Associação entre comprometimento pulmonar, fatores de risco e desfechos em pacientes com covid-19 atendidos em hospital de referência na Paraíba / Association between lung involvement, risk factors and outcomes in COVID-19 patients treated at a reference hospital in Paraíba

Objetivo: Avaliar a associação entre o grau de comprometimento pulmonar (CP) na TC de tórax dos pacientes com COVID-19 com fatores de risco e desfechos. Métodos: Estudo observacional e retrospectivo com 284 pacientes com COVID-19. Avaliou-se idade, sexo, quadro clínico, saturação na admissão, fatores de risco, tempo de sinto-mas, porcentagem de CP, tempo de internação em enfermaria, UTI e de IOT, e óbito. Foram divididos três grupos conforme o grau de CP. Resultados: 167 pacientes possuíam comprometimento <25%; 80, 25-50%; e 37, >50%. O grupo com maior comprometimento pulmonar possuía maior idade, mais homens e maior presença de tosse, dispneia e alguma comorbidade. Também apresentou menor saturação à admissão, maior necessidade de IOT, in-ternação em enfermaria ou UTI e maior mortalidade. O CP, IOT e idade foram fatores preditores de mortalidade.Conclusões: O grau de CP aparenta estar significativamente associado a alguns parâmetros clínicos, necessidade de internação, intubação e óbito (AU)

Objective: To assess the association between the degree of lung involvement (LI) on chest CT scans of COVID-19 patients, risk factors and outcomes. Methods: Observational and retrospective study of 284 COVID-19 patients. Age, sex, clinical presentation, oxygen saturation on admission, risk factors, time after symptom onset, percentage of LI, length of stay in ward and ICU, duration of ETI, and death were assessed. 3 groups were created according to the LI. Results: 167 patients had an involvement of <25%; 80, 25-50%; and 37, >50%. The group with gre-ater LI was older, had more males and a higher incidence of cough, dyspnea and some comorbidity. Moreover, the group with greater LI had lower saturation on admission, more ETI, more admissions to the ward or ICU, and higher mortality. LI, ETI and age were predictors of mortality. Conclusion: The degree of LI appears to be significantly associated with some clinical parameters, need for hospitalization, intubation, and death (AU)

Challenges of Implementing Lung Cancer Screening in a Developing Country: Results of the Second Brazilian Early Lung Cancer Screening Trial (BRELT2).

PURPOSE: This paper aims to present the results of a series of several Brazilian institutions that have been carrying out lung cancer screening (LCS). MATERIALS AND METHODS: This is a retrospective, cohort study, with follow-up of individuals of both sexes, with a heavy smoking history, who participated in LCS programs between December 2013 and January 2021 in six Brazilian institutions located in the states of São Paulo, Rio Grande do Sul, and Bahia. RESULTS: Three thousand four hundred seventy individuals were included, of which 59.8% were male (n = 2,074) and 50.6% were current smokers (n = 1,758), with 60.7 years (standard deviation 8.8 years). Lung-RADS 4 was observed in 233 (6.7%) patients. Biopsy was indicated by minimally invasive methods in 122 patients (3.5%). Two patients who demonstrated false-negative biopsies and lung cancer were diagnosed in follow-up. Diagnosis of lung cancer was observed in 74 patients (prevalence rate of 2.1%), with 52 (70.3%) in stage I or II. Granulomatous disease was found in 20 patients. There were no statistical differences in the incidence of lung cancer, biopsies, granulomatous disease, and Lung-RADS 4 nodules between public and private patients. CONCLUSION: There are still many challenges and obstacles in the implementation of LCS in developing countries; however, our multi-institutional data were possible to obtain satisfactory results in these scenarios and to achieve similar results to the main international studies. Granulomatous diseases did not increase the number of lung biopsies. The authors hope that it could stimulate the creation of organized screening programs in regions still endemic for tuberculosis and other granulomatous diseases.

Balões de látex: um modelo alternativo e de baixo custo para treinamento de anastomoses vasculares no ensino médico / Latex balloons: an alternative, low-cost model for vascular anastomosis training in medical education

O uso de simuladores na educação médica tem sido cada vez mais frequente, porém pouco acessíveis devido ao custo elevado. Foi desenvolvido para tal um modelo acessível e de baixo custo para o aprendizado e o treinamento de suturas e anastomoses vasculares em Laboratório de Bases das Técnicas Cirúrgicas. Foram utilizados balões de látex de cores variadas, fio de polipropileno 6.0 e outros materiais específicos para sutura vascular (porta-agulhas e pinças). Para facilitar o reparo dos balões, eles foram fixados em parafusos sobre placas de madeira. Foram feitas anastomoses terminoterminal, terminolateral e laterolateral e construção de patch. A perviedade da anastomose foi testada a partir da injeção de água em uma extremidade do balão e a observação da saída do conteúdo líquido na extremidade oposta. As vantagens observadas nesse modelo de treinamento para anastomoses foram a maleabilidade, a resistência à passagem do fio e o fato de ser inorgânico. Os balões de látex são uma alternativa barata, viável, não perecível e de uso prolongado no ensino e treinamento das suturas e anastomoses arteriais

Simulators are increasingly being used in medical education, but accessibility is restricted by their elevated cost. A accessible and low-cost model was developed for teaching and learning vascular sutures and anastomoses at a Basic Surgical Techniques Laboratory. Latex balloons of varying colors, polypropylene 6.0 sutures, and other materials specifically for suturing (needle holder and forceps) were used. The balloons were fixed to screws inserted into wooden boards in order to facilitate repairs. E end-to-end, end-to-side, and side-to-side anastomoses and patching were performed. Anastomosis patency was tested by injecting water into one extremity of the balloon and observing the liquid exit via the opposite extremity. The advantages observed with this training model for anastomoses were malleability, resistance to passage of the suture, and the fact that it is inorganic. Latex balloons are an inexpensive option that are non-perishable and offer prolonged use for teaching and practice of arterial sutures and anastomoses

Latex balloons: an alternative, low-cost model for vascular anastomosis training in medical education.

Simulators are increasingly being used in medical education, but accessibility is restricted by their elevated cost. A accessible and low-cost model was developed for teaching and learning vascular sutures and anastomoses at a Basic Surgical Techniques Laboratory. Latex balloons of varying colors, polypropylene 6.0 sutures, and other materials specifically for suturing (needle holder and forceps) were used. The balloons were fixed to screws inserted into wooden boards in order to facilitate repairs. E end-to-end, end-to-side, and side-to-side anastomoses and patching were performed. Anastomosis patency was tested by injecting water into one extremity of the balloon and observing the liquid exit via the opposite extremity. The advantages observed with this training model for anastomoses were malleability, resistance to passage of the suture, and the fact that it is inorganic. Latex balloons are an inexpensive option that are non­perishable and offer prolonged use for teaching and practice of arterial sutures and anastomoses.

Mediastinite descendente necrosante: tratamento cirúrgico torácico minimamente invasivo / Descending necrotizing mediastinitis: minimally invasive thoracic surgical treatment

OBJETIVO: Relatar uma série de casos de pacientes com mediastinite descendente necrosante (MDN) tratados com cirurgia torácica minimamente invasiva. MÉTODOS: Relatamos os casos de três pacientes com MDN submetidos à desbridamento mediastinal através de cirurgia torácica videoassistida no Hospital São Paulo, São Paulo (SP), desde a sua admissão até o desfecho final. RESULTADOS: Os três pacientes apresentaram boa evolução pós-operatória, com tempo médio de internação de 16,7 dias. CONCLUSÕES: Concluímos que a videotoracoscopia é uma técnica efetiva para a drenagem mediastinal no tratamento da MDN, com os benefícios da cirurgia minimamente invasiva: menos dor pós-operatória, menor liberação de fatores inflamatórios, retorno precoce às atividades diárias e melhores resultados estéticos.

OBJECTIVE: To report a case series of patients with descending necrotizing mediastinitis (DNM) who were treated with minimally invasive thoracic surgery. METHODS: We report three cases of male patients with DNM who underwent mediastinal debridement by video-assisted thoracic surgery at the Hospital São Paulo, located in the city of São Paulo, Brazil, from admission to the final outcome. RESULTS: The postoperative evolution was favorable in all three cases. The mean length of hospital stay was 16.7 days. CONCLUSIONS: We conclude that video-assisted thoracoscopy is an effective technique for mediastinal drainage in the treatment of DNM, with the benefits common to minimally invasive surgery: less postoperative pain, lower production of inflammatory factors, earlier return to activities of daily living, and better aesthetic results.

Descending necrotizing mediastinitis: minimally invasive thoracic surgical treatment.

OBJECTIVE: To report a case series of patients with descending necrotizing mediastinitis (DNM) who were treated with minimally invasive thoracic surgery. METHODS: We report three cases of male patients with DNM who underwent mediastinal debridement by video-assisted thoracic surgery at the Hospital São Paulo, located in the city of São Paulo, Brazil, from admission to the final outcome. RESULTS: The postoperative evolution was favorable in all three cases. The mean length of hospital stay was 16.7 days. CONCLUSIONS: We conclude that video-assisted thoracoscopy is an effective technique for mediastinal drainage in the treatment of DNM, with the benefits common to minimally invasive surgery: less postoperative pain, lower production of inflammatory factors, earlier return to activities of daily living, and better aesthetic results.

Repeat pulmonary thromboendarterectomy after recurrence of chronic thromboembolic pulmonary hypertension.

Pulmonary thromboendarterectomy has been established as the standard method for the treatment of chronic thromboembolic pulmonary hypertension, with excellent results. However, repeat pulmonary thromboendarterectomy due to recurrence of pulmonary embolism has never been reported in the Brazilian literature. Its safety and effectiveness remain obscure. We report the case of a patient presenting recurrence of chronic thromboembolic pulmonary hypertension five years after the first pulmonary thromboendarterectomy and requiring a second operation for resolution of the symptoms.

Reoperação de tromboendarterectomia pulmonar em recidiva de tromboembolismo pulmonar crônico hipertensivo / Repeat pulmonary thromboendarterectomy after recurrence of chronic thromboembolic pulmonary hypertension

A cirurgia de tromboendarterectomia tem se estabelecido como método padrão de tratamento do tromboembolismo pulmonar crônico hipertensivo, com excelentes resultados. Entretanto, a reoperação na recidiva do embolismo pulmonar não tem relato na literatura nacional, permanecendo obscuras a sua segurança e efetividade. Relatamos o caso de uma paciente com recorrência de tromboembolismo pulmonar crônico hipertensivo ocorrido cinco anos após a primeira cirurgia de tromboendarterectomia pulmonar, e que necessitou de reoperação para resolução dos sintomas.

Pulmonary thromboendarterectomy has been established as the standard method for the treatment of chronic thromboembolic pulmonary hypertension, with excellent results. However, repeat pulmonary thromboendarterectomy due to recurrence of pulmonary embolism has never been reported in the Brazilian literature. Its safety and effectiveness remain obscure. We report the case of a patient presenting recurrence of chronic thromboembolic pulmonary hypertension five years after the first pulmonary thromboendarterectomy and requiring a second operation for resolution of the symptoms.