental documentation); Diagnosis and planning (diagnosis of dental caries, pulp and periapical changes, and periodontal diseases, clinical and imaging exam, and single treatment planning); Preventive activities (oral hygiene guidance and oral cancer prevention); and Dental care (anesthesia, basic oral surgery, drug prescription, subgingival scaling and root planing, dental restoration, minimally and non-invasive restoration treatment, and dental urgencies). The developed model represents a differentiated alternative for the construction of an innovative curriculum in Dentistry, aimed at the training of general practitioners to provide humanized, highly effective, and resolving care. The importance of clinical tutoring by professors on the essential clinical skills and abilities is highlighted in this study.

Análise do perfil epidemiológico dos pacientes submetidos a transplante de córnea no Espírito Santo / Analysis of the epidemiological profile of patients submitted to corneal transplantation in the Espirito Santo

Resumo Objetivo: Descrever o perfil epidemiológico dos pacientes submetidos a transplante de córnea no estado do Espírito Santo. Métodos: Estudo transversal e descritivo realizado entre o período de janeiro de 2017 a janeiro de 2018, com o total de 1310 cadastrados na Central de Notificação, Captação e Distribuição de Órgãos do Espírito Santo (CNCDO/ES) por meio do Sistema Nacional de Transplantes (SNT) e que foram submetidos a transplante de córnea. Os dados foram apresentados em estatística descritiva como frequências e mediana e a análise dos dados foi realizada com o software SPSS versão 23. Resultados: em relação à frequência, obteve-se 54,3% do gênero feminino, 57,33% (751) provenientes da Região Metropolitana de Vitória. Os pacientes do Espírito Santo correspondem a 86% da frequência na fila, seguidos por Rio de Janeiro, Minas Gerais e Bahia, que juntos correspondem a 6,3%. O principal diagnóstico na indicação de transplante foi a Ceratopatia Bolhosa (25,9%), seguido por Ceratocone (16,5%) e Ceratite Intersticial (15,5%). A média de tempo de espera foi de 195 dias, sendo no máximo 1345 dias. Verificou-se que 1310 pacientes foram transplantados de córnea, a faixa etária dos transplantados é de 57 anos, sendo a maioria destes da Região Metropolitana de Vitória. Conclusão: Os diagnósticos mais prevalentes nos pacientes transplantados no Espírito Santo foram Ceratopatia Bolhosa e Ceratocone, em pacientes majoritariamente do sexo feminino, 57 anos em média, da região metropolitana da grande Vitória e provenientes do próprio estado. O estudo permite traçar estratégias de prevenção, cuidado e ações sociais de conscientização de doação de córnea.

Abstract Objective: To describe the epidemiological profile of patients submitted to corneal transplantation in state of Espirito Santo, Brazil. Methods: Transversal and descriptive study, with 1301 patients, in the period of January 2017 until to January 2018, the patients were registered in the Central Notification, Captation and Distribution of Organs of Espirito Santo (CNCDO/ES) through the National Transplant System (SNT) and submitted to corneal transplantation. The data were shown as descriptive statistics (frequencies and medians) and analysis of the data was performed using SPSS software, 23 version. Results: In relation to frequency, it was obtained 54.5% female, 57.33% from the metropolitan area of Vitória. Eighty-six percent were patients from Espirito Santo and the others 6.3% were from Rio de Janeiro, Minas Gerais and Bahia. The main indications for corneal transplantation were Bullous Keratopathy (25.9%), Keratoconus (16.5%) and interstitial keratitis (15.5%). The average of waiting time was 195 days and the longest was 1345 days. It was found that 1301 patients underwent corneal transplantation, they are in the 57-year age group, and the biggest part of them are from the metropolitan area of Vitória. Conclusion: The most prevalent diagnoses in patients submitted to corneal transplantation in state of Espirito Santo were Bullous Keratopathy and Keratoconus, in patients mostly female, 57 years old on average, from the metropolitan region of greater Vitória and from the state itself. The study allows to outline prevention strategies, care and social actions to raise awareness of corneal donation.

Neurotology: definitions and evidence-based therapies - Results of the I Brazilian Forum of Neurotology / Otoneurologia: definições e terapias baseadas em evidências - Resultados do I Fórum Brasileiro de Otoneurologia

Abstract Introduction: Neurotology is a rapidly expanding field of knowledge. The study of the vestibular system has advanced so much that even basic definitions, such as the meaning of vestibular symptoms, have only recently been standardized. Objective: To present a review of the main subjects of neurotology, including concepts, diagnosis and treatment of Neurotology, defining current scientific evidence to facilitate decision-making and to point out the most evidence-lacking areas to stimulate further new research. Methods: This text is the result of the I Brazilian Forum of Neurotology, which brought together the foremost Brazilian researchers in this area for a literature review. In all, there will be three review papers to be published. This first review will address definitions and therapies, the second one will address diagnostic tools, and the third will define the main diseases diagnoses. Each author performed a bibliographic search in the LILACS, SciELO, PubMed and MEDLINE databases on a given subject. The text was then submitted to the other Forum participants for a period of 30 days for analysis. A special chapter, on the definition of vestibular symptoms, was translated by an official translation service, and equally submitted to the other stages of the process. There was then a in-person meeting in which all the texts were orally presented, and there was a discussion among the participants to define a consensual text for each chapter. The consensual texts were then submitted to a final review by four professors of neurotology disciplines from three Brazilian universities and finally concluded. Based on the full text, available on the website of the Brazilian Association of Otorhinolaryngology and Cervical-Facial Surgery, this summary version was written as a review article. Result: The text presents the official translation into Portuguese of the definition of vestibular symptoms proposed by the Bárány Society and brings together the main scientific evidence for each of the main existing therapies for neurotological diseases. Conclusion: This text rationally grouped the main topics of knowledge regarding the definitions and therapies of Neurotology, allowing the reader a broad view of the approach of neurotological patients based on scientific evidence and national experience, which should assist them in clinical decision-making, and show the most evidence-lacking topics to stimulate further study.

Resumo Introdução: A otoneurologia é uma área de conhecimento que tem se expandido muito rapidamente. O estudo do sistema vestibular tem avançado tanto que mesmo definições básicas, como o significado dos sintomas vestibulares, foram apenas recentemente padronizadas. Objetivo: Apresentar uma revisão dos principais assuntos da otoneurologia, inclusive conceitos, diagnóstico e tratamento da otoneurologia, definir a evidência científica atual para facilitar a tomada de decisões e demonstrar as áreas mais carentes de evidência para estimular novas pesquisas. Método: Este texto é fruto do I Fórum Brasileiro de Otoneurologia, que reuniu os principais pesquisadores brasileiros dessa área para uma revisão da literatura. Serão feitos três trabalhos de revisão a serem publicados. Este primeiro abordou as definições e as terapias, o segundo abordará as ferramentas diagnósticas e o terceiro definirá os principais diagnósticos. Cada autor fez um levantamento bibliográfico na base de dados da Lilacs, SciELO, Pubmed e Medline de um determinado assunto. O seu texto foi então submetido aos demais participantes do Fórum por 30 dias para análise. Um capítulo especial, da definição dos sintomas vestibulares, foi traduzido por serviço de tradução oficial e igualmente submetido às demais etapas do processo. Houve então uma reunião presencial em que todos os textos foram apresentados oralmente e houve uma discussão entre os participantes para a definição de um texto consensual para cada capítulo. Os textos consensuais foram então submetidos a uma revisão final por quatro professores de otoneurologia de três universidades brasileiras e, por fim, finalizado. A partir do texto completo, publicado no site da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, foi escrita esta versão-resumo como artigo de revisão. Resultado: O texto apresenta a tradução oficial para o português da definição dos sintomas vestibulares propostos pela Barany Society e agrupa as principais evidências científicas para cada um das principais terapias existentes para as doenças otoneurológicas. Conclusão: Este texto agrupou de forma racional os principais tópicos de conhecimento a respeito das definições e terapias da otoneurologia, permite ao leitor uma visão ampla da abordagem dos pacientes otoneurológicos baseada em evidências científicas e experiência nacional, que deverá auxiliá-lo na tomada de decisões clínicas, e mostra os assuntos mais carentes de evidência para estimular novos estudos.

Robotic thoracic surgery for non-small cell lung cancer: initial experience in Brazil / Cirurgia torácica robótica no tratamento do câncer de pulmão de células não pequenas: experiência inicial no Brasil

ABSTRACT Objective: To describe the morbidity, mortality, and rate of complete resection associated with robotic surgery for the treatment of non-small cell lung cancer in Brazil, as well as to report the rates of overall survival and disease-free survival in patients so treated. Methods: This was a retrospective study of patients diagnosed with non-small cell lung carcinoma and undergoing resection by robotic surgery at one of six hospitals in Brazil between February of 2015 and July of 2018. Data were collected retrospectively from the electronic medical records. Results: A total of 154 patients were included. The mean age was 65 ± 9.5 years (range, 30-85 years). The main histological diagnosis was adenocarcinoma, which was identified in 128 patients (81.5%), followed by epidermoid carcinoma, identified in 14 (9.0%). Lobectomy was performed in 133 patients (86.3%), and segmentectomy was performed in 21 (13.7%). The mean operative time was 209 ± 80 min. Postoperative complications occurred in 32 patients (20.4%). The main complication was air leak, which occurred in 15 patients (9.5%). The median (interquartile range) values for hospital stay and drainage time were 4 days (3-6 days) and 2 days (2-4 days), respectively. There was one death in the immediate postoperative period (30-day mortality rate, 0.5%). The mean follow-up period was 326 ± 274 days (range, 3-1,110 days). Complete resection was achieved in 97.4% of the cases. Overall mortality was 1.5% (3 deaths), and overall survival was 97.5%. Conclusions: Robotic pulmonary resection proved to be a safe treatment for lung cancer. Longer follow-up periods are required in order to assess long-term survival.

RESUMO Objetivo: Descrever morbidade, mortalidade e completude da ressecção associadas à cirurgia robótica para o tratamento de câncer de pulmão não pequenas células no Brasil, assim como sobrevida global e sobrevida livre de doença. Métodos: Estudo retrospectivo incluindo pacientes com diagnóstico de carcinoma pulmonar de células não pequenas submetidos à ressecção anatômica por cirurgia robótica em seis hospitais brasileiros entre fevereiro de 2015 e julho de 2018. Os dados foram coletados retrospectivamente de prontuários eletrônicos. Resultados: Foram incluídos 154 pacientes. A média de idade foi de 65,0 ± 9,5 anos (variação: 30-85 anos). Adenocarcinoma foi o principal tipo histológico, em 128 pacientes (81,5%), seguido por carcinoma epidermoide, em 14 (9,0%). Lobectomia foi o tipo de cirurgia mais frequente, em 133 pacientes (86,3%), seguida por segmentectomia anatômica, em 21 (13,7%). A média de tempo operatório foi de 209 + 80 min. Complicações pós-operatórias ocorreram em 32 pacientes (20,4%). Fístula aérea foi a principal complicação, em 15 pacientes (9,5%). A mediana (intervalo interquartil) de permanência hospitalar foi de 4 dias (3-6 dias) e a de tempo de drenagem foi de 2 dias (2-4 dias). Houve mortalidade operatória em 1 paciente (0,5%). O tempo médio de seguimento foi de 326 + 274 dias (variação: 3-1.110 dias). A ressecção foi completa em 97,4% dos casos. A mortalidade geral foi de 1,5% (n = 3), com sobrevida global de 97,5%. Conclusões: A ressecção pulmonar anatômica robótica no tratamento do câncer de pulmão demonstrou ser segura. Um maior tempo de seguimento é necessário para avaliar a sobrevida de longo prazo.

Análise bibliométrica de teses e dissertações brasileiras sobre travestilidade, transexualidade e saúde / Bibliometric analysis of Brazilian theses and dissertations on transvestite, transsexuality and health / Análisis bibliométrica de tesis y disertaciones brasileñas sobre travestilidad, transexualidad y salud

Resumo Objetivou-se analisar o perfil das teses e dissertações sobre travestilidade, transexualidade e saúde nos Programas de Pós-Graduação stricto sensu do Brasil, por meio de um estudo fundamentado no referencial teórico-metodológico da análise bibliométrica. Os 65 trabalhos selecionados foram extraídos do Catálogo de Teses e Dissertações da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior e da Biblioteca Digital Brasileira de Teses e Dissertações. Constata-se que a maioria das produções são dissertações (82%) advindas dos Programas de Pós-Graduação em Saúde Coletiva (27%) e de Instituições Federais de Educação Superior (65%), localizadas nas regiões Sul e Sudeste (70%). A abordagem qualitativa foi a mais utilizada (82%) e o processo transexualizador no Sistema Único de Saúde foi o tema predominante (35%). O estudo revelou que as teses e dissertações brasileiras sobre a tríade travestilidade-transexualidade-saúde estão em ascensão nos últimos vinte anos, com diminuição no enfoque no adoecimento das travestis e de transexuais e aumento do foco nos aspectos sociais, organizacionais e políticos que interferem no acesso dessas pessoas aos serviços de saúde. Ainda assim, é preciso expandir as pesquisas sobre a temática para as demais regiões do país, impactando positivamente na produção científica e em um sistema de saúde mais equânime e universal.

Abstract The aim of this study was to analyze the profile of theses and dissertations on transvestite, transsexuality and health in the stricto sensu Post-Graduate Programs in Brazil, through a study based on the theoretical-methodological framework of bibliometric analysis. The 65 selected works were extracted from the Theses and Dissertations Catalog of the Coordination for the Improvement of Higher Education Personnel and the Brazilian Digital Library of Theses and Dissertations. It appears that most of the productions are dissertations (82%) coming from the Graduate Programs in Collective Health (27%) and from Federal Institutions of Higher Education (65%), located in the South and Southeast (70%). The qualitative approach was the most used (82%) and the transsexualizing process in the Unified Health System was the predominant theme (35%). The study revealed that Brazilian theses and dissertations on the transvestite-transsexuality-health triad have been on the rise in the last twenty years, with a decrease in the focus on the illness of transvestites and transsexuals and an increased focus on the social, organizational and political aspects that interfere in the access of these people to health services. Even so, it is necessary to expand research on the theme to other regions of the country, positively impacting scientific production and a more equitable and universal health system.

Resumen Se tuvo como objetivo analizar el perfil de las tesis y disertaciones sobre travestilidad, transexualidad y salud en los Programas de Posgrado stricto sensu de Brasil, por medio de un estudio fundamentado en lo referencial teórico-metodológico del análisis bibliométrico. Los 65 trabajos seleccionados se extrajeron del Catálogo de Tesis y Disertaciones de la Coordinación de Perfeccionamiento del Personal de Nivel Superior y de la Biblioteca Digital Brasileña de Tesis y Disertaciones. Se constata que la mayoría de las producciones son disertaciones (82%) que tienen lugar en los Programas de Posgrado en salud Colectiva (27%) y en Instituciones Federales de Educación Superior (65%), localizadas en las regiones Sur y Sureste (70%). El abordaje cualitativo fue el más utilizado (82%) y el proceso transexualizador en el Sistema Único de Salud fue el tema predominante (35%). El estudio reveló que las tesis y disertaciones brasileñas sobre la tríada travestilidad-transexualidad-salud están en ascensión en los últimos veinte años, y se nota una disminución en el enfoque sobre las enfermedades de las travestis y de transexuales y el aumento del enfoque en los aspectos sociales, organizacionales y políticos que interfieren en el acceso de esas personas a los servicios de salud. Aún así, es necesario expandir las investigaciones sobre la temática para las demás regiones del país, impactando positivamente en la producción científica y en un sistema de salud más ecuánime y universal.

Segmentectomia pulmonar anatômica robótica: aspectos técnicos e desfechos / Robotic anatomic pulmonary segmentectomy: technical approach and outcomes

RESUMO Objetivo: relatar nossa experiência inicial com a segmentectomia robótica, descrevendo a técnica operatória, a colocação preferencial dos portais, os resultados iniciais e desfechos. Métodos: dados clínicos de pacientes submetidos à segmentectomia robótica, entre janeiro de 2017 e dezembro de 2018, foram obtidos de um banco de dados prospectivo de cirurgia robótica. Todos os pacientes tinham câncer de pulmão, primário ou secundário, ou doenças benignas, e foram operados usando o sistema Da Vinci com a técnica de três portais mais uma incisão utilitária de 3cm. As estruturas hilares foram dissecadas individualmente e as ligaduras dos ramos arteriais e venosos, dos brônquios segmentares, assim como, a transecção do parênquima, realizadas com grampeadores endoscópicos. Dissecção sistemática dos linfonodos mediastinais foi realizada para os casos de câncer de pulmão não de pequenas células (CPNPC). Resultados: quarenta e nove pacientes, dos quais 33 mulheres, foram submetidos à segmentectomia robótica. A média de idade foi de 68 anos. A maioria dos pacientes tinha CPNPC (n=34), seguido de doença metastática (n=11) e doenças benignas (n=4). Não houve conversão para cirurgia aberta ou vídeo, ou conversão para lobectomia. A mediana do tempo operatório total foi de 160 minutos e do tempo de console foi de 117 minutos. Complicações pós-operatórias ocorreram em nove pacientes (18,3%), dos quais sete (14,2%) tiveram internação prolongada (>7 dias) devido à fístula aérea persistente (n=4; 8,1%) ou complicações abdominais (n=2; 4%). Conclusão: a segmentectomia robótica é um procedimento seguro e viável, oferecendo curto período de internação e baixa morbidade.

ABSTRACT Objective: to report our initial experience with pulmonary robotic segmentectomy, describing the surgical technique, the preferred positioning of portals, initial results and outcomes. Methods: we collected data, from a prospective robotic surgery database, on patients undergoing robotic segmentectomy between January 2017 and December 2018. All patients had lung cancer, primary or secondary, or benign diseases, and were operated on with the Da Vinci system, by the three portals technique plus one utilitarian incision of 3cm. We dissected the hilar structures individually and performed the ligatures of the arterial and venous branches, of the segmental bronchi, as well as a parenchymal transection, with endoscopic staplers. We carried out systematic dissection of mediastinal lymph nodes for non-small cell lung cancer (NSCLC) cases. Results: forty-nine patients, of whom 33 were women, underwent robotic segmentectomy. The average age was of 68 years. Most patients had NSCLC (n=34), followed by metastatic disease (n=11) and benign disease (n=4). There was no conversion to laparoscopic or open surgery, or to lobectomy. The median total operative time was 160 minutes, and the median console time, 117 minutes. Postoperative complications occurred in nine patients (18.3%), of whom seven (14.2%) had prolonged hospitalization (>7 days) due to persistent air fistula (n=4; 8.1%) or abdominal complications (n=2.4%). Conclusion: robotic segmentectomy is a safe and viable procedure, offering a short period of hospitalization and low morbidity.

Optimization of RT-PCR reactions in studies with genes of lignin biosynthetic route in Saccharum spontaneum

ABSTRACT Saccharum spontaneum has been used for the development of energy cane a crop aimed to be used for the production of second-generation ethanol, or lignocellulosic ethanol. Lignin is a main challenge in the conversion of cell wall sugars into ethanol. In our studies to isolate the genes the lignin biosynthesis in S. spontaneum we have had great difficulty in RT-PCR reactions. Thus, we evaluated the effectiveness of different additives in the amplification of these genes. While COMT and CCoAOMT genes did not need any additives for other genes there was no amplification (HCT, F5H, 4CL and CCR) or the yield was very low (CAD and C4H). The application of supplementary cDNA was enough to overcome the non-specificity and low yield for C4H and C3H, while the addition of 0.04% BSA + 2% formamide was effective to amplify 4CL, CCR, F5H and CCR. HCT was amplified only by addition of 0.04% BSA + 2% formamide + 0.1 M trehalose and amplification of PAL was possible with addition of 2% of DMSO. Besides optimization of expression assays, the results show that additives can act independently or synergistically.

En bloc vertebrectomy for the treatment of spinal lesions. Five years of experience in a single institution: a case series

OBJECTIVES: The objective of this study is to describe the experience of a Brazilian public university hospital regarding the treatment of metastatic or benign spine lesions with en bloc vertebrectomy of the thoracic and lumbar spines. METHODS: This study was a retrospective case series and included all medical records of patients with benign aggressive, primary malignant, or metastatic spine lesions who underwent en bloc vertebrectomy from 2010 to 2015. RESULTS: A total of 17 patients were included in the analysis. Most of them (71%) were indicated for surgery based on an oncologic resection for localized disease cure. Overall, 10 of the 17 patients (59%) underwent vertebrectomy via an isolated posterior approach using the technique described by Roy-Camille et al. and Tomita et al., while 7 patients (41%) underwent double approach surgeries. Of the 17 patients who underwent the en bloc resection, 8 are still alive and in the outpatient follow-up (47%), and almost all patients with metastatic lesions (8/9) died. The average survival time following the surgical procedure was 23.8 months. Considering the cases of metastatic lesions and the cases of localized disease (malignant or benign aggressive disease) separately, we observed an average survival time of 15 months and 47.6 months respectively. CONCLUSION: This study demonstrates and reinforces the reproducibility of the en bloc vertebrectomy technique described by Tomita et al.