Thromboembolism in Arthroplasty: Compliance to Prophylaxis.

Objective The present paper aims to identify the profile of compliance to thromboembolism drug prophylaxis in patients undergoing knee or hip arthroplasty at a public hospital. Methods This is a prospective cohort study, carried out from August 2017 to September 2018, with adult patients who were followed-up from admission until the postoperative period. The Morisky Medication Adherence Scale, consisting of eight items, was applied. Compliance was quantified according to the sum of all correct answers as high (8 points), medium (6 to < 8 points), and low compliance (< 6 points). For the present study, subjects with high compliance were referred as highly compliant, whereas those with medium to low compliance were referred as partially compliant. Results The compliance analysis showed that 73.0% of the patients were highly compliant and 27.0% were partially compliant to thromboprophylaxis. The anticoagulant prescribed at hospital discharge was rivaroxaban, a direct factor Xa inhibitor. Compliance was greater in patients who did not require reinforcement in prophylaxis guidance during follow-up; these subjects reported good and excellent acceptance of prophylaxis, although they were on multiple medications at discharge. Conclusion The data analysis allowed us to conclude that the factors that most influenced compliance were the levels of understanding and acceptance of prophylaxis by the patients, the amount of medication used per day by the subject, the cost of the anticoagulant agent, and its potential to cause adverse reactions.

Alterations in postmenopausal plasmatic lipidome.

BACKGROUND: Menopause consists of a physiological process in women between 40 and 50 years of age, and it has substantial consequences for health, ranging from disturbances in lipid and glycidic metabolism to psychological stress and sleep alterations, thereby increasing women's risk of cardiovascular diseases. Here, we attempted to identify potential lipid alterations not identified by the classic methods. METHODS AND RESULTS: We analyzed the serum lipid profile in 40 women in pre- and post-menopause using a lipidomic approach and mass spectrometry. Lipid species presented increased concentrations, with a difference of more than 25% post-menopause and with the ceramides (N.C23:0.Cer, N.C23:0(OH).Cer and N.C24:0(OH).Cer) standing out with a fold change of 1.68, 1.59, and 1.58, respectively. It was also observed that 14 metabolites presented a significant difference in the average concentrations between pre- and post-menopause, especially the ceramide species. Strong and positive correlations were identified between various metabolites and fasting glucose, glycated hemoglobin, total cholesterol, LDL, and triglycerides. Of note were the association ceramide (N.C10:0.Cer) and lysophosphatidylethanolamine (LPE.a.C18:0) between fasting glucose and glycated hemoglobin. CONCLUSION: This study detected lipid alterations, especially in ceramides, post-menopause, as well as correlations with glycidic and lipid markers, which may in the future be useful to investigate diseases associated with menopause.

Avaliação clínica e econômica do uso de dexmedetomidina em um hospital universitário / Clinical and economic evaluation of dexmetomidine use at an university hospital

Objetivo: Avaliar a utilização clínica da dexmedetomidina e o custo econômico de sua aquisição em pacientes adultos em um hospital universitário. Métodos: Estudo observacional e descritivo do tipo prospectivo, em que foram analisados os formulários de solicitações do medicamento entre 15 de dezembro de 2016 e 15 de dezembro de 2017. Os dados coletados foram idade, gênero, dias solicitados e liberados, justificativa clínica, dose, posologia e via de administração. O custo financeiro foi calculado considerando o valor unitário do medicamento. A análise estatística foi realizada pelo STATA12.0. Resultados: Foram coletados 79 formulários; 14 foram da UTI cardiológica, 41, da UTI de adulto e 24, do centro cirúrgico. As solicitações foram separadas em grupos cirúrgico e clínico. Foi observada prevalência de pacientes com idade acima de 30 anos e sexo masculino. No grupo cirúrgico, o tempo médio de solicitação e liberação foi igual, enquanto no grupo clínico foi de 3,73 e 3 dias, respectivamente. A dose diária foi de 233,33 mcg/dia no grupo cirúrgico e de 773,77 µg/dia no clínico. No grupo cirúrgico, o uso foi para sedação em plástica mamária não estética; no grupo clínico, foi para agitação psicomotora, sedoanalgesia e delirium. O custo no grupo clínico foi de R$ 58.470,65, enquanto no grupo cirúrgico foi de R$ 2.995,65, totalizando R$ 61.466,30. Conclusão: O custo econômico encontrado com o uso do medicamento foi similar ao achado em outro hospital público de alta complexidade.

Objective: Evaluate clinical dexmetomidine use and economic impact of its acquisition to adult patients at a university hospital. Methods: Observational and descriptive study, of prospective type, in which the medication request forms received between December 15th, 2016 and December 15th, 2017 were analized. The data collected were age, gender, days requested and released, clinical justification, dosage, posology and method of administration. The financial cost was calculated assuming the unitary value of the medicine. The statistical analysis was performed by Stata 12.0. Results: 79 forms were collected. 14 were from the coronary care unit, 41 from the adult intensive care unit and 24 from the surgery center. The requests were divided into surgical group and clinical group. Most patients were male aged 30 or more. For the surgical group, the request and release time were mostly the same, meanwhile for the clinical one it was 3.73 and 3 days, respectively. The daily dosage was 233.33 mcg/day in the surgical group and 773.77 µg/day in the clinical one. In the surgical group the use was due to sedation in non-aesthetic breast surgeries. In the clinical one it was for psychomotor agitation, sedoanalgesia and delirium. The cost for the clinical group was R$ 58,470.65, while for the surgical one it was R$ 2,995,65, summing up R$ 61,466.30. Conclusion: The financial cost demanded with the use of the medicine was similar to the one found in another high complexity public hospital.

Síndrome metabólica e resistência insulínica pelo Homa-IR no climatério / Metabolic syndrome and insulin resistance by HOMA-IR in menopause

Fundamento: Síndrome metabólica é um importante fator de risco cardiovascular, e sua prevalência aumenta após a menopausa. Ainda é incerto, porém, se a menopausa é fator de risco independente para a síndrome metabólica. Uma das bases fisiopatológicas para síndrome metabólica é a resistência insulínica, que pode ser calculada pelo método Homeostatic Model Assessment-Insulin Resitance (HOMA-IR), sendo pouco conhecida a relação entre resistência insulínica e menopausa. Objetivos: Avaliar a relação entre síndrome metabólica e resistência insulínica em mulheres climatéricas. Métodos: Estudo descritivo, que avaliou 150 mulheres, com idades entre 40 e 65 anos, atendidas em um ambulatório de ginecologia em um hospital terciário público, entre maio e dezembro de 2013. A amostra foi dividida em dois grupos, sendo o Grupo I com pacientes na pré-menopausa e o II com pacientes na pós-menopausa. Foi avaliada a presença de síndrome metabólica, bem como de seus componentes, além da ocorrência de resistência insulínica nos dois grupos. A associação do estado menopausal e as variáveis estudadas foi realizada com os testes Mann-Whitney, qui quadrado e exato de Fisher. O nível de significância foi de 5%. A análise estatística foi feita por meio do STATA 12.0. Resultados: A síndrome metabólica foi mais prevalente nas mulheres pós-menopausa, bem como todos seus componentes tiveram maior frequência também nesse grupo. As mulheres pós-menopausa também apresentaram maior prevalência de resistência insulínica, mas não foi observada relação estatística entre os achados. Conclusão: O estado menopausal não se associou significativamente com síndrome metabólica e resistência insulínica. A resistência insulínica foi considerada fator de risco independente para o desenvolvimento de síndrome metabólica apenas no grupo pós-menopausa

Background: Metabolic syndrome is an important cardiovascular risk factor, and its prevalence increases after menopause. However, it is still uncertain whether menopause is an independent risk factor for metabolic syndrome. One of the pathophysiological basis for metabolic syndrome is insulin resistance, which can be calculated by the Homeostatic Model Assessment-Insulin Resistance (HOMA-IR) method, and the association between insulin resistance and menopause is little known. Objective: To evaluate the association between metabolic syndrome and insulin resistance in menopausal women. Method: Descriptive study, which evaluated 150 women, aged 40 to 65, treated at a Gynecology Outpatient Clinic of a tertiary public hospital, from May to December of 2013. The sample was divided into two groups: Group I, comprising women in the premenopausal period and Group II, comprising women in the post-menopausal period. The presence of metabolic syndrome and its components were evaluated, as well as occurrence of insulin resistance in both groups. The association of menopausal status and the assessed variables was assessed using the Mann-Whitney, Chi-square and Fisher's exact tests. The significance level was set at 5%. The statistical analysis was performed using STATA 12.0. Results: Metabolic syndrome and its components were more prevalent in postmenopausal women. Postmenopausal women also had a higher prevalence of insulin resistance, but no statistical association was observed between the findings. Conclusion: The menopausal status was not significantly associated with metabolic syndrome and insulin resistance. Insulin resistance was considered an independent risk factor for the development of metabolic syndrome only in the postmenopausal group

Angioplastia guiada por ultrassom intracoronariano: metanálise de ensaios clínicos randomizados / Angioplasty guided by intravascular ultrasound: meta-analysis of randomized clinical trials

FUNDAMENTO: O impacto do uso do ultrassom intracoronariano (USIC) na implantação de stents tem resultados inconclusivos. OBJETIVO: Revisão sistemática, com metanálise, do impacto do USIC na implantação de stents quanto à evolução clínica e angiográfica. MÉTODOS: Efetuada busca nas bases Medline/Pubmed, CENTRAL, Embase, Lilacs, Scopus e Web of Science. Incluídos estudos clínicos randomizados (ECR) que avaliaram o implante de stents, orientados pela USIC, comparados com aqueles utilizando a angiografia isoladamente (ANGIO). O intervalo mínimo de acompanhamento foi de seis meses, avaliados os desfechos: trombose, mortalidade, infarto do miocárdio, revascularização percutânea e cirúrgica, eventos cardiovasculares maiores (ECVM) e reestenose. Os desfechos binários foram apresentados considerando o número de eventos em cada grupo; as estimativas foram geradas por um modelo de efeitos aleatórios, considerando a estatística de Mantel-Haenzel como ponderadora e magnitude de efeito ao risco relativo (RR) com seu respectivo intervalo de confiança de 95% (IC 95%). Para quantificação da consistência entre os resultados de cada estudo, utilizou-se o teste de inconsistência I² de Higgins. RESULTADOS: Avaliados 2.689 artigos, incluídos 8 ECR. Houve redução de 27% na reestenose angiográfica (RR: 0,73; IC 95%: 0,54 - 0,97; I² = 51%) e redução estatisticamente significativa nas taxas de revascularizações percutânea e geral (RR: 0,88; IC 95%: 0,51 - 1,53; I² = 61% e RR: 0,73; IC 95%: 0,54 - 0,99; I² = 55%), sem diferença estatística na revascularização cirúrgica (RR: 0,95; IC 95%: 0,52 - 1,74; I² = 0%) em favor do USIC vs. ANGIO. Não foram observadas diferenças nos demais desfechos na comparação entre as duas estratégias. CONCLUSÃO: Angioplastias com implante de stents guiadas por USIC reduzem taxas de reestenose e de revascularizações, não tendo impacto nos desfechos ECVM, infarto agudo do miocárdio, mortalidade ou trombose.

BACKGROUND: The impact of intravascular ultrasound (IVUS) use on stenting has shown inconclusive results. OBJECTIVE: Systematic review and meta-analysis of the impact of IVUS on stenting regarding the clinical and angiographic evolution. METHODS: A search was performed in Medline/Pubmed, CENTRAL, Embase, Lilacs, Scopus and Web of Science databases. It included randomized clinical trials (RCTs) that evaluated the implantation of stents guided by IVUS, compared with those using angiography alone (ANGIO). The minimum follow-up duration was six months and the following outcomes were assessed: thrombosis, mortality, myocardial infarction, percutaneous and surgical revascularization, major adverse cardiovascular events (MACE) and restenosis. The binary outcomes were presented considering the number of events in each group; the estimates were generated by a random effects model, considering Mantel-Haenszel statistics as weighting agent and magnitude of effect for the relative risk (RR) with its respective 95% confidence interval (95%CI). Higgins I² test was used to quantify the consistency between the results of each study. RESULTS: A total of 2,689 articles were evaluated, including 8 RCTs. There was a 27% reduction in angiographic restenosis (RR: 0.73, 95% CI: 0.54-0.97, I² = 51%) and statistically significant reduction in the rates of percutaneous revascularization and overall (RR: 0.88; 95% CI: 0.51 to 1.53, I² = 61%, RR: 0.73, 95% CI: 0.54 to 0.99, I² = 55%), with no statistical difference in surgical revascularization (RR: 0.95, 95% CI: 0.52-1.74, I² = 0%) in favor of IVUS vs. ANGIO. There were no differences regarding the other outcomes in the comparison between the two strategies. CONCLUSION: Angioplasty with stenting guided by IVUS decreases the rates of restenosis and revascularization, with no impact on MACE, acute myocardial infarction, mortality or thrombosis outcomes.

Angioplasty guided by intravascular ultrasound: meta-analysis of randomized clinical trials.

BACKGROUND: The impact of intravascular ultrasound (IVUS) use on stenting has shown inconclusive results. OBJECTIVE: Systematic review and meta-analysis of the impact of IVUS on stenting regarding the clinical and angiographic evolution. METHODS: A search was performed in Medline/Pubmed, CENTRAL, Embase, Lilacs, Scopus and Web of Science databases. It included randomized clinical trials (RCTs) that evaluated the implantation of stents guided by IVUS, compared with those using angiography alone (ANGIO). The minimum follow-up duration was six months and the following outcomes were assessed: thrombosis, mortality, myocardial infarction, percutaneous and surgical revascularization, major adverse cardiovascular events (MACE) and restenosis. The binary outcomes were presented considering the number of events in each group; the estimates were generated by a random effects model, considering Mantel-Haenszel statistics as weighting agent and magnitude of effect for the relative risk (RR) with its respective 95% confidence interval (95%CI). Higgins I² test was used to quantify the consistency between the results of each study. RESULTS: A total of 2,689 articles were evaluated, including 8 RCTs. There was a 27% reduction in angiographic restenosis (RR: 0.73, 95% CI: 0.54-0.97, I² = 51%) and statistically significant reduction in the rates of percutaneous revascularization and overall (RR: 0.88; 95% CI: 0.51 to 1.53, I² = 61%, RR: 0.73, 95% CI: 0.54 to 0.99, I² = 55%), with no statistical difference in surgical revascularization (RR: 0.95, 95% CI: 0.52-1.74, I² = 0%) in favor of IVUS vs. ANGIO. There were no differences regarding the other outcomes in the comparison between the two strategies. CONCLUSION: Angioplasty with stenting guided by IVUS decreases the rates of restenosis and revascularization, with no impact on MACE, acute myocardial infarction, mortality or thrombosis outcomes.