Perfil pedagógico da preceptoria na residência médica em anestesiologia da cidade de Manaus / Pedagogical profile of preceptorship in anesthesiology medical residency in the city of Manaus

Resumo: Introdução: A residência médica é identificada como o melhor programa de formação de médicos em especialidades, sendo desenvolvida em cenário de treinamento em serviço, de duração extensa, entendida como um espaço de educação e ensino constantes. Nela, o médico em formação desenvolve não unicamente habilidades técnicas, mas também práticas de conduta responsável. Objetivo: Este estudo teve como objetivos conhecer o perfil de formação profissional dos preceptores do Programa de Residência Médica em Anestesiologia, verificar a percepção deles sobre a sua prática educativa desenvolvida no programa e identificar os modelos pedagógicos utilizados no mesmo ambiente. Método: Trata-se de um estudo transversal, do tipo descritivo exploratório, com abordagem quantitativa e componente analítico, realizado no período de janeiro de 2017 a janeiro de 2018, em três instituições públicas de ensino que oferecem o Programa de Residência Médica em Anestesiologia na cidade de Manaus, no Amazonas. Os dados foram coletados por meio de um instrumento contendo informações sociodemográficas, um questionário validado (com foco na percepção acerca da preceptoria), acrescido de uma questão sobre o modelo pedagógico adotado. Resultado: A amostra do estudo foi composta majoritariamente por preceptores do sexo feminino (60%) e com maior titulação na residência médica (96,6%). Um percentual expressivo (80%) informou não possuir formação pedagógica para desenvolver a preceptoria. O modelo pedagógico tradicional foi o mais adotado na prática docente dos preceptores. Conclusão: Mostra-se a importância do diagnóstico situacional da preceptoria na residência médica em Anestesiologia, apontando a necessidade de formação docente para o desenvolvimento da atividade do preceptor, bem como sua valorização adequada, objetivando a melhor formação médica.

Abstract: Introduction: Medical Residency is identified as the best program for training physicians in specialties, developed in an in-service training setting for an extensive period, and understood as a space for constant education and teaching. The trainee doctor develops not only technical skills but also practices of responsible conduct. Objectives: To understand the professional training profile of preceptors of the Medical Residency Program in Anesthesiology, to verify the preceptors' view of their educational practice developed in the Program, and to identify the pedagogical models used in the same environment. Methods: This is a cross-sectional, exploratory descriptive study, with a quantitative approach and analytical component, carried out from January 2017 to January 2018, in three public educational institutions that offer the Medical Residency Program in Anesthesiology in the city of Manaus - AM. Data were collected using an instrument containing sociodemographic information; a validated questionnaire (focusing on perception regarding preceptorship); plus a question about the adopted pedagogical model. Results: The study sample consisted mostly of female preceptors (60%) with medical residency as the highest level of their qualification (96.6%). A significant percentage (80%) reported not having pedagogical training to develop preceptorship. The traditional pedagogical model was the most commonly adopted in the teaching practice of preceptors. Conclusions: The importance of the situational diagnosis of preceptorship in the Medical Residency in Anesthesiology is shown, pointing out the need for teacher training for the development of the preceptor role, as well as it being given its due value, with the aim of achieving the best medical training.

Fixation of Intertrochanteric Fractures with Dynamic Hip Screws: Randomized Controlled Trial Comparing Hardinge and Minimally Invasive Approaches.

Objective To compare the techniques for the osteosynthesis of intertrochanteric fractures with dynamic hip screws (DHSs) through the Hardinge and minimally-invasive access routes of the hip, evaluating the operative time, the degree of pain in the immediate postoperative period, the hematimetric loss, and the functional aspects of active mobility. Methods A randomized, double-blinded clinical trial in which 66 patients with intertrochanteric fractures were submitted to osteosynthesis by DHS. The patients were divided into a test group, submitted to the minimally-invasive access, and a control group, in whom the surgery was performed through the Hardinge route. Results Patients submitted to the minimally-invasive treatment presented a lower degree of postoperative pain compared to the group treated by the Hardinge lateral route ( p < 0.001), as well as lower hematimetric loss ( p < 0.001), shorter operative time ( p < 0.001), and improvement in immediate postoperative active mobility tests ( p <0.05). Conclusion The study demonstrated the clinical superiority of the minimally-invasive access route parameters analyzed in relation to the Hardinge access for the fixation of intertrochanteric fractures when DHS is the choice osteosynthesis method. Level of evidence I.

Fixation of Intertrochanteric Fractures with Dynamic Hip Screws: Randomized Controlled Trial Comparing Hardinge and Minimally Invasive Approaches / Fraturas intertrocantéricas fixadas com parafuso dinâmico de quadril: Ensaio clínico randomizado comparando a via lateral de Hardinge e o acesso minimamente invasivo

Abstract Objective To compare the techniques for the osteosynthesis of intertrochanteric fractures with dynamic hip screws (DHSs) through the Hardinge and minimally-invasive access routes of the hip, evaluating the operative time, the degree of pain in the immediate postoperative period, the hematimetric loss, and the functional aspects of active mobility. Methods A randomized, double-blinded clinical trial in which 66 patients with intertrochanteric fractures were submitted to osteosynthesis by DHS. The patients were divided into a test group, submitted to the minimally-invasive access, and a control group, in whom the surgery was performed through the Hardinge route. Results Patients submitted to the minimally-invasive treatment presented a lower degree of postoperative pain compared to the group treated by the Hardinge lateral route (p< 0.001), as well as lower hematimetric loss (p< 0.001), shorter operative time (p< 0.001), and improvement in immediate postoperative active mobility tests (p <0.05). Conclusion The study demonstrated the clinical superiority of the minimally-invasive access route parameters analyzed in relation to the Hardinge access for the fixation of intertrochanteric fractures when DHS is the choice osteosynthesis method. Level of evidence I.

Resumo Objetivo Comparar as técnicas de osteossíntese de fraturas intertrocantéricas com o parafuso dinâmico de quadril (dynamic hip screw, DHS, em inglês) pelas vias de acesso de Hardinge e minimamente invasiva do quadril, avaliando o tempo cirúrgico, o grau de dor no pós-operatório imediato, a perda hematimétrica, e os aspectos funcionais de mobilidade ativa. Métodos Estudo clínico randomizado e duplo-cego, em que 66 pacientes com fratura intertrocantérica foram submetidos a osteossíntese com DHS. Os pacientes foram divididos em um grupo teste, submetidos ao acesso minimamente invasivo, e um controle, em que a cirurgia foi realizada pela via de Hardinge. Resultados Os pacientes submetidos ao tratamento pela via minimamente invasiva apresentaram um grau de dor pós-operatória inferior em comparação ao grupo tratado pela via lateral de Hardinge (p< 0,001), assim como menor perda hematimétrica (p< 0,001), menor tempo operatório (p< 0,001), e melhora nos testes de mobilidade ativa pós-operatória imediata (p< 0,05). Conclusão O estudo demonstrou a superioridade clínica nos parâmetros analisados da via de acesso minimamente invasiva em relação ao acesso de Hardinge para a fixação de fraturas intertrocantéricas, quando o DHS for a opção de osteossíntese escolhida. Nível de evidência I.

Desempenho do escore prognóstico de Glasgow no câncer gástrico / Performance of the Glasgow prognostic score in gastric cancer

RESUMO: A resposta inflamatória sistêmica e o déficit nutricional são características frequentes nos pacientes com câncer e o escore prognóstico de Glasgow tem se mostrado excelente valor prognóstico no câncer gastresofágico e ferramenta validada na avaliação clínica de pacientes com câncer. Assim, o presente estudo teve como objetivo analisar a associação do escore prognóstico de Glasgow com sobrevida de pacientes portadores de carcinoma gástrico, através de revisão sistemática e meta-análise. Foi seguida a metodologia Preferred Reporting Items for Systematic Reviews and Meta-Analyses-PRISMA, com pesquisa nas plataformas Medline, Web of Science e SCOPUS, utilizando descritores apropriados. Foram incluídos estudos clínicos e observacionais, publicados antes de 30.09.2017 e sem restrição de linguagem. Os critérios de inclusão foram a utilização do escore prognóstico de Glasgow como fator prognóstico em pacientes portadores de diagnóstico histológico de carcinoma gástrico; com idade superior a 18 anos; submetidos à quimioterapia, radioterapia ou cirurgia; com dosagem de Proteína C Reativa e albumina no pré-tratamento; e com dados referentes à sobrevida durante o estudo. A qualidade dos estudos foi avaliada com a Escala de Newcastle-Ottawa e o risco de viés com ferramenta da Cochrane Collaboration. Hazard-Ratio e Intervalo de Confiança de 95% foram extraídos dos estudos, e a significância estatística definida como p<0,05. Foram identificados 255 artigos, e por fim, analisados 15 estudos. A análise apresentou o escore prognóstico de Glasgow como fator de risco relacionado à sobrevida e considerado marcador prognóstico independente quando relacionado à sobrevida global dos pacientes com câncer gástrico que realizaram cirurgia e quimioterapia. (AU)

ABSTRACT: The systemic inflammatory response and nutritional deficit are frequent features in cancer patients, and the Glasgow prognostic score has shown to be an excellent prognostic value in gastroesophageal cancer and a validated tool in the clinical evaluation of cancer patients. Thus, the present study aimed to analyze the association of Glasgow's prognostic score with the survival of patients with gastric carcinoma through systematic review and meta-analysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses-PRISMA methodology was considered, with research on the Medline, Web of Science, and SCOPUS platforms, using appropriate descriptors. Clinical and observational studies published before September 30, 2017, and without language restriction were included. Inclusion criteria were the use of Glasgow prognostic score as a prognostic factor in patients with histological diagnosis of gastric carcinoma; over the age of 18; undergoing chemotherapy, radiation or surgery; with dosages of Reactive Protein C and albumin in the pre-treatment; and with data regarding survival during the study. The quality of the studies was assessed using the Newcastle-Ottawa Scale and the risk of bias using the Cochrane Collaboration tool. Hazard-Ratio and 95% Confidence Interval were extracted from the studies, with statistical significance defined as p <0.05. Two hundred fifty-five articles were identified, and finally, 15 studies were analyzed. The analysis presented Glasgow prognostic score as a risk factor related with survival and considered an independent prognostic marker when related to the overall survival of patients with gastric cancer who underwent surgery and chemotherapy. (AU)

Chest tubes in COVID-19 times: a safe way to protect the team.

INTRODUCTION: What has been published so far regarding safe methods to deal with chest tube insertion during COVID-19. METHODS: A descriptive study of the literature available in the Medline/PubMed, Lilacs, Scopus databases and specialized books. The search was carried out using the terms "infectious diseases"; "COVID-19"; "Chest tubes". RESULTS: This paper aggregates and consolidates some old concepts to new tactics to minimize the contamination of teams who deal with chest tubes, before, during, and after the procedure. CONCLUSIONS: Health officials are under increasing pressure to control the spread of COVID-19, which is a very virulent disease. Our analysis brought together old rules against contamination along with new tactics for professionals who deal with chest drains in order to minimize the contamination of teams during the Pandemic.

A prospective controlled randomized multicenter study to evaluate the severity of compensatory sweating after one-stage bilateral thoracic sympathectomy versus unilateral thoracic sympathectomy in the dominant side.

OBJECTIVE: To evaluate the contribution that unilateral thoracic sympathectomy in dominant side or two-stage bilateral thoracic sympathectomy can have as strategies to reduce the incidence of compensatory sweating after sympathectomy for palmar hyperhidrosis. METHODS: This is a prospective, controlled, randomized multicenter trial of 200 participants with palmar hyperhidrosis, which will be randomized into two arms: (a) one-stage bilateral thoracic sympathectomy (control arm); or (b) unilateral thoracic sympathectomy in dominant side (intervention arm). At six months the participants submitted to unilateral procedure can make the contralateral surgery if they wanted it, creating a third group called two-stage bilateral sympathectomy. Participants will be evaluated for the degree of sweating by the Hyperhidrosis Disease Severity Scale (HDSS) and of quality of life questionnaires. RESULTS: 96 participants out of the 200 proposed have been included so far, with 48 participants randomized to each arm. From the sample 61 (63.5%) are female, with a mean age of 24 (20-32) years. There were exclusive palmar hiperhydrosis in 14 cases (14.5%), palmar and plantar hyperhidrosis in 36 (37.5%) cases, palmar and axillar hyperhidrosis in 12 (12,5%) cases and palmar-axillary-plantar hyperhidrosis in 34 (35,4%) cases. The age at the beginning of the disease was childhood (78%), with mean of time of disease 15 (11-22) years. CONCLUSIONS: If one or both hypothesis: (a) unilateral sympathectomy in dominant hand is a satisfactory treatment; b) two-stage bilateral sympathectomy causes less compensatory sweating than in one stage are confirmed there is a chance that surgical therapy for palmar hyperhidrosis can be changed for better.

Chest tubes in COVID-19 times: a safe way to protect the team

SUMMARY INTRODUCTION What has been published so far regarding safe methods to deal with chest tube insertion during COVID-19. METHODS A descriptive study of the literature available in the Medline/PubMed, Lilacs, Scopus databases and specialized books. The search was carried out using the terms "infectious diseases"; "COVID-19"; "Chest tubes". RESULTS This paper aggregates and consolidates some old concepts to new tactics to minimize the contamination of teams who deal with chest tubes, before, during, and after the procedure. CONCLUSIONS Health officials are under increasing pressure to control the spread of COVID-19, which is a very virulent disease. Our analysis brought together old rules against contamination along with new tactics for professionals who deal with chest drains in order to minimize the contamination of teams during the Pandemic.

Fatal cardiac trauma in the city of Manaus, Amazonas state, Brazil. / Trauma cardíaco fatal na cidade de Manaus/AM, Brasil.

OBJECTIVE: to determine the frequency of fatal cardiac trauma in the city of Manaus, Brazil, between November 2015 and October 2016, and to clarify the mechanisms of trauma and death, previous hospital treatment, as well as the injuries associated with cardiac trauma. METHODS: retrospective, observational, and cross-sectional study, which reviewed the necropsy reports of individuals whose cause of death was cardiac injury. RESULTS: the cardiac trauma rate was of 5.98% (138 cases) out of 2,306 necropsies performed in the study period by Instituto Médico Legal (IML) de Manaus (IML is a Brazilian institute responsible for necropsies and cadaveric reports). Males accounted for 92% of the cases. The median age was 27 years (14-83). Gunshot wounds (GSW) was the trauma mechanism in 62.3% and stab wound (SW) in 29.7%. Exsanguination was responsible for most of the deaths and cardiac tamponade was present in second place. On-site death occurred in 86.2% of the cases. The ventricles were the most common site of cardiac injury. Hemothorax was identified in 90.6% of the individuals. Only 23 patients (16.7%) were taken to the hospital (Emergency Room), but six (26.2%) were submitted only to chest drainage, not to thoracotomy. The lung was unilaterally affected in 57% of the cases and bilaterally in 43%. CONCLUSION: fatal cardiac trauma represented an index of 5.98% in the city of Manaus. Most patients die at the scene of the trauma, usually due to exsanguination caused by gunshot wound. About a quarter of patients who reached the hospital and died were not diagnosed with cardiac trauma in time.

OBJETIVO: determinar o índice de trauma cardíaco fatal na cidade de Manaus e esclarecer os mecanismos de trauma e de morte, o tratamento hospitalar prévio, assim como as lesões associadas ao trauma cardíaco. MÉTODOS: estudo retrospectivo, observacional, transversal, que revisou os laudos de necropsias do Instituto Médico Legal de Manaus entre novembro de 2015 e outubro de 2016, cuja causa mortis foi lesão cardíaca. RESULTADOS: o índice de trauma cardíaco foi de 5,98% (138 casos) dentre 2306 necropsias realizadas no período do estudo. Homens foram afetados em 92%. A mediana de idade foi de 27 anos (14 a 83). A arma de fogo foi o mecanismo de trauma em 62,3% e a arma branca em 29,7%. A exsanguinação foi responsável pela maioria das mortes e o tamponamento cardíaco esteve presente em segundo lugar. Óbito no local ocorreu em 86,2%. Os ventrículos foram as câmaras mais lesionadas. O hemotórax foi descrito em 90,6%. Apenas 23 (16,7%) doentes foram removidos até o pronto socorro, porém seis deles (26,2%) não foram submetidos à toracotomia, apenas à drenagem de tórax. O pulmão foi acometido em 57% unilateralmente e 43% bilateralmente. CONCLUSÃO: o trauma cardíaco fatal representou um índice de 5,98% na cidade de Manaus. A maioria dos doentes morre na cena do trauma, geralmente devido à exsanguinação causada por ferimento de arma de fogo. Cerca de um quarto dos pacientes que chegaram ao pronto socorro e morreram, não foram diagnosticados com trauma cardíaco em tempo hábil.

Elaboration of a tracheostomy conduct protocol in the Amazonas cancer reference hospital. / Elaboração de protocolo de condutas em traqueostomias no hospital referência de tratamento do câncer do Amazonas.

OBJECTIVE: to create a multidisciplinary conducts manual for tracheostomies in adult and pediatric patients in the Amazonas State Oncology Control Center Foundation. METHODS: we developed a protocol using the modified Delphi method, which consisted in the application of two series of questionnaires to 20 professionals of the unit. RESULTS: thirteen professionals completed the two steps. In the first stage, there was consensus in 53 out of 92 questions (57.6%). The questions that obtained consensus formed the text of the second stage, divided into eight chapters and evaluated by marking the answers offered on a Linkert scale. All the chapters presented in the second stage obtained consensus, meaning that the sum of the answers "agree" and "fully agree" were above 70%. CONCLUSION: using the data obtained in the consensus, we elaborated a tracheostomy conduct protocol and a care guidelines manual for the patients and their caregivers.

OBJETIVO: criar um manual de rotina multidisciplinar de condutas em traqueostomias para pacientes adultos e pediátricos da Fundação Centro de Controle de Oncologia do Estado do Amazonas. MÉTODOS: o protocolo foi desenvolvido por meio do método Delphi modificado, que consistiu na aplicação de duas séries de questionários a 20 profissionais da unidade. RESULTADOS: treze profissionais concluíram as duas etapas. Na primeira etapa, 53 de 92 questões apresentadas obtiveram consenso (57,6%). Estas sentenças que obtiveram consenso formaram o texto da segunda etapa, que foi dividido em oito capítulos que foram avaliados por meio da marcação de respostas oferecidas em uma escala Linkert. Todos os capítulos apresentados na segunda etapa obtiveram consenso, significando que a soma das respostas concordo e concordo plenamente foram todas acima de 70%. CONCLUSÃO: utilizando os dados obtidos no consenso, foi elaborado um protocolo de condutas em traqueostomias e um manual de orientações de cuidados para os pacientes e seus cuidadores.

Trauma cardíaco fatal na cidade de Manaus/AM, Brasil / Fatal cardiac trauma in the city of Manaus, Amazonas state, Brazil

RESUMO Objetivo: determinar o índice de trauma cardíaco fatal na cidade de Manaus e esclarecer os mecanismos de trauma e de morte, o tratamento hospitalar prévio, assim como as lesões associadas ao trauma cardíaco. Métodos: estudo retrospectivo, observacional, transversal, que revisou os laudos de necropsias do Instituto Médico Legal de Manaus entre novembro de 2015 e outubro de 2016, cuja causa mortis foi lesão cardíaca. Resultados: o índice de trauma cardíaco foi de 5,98% (138 casos) dentre 2306 necropsias realizadas no período do estudo. Homens foram afetados em 92%. A mediana de idade foi de 27 anos (14 a 83). A arma de fogo foi o mecanismo de trauma em 62,3% e a arma branca em 29,7%. A exsanguinação foi responsável pela maioria das mortes e o tamponamento cardíaco esteve presente em segundo lugar. Óbito no local ocorreu em 86,2%. Os ventrículos foram as câmaras mais lesionadas. O hemotórax foi descrito em 90,6%. Apenas 23 (16,7%) doentes foram removidos até o pronto socorro, porém seis deles (26,2%) não foram submetidos à toracotomia, apenas à drenagem de tórax. O pulmão foi acometido em 57% unilateralmente e 43% bilateralmente. Conclusão: o trauma cardíaco fatal representou um índice de 5,98% na cidade de Manaus. A maioria dos doentes morre na cena do trauma, geralmente devido à exsanguinação causada por ferimento de arma de fogo. Cerca de um quarto dos pacientes que chegaram ao pronto socorro e morreram, não foram diagnosticados com trauma cardíaco em tempo hábil.

ABSTRACT Objective: to determine the frequency of fatal cardiac trauma in the city of Manaus, Brazil, between November 2015 and October 2016, and to clarify the mechanisms of trauma and death, previous hospital treatment, as well as the injuries associated with cardiac trauma. Methods: retrospective, observational, and cross-sectional study, which reviewed the necropsy reports of individuals whose cause of death was cardiac injury. Results: the cardiac trauma rate was of 5.98% (138 cases) out of 2,306 necropsies performed in the study period by Instituto Médico Legal (IML) de Manaus (IML is a Brazilian institute responsible for necropsies and cadaveric reports). Males accounted for 92% of the cases. The median age was 27 years (14-83). Gunshot wounds (GSW) was the trauma mechanism in 62.3% and stab wound (SW) in 29.7%. Exsanguination was responsible for most of the deaths and cardiac tamponade was present in second place. On-site death occurred in 86.2% of the cases. The ventricles were the most common site of cardiac injury. Hemothorax was identified in 90.6% of the individuals. Only 23 patients (16.7%) were taken to the hospital (Emergency Room), but six (26.2%) were submitted only to chest drainage, not to thoracotomy. The lung was unilaterally affected in 57% of the cases and bilaterally in 43%. Conclusion: fatal cardiac trauma represented an index of 5.98% in the city of Manaus. Most patients die at the scene of the trauma, usually due to exsanguination caused by gunshot wound. About a quarter of patients who reached the hospital and died were not diagnosed with cardiac trauma in time.

Elaboração de protocolo de condutas em traqueostomias no hospital referência de tratamento do câncer do Amazonas / Elaboration of a tracheostomy conduct protocol in the Amazonas cancer reference hospital

RESUMO Objetivo: criar um manual de rotina multidisciplinar de condutas em traqueostomias para pacientes adultos e pediátricos da Fundação Centro de Controle de Oncologia do Estado do Amazonas. Métodos: o protocolo foi desenvolvido por meio do método Delphi modificado, que consistiu na aplicação de duas séries de questionários a 20 profissionais da unidade. Resultados: treze profissionais concluíram as duas etapas. Na primeira etapa, 53 de 92 questões apresentadas obtiveram consenso (57,6%). Estas sentenças que obtiveram consenso formaram o texto da segunda etapa, que foi dividido em oito capítulos que foram avaliados por meio da marcação de respostas oferecidas em uma escala Linkert. Todos os capítulos apresentados na segunda etapa obtiveram consenso, significando que a soma das respostas concordo e concordo plenamente foram todas acima de 70%. Conclusão: utilizando os dados obtidos no consenso, foi elaborado um protocolo de condutas em traqueostomias e um manual de orientações de cuidados para os pacientes e seus cuidadores.

ABSTRACT Objective: to create a multidisciplinary conducts manual for tracheostomies in adult and pediatric patients in the Amazonas State Oncology Control Center Foundation. Methods: we developed a protocol using the modified Delphi method, which consisted in the application of two series of questionnaires to 20 professionals of the unit. Results: thirteen professionals completed the two steps. In the first stage, there was consensus in 53 out of 92 questions (57.6%). The questions that obtained consensus formed the text of the second stage, divided into eight chapters and evaluated by marking the answers offered on a Linkert scale. All the chapters presented in the second stage obtained consensus, meaning that the sum of the answers "agree" and "fully agree" were above 70%. Conclusion: using the data obtained in the consensus, we elaborated a tracheostomy conduct protocol and a care guidelines manual for the patients and their caregivers.

Nuss procedure for Pectus excavatum repair: critical appraisal of the evidence / Procedimento de Nuss para correção de Pectus excavatum: avaliação crítica da evidência

Objective: To evaluate the effectiveness and safety of correction of pectus excavatum by the Nuss technique based on the available scientific evidence. Methods: We conducted an evidence synthesis following systematic processes of search, selection, extraction and critical appraisal. Outcomes were classified by importance and had their quality assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: The process of selection of items led to the inclusion of only one systematic review, which synthesized the results of nine observational studies comparing the Nuss and Ravitch procedures. The evidence found was rated as poor and very poor quality. The Nuss procedure has increased the incidence of hemothorax (RR = 5.15; 95% CI: 1.07; 24.89), pneumothorax (RR = 5.26; 95% CI: 1.55; 17.92) and the need for reintervention (RR = 4.88; 95% CI: 2.41; 9.88) when compared to the Ravitch. There was no statistical difference between the two procedures in outcomes: general complications, blood transfusion, hospital stay and time to ambulation. The Nuss operation was faster than the Ravitch (mean difference [MD] = -69.94 minutes, 95% CI: -139.04, -0.83). Conclusion: In the absence of well-designed prospective studies to clarify the evidence, especially in terms of aesthetics and quality of life, surgical indication should be individualized and the choice of the technique based on patient preference and experience of the team. .

Objetivo: avaliar a efetividade e segurança da correção de pectus excavatum, através da técnica de Nuss, com base nas evidências científicas disponíveis. Métodos: realizou-se uma síntese de evidências seguindo processos sistemáticos de busca, seleção, extração e avaliação crítica. Os desfechos foram classificados pela importância e tiveram sua qualidade avaliada pela ferramenta Grading of Recommendations Assessment, Development and Evaluation (GRADE). Resultados: O processo de seleção dos artigos culminou na inclusão de apenas uma revisão sistemática, a qual sintetizou os resultados de nove estudos observacionais comparando o procedimento de Nuss e ao de Ravitch. A evidência encontrada foi classificada como baixa e muito baixa qualidade. O procedimento de Nuss causou maior incidência de hemotórax (RR=5,15; IC95%: 1,07; 24,89), pneumotórax (RR=5,26; IC95%: 1,55; 17,92) e necessidade de reintervenção operatória (RR=4,88; IC95%: 2,41; 9,88) quando comparado ao de Ravitch. Não houve diferença estatística entre os dois procedimentos nos desfechos: complicações gerais, transfusão de sangue, tempo de hospitalização e tempo para deambulação. A operação de Nuss foi mais rápida que a de Ravitch (diferença média [MD] = -69,94 minutos; IC95%: -139,04, -0,83). Conclusão: Na ausência de estudos prospectivos bem delineados para clarificar a evidência, sobretudo quanto à estética e à qualidade de vida, a indicação operatória deve ser individualizada e a escolha da técnica baseada na preferência do paciente e experiência da equipe. .

Pleurodesis induction in rats by Copaiba (Copaifera multijuga Hayne) oil.

This study aims to assess and compare copaiba oleoresin of Copaifera multijuga and 0.5% silver nitrate for the induction of pleurodesis in an experimental model. Ninety-six male Wistar rats were divided into three groups: control (0.9% saline solution), copaiba (copaiba oil), and silver nitrate (0.5% silver nitrate). The substances were injected into the right pleural cavity and the alterations were observed macroscopically and microscopically at 24, 48, 72, and 504 h. The value of macroscopic alterations grade and acute inflammatory reaction grade means was higher in the 24 h copaiba group in relation to silver nitrate. Fibrosis and neovascularization means in the visceral pleura were higher in 504 h copaiba group in relation to the silver nitrate group. The grade of the alveolar edema mean was higher in the silver nitrate group in relation to the copaiba group, in which this alteration was not observed. The presence of bronchopneumonia was higher in the 24 h silver nitrate group (n = 4) in relation to the copaiba group (n = 0). In conclusion, both groups promoted pleurodesis, with better results in copaiba group and the silver nitrate group presented greater aggression to the pulmonary parenchyma.

Nuss procedure for pectus excavatum repair: critical appraisal of the evidence.

OBJECTIVE: To evaluate the effectiveness and safety of correction of pectus excavatum by the Nuss technique based on the available scientific evidence. METHODS: We conducted an evidence synthesis following systematic processes of search, selection, extraction and critical appraisal. Outcomes were classified by importance and had their quality assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: The process of selection of items led to the inclusion of only one systematic review, which synthesized the results of nine observational studies comparing the Nuss and Ravitch procedures. The evidence found was rated as poor and very poor quality. The Nuss procedure has increased the incidence of hemothorax (RR = 5.15; 95% CI: 1.07; 24.89), pneumothorax (RR = 5.26; 95% CI: 1.55; 17.92) and the need for reintervention (RR = 4.88; 95% CI: 2.41; 9.88) when compared to the Ravitch. There was no statistical difference between the two procedures in outcomes: general complications, blood transfusion, hospital stay and time to ambulation. The Nuss operation was faster than the Ravitch (mean difference [MD] = -69.94 minutes, 95% CI: -139.04, -0.83). CONCLUSION: In the absence of well-designed prospective studies to clarify the evidence, especially in terms of aesthetics and quality of life, surgical indication should be individualized and the choice of the technique based on patient preference and experience of the team.