ABSTRACT
The new Coronavirus pandemic affects thousands of people day after day. Once installed in the body, COVID-19 manifests itself through non-specific symptoms in the respiratory, gastrointestinal or sensory systems. As the number of infected people grows and the demand for special care becomes more expressive, it is extremely important to check the number of ICU beds created in the country and their distribution in the Brazilian territory. The objective of this study was to analyze the evolution of COVID-19 and the number of ICU beds in Brazilian states and capitals in the first half of 2020. The study was observational, ecological, descriptive and analytical, using DATASUS and Oswaldo Cruz Foundation (FIOCRUZ) as databases. The present research found a significant increase in the number of ICU II COVID-19 beds, mainly adult subtype, due to the lower involvement of children and the greater need of the adult population. In addition, there was a greater concentration of these beds in the south and southeast regions, when analyzing absolute numbers. Finally, the north/northeast regions were the most affected by the heterogeneity of bed distribution, concentrating practically all new beds in the capitals of their respective states. There was no significant correlation between the supply of beds and accumulated cases of COVID-19 in the country.
A pandemia do novo Coronavírus afeta milhares de pessoas dia após dia. Uma vez instalado no corpo, o COVID-19 se manifesta através de sintomas inespecíficos nos sistemas respiratório, gastrointestinal ou ainda sensorial. Com o crescente número de infectados e a expressiva demanda por cuidados especiais, é de suma importância verificar o número de leitos UTI criados no país e a sua distribuição no território brasileiro. O objetivo deste trabalho foi analisar a evolução da COVID-19 e número de leitos de UTI nos estados e capitais brasileiras no primeiro semestre de 2020. O estudo foi observacional de tipo ecológico, descritivo e analítico, utilizando como bases de dados o DATASUS e Fundação Oswaldo Cruz (FIOCRUZ). A presente pesquisa verificou um aumento expressivo dos leitos de UTI II COVID-19, principalmente subtipo adulto, devido ao menor acometimento das crianças e maior necessidade da população adulta. Ademais, houve maior concentração destes leitos nas regiões sul e sudeste, quando analisados números absolutos. Por fim, as regiões norte/nordeste foram as mais afetadas pela heterogeneidade da distribuição de leitos, concentrando praticamente todos os novos leitos nas capitais de seus respectivos estados. Não houve correlação significativa entre a oferta de leitos e casos acumulados de COVID-19 no país.
ABSTRACT
BACKGROUND: Despite the advantages of percutaneous coronary intervention (PCI) compared to fibrinolytic therapy, it holds some potential risks such as contrast related reactions and technical problems. In addition, recent studies have shown disparities in which access is more exposed to radiation. OBJECTIVES: To analyze the clinical profile, differences between radial and femoral approach and complications presented in patients who underwent PCI performed in a hospital in the south of Brazil. METHODS: A total of 733 patients who underwent PCI in 2016 were included and retrospectively analyzed through their clinical records. The primary outcomes analyzed were procedure approach and the presence of complications. RESULTS: The median age was 62.5 years; 54.8% were male; 50.8% had hypertension and 18.6% were diabetic; and mortality was seen in 2.3% of the population. Femoral approach was the most exposed to radiation, as well as the most used in ST-elevation myocardial infarction (STEMI). Complications were seen in 16.1% of the population and cardiovascular complication was the most frequent. Different accesses or degree of urgency showed no association with complication development. On the other hand, STEMI was related to a bigger complication burden. CONCLUSION: The femoral approach demonstrated more expressive radiation exposure, which can be explained by anatomic reasons. Femoral access represented a safe approach for interventionists in more urgent cases, such as STEMI. Different accesses or degree of urgency did not show an association with complications, as opposed to STEMI, revealing that this condition deserves more attention regarding its procedures and post-PCI care.
ABSTRACT
PURPOSE: The aim of this study was to evaluate and compare the capacity to predict hemodynamic variables obtained with photoplethysmography (PPG) and Acute Physiology and Chronic Health Evaluation (APACHE II) in patients hospitalized in the intensive care unit (ICU). MATERIALS AND METHODS: A prospective cohort study was conducted in the adult ICU of Hospital Nossa Senhora da Conceição, located in Tubarão, Santa Catarina, Brazil. The data collected included the diagnosis for hospitalization, age, gender, clinical or surgical profile, PPG pulse curve signal, and APACHE II score in the first 24 hours. A bivariate and a multivariate logistic regressions were performed, with death as an outcome. A mortality model using artificial neural networks (ANNs) was proposed. RESULTS: A total of 190 individuals were evaluated. Most of them were males (6:5), with a median age of 67 (54-75) years, and the main reasons for hospitalization were cardiovascular and neurological causes; half of them were surgical cases. APACHE II median score was 14 (8-19), with a median length of stay of 6 (3-15) days, and 28.4% of the patients died. The following factors were associated with mortality: age (OR=1.023; 95% CI 1.001-1.044; P=0.039), clinical profile (OR=5.481; 95% CI 2.646-11.354; P<0.001), APACHE II (OR=1.168; 95% CI 1.106-1.234; P<0.001), heart rate in the first 24 hours (OR=1.020; 95% CI 1.001-1.039; P=0.036), and time between the systolic and diastolic peak (∆T) intervals obtained with PPG (OR=0.989; 95% CI 0.979-0.998; P=0.015). Compared with the accuracy (area under the receiver-operating characteristic curve) 0.780 of APACHE II (95% CI 0.711-0.849; P<0.001), the multivariate logistic model showed a larger area of 0.858 (95% CI 0.803-0.914; P<0.001). In the model using ANNs, the accuracy was 0.895 (95% CI 0.851-0.940; P<0.001). CONCLUSION: The mortality models using variables obtained with PPG, with the inclusion of epidemiological parameters, are very accurate and, if associated to APACHE II, improve prognostic accuracy. The use of ANN was even more accurate, indicating that this tool is important to help in the clinical judgment of the intensivist.
Subject(s)
Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/mortality , Decision Support Techniques , Hemodynamics , Hospital Mortality , Intensive Care Units , Nervous System Diseases/diagnosis , Nervous System Diseases/mortality , Photoplethysmography , APACHE , Adolescent , Adult , Aged , Brazil/epidemiology , Cardiovascular Diseases/physiopathology , Cardiovascular Diseases/therapy , Female , Humans , Length of Stay , Male , Middle Aged , Nervous System Diseases/physiopathology , Nervous System Diseases/therapy , Neural Networks, Computer , Predictive Value of Tests , Prevalence , Prospective Studies , Risk Assessment , Risk Factors , Time Factors , Young AdultABSTRACT
OBJECTIVE: To analyze factors associated with mortality among elderly people hospitalized in a single-center regional hospital due to femoral fractures. METHODS: This was a retrospective cohort study. Patients aged 60 years or over who were hospitalized with a diagnosis of femoral fracture (ICD S72) between 2008 and 2013 were selected through the electronic medical records. RESULTS: The study evaluated 195 individuals of mean age 78.5 ± 9.6 years; females predominated (68.2%). The main mechanism for falls was low-energy (87.2%). Surgery was performed on 93.3% of the patients; the mean length of hospital stay was 13.6 ± 7.5 days and the mean waiting time for the surgery was 7.7 ± 4.2 days. The prevalence of mortality was 14.4%, and this occurred mostly among older individuals (p = 0.029); patients with leukocytosis (p < 0.001); those who needed intensive care (p < 0.001); and those who did not undergo surgery (p < 0.001). The mean survival was significantly longer among patients who underwent surgery and shorter among those who needed intensive care. CONCLUSION: Women predominated among the hospitalizations, and the degree of leukocytosis associated with advanced age presented a relationship with mortality, independent of the type of lesion or surgical procedure. More studies still need to be conducted in order to assess other factors associated with mortality.
OBJETIVO: Analisar os fatores associados à mortalidade em idosos hospitalizados por fratura de fêmur em um hospital unicêntrico regional. MÉTODOS: Estudo de coorte retrospectiva. Foram selecionados, por meio do prontuário eletrônico, pacientes internados com diagnóstico de fratura de fêmur (CID S72) com 60 anos ou mais de 2008 a 2013. RESULTADOS: Foram avaliados 195 indivíduos com idade média de 78,5 ± 9,6 e o gênero feminino foi mais prevalente (68,2%). O principal mecanismo de queda foi o de baixa energia (87,2%), a feitura de cirurgia foi de 93,3%, o tempo de internação médio foi de 13,6 ± 7,5 dias, o tempo de espera para a cirurgia médio foi de 7,7 ± 4,2 dias. A prevalência de mortalidade foi de 14,4%, ocorreu principalmente nos indivíduos mais idosos (p = 0,029), com leucocitose (p < 0,001), com necessidade de cuidados intensivos (p < 0,001) e que não foram submetidos a cirurgia (p < 0,001). A sobrevida média foi significativamente maior nos pacientes submetidos a cirurgia e inversamente nos pacientes que necessitaram da unidade de terapia intensiva. CONCLUSÃO: As mulheres predominaram nas internações e o grau de leucocitose associado a idade avançada apresentou relação com a mortalidade, independentemente do tipo de lesão e procedimento cirúrgico. Ainda devem ser feitos mais estudos para avaliar outros fatores associados à mortalidade.