Papel causal do sexo nas artroplastias de quadril: quadril acometido, diagnóstico prévio e tempo de internação / Causal role of gender in hip arthroplasty: affected hip, previous diagnosis and hospitalization duration

O objetivo deste trabalho foi analisar uma relação causal entre o sexo dos pacientes que realizaram artroplastia de quadril quanto ao quadril acometido, diagnóstico prévio, tipo de artroplastia e tempo de internação. Trata-se de estudo retrospectivo e transversal com 100 pacientes de um serviço de ortopedia que realizaram artroplastia total (ATQ) e parcial (APQ) de quadril. A amostra foi coletada entre março de 2018 a janeiro de 2019. A análise consistiu de um modelo causal comparativo entre homens e mulheres através de escore de propensão. As covariáveis foram ilustradas pelo Gráfico Acíclico Direcionado (DAG). O sexo do paciente associou-se causalmente com o quadril acometido (p = 0.038), diagnóstico prévio - osteoartrose ou fratura do colo do fêmur (p = 0.004) e tempo de internação (p < 0.001) mas não explicou a escolha do tipo de artroplastia (p = 0.385). O quadril esquerdo foi mais acometido nos homens (71%). As mulheres tiveram diagnóstico prevalente de fratura de fêmur (69,3%) e os homens por osteoartrose (65,7%). 71% dos homens realizaram ATQ e as mulheres não diferiram. Os homens ficaram internados -2.12 dias que as mulheres. O sexo apresentou uma relação causal com o quadril acometido, o diagnóstico prévio e o tempo de internação nas ATQ, mas não se associou ao tipo de artroplastia.

Causal relationship between the gender of patients who underwent hip arthroplasty with regard to affected hip, previous diagnosis, type of arthroplasty and hospitalization duration is analyzed by a retrospective and cross-sectional study with 100 patients from an orthopedic clinic, who underwent total (THA) and partial (PHA) hip arthroplasty. The sample was collected between March 2018 and January 2019. The analysis consisted of a comparative causal model between males and females through propensity score. The covariates were illustrated by the Directed Acyclic Graph (DAG). The patient's gender was causally associated with the affected hip (p = 0.038), previous diagnosis - osteoarthritis or femoral neck fracture (p = 0.004) and duration of hospitalization (p < 0.001), but failed to explain the hip arthroplasty type (p = 0.385). The left hip was more affected in males (71%), whilst females had a prevalent diagnosis of femur fracture (69.3%) and osteoarthritis in males (65.7%). Further, 71% of males underwent THA, similar to females. Males were hospitalized for -2.12 days less than females. Gender had a causal relationship with affected hip, previous diagnosis, and length of stay in THA, but it was not associated with type of arthroplasty.

Multicenter Study of Pipeline Flex for Intracranial Aneurysms.

BACKGROUND: The Pipeline Flex (PED Flex; Medtronic, Dublin, Ireland) was designed to facilitate deployment and navigation compared to its previous iteration to reduce the rate of technical events and complications. OBJECTIVE: To assess the neurological morbidity and mortality rates of the PED Flex at 30 d. METHODS: Information from 9 neurovascular centers was retrospectively obtained between July 2014 and March 2016. Data included patient/aneurysm characteristics, periprocedural events, clinical, and angiographic outcomes. Multivariate logistic regression was performed to determine predictors of unfavorable clinical outcome (modified Rankin Scale [mRS] > 2). RESULTS: A total of 205 patients harboring 223 aneurysms were analyzed. The 30-d neurological morbidity and mortality rates were 1.9% (4/205) and 0.5% (1/205), respectively. The rate of intraprocedural events without neurological morbidity was 6.8% (14/205), consisting of intraprocedural ischemic events in 9 patients (4.5%) and hemorrhage in 5 (2.4%). Other technical events included difficulty capturing the delivery wire in 1 case (0.5%) and device migration after deployment in another case (0.5%). Favorable clinical outcome (mRS 0-2) was achieved in 186 patients (94.4%) at discharge and in 140 patients (94.5%) at 30 d. We did not find predictors of clinical outcomes on multivariate analysis. CONCLUSION: The 30-d rates of neurological morbidity and mortality in this multicenter cohort using the PED Flex for the treatment of intracranial aneurysms were low, 1.9% (4/205) and 0.5% (1/205), respectively. In addition, technical events related to device deployment were also low, most likely due to the latest modifications in the delivery system.

Mobile Real-time Tracking of Acute Stroke Patients and Instant, Secure Inter-team Communication - the Join App.

PURPOSE: The primary correlate to survival and preservation of neurologic function in patients suffering from an acute ischemic stroke is time from symptom onset to initiation of therapy and reperfusion. Communication and coordination among members of the stroke team are essential to maximizing efficiency and subsequently early reperfusion. In this work, we aim to describe our preliminary experience using the Join mobile application as a means to improve interdisciplinary team communication and efficiency. MATERIALS AND METHODS: We describe our pilot experience with the initiation of the Join mobile application between July 2015 and July 2016. With this application, a mobile beacon is transported with the patient on the ambulance. Transportation milestone timestamps and geographic coordinates are transmitted to the treating facility and instantly communicated to all treatment team members. The transport team / patient can be tracked en route to the treating facility. RESULTS: During our pilot study, 62 patients were triaged and managed using the Join application. Automated time-stamping of critical events, geographic tracking of patient transport and summary documents were obtained for all patients. Treatment team members had an overall favorable impression of the Join application and recommended its continued use. CONCLUSION: The Join application is one of several components of a multi-institutional, interdisciplinary effort to improve the treatment of patients with acute ischemic stroke. The ability of the treatment team to track patient transport and communicate with the transporting team may improve reperfusion time and, therefore, improve neurologic outcomes.

Perfil epidemiológico de malformações arteriovenosas encefálicas em uma série monocêntrica / Epidemiologic profile of brain arteriovenous malformation in a monocentric series

Objetivo: Avaliar o perfil epidemiológico dos pacientes atendidos na Unidade de Neurocirurgia do Hospital de Base do Distrito Federal (HBDF), unidade de referência de doenças cerebrovasculares no Distrito Federal, bem como os métodos multidisciplinares de tratamento utilizados e a evolução clínica. Métodos: Realizou-se a análise retrospectiva de 42 pacientes portadores de malformações arteriovenosas (MAV) encefálicas admitidos no Serviço de Neurocirurgia do HBDF entre agosto de 2007 e janeiro de 2012, tratados conservadoramente ou submetidos a algum tipo de intervenção:microcirurgia intracraniana, embolização, técnica combinada ou radiocirurgia. Resultados: A distribuição por gênero perfez uma relação de 1,1:1,0 (masculino:feminino). Houve predomínio da localização supratentorial (85%, 36/42). Conforme a Escala de Spetzler-Martin (ESM), evidenciou-se predomínio de graus intermediários (graus II, III e IV), totalizando 96% (40/42). Dez pacientes (24%, 10/42) foram submetidos a tratamento cirúrgico convencional, 22 pacientes (52%, 22/42) à embolização (tratamento endovascular), 1 paciente (2,38%, 1/42) a tratamento combinado (endovascular e cirurgia), 1 (2,38%, 1/42) à radiocirurgia e 8 pacientes (19,05%, 8/42) foram tratados conservadoramente. A evolução clínica caracterizada pela Escala Modificada de Rankin (EMR) mostrou semelhança estatística em relação aos diversos tratamentos estabelecidos. Conclusão: As MAVs são lesões congênitas que, apesar de baixa prevalência, são alvo importante de estudo, por acometer principalmente adultos jovens e em idade produtiva. Este estudo, realizado em um centro de referência do Distrito Federal, evidencia característicasdemográficas peculiares dessas lesões, que são compatíveis com dados prévios da literatura e mostra que a abordagem terapêutica multidisciplinar é essencial para seu correto tratamento.

Objective: To assess the epidemiological profile of patients treated in the Neurosurgery Unit of the Hospital de Base of the Federal District (HBDF) reference unit of cerebrovascular diseases in the Federal District, as well as multidisciplinary treatment methods used and the clinical outcome. Methods: We performed a retrospective analysis of 42 patients with arteriovenous malformations (AVMs) in the brain admitted at Neurosurgery Service of HBDF between August 2007 and January 2012, treated conservatively or undergoing some type of intervention: intracranial microsurgery, embolization, combined technique or radiosurgery. Results: The gender distribution amounted a ratio of 1.1:1.0 (male:female). Predominated supratentorial localization (85%, 36/42). According to the Spetzler-Martin Scale (ESM), we observed a predominance of intermediate grades (grades II, III and IV) totaling 96% (40/42). Ten patients (24%, 10/42) were subjected to conventional surgical treatment, 22 patients (52%, 22/42) to embolization (endovascular treatment), 1 patient (2.38%, 1/42) the combined treatment (endovascular and surgery), 1 (2.38%, 1/42) radiosurgery and 8 patients (19.05% 8/42) were treated conservatively. The clinical evolution characterized by the modified Rankin Scale (EMR) showed statistical similarity with respect to several established treatments. Conclusion: The AVMs are congenital lesions that despite low prevalence are important target of study, since it affects mostly young adults and working age. This study, conducted in a referral center in the Federal District, shows peculiar demographic characteristics of these lesions, which are consistent with previous literature data and shows that the multidisciplinary therapeutic approach is essential for its proper treatment.

Implications of ketogenic diet on weight gain, motor activity and cicatrization in Wistar rats.

The ketogenic diet (KD) was initially developed for the treatment of pharmacoresistant epilepsy and a possible alternative for the obesity treatment, dyslipidemia, resistance to insulin, and nonalcoholic steatosis. However, few studies evaluate the diet effects in rats behavior or cicatrization. The objective of this work was to analyze the influence of the ketogenic diet on the weight gain, emotional behavior of the rats submitted to experimental models such as elevated plus maze (EPM) and open field (OF). The cicatrization time and leukocyte differentiations were also observed. Twenty male Wistar rats of two months age were divided into two groups. One was submitted to ketogenic diet (KD), and the control group (Co) was fed on commercial rations. After 7 days, the animals were weighed and submitted to EPM and OF. A small surgical incision was made and their blood was collected to a leukocyte count. It was verified that the rats from the KD presented less weight gain as compared with the rats from the Co (p < 0.05). The KD did not reveal differences on the behavior measures in the EPM model, but in the OF presented an ambulatory activity significantly bigger. The animals from the KD presented a cicatrization significantly better than Co after 72 h (p = 0.0035) and 96 h (p < 0.1). There was no difference between the groups for leukocyte count. Our results suggest that the KD can interfere on rats deambulation in animal models and improve the cicatrization response.

Índice de diminuição de comorbidades associadas à obesidade mórbida após um ano de cirurgia bariátrica

A obesidade é uma doença endócrino metabólica, caracterizada pelo excesso de tecido adiposo. Atualmente esta doença se tornou universal de prevalência crescente, sendo um dos principais problemas de saúde pública na sociedade moderna. Tendo em vista que a obesidade mórbida está associada à um risco de mortalidade doze vezes maior à população sadia, este estudo teve como objetivo verificar a diminuição das comorbidades associadas ao excesso de peso no pós operatório de um ano de pacientes submetidos à cirurgia bariátrica. Foi realizado um estudo retrospectivo de 57 pacientes, com IMC médio de 45,5 Kg/m2, após um ano de se submeterem à cirurgia bariátrica pela técnica Fobi-Capella. 97% destes pacientes apresentavam comorbidades associadas ao excesso de peso sendo elas: hipertensão, diabetes, esofagite, distúrbios menstruais, artropatias (dor articular) e colecistopatia. Após um ano de cirurgia, pode-se observar juntamente com a perda de peso, uma diminuição significativa dessas comorbidades, apresentando uma diminuição de 85% nos casos de hipertensão, 81% nos casos de diabetes, 89% nos casos de esofagite, 88% de melhora nos casos de distúrbios menstruais e 100% de melhora das artropatias (dor articular) e colecistopatia (após colecistectomia associada à gastroplastia redutora). Conclui-se que o tratamento cirúrgico da obesidade mórbida representa um importante recurso terapêutico para os pacientes obesos, tendo como resultado melhora na qualidade de vida dos mesmos

Índice de diminuição de comorbidades associadas à obesidade mórbida após um ano de cirurgia bariátrica / Index decrease of comorbidities associated with morbid obesity after a year of bariatric surgery

A obesidade é uma doença endócrino metabólica, caracterizada pelo excesso de tecido adiposo. Atualmente esta doença se tornou universal de prevalência crescente, sendo um dos principais problemas de saúde pública na sociedade moderna. Tendo em vista que a obesidade mórbida está associada à um risco de mortalidade doze vezes maior à população sadia, este estudo teve como objetivo verificar a diminuição das comorbidades associadas ao excesso de peso no pós operatório de um ano de pacientes submetidos à cirurgia bariátrica. Foi realizado um estudo retrospectivo de 57 pacientes, com IMC médio de 45,5 Kg/m2, após um ano de se submeterem à cirurgia bariátrica pela técnica Fobi-Capella. 97% destes pacientes apresentavam comorbidades associadas ao excesso de peso sendo elas: hipertensão, diabetes, esofagite, distúrbios menstruais, artropatias (dor articular) e colecistopatia. Após um ano de cirurgia, pode-se observar juntamente com a perda de peso, uma diminuição significativa dessas comorbidades, apresentando uma diminuição de 85% nos casos de hipertensão, 81% nos casos de diabetes, 89% nos casos de esofagite, 88% de melhora nos casos de distúrbios menstruais e 100% de melhora das artropatias (dor articular) e colecistopatia (após colecistectomia associada à gastroplastia redutora). Conclui-se que o tratamento cirúrgico da obesidade mórbida representa um importante recurso terapêutico para os pacientes obesos, tendo como resultado melhora na qualidade de vida dos mesmos

Left atrial myxoma as the cause of syncope in an adolescent.

A case of left atrial myxoma is reported in a 14-year-old female patient with recurrent episodes of syncope. The patient was immediately referred to the cardiologist after an inconclusive neurological investigation. Syncope is a symptom thoroughly described as being associated with heart myxomas, but its specific association with adolescence is extremely rare. The authors discuss the clinical manifestations of the disease, emphasizing the diagnostic difficulties on the basis of the unspecific symptoms. As part of the analysis a Brazilian literature review was carried out. Also, the authors experience in the surgical treatment of the heart tumors is briefly presented.

Mixoma atrial esquerdo como causa de síncope em uma adolescente / Left atrial myxoma as the cause of syncope in an adolescent

A case of left atrial myxoma is reported in a 14-year-old female patient with recurrent episodes of syncope. The patient was immediately referred to the cardiologist after an inconclusive neurological investigation. Syncope is a symptom thoroughly described as being associated with heart myxomas, but its specific association with adolescence is extremely rare. The authors discuss the clinical manifestations of the disease, emphasizing the diagnostic difficulties on the basis of the unspecific symptoms. As part of the analysis a Brazilian literature review was carried out. Also, the authors experience in the surgical treatment of the heart tumors is briefly presented