Management and outcomes among patients with hard-to-heal ulcers in Sweden: a national mapping of data from medical records, focusing on diagnoses, ulcer healing, ulcer treatment time, pain and prescription of analgesics and antibiotics.

OBJECTIVE: To investigate whether patients with hard-to-heal ulcers in Sweden were treated according to an aetiological diagnosis and to explore ulcer healing, treatment time, ulcer-related pain and the prescription of analgesics and antibiotics. DESIGN: A national mapping of data from the patients' medical records, between April 2021 and March 2023. SETTING: Data from medical records for patients with hard-to-heal ulcers from a randomised clustered sample of two units per level of care and region. PARTICIPANTS: Patients with hard-to-heal ulcers treated in primary, community and specialist care, public or private, within units covering all 21 regions in Sweden. OUTCOME MEASURES: Descriptive analysis of data from the patients' medical records. RESULTS: A total of 2470 patients from 168 units were included, of which 39% were treated in primary care, 24% in community care and 37% in specialist care. A total of 49% of patients were treated without an aetiological diagnosis. Healing occurred in 37% of patients and ulcer-related pain was experienced by 1224 patients (50%). Antibiotics were given to 56% of the patients. Amputation occurred in 5% and 11% were deceased. CONCLUSION: Only 51% of patients with hard-to-heal ulcers had a documented aetiological ulcer diagnosis, which means that approximately 20 000 patients in Sweden might receive suboptimal treatment. Future research needs to explore why so many patients are undiagnosed and how to improve diagnosis, which could lead to faster healing and shorter treatment times.

Two-Year Mortality Predictors in Fragility Fractures-A Medical Records Review Study.

PURPOSE: To evaluate two-year mortality predictors in all subtypes of fragility fractures. METHODS: Medical records review, single-center study with Portuguese patients with fragility fractures; A univariate analysis, with chi-square for categorical variables and parametric t-student and non-parametric Wilcoxon tests for continuous variables, was performed. Posteriorly, a survival analysis, with subsequent Cox regression was conducted to establish independent risk factors/ predictors of two-year mortality in fragility fractures. RESULTS: 758 patients were enrolled in the study. We found a total of 151 deaths within the first two years post-fracture. On Cox regression, older age [OR1.10 CI (1.05-1.11)], male sex [OR1.85 CI(1.24-2.75)], anemia at baseline [OR2.44 CI(1.67-3.57)], malignancy [OR4.68 CI (2.13-10.27)], and multimorbidity [OR1.78 CI(1.11-2.87)] were found as independent predictors for two-year post-fracture mortality. CONCLUSION: Our study suggests that male sex, older age, anemia, malignancy, and multimorbidity are mortality predictors in the first two years after fragility fractures, reinforcing the importance of comorbidity management in preventing or, at least, minimizing adverse outcomes following fragility fractures.

Emergency department length of stay and re-presentation rates in patients with low back pain: A medical record review study.

BACKGROUND: Low back pain (LBP) is ranked in the top 10 conditions presenting to emergency departments (ED) in Australia. We aimed to investigate ED re-presentation rates and length of stay (LOS) of patients with LBP, including associated factors. METHODS: We reviewed medical records of three EDs in Sydney, Australia from January 2016 to October 2021. The primary outcome was the proportion of episodes of non-serious LBP with at least one re-presentation within 12 months. Secondary outcomes were re-presentation rates within 3-days, 1-week, 1-month, 3-months, 6-months, and mean LOS. Multivariable logistic regression analyses were performed to investigate the associated factors with re-presentation and prolonged stay (>4 h) and reported as adjusted odds ratios (aORs) and 95% confidence intervals (95% CI). RESULTS: Of 8289 episodes of non-serious LBP, 7.7% included at least one re-presentation within 12 months. There were only 14 re-presentations (0.2%) where the diagnosis changed from non-serious LBP at the index visit to serious spinal pathology at the repeat visit. The overall mean LOS was 4.1 h, and 26.9% of patients stayed in the ED for >4 h. Those who received opioids (aOR: 1.31; 95% CI: 1.08-1.59) were more likely to re-present. In contrast, patients receiving imaging were less likely to re-present (aOR: 0.78, 95% CI: 0.65-0.94). Receiving imaging (aOR: 2.83; 95% CI: 2.56-3.13) and opioids (aOR: 1.64; 95% CI: 1.47-1.82) increased the odds of prolonged stay. CONCLUSION: A re-presentation within 12 months occurs in 7.7% of episodes of LBP in ED. Over one-quarter of patients stayed longer than 4 h.

Last general practitioner consultation during the final month of life: a national medical record review of suicides in Sweden.

OBJECTIVES: Individuals who die by suicide often consult their general practitioners (GPs) in their final weeks of life. The aim of this study was to gain a deeper knowledge of the clinical characteristics and GP assessments and treatments among individuals who consulted their GPs during the month preceding suicide. Further, we compared these features in those with and without contact with psychiatric services (PC and NPC, respectively) during the two years that preceded the suicide. DESIGN: A nationwide retrospective explorative study investigating medical records. SETTING: Primary care in Sweden. PARTICIPANTS: Individuals who died by suicide in Sweden in 2015 with a GP visit within 30 days of death. RESULTS: The study cohort corresponds to one fifth (n = 238) of all suicides that occurred in Sweden in 2015 (n = 1179), representing all those with available primary care records showing contact with a GP during the final 30 days of life (NPC: n = 125; PC: n = 113). The mean age was 58 years ± 19. Patients in the NPC group were older (NPC: 63 years ± 19 vs. PC: 53 years ± 18, p < 0.0001) and presented psychiatric symptoms less often (NPC: 50% vs. PC: 67%, p < 0.006). Somatic symptoms were as common as psychiatric symptoms for the whole sample, being present in more than half of individuals. Suicide risk was noted in only 6% of all individuals. Referral to psychiatric services occurred in 14%, less commonly for the NPC group (NPC: 6% vs. PC: 22%, p < 0.001). Cardiovascular or respiratory symptoms were noted in 19%, more often in the NPC group (NPC: 30% vs. PC: 6%, p < 0.001), as were diagnoses involving the circulatory system (all 10%, NPC:14% vs. PC: 5%, p < 0.020). CONCLUSION: A high level of somatic symptoms was observed in primary care patients both with and without psychiatric contact, and this might have influenced GPs' management decisions. Psychiatric symptoms were noted in two thirds of those with psychiatric contact but only half of those without. While GPs noted psychiatric symptoms in over half of all individuals included in the study, they seldom noted suicide risk. These findings highlight the need for increased attention to psychiatric symptoms and suicide risk assessment, particularly among middle-aged and older individuals presenting with somatic symptoms. STRENGTHS AND LIMITATIONS OF THIS STUDY: The National Cause of Death Register has excellent coverage of suicide deaths and access to medical records was very good. The medical record review provided detailed information regarding primary care utilization before death by suicide. Because of the lack of statistical power, due to the limited number of persons with GP contact during the last month of life, we chose not to correct for multiple comparisons. Our study approach did not capture the reasons behind GPs' documentation of elevated suicide risk. No systematic inter-rater reliability (IRR) testing was made, however, reviewers received training and continuous support from the research group.

Concomitant treatment with safinamide and antidepressant drugs: Safety data from real clinical practice / Tratamiento concomitante de safinamida y antidepresivos: Datos de seguridad sobre la práctica en la vida real

Background and purpose: The aim of this study was to assess the possible pharmacological interactions between safinamide and antidepressants, and in particular the appearance of serotonin syndrome with data from real life. Methods: We conducted a retrospective observational study of patients with Parkinson's disease from our Movement Disorders Unit, who were under treatment with any antidepressant drug and safinamide. Specifically, symptoms suggestive of serotonin syndrome were screened for. Also, we collected time of simultaneous use, doses of levodopa and other antiparkinsonian drugs. Results: Clinical records were reviewed for the study period of September 2018 to September 2019. Seventy-eight PD patients who were treated with safinamide of which 25 (32.05%) had a concomitant treatment with an antidepressant drug, being sertraline and escitalopram the most frequent. Mean age was 80 years ± 8.43 and H&Y stage was 3 [2–4]. Mean dose of levodopa used was 703.75 mg ± 233.15. Median duration of concomitant treatment with safinamide and antidepressant drug was 6 months (IQR 20.5), and over eighteen months in 5 cases. No case of serotonin syndrome was recorded, neither was any of its typical manifestations combined or in isolation. Conclusions: Our real clinical practice study suggests that concomitant use of safinamide with antidepressant drugs in PD patients seemed to be safe and well tolerated, even in the long term. However, caution is warranted, individualizing treatment regimens and monitoring the potential appearance of adverse effects.(AU)

Objetivos: El objetivo de este estudio ha sido evaluar las posibles interacciones farmacológicas entre safinamida y antidepresivos; en particular la aparición del síndrome serotoninérgico mediante datos obtenidos en la vida real. Material y métodos: Realizamos un estudio observacional retrospectivo de pacientes con enfermedad de Parkinson (EP) de nuestra unidad de trastornos del movimiento, que estaban en tratamiento con algún fármaco antidepresivo y safinamida. Específicamente, se examinaron los síntomas sugestivos de síndrome serotoninérgico. Además, se recogieron tiempos de uso simultáneo, dosis de levodopa y otros fármacos antiparkinsonianos concomitantes. Resultados: Se revisaron las historias clínicas correspondientes al período de estudio de septiembre de 2018 a septiembre de 2019. Setenta y ocho pacientes con EP se encontraban en tratamiento con safinamida, de los cuales 25 (32,05%) se encontraban recibiendo además un fármaco antidepresivo, siendo sertralina y escitalopram los más frecuentes. La edad media fue de 80 años ± 8,43 y el estadio H&Y fue de 3 [2-4]. La dosis media de levodopa utilizada fue de 703,75 mg ± 233,15. La mediana de duración del tratamiento concomitante con safinamida y un fármaco antidepresivo fue de 6 meses (IQR: 20,5), y más de 18 meses en 5 casos. No se registró ningún caso de síndrome serotoninérgico, ni tampoco ninguno de sus síntomas de forma aislada. Conclusión: Nuestro estudio de práctica clínica real sugiere que el uso concomitante de safinamida con fármacos antidepresivos en pacientes con EP parece ser seguro y bien tolerado, incluso a largo plazo. Sin embargo, es necesaria precaución, individualizando los regímenes de tratamiento, y controlando la posible aparición de efectos adversos.(AU)

The impact of specialized pediatric palliative care on advance care planning and healthcare utilization in children and young adults: a retrospective analysis of medical records of in-hospital deaths.

BACKGROUND: Pediatric palliative care supports children and young adults with life-limiting conditions and their families, seeking to minimize suffering and enhance quality of life. This study evaluates the impact of specialized palliative care (SPC) on advance care planning (ACP) and patterns of end-of-life care for patients who died in the hospital. METHODS: This is a retrospective cohort study of medical records extracted from a clinical data warehouse, covering patients who died aged 0-24 in an academic tertiary children's hospital in South Korea. Participants were categorized into before (2011-2013; pre-period) and after (2017-2019; post-period) the introduction of an SPC service. Within the post-period, patients were further categorized into SPC recipients and non-recipients. RESULTS: We identified 274 and 205 patients in the pre-period and post-period, respectively. ACP was conducted more and earlier in the post-period than in the pre-period, and in patients who received palliative care than in those who did not. Patients who received SPC were likely to receive less mechanical ventilation or cardiopulmonary resuscitation and more opioids. A multivariable regression model showed that earlier ACP was associated with not being an infant, receiving SPC, and having a neurological or neuromuscular disease. CONCLUSIONS: SPC involvement was associated with more and earlier ACP and less intense end-of-life care for children and young adults who died in the hospital. Integrating palliative care into routine care can improve the quality of end-of-life care by reflecting patients' and their families' values and preferences.

Validating the indicator "maternal death review coverage" to improve maternal mortality data: A retrospective analysis of district, facility, and individual medical record data.

BACKGROUND: Understanding causes and contributors to maternal mortality is critical from a quality improvement perspective to inform decision making and monitor progress toward ending preventable maternal mortality. The indicator "maternal death review coverage" is defined as the percentage of maternal deaths occurring in a facility that are audited. Both the numerator and denominator of this indicator are subject to misclassification errors, underreporting, and bias. This study assessed the validity of the indicator by examining both its numerator-the number and quality of death reviews-and denominator-the number of facility-based maternal deaths and comparing estimates of the indicator obtained from facility- versus district-level data. METHODS AND FINDINGS: We collected data on the number of maternal deaths and content of death reviews from all health facilities serving as birthing sites in 12 districts in three countries: Argentina, Ghana, and India. Additional data were extracted from health management information systems on the number and dates of maternal deaths and maternal death reviews reported from health facilities to the district-level. We tabulated the percentage of facility deaths with evidence of a review, the percentage of reviews that met the World Health Organization defined standard for maternal and perinatal death surveillance and response. Results were stratified by sociodemographic characteristics of women and facility location and type. We compared these estimates to that obtained using district-level data. and looked at evidence of the review at the district/provincial level. Study teams reviewed facility records at 34 facilities in Argentina, 51 facilities in Ghana, and 282 facilities in India. In total, we found 17 deaths in Argentina, 14 deaths in Ghana, and 58 deaths in India evidenced at facilities. Overall, >80% of deaths had evidence of a review at facilities. In India, a much lower percentage of deaths occurring at secondary-level facilities (61.1%) had evidence of a review compared to deaths in tertiary-level facilities (92.1%). In all three countries, only about half of deaths in each country had complete reviews: 58.8% (n = 10) in Argentina, 57.2% (n = 8) in Ghana, and 41.1% (n = 24) in India. Dramatic reductions in indicator value were seen in several subnational geographic areas, including Gonda and Meerut in India and Sunyani in Ghana. For example, in Gonda only three of the 18 reviews conducted at facilities met the definitional standard (16.7%), which caused the value of the indicator to decrease from 81.8% to 13.6%. Stratification by women's sociodemographic factors suggested systematic differences in completeness of reviews by women's age, place of residence, and timing of death. CONCLUSIONS: Our study assessed the validity of an important indicator for ending preventable deaths: the coverage of reviews of maternal deaths occurring in facilities in three study settings. We found discrepancies in deaths recorded at facilities and those reported to districts from facilities. Further, few maternal death reviews met global quality standards for completeness. The value of the calculated indicator masked inaccuracies in counts of both deaths and reviews and gave no indication of completeness, thus undermining the ultimate utility of the measure in achieving an accurate measure of coverage.

Hipouricemia con hipercalciuria. Estudio longitudinal y revisión del tema / Hypouricemia with hypercalciuria: Longitudinal study and review of the topic

Antecedentes y objetivo: La asociación de hipouricemia e hipercalciuria es poco frecuente. En 1974 se describió un nuevo síndrome nominado Hipouricemia con hipercalciuria y reducción de la densidad ósea. Posteriormente, se publicaron algunos casos con esa asociación en los que la excreción fraccional de urato era superior a 20/100ml FGR. Hemos analizado una serie de niños que fueron diagnosticados de hipouricemia e hipercalciuria y que fueron controlados evolutivamente. El objetivo del trabajo es intentar conocer si nuestros pacientes podrían estar afectos del síndrome antes mencionado o ser portadores de una variante de hipercalciuria idiopática. Pacientes y métodos: Estudio retrospectivo longitudinal en el que se estudiaron las historias clínicas de 8 pacientes (5V y 3M) diagnosticados de hipouricemia e hipercalciuria en la infancia. Se anotaron la clínica al diagnóstico, los hallazgos ecográficos y densitométricos, y determinadas variables bioquímicas, con especial hincapié en el manejo tubular renal del urato. Los resultados se compararon con los de 36 niños afectos de hipercalciuria idiopática sin hipouricemia (14V y 22M). Resultados: En el grupo con hipouricemia los niveles iniciales de uricemia fueron 1,9 (0,3) mg/dl (rango: 1,5-2) y los del cociente calcio/creatinina en primera orina del día, 0,27 (0,05) mg/mg (rango: 0,23-0,31). En todos los casos la excreción fraccional de urato fue inferior a 20ml/100ml FGR. Los valores de z-DMO fueron menores de −1 en 4/8 casos. En el último control, solo en 3 casos persistía el cociente calcio/creatinina elevado, y en todos la uricemia era superior a 2mg/dl. El valor de z-DMO había mejorado en 5 casos y empeorado en otros 3... (AU)

Background and objective: The association of hypouricemia and hypercalciuria is rare. In 1974 a new syndrome named Hypouricemia with hypercalciuria and decreased bone density was described. Afterwards, some cases with such association were published in which the fractional excretion of urate was higher than 20/100ml FGR. We have analyzed a series of children who were diagnosed with hypouricemia and hypercalciuria and who were monitored. The aim of this study was to determine whether our patients could be affected by the aforementioned syndrome or be carriers of a variant of idiopathic hypercalciuria. Patients and methods: Retrospective longitudinal study in which the medical records of eight patients (5V and 3M) diagnosed with hypouricemia and hypercalciuria in childhood. Clinical features at diagnosis, ultrasound and densitometric findings and selected biochemical variables were noted, with special emphasis on renal tubular handling of urate. Results were compared with 36 children with idiopathic hypercalciuria without hypouricemia (14V and 22M). Results: In the hypouricemia group baseline urate levels were 1.9 (0.3)mg/dl (range: 1.5-2) and first day urine calcium/creatinine ratio 0.27 (0.05)mg/mg (range: 0.23-0.31). In all cases fractional urate excretion was less than 20/100ml FGR. The z-DMO values were less than −1 in 4/8 cases. At the last follow-up only three cases still had an elevated calcium/creatinine ratio and in all of them the urates levels was greater than 2mg/dl. The z-DMO value had improved in five cases and worsened in three others. In relation to the group without hypouricemia, no differences were observed between the various parameters studied including the z-DMO value, with the exception of fractional excretion and tubular urate reabsorption although plasmatic uric acid levels were still significantly lower... (AU)

Perfil clínico e epidemiológico de gestantes que vivem com HIV na Macrorregião Sul de Saúde de Santa Catarina / Clinical and epidemiological profile of pregnant women living with HIV in the Southern Health Macroregion of Santa Catarina

Objetivo: Nos últimos anos, a epidemia de HIV tem incidido consideravelmente e de forma silenciosa na população de mulheres gestantes, sobretudo devido à subnotificação, ao diagnóstico tardio e à negligência quanto à realização de teste anti-HIV pelas infectadas. Diante disso, este estudo tem por objetivo descrever o perfil clínico e epidemiológico de gestantes que vivem com HIV na Macrorregião Sul de Saúde de Santa Catarina. Métodos: Trata-se de um estudo ecológico, ana- lítico, retrospectivo, com base em dados secundários retirados das plataformas Sistema de Informações de Agravos de Notificação (Sinan) e Sistema de Monitora- mento Clínico das Pessoas Vivendo com HIV/AIDS (SIMC), acerca de gestantes que vivem com HIV na Macrorregião Sul de Saúde de Santa Catarina, no período entre 2019 e 2022. Resultados: A partir dos dados sociodemográficos, obteve-se um perfil epidemiológico prevalente de mulheres com idade entre 30 e 49 anos, brancas, com baixo nível de escolaridade e entre 1 a 13 semanas de gestação no momento da notificação de infecção por HIV. O perfil clínico apontou para a prevalência de mulheres em uso de terapia antirretroviral, com carga viral acima de 1.000 cópias/ mL e contagem de linfócitos T-CD4+ superior a 350 células/mm3. Conclusão: Apesar do baixo nível de escolaridade e da elevada carga viral, o resultado foi positivo para a população selecionada, uma vez que foi demonstrada boa adesão ao tra- tamento e alta contagem de linfócitos, sendo esses bons preditores de evolução clínica para o HIV.

Objective: In recent years, the HIV epidemic has significantly and silently affected the population of pregnant women, mainly due to underreporting, late diagnosis, and neglect of HIV testing among infected individuals. In light of this, the aim of this study is to describe the clinical and epidemiological profile of pregnant women living with HIV in the Southern Health Macroregion of Santa Catarina. Methods: This is an ecological, analytical, retrospective study based on secondary data retrieved from the Notifiable Diseases Information System (Sinan) and the Clinical Monitoring System for People Living with HIV/ AIDS (SIMC), regarding pregnant women living with HIV in the Southern Health Macroregion of Santa Catarina from 2019 to 2022. Results: Based on sociodemographic data, a prevalent epidemiological profile was identified, with women aged 30 to 49 years, white, with low educational level, and between 1 to 13 weeks of gestation at the time of HIV infection notifica- tion. The clinical profile revealed a prevalence of women on antiretroviral therapy, with a viral load above 1,000 copies/ mL and a T-CD4+ lymphocyte count above 350 cells/mm3. Conclusion: Despite the low educational level and high viral load, the outcome was positive for the selected population, as good treatment adherence and high lymphocyte count were demonstrated, both of which are good predictors of clinical progression for HIV.

Índice de massa corporal e desfechos clínicos: um estudo retrospectivo durante a pandemia de Covid-19 / Body mass index and clinical outcomes: a retrospective study in Covid-19 / Índice de masa corporal y resultado clínico: un estudio retrospectivo durante la pandemia de Covid-19

A COVID-19 é uma doença respiratória aguda provocada pela infecção do vírus SARS-CoV-2, que pode causar uma grave insuficiência respiratória hipoxêmica, complicações e mortes, principalmente na população com condições crônicas de saúde. Os mecanismos pelos quais a obesidade pode aumentar a gravidade da COVID-19 incluem mecanismos físicos, inflamação crônica e uma função imunológica prejudicada. Além disso, o índice de massa corporal elevado é um fator de risco para várias condições médicas que têm sido sugeridas para aumentar o risco de gravidade da COVID-19. Objetivo: analisar a associação entre o índice de massa corporal e desfechos clínicos dos casos confirmados de COVID-19. Metodologia: Estudo transversal, com coleta de dados de prontuários, conduzido de março de 2020 a dezembro 2021. Foram analisados os registros de prontuários, exames bioquímicos e de imagem de pacientes internados com COVID-19 em três hospitais da cidade de Francisco Beltrão (PR). As variáveis analisadas foram o diagnóstico nutricional, idade, sexo, necessidade de internação em UTI, comorbidades, dias de hospitalização, complicações, exames laboratoriais e desfecho. Os critérios para inclusão no estudo foram, pacientes hospitalizados com diagnóstico para COVID-19, com presença de diagnóstico nutricional relatado. Resultados: No ano de 2020 foram analisados 292 prontuários e no ano de 2021 foram 860 prontuários. Destes, somente 413 possuíam diagnóstico nutricional, sendo assim incluídos no presente estudo. Foram classificados como peso normal 78 (18,9%), com sobrepeso 153 (37%)e como obeso 182 (44,1%) participantes. A maior prevalência de obesidade foi encontrada no sexo feminino (52,5%), portadores de diabetes (27,6%), pacientes com estado geral comprometido (67,9%), que apresentaram complicações pulmonares (54,5%) e arritmias (23%). A média de idade encontrada em pacientes com obesidade foi mais jovem (55,54) em comparação com os classificados com sobrepeso (59,08) e normal (62,51). Observou-se que quanto maior o IMC menor foram os valores encontrados para idade (rho = -0,190), leucócitos (rho = -0,109), ureia (rho = -0,145) e D-dímero (rho = -0,155). Conclusão: Este estudo fornece evidências de que o sobrepeso e/ou obesidade então associadas a um pior quadro clínico durante a internação dos pacientes com COVID-19. Em relação a frequência de óbito, não houve diferença estatística em relação ao diagnóstico nutricional.

COVID-19 is an acute respiratory disease caused by SARS-CoV-2 virus infection, which can cause severe hypoxemic respiratory failure, complications, and deaths, especially in the population with chronic health conditions. The mechanisms by which obesity may increase the severity of COVID-19 include physical mechanisms, chronic inflammation, and impaired immune function. In addition, high body mass index is a risk factor for several medical conditions that have been suggested to increase the risk of COVID-19 severity. Objective: to analyze the association between body mass index and clinical outcomes of confirmed cases of COVID-19. Methodology: Cross-sectional study, with data collection from medical records, conducted from March 2020 to December 2021. The records of medical records, biochemical and imaging tests of patients hospitalized with COVID-19 in three hospitals in the city of Francisco Beltrão (PR) were analyzed. The variables analyzed were nutritional diagnosis, age, gender, need for ICU admission, comorbidities, days of hospitalization, complications, laboratory tests and outcome. The inclusion criteria for the study were, hospitalized patients with diagnosis for COVID-19, with presence of nutritional diagnosis reported. Results: In the year 2020, 292 medical records were analyzed and in the year 2021 there were 860 medical records. Of these, only 413 had nutritional diagnosis, thus being included in this study. Were classified as normal weight 78 (18.9%), overweight 153 (37%), and obese 182 (44.1%) participants. The highest prevalence of obesity was found in females (52.5%), patients with diabetes (27.6%), patients with impaired general condition (67.9%), who presented pulmonary complications (54.5%) and arrhythmias (23%). The mean age found in obese patients was younger (55.54) compared to those classified as overweight (59.08) and normal (62.51). It was observed that the higher the BMI the lower were the values found for age (rho = -0.190), leukocytes (rho = -0.109), urea (rho = -0.145) and D-dimer (rho = -0.155). Conclusion: This study provides evidence that overweight and/or obesity then associated with a worse clinical picture during hospitalization of patients with COVID-19. Regarding the frequency of death, there was no statistical difference in relation to nutritional diagnosis.

COVID-19 es una enfermedad respiratoria aguda causada por la infección por el virus SARS-CoV-2, que puede provocar insuficiencia respiratoria hipoxémica grave, complicaciones y muertes, especialmente en poblaciones con enfermedades crónicas. Los mecanismos por los cuales la obesidad puede aumentar la gravedad de la COVID-19 incluyen mecanismos físicos, inflamación crónica y función inmune deteriorada. Además, un índice de masa corporal alto es un factor de riesgo para varias afecciones médicas que, según se ha sugerido, aumentan el riesgo de gravedad del COVID-19. Objetivo: analizar la asociación entre el índice de masa corporal y los resultados clínicos de casos confirmados de COVID-19. Metodología: Estudio transversal, con recolección de datos de historias clínicas, realizado de marzo de 2020 a diciembre de 2021. Se analizaron historias clínicas, exámenes bioquímicos y de imagen de pacientes hospitalizados con COVID-19 en tres hospitales de la ciudad de Francisco Beltrão (PR). Las variables analizadas fueron diagnóstico nutricional, edad, sexo, necesidad de ingreso a UCI, comorbilidades, días de internación, complicaciones, exámenes de laboratorio y evolución. Los criterios de inclusión en el estudio fueron pacientes hospitalizados con diagnóstico de COVID-19, con presencia de diagnóstico nutricional informado. Resultados: En 2020 se analizaron 292 historias clínicas y en 2021 se analizaron 860 historias clínicas. De ellos, sólo 413 tenían diagnóstico nutricional, por lo que fueron incluidos en el presente estudio. 78 (18,9%) participantes fueron clasificados como normopeso, 153 (37%) como sobrepeso y 182 (44,1%) como obesidad. La mayor prevalencia de obesidad se encontró en el sexo femenino (52,5%), pacientes con diabetes (27,6%), pacientes con estado general comprometido (67,9%), quienes presentaron complicaciones pulmonares (54,5%) y arritmias (23%). La edad promedio encontrada en los pacientes con obesidad fue menor (55,54) en comparación con los clasificados como con sobrepeso (59,08) y normales (62,51). Se observó que a mayor IMC, menores son los valores encontrados para edad (rho = -0,190), leucocitos (rho = -0,109), urea (rho = -0,145) y dímero D (rho = -0,155). Conclusión: Este estudio proporciona evidencia de que el sobrepeso y/u obesidad se asocia con una peor condición clínica durante la hospitalización de pacientes con COVID-19. En cuanto a la frecuencia de muerte, no hubo diferencia estadística en relación al diagnóstico nutricional.

Perfil sociodemográfico e laboratorial dos pacientes submetidos à hemodiálise em um centro de referência do Estado do Ceará / Sociodemographic and laboratory profile of patients undergoing hemodialysis in a reference center in the State of Ceará / Perfil sociodemográfico y de laboratorio de dos pacientes sometidos a hemodiálisis en un centro de referencia del Estado de Ceará

A Doença Renal Crônica (DRC) é uma importante redução da função renal que causa alterações no metabolismo dos indivíduos. Para acompanhar a progressão da DRC e prevenir possíveis complicações, foi realizada uma pesquisa para avaliar o perfil sociodemográfico, bioquímico e hematológico de pacientes com Insuficiência Renal Crônica (IRC) submetidos a hemodiálise. Esta pesquisa foi quantitativa, descritiva e transversal de caráter retrospectivo, realizada por meio da análise de dados secundários contidos nos prontuários dos pacientes. A coleta de dados ocorreu no Centro de Hemodiálise da cidade de Russas, no Ceará. A amostra foi constituída por 161 pacientes com DRC, sendo 63,35% do sexo masculino e 85,71% pardos, com uma idade média de 54,39 anos. Desses, 63,97% tinham entre 2 e 10 anos de tratamento e 57,76% possuíam ensino fundamental incompleto. 19,25% residiam em Russas. Resultados: Após a hemodiálise, os resultados mostraram 44 mg/dL de Ureia, 48,44% dos pacientes com valores normais. A hemoglobina e hematócrito médios foram 11,8 g/dL e 33,7%, respectivamente, sendo que 63,35% tiveram valores reduzidos. 85,10% dos pacientes tiveram contagem de plaquetas normal, 72,04% níveis adequados de ferro e albumina, 52,79% tiveram níveis elevados de ferritina, 23,61% redução de transferrina e níveis lipídicos satisfatórios. 79,50% apresentaram níveis séricos de potássio dentro da normalidade, 12,42% de fósforo acima do normal, 85,09% de cálcio dentro dos valores normais, 39,13% de PTHi normais e 86,33% de glicose dentro dos valores considerados normais. Com base nos resultados, concluiu-se que todos os pacientes em tratamento hemodialítico apresentam diversas alterações em decorrência da DRC e do próprio processo de tratamento. Portanto, a realização de exames para avaliar ou monitorar possíveis complicações da IRC é essencial para criar estratégias e intervenções mais eficazes, que melhorem a assistência prestada a esses pacientes e, consequentemente, da qualidade e expectativa de vida dos mesmos.

Chronic Kidney Disease (CKD) is an important reduction in kidney function that causes changes in the metabolism of individuals. To monitor the progression of CKD and prevent possible complications, a survey was carried out to assess the sociodemographic, biochemical and hematological profile of patients with Chronic Renal Failure (CRF) undergoing hemodialysis. This research was quantitative, descriptive and cross-sectional with a retrospective character, carried out through the analysis of secondary data contained in the patients' medical records. Data collection took place at the Hemodialysis Center in the city of Russas, Ceará. The sample consisted of 161 patients with CKD, 63.35% male and 85.71% brown, with an average age of 54.39 years. Of these, 63.97% had between 2 and 10 years of treatment and 57.76% had incomplete primary education. 19.25% resided in Russas. Results: After hemodialysis, the results showed 44 mg/dL of Urea, 48.44% of patients with normal values. Average hemoglobin and hematocrit were 11.8 g/dL and 33.7%, respectively, with 63.35% having reduced values. 85.10% of the patients had normal platelet counts, 72.04% had adequate levels of iron and albumin, 52.79% had high levels of ferritin, 23.61% had reduced transferrin and satisfactory lipid levels. 79.50% had serum levels of potassium within the normal range, 12.42% of phosphorus above normal, 85.09% of calcium within normal values, 39.13% of PTHi normal and 86.33% of glucose within the values considered normal. Based on the results, it was concluded that all patients on hemodialysis have several changes due to CKD and the treatment process itself. Therefore, carrying out tests to assess or monitor possible complications of CRF is essential to create more effective strategies and interventions that improve the care provided to these patients and, consequently, their quality and life expectancy.

La Enfermedad Renal Crónica (ERC) es una reducción importante de la función renal que provoca cambios en el metabolismo de los individuos. Para monitorizar la evolución de la ERC y prevenir posibles complicaciones, se realizó una encuesta para evaluar el perfil sociodemográfico, bioquímico y hematológico de los pacientes con Insuficiencia Renal Crónica (IRC) en hemodiálisis. Esta investigación fue cuantitativa, descriptiva y transversal con carácter retrospectivo, realizada a través del análisis de datos secundarios contenidos en las historias clínicas de los pacientes. La recolección de datos ocurrió en el Centro de Hemodiálisis de la ciudad de Russas, Ceará. La muestra estuvo constituida por 161 pacientes con ERC, 63,35% del sexo masculino y 85,71% pardos, con una edad media de 54,39 años. De estos, 63,97% tenían entre 2 y 10 años de tratamiento y 57,76% tenían primaria incompleta. El 19,25% residía en Russas. Resultados: Posterior a la hemodiálisis los resultados arrojaron 44 mg/dL de Urea, 48,44% de los pacientes con valores normales. La hemoglobina y el hematocrito medios fueron 11,8 g/dl y 33,7 %, respectivamente, con un 63,35 % con valores reducidos. El 85,10% de los pacientes presentaba plaquetas normales, el 72,04% presentaba niveles adecuados de hierro y albúmina, el 52,79% presentaba niveles elevados de ferritina, el 23,61% presentaba transferrina reducida y niveles satisfactorios de lípidos. El 79,50% presentaba niveles séricos de potasio dentro de la normalidad, el 12,42% de fósforo por encima de lo normal, el 85,09% de calcio dentro de los valores normales, el 39,13% de PTHi normal y el 86,33% de glucosa dentro de los valores considerados normales. Con base en los resultados, se concluyó que todos los pacientes en hemodiálisis tienen varios cambios debido a la ERC y al propio proceso de tratamiento. Por tanto, la realización de pruebas para evaluar o monitorizar las posibles complicaciones de la IRC es fundamental para crear estrategias e intervenciones más eficaces que mejoren la atención a estos pacientes y, en consecuencia, su calidad y esperanza de vida.

Comparacion de las escalas Heart, Grace Score y los parámetros clínicos como predictores de eventos cardiovasculares en pacientes con dolor torácico en Urgencias / Comparison of Heart, Grace Scores and clinical parameters as predictors of cardiovascular events in patients with chest pain in the Emergency Department

Fundamentos: La valoración del riesgo de los pacientes con dolor torácico se basa en los parámetros clínicos. Sin embargo, sin un sistema de puntuación, como las escalas de estratificación del riesgo, las estimaciones son menos precisas y exactas. El objetivo de este estudio fue comparar las escalas HEART, GRACE Score y los parámetros clínicos en la predicción de eventos mayores cardiovasculares (mortalidad cardiovascular o infarto agudo de miocardio) durante la hospitalización, en pacientes con dolor torácico atendidos en Urgencias. Métodos: Se realizó un estudio observacional descriptivo de pacientes que, durante un año, acudieron a Urgencias del Hospital Universitario Miguel Servet (Zaragoza) por dolor torácico de tipo isquémico. Las puntuacionesHEART y GRACE se calcularon retrospectivamente a partir de las historias clínicas. Las variables cuantitativas se expresaron como media (±desviación estándar), y las cualitativas como frecuencias y porcentajes. Se llevó a cabo un análisis bivariante mediante la prueba chi cuadrado. El rendimiento de las escalas y parámetros clínicos se comparó mediante el cálculo del área bajo la curva. El resultado primario fue la ocurrencia de un evento mayor cardiovascular (mortalidad cardiovascular o infarto agudo de miocardio) durante el ingreso hospitalario. Resultados: Se registraron 306 pacientes (66,3% eran hombres, n=203), con edad media de 71,45±12,85 años y un 48,7% de antecedentes de cardiopatía isquémica. El área bajo la curva, para el evento primario, de las escalasHEART, GRACE y parámetros clínicos fue 0,80 (IC al 95%: 0,73-0,86), 0,79 (IC al 95%: 0,72- 0,85) y 0,74 (IC del 95%: 0,68-0,80), respectivamente. Durante la hospitalización, la incidencia del evento primario fue del 13,4% y ningún paciente de bajo riesgo, en ambas escalas, presentó un evento mayor cardiovascular. Conclusiones: En pacientes con dolor torácico de tipo isquémico atendidos en Urgencias, tanto la escala...(AU)

Background: Risk assessment of patients with chest pain is based on clinical parameters; however, without a scoring system, such as risk stratification scales, estimates are less precise and accurate. The aim of this paper was to compare the HEART, GRACE score and clinical parameters in the prediction of major cardiovascular events (cardiovascular mortality or acute myocardial infarction) during hospitalization, in patients with chest pain attended in the emergency department.Methods: A descriptive observational study of patients with ischemic chest pain, who attended to the Miguel Servet University Hospital emergency department (Zaragoza, Spain) during one year was carried out.HEART and GRACE scores were calculated retrospectively from clinical history. Quantitative variables were expressed as mean (±standard deviation), and qualitative variables as frequencies and percentages. A bivariate analysis was carried out using the chi-square test. The performance of the scales and clinical parameters was compared by calculating the area under the curve. The primary outcome was the occurrence of a major cardiovascular event (cardiovascular mortality or acute myocardial infarction) during hospital admission. Results: 306 patients were registered (66.3% men, n=203), with a mean age of 71.45±12.85 years and a 48.7% history of ischemic heart disease. The areas under the curve for HEART scales, GRACE and clinical parameters were 0.80 (95% CI: 0.73-0.86), 0.79 (95% CI: 0.72-0.85) and 0.74 (95% CI: 0.68-0.80), respectively. During hospitalization, the incidence of the primary event was 13.4% and no low-risk patient, in both scales, presented a major cardiovascular event. Conclusions: In patients with ischemic chest pain attended in the emergency department, the GRACE and HEART scale have a greater area under curve than clinical parameters.(AU)

Prevalência e desfechos materno-fetais de pacientes internadas por amniorrexe prematura no pré-termo no Hospital Universitário da Faculdade de Medicina de Jundiaí nos anos de 2020 e 2021 / Prevalence and maternal-fetal outcomes in patients hospitalized with preterm premature rupture of membranes at the University Hospital of Jundiaí's Medical School in the years 2020 and 2021

Objetivo: Atualizar a estatística do serviço, reconhecendo a prevalência de amnior- rexe prematura no pré-termo e seus principais desfechos materno-fetais. Méto- dos: Estudo transversal realizado pela análise de prontuários médicos de pacien- tes internadas devido a amniorrexe prematura no pré-termo e de seus respectivos conceptos no Hospital Universitário da Faculdade de Medicina de Jundiaí durante o período de janeiro de 2020 a dezembro de 2021. Resultados: Participaram da pesquisa 161 pacientes e 166 conceptos, resultando em uma prevalência de 2,12% no período estudado, com intervalo de confiança de 95% (1,80-2,47). Entre os des- fechos maternos, 2,5% das gestantes compunham critérios para near miss mater- no; enquanto entre os desfechos fetais, o resultado foi de 54,8% dos conceptos apresentando complicações, sendo as mais prevalentes a síndrome do desconfor- to respiratório (36,3%), icterícia (39,5%), baixo peso (27,5%) e hipoglicemia (24,2%). Além disso, 40,4% necessitaram de internação na unidade de terapia intensiva, 22,9% foram classificados como near miss neonatal e 4,4% foram a óbito. Conclu- são: Os resultados seguiram os padrões nacionais e internacionais esperados para prevalência de amniorrexe prematura no pré-termo e seus desfechos materno-fe- tais, com alta porcentagem de internações e complicações neonatais e baixa taxa de complicações maternas.

Objective: To update service statistics, recognizing the preva- lence of the pathology and its main outcomes. Methods: Cros- s-sectional study carried out through the analysis of medical records of patients hospitalized due to preterm premature rup- ture of membranes and their respective fetuses at the Univer- sity Hospital of Jundiaí's Medical School during the period from January 2020 to December 2021. Results: A total of 161 patients and 166 fetuses participated in the research, resulting in a pre- valence of 2.12% in the period studied with 95% confidence in- terval (1.80-2.47). About the outcomes, 2.5% of the pregnant wo- men composed the criteria for maternal near miss; as for the fetus, complications evolved in 54.8% of the fetuses, the most prevalent being respiratory distress syndrome (36.3%), jaundice (39.5%), low birth weight (27.5%) and hypoglycemia (24.2%). In addition, 40.4% required admission to the intensive care unit, 22.9% were neonatal near miss and 4.4% died. Conclusion: The results followed the expected national and international standards for the prevalence of preterm premature rupture of membranes and its maternal and fetal outcomes, with a high percentage of hospitalizations and neonatal complications, and a low rate of maternal complications.

Rastreabilidade dos usuários atendidos no Núcleo de Acolhimento e Pronto Atendimento de uma clínica-escola de Odontologia / Trazabilidad de los usuarios atendidos en el Centro de Acogida y Urgencias de una clínica-escuela de odontología / Traceability of users attended at the Reception and Emergency Care Center of a dental clinic-school

A pesquisa teve como objetivo verificar a rastreabilidade dos pacientes atendidos no setor de urgência do Núcleo de Acolhimento e Pronto Atendimento da Universidade Federal de Pernambuco (NAPA-UFPE), o tempo decorrido entre seu encaminhamento e a continuidade do tratamento na instituição, além de identificar o perfil dos usuários. Trata-se de estudo observacional descritivo, com coleta de dados a partir dos prontuários físicos e eletrônicos dos pacientes atendidos no segundo semestre de 2014 (2014.2) e no primeiro semestre de 2015 (2015.1). Ao total, foram analisados 373 prontuários. Em ambos os semestres houve maior prevalência do sexo feminino e da faixa etária entre 20 e 59 anos. A rastreabilidade revelou que 40,75% dos pacientes continuaram seus tratamentos na instituição. Nos semestres 2014.2 e2015.1, respectivamente, 31,20% e 82,00% dos pacientes prosseguiram com o tratamento eletivo até 30 dias após a realização do atendimento de urgência. Em conclusão, a rastreabilidade revelou maior prevalência do sexo feminino e da faixa etária adulta. O quantitativo de pacientes que deram continuidade ao tratamento na instituição em até 30 dias após o encaminhamento esteve dentro do previsto, considerando-se as características das clínicas-escola (AU).

El objetivo de la investigación fue verificar la trazabilidad de los pacientes atendidos en el sector de urgencias del Centro de Recepción y Atención de Urgencias de la Universidade Federal de Pernambuco (NAPA-UFPE), el tiempo transcurrido entre su derivación y la continuidad del tratamiento en la institución, además de identificar el perfil de los usuarios. Se trata de un estudio observacional descriptivo, con recolección de datos de los registros físicos y electrónicos de pacientes atendidos en el segundo semestre de 2014 (2014.2) y en el primer semestre de 2015 (2015.1). En total se analizaron 373historias clínicas. En ambos semestres hubo mayor prevalencia del sexo femenino y del grupo de edad entre 20 y 59 años. La trazabilidad reveló que el 40,75% de los pacientes continuaron sus tratamientos en la institución. En los semestres 2014.2 y 2015.1,respectivamente, el 31,20% y el 82,00% de los pacientes continuaron con el tratamiento electivo hasta 30 días después de la atención de emergencia. En conclusión, la trazabilidad reveló una mayor prevalencia del sexo femenino y del grupo etario adulto. Elnúmero de pacientes que continuaron el tratamiento en la institución dentro de los 30 días posteriores a la derivación estuvo dentro del rango esperado, considerando las características de las clínicas docentes (AU).

The objective of this study was to verify the traceability of patients attended in the emergency sector of the Reception and Emergency Care Center of the Federal University of Pernambuco (NAPA-UFPE), the time elapsed between their referral and the continuity of treatment at the institution, in addition to identifying the users' profile. This is a descriptive observational study, with data collection from the physical and electronic medical records of patients treated in the second half of 2014 (2014.2) and in the first half of 2015 (2015.1). A total of 373 medical records were analyzed There was a higher prevalence of females and an age group between 20 and 59 years in both semesters. The traceability revealed that 40.75% of the patients continued their treatments at the institution. Moreover, 31.20% and 82.00% of the patients in the 2014.2 and 2015.1 semesters continued with the elective treatment up to 30 days after the emergency care, respectively. In conclusion, traceability revealed a higher prevalence of females and the adult age group. The number of patients who continued treatment at the institution within 30 days after referral was within the expected range, considering the characteristics of the teaching clinics (AU).

Fatores clínicos e obstétricos de óbitos fetais em uma maternidade de alto risco / Clinical and obstetric factors of fetal death in a high-risk maternity

Objetivo: Caracterizar os fatores clínicos e obstétricos de mulheres que tiveram diagnóstico de óbito fetal em uma maternidade escola de alto risco. Metodologia: estudo de abordagem quantitativa, de corte transversal e caráter descritivo exploratório. Foram incluídos 354 prontuários de mulheres admitidas com diagnóstico e óbito fetal entre janeiro de 2018 a janeiro de 2022. Analisou-se os dados a partir da distribuição de frequências absolutas e relativas (%). Resultados: A idade média das participantes foi de 26 anos. A maioria era primípara sem perdas fetais prévias. Hipóxia Fetal Intraútero foi a causa de óbito mais frequente (17,8%). Conclusão: O óbito fetal intraútero ainda é um diagnóstico que requer mais visibilidade por parte do sistema de saúde. Foi constatada a deficiência dos registros em prontuário de dados importantes, ressaltando a necessidade de promover treinamento e capacitação para os profissionais que realizam assistência

Objective: To characterize the clinical and obstetric factors of women who were diagnosed with fetal death in a high-risk maternity hospital. Methodology: cross-sectional, analytical and retrospective study, carried out in a high-risk maternity hospital in the Central Region of Goiás. A total of 354 medical records of women admitted with a diagnosis and fetal death between January 2018 and January 2022 were included. Data were analyzed based on the distribution of absolute and relative frequencies (%). Results: The average age of the participants was 26 years old. Most were primiparous without previous fetal losses. Intrauterine Fetal Hypoxia was the most frequent cause of death (17.8%). Conclusion: Intrauterine fetal death is still a diagnosis that requires more visibility from the health system. It was verified the deficiency of records in medical records of important data, emphasizing the need to promote training and qualification for professionals who perform assistance

Oral Mucositis in Children with Leukemia Undergoing Chemotherapy: A Case Series

ABSTRACT Objective: To report nine cases of pediatric patients with Acute Lymphoid Leukemia (ALL) or Acute Myeloid Leukemia who developed severe oral mucositis (SOM) at the first week of chemotherapy. Material and Methods: The cases were selected from a sample of 105 children followed for 10 consecutive weeks. Hematological and personal data were obtained from the patient's medical records. The oral cavity was examined weekly using the modified Oral Assessment Guide. Results: More of the patients were male (55.6%), had black/brown skin (55.6%), with ALL (66.7%), and the mean age was 5.55. Two patients had values below normal for leukocytes, platelets, and creatinine over the follow-up. However, all patients showed changes in the normality of hematological data in most weeks. The most used chemotherapeutic agents were aracytin, etoposide, and methotrexate, known for their high stomatotoxic potential. Patients had 2 to 6 (mean of 4) episodes of SOM and 4 to 7 (mean of 5.5) episodes of OM. One patient at week 7, one patient at week 5, and one patient at weeks 2 and 10 did not have OM. Saliva (84 times) and lips (44 times) were the most affected items. Conclusion: The patients showed oscillations in the severity of oral mucositis and hematological parameters over the follow-up. All patients were exposed to stomatotoxic drugs during the initial phase of cancer treatment.

Tratamentos e desfechos em indivíduos internados no hospital do Juquery: o cotidiano na era Vargas / Treatments and outcomes in people hospitalized at Juquery hospital: daily life in the Vargas era / Tratamientos y resultados en personas hospitalizadas en el hospital Juquery: la vida cotidiana en la era Vargas

Objetivo: analisar os tratamentos e desfechos nos internados no Hospital do Juquery no período de 1930 a 1945. Métodos: estudo quanti-qualitativo, exploratório-descritivo, análise dos dados pelo referencial da análise documental. Coleta dos dados foi realizada no Acervo do Patrimônio Histórico-cultural do Complexo Hospitalar do Juquery, entre março e julho de 2022.Resultados: analisados 2.166 prontuários; 920 prontuários sem dados de tratamentos; 213 sem definição de tratamentos; principais tipos de tratamento 494 monoterapia e 235 politerapia; 2.005 prontuários sem dados dos efeitos dos tratamentos. Quanto ao resultado 106 inalterado/não melhorou, 21 melhorou, 18 piorou, 16 morte súbita. Houve 366 desfechos sem dados, 868 óbitos dos quais 496 não especificados, 263 saídas sem alta, 365 saídas com alta, evadidos 36 e 252 transferidos para outras instituições psiquiátricas. Conclusão: os tratamentos eram majoritariamente orgânicos e não produziram resultados efetivos; desfechos apontam para inadequação e ineficiência da assistência psiquiátrica e da internação.

Objective: to analyze the treatments and outcomes of patients admitted to the Juquery Hospital from 1930 to 1945. Methods: quanti-qualitative, exploratory-descriptive study, data analysis by the reference of documentary analysis. Data collection was carried out in the Historical-Cultural Heritage Collection of the Juquery Hospital Complex, between March and July 2022. Results: 2,166 medical records were analyzed; 920 medical records without treatment data; 213 without definition of treatments; main types of treatment: 494 monotherapy and 235 polytherapy; 2,005 medical records without data on the effects of treatments. Regarding outcome: 106 unchanged/not improved, 21 improved, 18 worsened, 16 sudden death. There were 366 outcomes without data, 868 deaths of which 496 unspecified, 263 discharged, 365 discharged, 36 absconded and 252 transferred to other psychiatric institutions. Conclusion: treatments were mostly organic and did not produce effective results; outcomes point to inadequacy and inefficiency of psychiatric care and hospitalization.

Objetivos:analizar los tratamientos y resultados de los pacientes ingresados en el Hospital de Juquery de 1930 a 1945. Métodos: estudio cuantitativo-cualitativo, exploratorio-descriptivo, análisis de datos por la referencia del análisis documental. La recolección de datos se realizó en la Colección de Patrimonio Histórico-Cultural del Complejo Hospitalario Juquery, entre marzo y julio de 2022. Resultados: se analizaron 2.166 historias clínicas; 920 historias clínicas sin datos de tratamiento; 213 sin definición de tratamientos; principales tipos de tratamiento: 494 monoterapia y 235 politerapia; 2.005 historias clínicas sin datos sobre los efectos de los tratamientos. En cuanto al resultado: 106 sin cambios/no mejoría, 21 mejoría, 18 empeoramiento, 16 muerte súbita. Hubo 366 desenlaces sin datos, 868 fallecimientos de los cuales 496 sin especificar, 263 dados de alta, 365 dados de alta, 36 fugados y 252 trasladados a otras instituciones psiquiátricas. Conclusión: los tratamientos fueron en su mayoría orgánicos y no produjeron resultados eficaces; los resultados apuntan a la inadecuación e ineficacia de la atención psiquiátrica y la hospitalización.

Comparação de desfechos clínicos e correlação entre funcionalidade e tempo de ventilação mecânica de pacientes em uti / Comparison of clinical outcomes and correlation between functionality and time of mechanical ventilation in icu patients / Comparación de los resultados clínicos y correlación entre la funcionalidad y el tiempo de ventilación mecánica de los pacientes en uti

O objetivo deste estudo foi comparar os desfechos clínicos dos pacientes em suporte ventilatório invasivo por período curto e prolongado e correlacionar funcionalidade e tempo de ventilação mecânica (VM). Estudo documental retrospectivo, realizado na UTI neurocirúrgica de um hospital escola. Dos prontuários clínicos foram coletados: idade, sexo, hipótese diagnóstica de internação, tempo de internação e de VM em dias, o desfecho sucesso ou falha da extubação e o nível de funcionalidade. Os prontuários foram divididos em grupo um (GI): pacientes em VM por até três dias e grupo dois (GII): pacientes em VM por mais de três dias. Foram analisados 210 prontuários, 73% dos pacientes permaneceram menos de três dias em VM. A idade média de GI foi 51,8±15,5 anos e GII 48,7±16,3 anos (p=0,20), prevalência do sexo masculino em GI (59%) e GII (68%). O acidente vascular cerebral foi o diagnóstico mais prevalente no GI (18%) e o tumor cerebral no GII (21%) e hipertensão arterial, a comorbidade mais prevalente em GI (28%) e GII (25%). O GII permaneceu maior tempo (p<0,0001) em VM e internação na UTI que o GI e percentual de sucesso no desmame/extubação menor (p=0,01) que o GI. Não houve correlação significativa entre funcionalidade e tempo de VM em GI e GII (p>0,05). Os pacientes em suporte ventilatório invasivo por período prolongado evoluíram com maior permanência em VM, maior tempo de internação na UTI e menor taxa de sucesso no desmame/extubação. O tempo de permanência em suporte ventilatório invasivo não interferiu na funcionalidade desses pacientes.

The aim of this study was to compare the clinical outcomes of patients on short- and long-term invasive ventilatory support and to correlate functionality and duration of mechanical ventilation (MV). Retrospective documental study, carried out in the neurosurgical ICU of a teaching hospital. The following were collected from the clinical records: age, gender, diagnostic hypothesis of hospitalization, length of hospital stay and MV in days, the outcome of success or failure of extubation and the level of functionality. The medical records were divided into group one (GI): patients on MV for up to three days and group two (GII): patients on MV for more than three days. A total of 210 medical records were analyzed, 73% of the patients remained on MV for less than three days. The mean age of GI was 51.8±15.5 years and GII 48.7±16.3 years (p=0.20), male prevalence in GI (59%) and GII (68%). Stroke was the most prevalent diagnosis in GI (18%) and brain tumor in GII (21%) and hypertension was the most prevalent comorbidity in GI (28%) and GII (25%). GII remained longer (p<0.0001) in MV and ICU admission than GI and the percentage of success in weaning/extubation was lower (p=0.01) than GI. There was no significant correlation between functionality and time on MV in GI and GII (p>0.05). Patients on invasive ventilatory support for a long period evolved with longer MV stays, longer ICU stays and lower weaning/extubation success rates. The length of stay on invasive ventilatory support did not interfere with the functionality of these patients.

El objetivo de este estudio fue comparar los resultados clínicos de los pacientes con soporte ventilatorio invasivo a corto y largo plazo y correlacionar la funcionalidad y el tiempo de ventilación mecánica (VM). Se trata de un estudio documental retrospectivo, realizado en la UCI neuroquirúrgica de un hospital universitario. Se recogieron los siguientes datos de las historias clínicas: edad, sexo, hipótesis diagnóstica, duración de la estancia y tiempo de VM en días, el resultado éxito o fracaso de la extubación y el nivel de funcionalidad. Las historias clínicas se dividieron en el grupo uno (GI): pacientes bajo VM hasta tres días y el grupo dos (GII): pacientes bajo VM durante más de tres días. Se analizaron 210 historias clínicas, el 73% de los pacientes permanecieron menos de tres días con VM. La edad media de GI fue de 51,8±15,5 años y la de GII de 48,7±16,3 años (p=0,20), con prevalencia masculina en GI (59%) y GII (68%). El ictus fue el diagnóstico más prevalente en GI (18%) y el tumor cerebral en GII (21%) y la hipertensión, la comorbilidad más prevalente en GI (28%) y GII (25%). El GII permaneció más tiempo (p<0,0001) en la VM y la estancia en la UCI que el GI y el porcentaje de éxito en el destete/extubación fue menor (p=0,01) que el GI. No hubo correlación significativa entre la funcionalidad y el tiempo de VM en GI y GII (p>0,05). Los pacientes con soporte ventilatorio invasivo a largo plazo evolucionaron con una mayor estancia en la VM, una mayor estancia en la UCI y una menor tasa de éxito de destete/extubación. La duración de la estancia con soporte ventilatorio invasivo no interfirió en la funcionalidad de estos pacientes.

Análise do perfil clínico e epidemiológico dos pacientes atendidos em um serviço terciário de dermatologia / Analysis of the clinico-epidemiological profile of patients attended in a tertiary dermatology service / Análisis del perfil clínico y epidemiológico de los pacientes atendidos en un servicio terciario de dermatología

OBJETIVO: Este artigo analisou o perfil epidemiológico e clínico dos pacientes atendidos em um serviço terciário de Dermatologia no município de Ponta Grossa-PR no período de 2016 a 2018. MÉTODOS: Trata-se de um estudo descritivo, exploratório, transversal e de abordagem quantitativa com dados coletados do prontuário médico. RESULTADOS: A maioria dos pacientes atendidos (I) era do sexo feminino; (II) com mais de 50 anos; (III) realizaram somente uma consulta, (IV) não foram submetidos a exames adicionais; e (V) apresentavam comorbidades, sobretudo, dermatológicas; o segmento corporal com maior número de lesões dermatológicas foi a cabeça; o grupo diagnóstico mais comum foi a afecção dos anexos cutâneos e o diagnóstico mais frequente foi a ceratose actínica. CONCLUSÃO: O estudo é fundamental para demonstrar quais são os pacientes e as doenças dermatológicas comumente encaminhadas para o serviço especializado, o que pode direcionar ações de prevenção primária, secundária e terciária.

OBJECTIVE: This article analyzed the epidemiological and clinical profile of patients treated at the outpatient Dermatology clinic, during 2016-2018, located in the municipality of Ponta Grossa-PR. METHODS: This is a descriptive exploratory, cross-sectional study with a quantitative approach, with data collected from the medical records. RESULTS: Most of the patients examinated: (I) were female; (II) over 50 years old; (III) attended to a single consultation; (IV) were not submitted to additional exams; and (V) had comorbidities, especially dermatological; the head was the most affected body segment; the most common diagnostic group was cutaneous annexes affections and the most frequent diagnosis was actinic keratosis. CONCLUSION: The study is fundamental to demonstrate who are the patients and which are the dermatological diseases commonly referred to the specialized service, which can guide primary, secondary and tertiary prevention actions.

OBJETIVO: Este artículo analizó el perfil epidemiológico y clínico de los pacientes atendidos en un servicio terciario de Dermatología en el municipio de Ponta Grossa-PR en el período de 2016 a 2018. MÉTODOS: Se trata de un estudio descriptivo, exploratorio y transversal con un enfoque cuantitativo con datos recogidos de las historias clínicas. RESULTADOS: La mayoría de los pacientes atendidos (I) eran mujeres; (II) tenían más de 50 años; (III) tenían una sola consulta, (IV) no se sometieron a exámenes adicionales; y (V) presentaban comorbilidades, principalmente, dermatológicas; el segmento corporal con mayor número de lesiones dermatológicas fue la cabeza; el grupo diagnóstico más común fue la afección de apéndices cutáneos y el diagnóstico más frecuente fue la queratosis actínica. CONCLUSIÓN: El estudio es fundamental para demostrar cuáles son los pacientes y las enfermedades dermatológicas que se derivan habitualmente al servicio especializado, lo que puede dirigir las acciones de prevención primaria, secundaria y terciaria.