Evaluation of the effect of Muller muscle-conjunctival resection on meibomian glands by meibography.

PURPOSE: To evaluate the effect of upper eyelid ptosis repairwith Muller muscle-conjunctival resection on meibomian gland function and ocular surface parameters. METHODS: Thirty-eight patients who underwent ptosis repair with Muller muscle-conjunctival resection were retrospectively reviewed. Meibomian gland loss, Ocular Surface Disease Index OXFORD score, meiboscore, and noninvasive keratograph break-up time were measured preoperatively and at 1st, 3rd, and 6th months postoperatively. RESULTS: Noninvasive keratograph break-up time values decreased significantly at 1st and 3rd months postoperatively compared to the preoperative level, but were similar to the preoperative level at 6th months postoperatively (p<0.001 and p=0.628, respectively). Ocular surface disease index, OXFORD score, meibomian gland loss, and meiboscore values increased significantly in the 1st and 3rd postoperative months compared to the preoperative period, but these values decreased to preoperative levels in the 6th postoperative month (p<0.001 and p>0.05, respectively). CONCLUSION: There is a transient deterioration in meibography findings and OSDI score in the early postoperative period afterMuller muscle-conjunctival resection. Patients undergoing Muller muscle-conjunctival resection may require topical lubricants, especially in the first 3 postoperative months.

Association between preoperative fasting time and clinical outcomes in surgical patients in a private general hospital.

PURPOSE: Surgical patients are routinely subjected to long periods of fasting, a practice that can exacerbate the metabolic response to trauma and impair postoperative recovery. The aim of this study was to evaluate the association between preoperative fasting time and clinical outcomes in surgical patients. METHODS: An observational, prospective study with a non-probabilistic sample that included patients of both sexes, aged over 18, undergoing elective surgeries. Data were extracted from electronic medical records, and a questionnaire was applied in 48 hours after surgery. Variables related to postoperative discomfort were assessed using an 11-point numeric rating scale. RESULTS: The sample consisted of 372 patients, and the duration of the surgical event ranged from 30-680 minutes. The incidence of nausea (26.34%) was twice that of vomiting (13.17%) and showed an association with the surgical procedure's size (p = 0.018). A statistically significant difference was observed only between pain intensity and preoperative fasting times for liquids (p = 0.007) and postoperative fasting time (p = 0.08). The occurrence of postoperative complications showed no association with preoperative fasting time (p = 0.850). CONCLUSIONS: Although no association was observed between preoperative fasting time and surgical complications, it is noteworthy that both recommended and actual fasting time exceeded the proposed on clinical guidelines.

Prospective validation of a preoperative scoring system for difficult laparoscopy cholecystectomy.

Difficult laparoscopic cholecystectomy (LC) is defined by its surgical outcomes, including operative time, conversion to open surgery, bile duct and/or vascular injury. Difficult LC can be graded based on intraoperative findings. The main objective of this study is to apply and validate the reliability of their proposed risk score to predict the operative difficulty of an LC, based on their own validated intraoperative scale. Single-center prospective cohort study from 01/2020-12-2023. 367 patients > 18 years who underwent LC were included. The preoperative risk scale and intraoperative grading system were registered. Surgical outcomes were determined. Predictive accuracy was evaluated by the Receiver Operator Characteristic curve, sensitivity, specificity, positive, and negative predictive values, and Youden's Index (J). Patients' mean age was 44.1 ± 15.3 years. According to the risk score, 39.5% LC were "low" risk difficulty, 49.3% were "medium" risk, and 11.2% were "high" risk difficult LC. Based on the intraoperative grading system, 31.9% were difficult LC (Nassar grades 3-4) and 68.1% were easy LC (Nassar grades 1-2). There was a statistically significant correlation (0.428, p < 0.05) between the preoperative risk score and the intraoperative grading system. The AUC for the preoperative risk score scale and intraoperative difficult LC was 0.735 (95% CI 0.687-0.779) (J: 0.34). A preoperative risk score > 1.5 had an 83.7% sensitivity and a 50.8% specificity for intraoperative difficult LC. A predictive preoperative score for difficult LC and a routine collection of the intraoperative difficulty should be implemented to improve surgical outcomes and surgical planning.

Preoperative hypovitaminosis D and complications in plastic surgery: a pilot study.

INTRODUCTION: Vitamin D plays a crucial role in various biological processes, including the well-known regulation of the immune system and calcium metabolism. While its involvement in the surgical outcomes of various medical specialties is recognized, there is a lack of consistent data regarding plastic surgery. This study aimed to assess preoperative serum levels of 25-hydroxyvitamin D and its relationship with complications in patients undergoing reconstructive and aesthetic plastic surgeries. METHODS: prospective and observational cohort study, conducted from October 2021 to August 2023 at the Hospital das Clínicas, Universidade Federal de Pernambuco, involving 83 patients. RESULTS: vitamin D levels were deemed deficient in 7 (8,4%) patients, insufficient in 36 (43,4%), and sufficient in 40 (48,2%). No direct association was demonstrated between deficient or insufficient serum levels of 25-hydroxyvitamin D and the incidence of complications in plastic surgery, even when considering comorbidities. CONCLUSION: preoperative hypovitaminosis D was not associated with complications in plastic surgery.

Preoperative neutrophil/lymphocyte ratio as prognostic factor in epithelial ovarian cancer / Cociente neutrófilos/linfocitos preoperatorio como factor pronóstico en el cáncer epitelial de ovario.

Objectives: To determine if there is an association between the neutrophil to lymphocyte ratio (NLR) and prognosis in patients with epithelial ovarian cancer (EOC) diagnosed and treated in a Spanish population. Material and methods: Retrospective cohort of patients with epithelial ovarian cancer who had neutrophil and lymphocyte values in complete blood count before the histopathological diagnosis and survival of at least three months, in an intermediate complexity hospital. Convenience sampling. Measured variables included age, menopausal stage, parity, International Federation of Gynecology and Obstetrics (FIGO) stage, treatment type, residual tumor, lymph node involvement, presence of ascites, cytology, histologic type, differentiation grade, and CA-125 values. Additionally, outcomes, overall survival, disease/progression-free survival were also measured. Bivariate inferential and Cox regression analyses were performed. Results: Out of 78 candidates, 60 women with EOC were included. Of them, 24 (40%) had a low NLR (≤ 2,9) while 36 (60%) had a high NLR (> 2,9). An association was found between high NLR levels and suboptimal cytoreductive surgery. High NLR ratios were associated with lower overall survival (Hazard ratio (HR): 4.1; 95% CI: 1.4-11.8) and lower 5-year disease-free survival (HR: 2.6; 95% CI: 1.2-5.7). Conclusions: A plasma neutrophil to lymphocyte ratio of more than 2.9 was associated with poor prognosis in patients with epithelial ovarian cancer in our setting. There is a need to establish the optimal cut-off point and conduct prospective studies with larger patient numbers in order to support this information.

Objetivos: evaluar si hay asociación entre los valores del cociente plasmático neutrófilos/ linfocitos (NLR) y el pronóstico en pacientes con cáncer epitelial de ovario (CEO) diagnosticadas y tratadas en una población española. Materiales y métodos: cohorte retrospectiva de pacientes con cáncer epitelial de ovario que tuvieran un recuento de neutrófilos y linfocitos en hemograma previo al diagnóstico histopatológico en un hospital de nivel medio de complejidad y posterior sobrevida de, al menos, 3 meses. Muestreo por conveniencia. Se midieron: edad, estado menopáusico, paridad, estadio Federación International de Ginecología y Obstetricia (FIGO), tipo de tratamiento, tumor residual, afectación ganglionar, presencia de ascitis, citología, tipo histológico, grado de diferenciación y cifras de CA-125; como desenlaces, sobrevida global y sobrevida libre de enfermedad o progresión. Análisis inferencial bivariado y por regresión de Cox. Resultados: de 78 candidatas, ingresaron 60 mujeres con CEO. De ellas, 24 (40%) presentaron un NLR bajo (≤ 2,9) y 36 (60 %) elevado (> 2,9). Se encontró asociación entre los niveles altos de NLR y cirugía citoreductora subóptima. Los niveles altos de NLR se asociaron a menor sobrevida global (Hazard ratio (HR): 4,1; IC 95%: 1,4-11,8) y menor sobrevida libre de enfermedad a los 5 años (HR:2,6; IC 95 %: 1,2-5,7). Conclusiones: un cociente plasmático neutrófilos/linfocitos mayor de 2,9 se asoció a un mal pronóstico en pacientes con cáncer epitelial de ovario en nuestro medio. Se necesita determinar el punto de corte óptimo y realizar estudios prospectivos con mayor número de pacientes que avalen esta información.

Learning needs and the orientation received by patients in the preoperative period of myocardial revascularization.

OBJECTIVE: To identify the learning needs and the orientations received by patients in the preoperative period of coronary artery bypass surgery (CABG). METHOD: Descriptive study, with a qualitative approach. Data collection took place from January to April 2021, through interviews carried out with 13 pre-operative patients admitted to the cardiovascular unit of a university hospital in Northeastern Brazil. The data was analyzed using descriptive statistics and the content of the interviews was processed in the software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires. Next, an analysis of textual and similarity classes was carried out. RESULTS: The learning needs that were analyzed were divided in five classes: events that precede the surgery in the hospital; instructions received about the surgery; sites and recovery time after surgery; general questions about the surgery and content for the educational resource. Patients reported needs related to the process of disease, surgical procedures, and care before and after surgery. With regard to orientation, 53.85% reported not having received any. FINAL CONSIDERATIONS: The study identified that patients seldom received orientation. They need education on topics related to the process of the illness, the heart, surgical procedures, exams, care environments, risks, benefits, results, and changes in lifestyle to maintain health and quality of life.

THE VALUE OF PREOPERATIVE PROGNOSTIC NUTRITIONAL INDEX IN GASTRIC CANCER AFTER CURATIVE RESECTION.

BACKGROUND: Predicting short- and long-term outcomes of oncological therapies is crucial for developing effective treatment strategies. Malnutrition and the host immune status significantly affect outcomes in major surgeries. AIMS: To assess the value of preoperative prognostic nutritional index (PNI) in predicting outcomes in gastric cancer patients. METHODS: A retrospective cohort analysis was conducted on patients undergoing curative-intent surgery for gastric adenocarcinoma between 2009 and 2020. PNI was calculated as follows: PNI=(10 x albumin [g/dL])+(0.005 x lymphocytes [nº/mm3]). The optimal cutoff value was determined by the receiver operating characteristic curve (PNI cutoff=52), and patients were grouped into low and high PNI. RESULTS: Of the 529 patients included, 315 (59.5%) were classified as a low-PNI group (PNI<52) and 214 (40.5%) as a high-PNI group (PNI≥52). Older age (p=0.050), male sex (p=0.003), American Society of Anesthesiologists score (ASA) III/IV (p=0.001), lower hemoglobin level (p<0.001), lower body mass index (p=0.001), higher neutrophil-lymphocyte ratio (p<0.001), D1 lymphadenectomy, advanced pT stage, pN+ and more advanced pTNM stage were related to low-PNI patient. Furthermore, 30-day (1.4 vs. 4.8%; p=0.036) and 90-day (3.3 vs. 10.5%; p=0.002) mortality rates were higher in low-PNI compared to high-PNI group. Disease-free and overall survival were worse in low-PNI patients compared to high-PNI (p<0.001 for both). ASA III/IV score, low-PNI, pT3/T4, and pN+ were independent risk factors for worse survival. CONCLUSIONS: Preoperative PNI can predict short- and long-term outcomes of patients with gastric cancer after curative gastrectomy. Low PNI is an independent factor related to worse disease-free and overall survival.

Preoperative cancer antigen-125 levels as a predictor of recurrence in early-stage endometrial cancer.

OBJECTIVE: Endometrial cancer is the most common gynecological cancer in developed countries, with a majority of cases being low-grade endometrioid endometrial cancer. Identifying risk factors for disease recurrence and poor prognosis is critical. This study aimed to assess the correlation between preoperative cancer antigen-125 levels and disease recurrence in early-stage endometrioid endometrial cancer patients. METHODS: The study was a retrospective analysis of 217 patients diagnosed with endometrioid endometrial cancer who underwent surgical treatment at a university-affiliated tertiary hospital between 2016 and 2022. Patients were divided into two groups based on their preoperative cancer antigen-125 levels and compared with clinicopathological findings and disease recurrence. Disease-free survival rates were calculated, and logistic regression analysis was performed to determine independent factors affecting disease-free survival. RESULTS: The mean age of patients was 61.59±0.75 years, and the mean follow-up time was 36.95±1.18 months. The mean cancer antigen-125 level was 27.80±37.81 IU/mL. The recurrence rate was significantly higher in the group with elevated cancer antigen-125 levels (p=0.025). Disease-free survival was lower in patients with elevated cancer antigen-125 compared with those with normal levels (p=0.005). Logistic regression analysis revealed that elevated cancer antigen-125 levels were associated with disease recurrence (OR: 3.43, 95%CI 1.13-10.37, p=0.029). CONCLUSION: The findings of this study suggest that preoperative cancer antigen-125 levels can be used as a predictor of disease recurrence in early-stage endometrioid endometrial cancer patients. cancer antigen-125 levels may be a useful tool for risk stratification and patient management in endometrial cancer.

Effects of Preoperative Nutritional Status and Lymphocyte Count on the Development of Early-term Atrial Fibrillation After Coronary Artery Bypass Grafting: A Retrospective Study.

INTRODUCTION: Although there are publications in the literature stating that parameters related to the nutritional status of patients are associated with the clinical outcomes of those with coronary artery disease, it is also stated that there is insufficient data on the relationship between nutritional indices and long-term outcomes and major adverse cardiovascular events in patients undergoing isolated coronary artery bypass grafting. METHODS: This retrospective study was conducted with patients who underwent isolated elective on-pump coronary artery bypass grafting in our hospital. Patients who underwent emergency coronary artery bypass grafting or those with known atrial fibrillation in the preoperative period were excluded. Patients were analyzed and compared in two groups according to the development of postoperative atrial fibrillation. RESULTS: The data of 93 coronary artery bypass grafting patients (71 [76%] males) with a mean age of 62.86 ± 9.53 years included in the study were evaluated. Both groups had similar preoperative ejection fraction value, hemoglobin level, age, number of distal bypasses, and postoperative mortality rates. Although the mean cardiopulmonary bypass and aortic cross-clamping times were higher in Group 1, they were not statistically significant. In our study, the mean prognostic nutrition index value was 51.76 ± 3002. CONCLUSION: According to our study results, there was no statistically significant difference between prognostic nutrition index values and the development of atrial fibrillation after coronary artery bypass grafting, which is similar to some publications in the literature. We think that it would be beneficial to conduct randomized studies involving more patients on this subject.

Functional Physical Analysis and Quality of Life in the Preoperative and Early Postoperative Periods of Cardiac Surgery and 30 Days After Hospital Discharge.

INTRODUCTION: The analysis of patients submitted to heart surgery at three assessment times has been insufficiently described in the literature. OBJECTIVE: To analyze chest expansion, maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), distance traveled on the six-minute walk test (6MWT), and quality of life in the preoperative period, fourth postoperative day (4th PO), and 30th day after hospital discharge (30th-day HD) in individuals submitted to elective heart surgery. METHODS: A descriptive, analytical, cross-sectional study was conducted with 15 individuals submitted to elective heart surgery between 2016 and 2020 who did not undergo any type of physiotherapeutic intervention in Phase II of cardiac rehabilitation. The outcome variables were difference in chest expansion (axillary, nipple, and xiphoid), MIP, MEP, distance on 6MWT, and quality of life. The assessment times were preoperative period, 4th PO, and 30th-day HD. RESULTS: Chest expansion diminished between the preoperative period and 4th PO, followed by an increase at 30th-day HD. MIP, MEP, and distance traveled on the 6MWT diminished between the preoperative period and 4th PO, with a return to preoperative values at 30th-day HD. General quality of life improved between the preoperative period and 4th PO and 30th-day HD. An improvement was found in the social domain between the preoperative period and the 30th-day HD. CONCLUSION: Heart surgery causes immediate physical deficit, but physical functioning can be recovered 30 days after hospital discharge, resulting in an improvement in quality of life one month after surgery.

Uso do Reiki em pesquisa no ambiente hospitalar: relato de experiência / Use of Reiki in hospital research: experience report / Uso de Reiki en investigación en el entorno hospitalario: relato de experiencia

Objetivo: relatar o uso do Reiki para pesquisa no ambiente hospitalar em um ensaio clínico randomizado. Método: relato de experiência sobre a aplicação do Reiki em uma pesquisa realizada a partir de um estudo piloto e um ensaio clínico randomizado para avaliação da efetividade da técnica para redução da ansiedade no pré-operatório de cirurgia cardíaca. Resultados: o Reiki foi utilizado com um protocolo padronizado aplicado em duas sessões, sendo a primeira,três dias antes da cirurgia cardíaca e a segunda na véspera. Os indicadores da execução do estudo randomizado (percentual de recusa, percentual de randomização, perda de seguimento e percentual de conclusão do estudo) mostraram boa exequibilidadee aceitação do público para a intervenção. Considerações finais: o Reiki mostrou-se como uma intervenção não farmacológica disponível para enfermeiros com boa aceitação para pacientes internados em perioperatório com potencial para ser utilizado em novos estudos.

Objective:to report the use of Reiki in hospital researchin a randomized clinical trial. Method: experience report on the use of Reiki in a research carried out in two moments -a pilot study and a randomized clinical trial to evaluate the effectiveness of the technique to reduce preoperative anxiety. Results: Reiki was applied for a standardized protocol in two sessions, the first three days before heart surgery and the day before. The indicators of the execution of the randomized trial (percentage of refusal, percentage of randomization, loss to follow-up and percentage of completion of the study) showed good feasibility and public acceptance for the intervention. Conclusions: Reiki proved to be a non-pharmacological intervention available to nurses with good acceptance for perioperative hospitalized patients with the potential to be used in new studies.

Objetivo:reportar el uso de Reiki para la investigación en el ambiente hospitalario en un ensayo clínico aleatorizado. Método:se trata de un relato de experiencia sobre el uso de Reiki en una investigación realizada en dos momentos -un estudio piloto (y un ensayo clínico aleatorizado para evaluar la efectividad de la técnica para reducir la ansiedad preoperatoria. Resultados: se utilizó Reiki mediante un protocolo estandarizado aplicado en dos sesiones, los primeros tres días antes de la cirugía cardíaca y el día anterior. Los indicadores de ejecución del ensayo aleatorizado (porcentaje de rechazo, porcentaje de aleatorización, pérdidas durante el seguimiento y porcentaje de finalización del estudio) mostraron buena viabilidad y aceptación pública de la intervención. Conclusiones: Reiki demostró ser una intervención no farmacológica disponible para enfermeras con buena aceptación para pacientes hospitalizados perioperatorios con potencial para ser utilizada en nuevos estudios.

Prognostic value of dynamic changes of pre- and post-operative tumor markers in colorectal cancer.

BACKGROUND: Colorectal cancer (CRC) prognosis assessment is vital for personalized treatment plans. This study investigates the prognostic value of dynamic changes of tumor markers CEA, CA19-9, CA125, and AFP before and after surgery and constructs prediction models based on these indicators. METHODS: A retrospective clinical study of 2599 CRC patients who underwent radical surgery was conducted. Patients were randomly divided into training (70%) and validation (30%) datasets. Univariate and multivariate Cox regression analyses identified independent prognostic factors, and nomograms were constructed. RESULTS: A total of 2599 CRC patients were included in the study. Patients were divided into training (70%, n = 1819) and validation (30%, n = 780) sets. Univariate and multivariate Cox regression analyses identified age, total number of resected lymph nodes, T stage, N stage, the preoperative and postoperative changes in the levels of CEA, CA19-9, and CA125 as independent prognostic factors. When their postoperative levels are normal, patients with elevated preoperative levels have significantly worse overall survival. However, when the postoperative levels of CEA/CA19-9/CA125 are elevated, whether their preoperative levels are elevated or not has no significance for prognosis. Two nomogram models were developed, and Model I, which included CEA, CA19-9, and CA125 groups, demonstrated the best performance in both training and validation sets. CONCLUSION: This study highlights the significant predictive value of dynamic changes in tumor markers CEA, CA19-9, and CA125 before and after CRC surgery. Incorporating these markers into a nomogram prediction model improves prognostic accuracy, enabling clinicians to better assess patients' conditions and develop personalized treatment plans.

The influence of preoperative e intraoperative factors in predicting postoperative morbidity and mortality in perforated diverticulitis: a systematic review and meta-analysis.

To determine if preoperative-intraoperative factors such as age, comorbidities, American Society of Anesthesiologists (ASA) classification, body mass index (BMI), and severity of peritonitis affect the rate of morbidity and mortality in patients undergoing a primary anastomosis (PA) or Hartmann Procedure (HP) for perforated diverticulitis. This is a systematic review and meta-analysis, conducted according to PRISMA, with an electronic search of the PubMed, Medline, Cochrane Library, and Google Scholar databases. The search retrieved 614 studies, of which 11 were included. Preoperative-Intraoperative factors including age, ASA classification, BMI, severity of peritonitis, and comorbidities were collected. Primary endpoints were mortality and postoperative complications including sepsis, surgical site infection, wound dehiscence, hemorrhage, postoperative ileus, stoma complications, anastomotic leak, and stump leakage. 133,304 patients were included, of whom 126,504 (94.9%) underwent a HP and 6800 (5.1%) underwent a PA. There was no difference between the groups with regards to comorbidities (p = 0.32), BMI (p = 0.28), or severity of peritonitis (p = 0.09). There was no difference in mortality [RR 0.76 (0.44-1.33); p = 0.33]; [RR 0.66 (0.33-1.35); p = 0.25]. More non-surgical postoperative complications occurred in the HP group (p = 0.02). There was a significant association in the HP group between the severity of peritonitis and mortality (p = 0.01), and surgical site infection (p = 0.01). In patients with perforated diverticulitis, PA can be chosen. Age, comorbidities, and BMI do not influence postoperative outcomes. The severity of peritonitis should be taken into account as a predictor of postoperative morbidity and mortality.

Aplicativos móveis sobre segurança do paciente idoso no ambiente cirúrgico: uma prospecção tecnológica / Mobile applications on the safety of elderly patients in the surgical environment: a technological prospecting

OBJETIVO: Descrever os aplicativos voltados para a segurança do paciente idoso cirúrgico nos períodos pré e pós-operatório. MÉTODO: Prospecção tecnológica com abordagem qualitativa realizada nas lojas virtuais Apple Store, Google Play e aplicativo web. Como estratégia de busca utilizou-se os termos: 'autocuidado idoso', 'pré-operatório', 'pós-operatório', 'segurança do paciente', 'segurança do paciente idoso'. RESULTADOS: Foram identificados 12 aplicativos na loja virtual Apple Store, 17 na Google Play e um web app, os quais estavam voltados a gamificação de profissionais da saúde e da população; aplicativos educacionais aos profissionais de saúde e usuários do sistema de saúde; aplicativos relacionados como ferramenta de trabalho para os profissionais de saúde; aplicativos como ferramenta de autocuidado para usuários do sistema de saúde; e, aplicativos voltados para pós-operatório de usuários do sistema de saúde. CONCLUSÃO: Não foram encontradas tecnologias voltadas para o autocuidado e segurança do paciente idoso nos períodos pré e pós-operatório

OBJECTIVE: To describe applications focused on the safety of elderly surgical patients in the pre- and postoperative periods. METHOD: Technology prospecting with a qualitative approach in the Apple Store, Google Play virtual stores, and web application. As a search strategy, the following terms were used: 'elderly self-care', 'preoperative', 'postoperative', 'patient safety', 'elderly patient safety'. RESULTS: 12 applications were identified in the Apple Store, 17 in Google Play, and a web app, which focused on the gamification of health and population professionals; educational applications to health professionals and health system users; related applications as a work tool for health professionals; applications as a self-care tool for health system users; and, post-operative applications for health system users. CONCLUSION: Technologies aimed at self-care and the safety of elderly patients were not found in the pre- and postoperative periods.

Análise do filme lacrimal e dos sintomas de olho seco em pacientes submetidos à facoemulsificação / Analysis of the tear film and dry eye symptoms in patients undergoing phacoemulsification

RESUMO Objetivo: Avaliar o filme lacrimal e os sintomas de olho seco antes e após a realização da facoemulsificação. Métodos: Participaram deste estudo clínico 51 pacientes diagnosticados com catarata (55% mulheres; 78% brancos; 71,2 ± 6,5 anos de idade; sem uso de colírio lubrificante) que foram submetidos à facoemulsificação em um hospital na cidade de Aparecida (SP). A análise do filme lacrimal foi feita pelo teste de ruptura do filme lacrimal, e os sintomas de olho seco foram avaliados pelo Índice de Doença da Superfície Ocular, ambos antes da cirurgia e 30 e 60 dias de pós-operatório. Resultados: Na análise pré-operatória, 25,5% dos pacientes tinham olho seco pelo critério subjetivo (Índice de Doença da Superfície Ocular ≥ 25%), enquanto a proporção de pacientes com olho seco foi de 92,2% pelo critério objetivo (teste de ruptura do filme lacrimal < 10 segundos). Não houve correlação entre o teste de ruptura do filme lacrimal e o Índice de Doença da Superfície Ocular (r = −0,14; p = 0,33). Não foi observada redução dos sintomas de olho seco (15,9 ± 17,6 versus 12,2 ± 13,2 versus 7,8 ± 11,5; p < 0,001) e nem do tempo de ruptura do filme lacrimal (6,2 ± 2,2 vs. 4,3 ± 2,0 versus 6,9 ± 2,0 segundos; p < 0,001) no pré, 30 e 60 dias após a cirurgia. Conclusão: A facoemulsificação desencadeia sintomas de olho seco e altera os valores do teste de ruptura do filme lacrimal e do Índice de Doença da Superfície Ocular, havendo melhora depois da cirurgia, com o passar dos dias. Observou-se que, após os 60 dias, os sintomas de olho seco avaliados pelo Índice de Doença da Superfície Ocular apresentaram melhora. Em relação ao filme lacrimal, avaliado pelo teste de ruptura do filme lacrimal, observou-se que houve piora estatisticamente significativa aos 30 dias, seguida de melhora no pós-operatório de 60 dias. Os resultados sugerem que a análise clínica do olho seco deve ser realizada por diferentes métodos, preferencialmente objetivos.

ABSTRACT Objective: To evaluate the tear film and dry eye symptoms before and after phacoemulsification. Methods: Fifty-one patients diagnosed with cataracts participated in this clinical study (55% female; 78% white; 71.2 ± 6.5 years old; without the use of lubricating eye drops) and underwent phacoemulsification at a hospital in Aparecida (SP). Tear film analysis was performed by the tear film break-up test and dry eye symptoms were assessed by the Ocular Surface Disease Index, both before surgery and 30 and 60 days after surgery. Results: In the preoperative analysis, 25.5% of the patients had dry eye according to the subjective criterion (Ocular Surface Disease Index ≥ 25%), while the proportion of patients with dry eye was 92.2% according to the objective criterion (tear film break-up test < 10 seconds). There was no correlation between tear film break-up test and Ocular Surface Disease Index (r = −0.14; p = 0.33). There was no reduction in dry eye symptoms (15.9 ± 17.6 versus 12.2 ± 13.2 versus 7.8 ± 11.5; p<0.001) nor in tear film break-up time (6.2 ± 2.2 versus 4.3 ± 2.0 versus 6.9 ± 2.0 seconds; p < 0.001) before, 30 and 60 days after surgery. Conclusion: Phacoemulsification triggers dry eye symptoms and changes Ocular Surface Disease Index and tear film break-up test values, with improvement over the postoperative days. Sixty days after surgery, the symptoms of dry eye assessed according to the Ocular Surface Disease Index improved. Regarding the tear film, evaluated by tear film break-up test, it was observed that there was a statistically significant worsening at 30 days, followed by an improvement in the postoperative period of 60 days. The results suggest that the clinical analysis of dry eye should be performed using different methods, preferably objective ones.

Impresión 3D aplicada a la planificación y la resolución quirúrgicas en la cirugía ortopédica. Serie de casos / 3D printing for surgical planning and resolution in orthopaedic surgery. Case series

Introducción: La popularidad de la cirugía asistida con impresión 3D ha crecido en los últimos 10 años. El poco empleo en nuestro medio no permite aprovechar para el paciente todas las aplicaciones y los beneficios de esta herramienta. Materiales y métodos: Estudio retrospectivo sobre enfermedad del miembro inferior en pacientes tratados en nuestra institución analizando cada etapa del proceso y su utilidad en la planificación, la ejecución quirúrgica y el desarrollo de implantes. Resultados: Se describen 12 casos en los que se utilizó la impresión 3D para tratar defectos acetabulares, resecciones tumorales óseas y secuelas en huesos largos. Conclusiones: Nuestra serie y la bibliografía revisada demuestran que la cirugía asistida con impresión 3D mejora la predictibilidad con lo planificado y reduce los tiempos quirúrgicos, el sangrado y la radiación intraoperatoria, a un costo accesible. Además, no se han comunicado complicaciones asociadas a esta tecnología. Nivel de Evidencia: IV

Introduction: The popularity of 3D printing-assisted surgery has surged over the previous decade. The tool's limited use in our context prevents us from taking advantage of all of its applications and benefits for the patient. materials and methods: A retrospective study on lower limb disease in patients treated at our institution, analyzing each stage of the procedure and its applicability in planning, surgical execution, and implant development. Results: We describe 12 cases in which 3D printing was used to treat acetabular defects, bone tumor resections, and long bone sequelae. Conclusions: Our series and the literature reviewed demonstrate that 3D printing-assisted surgery improves plan predictability while also reducing surgical times, bleeding, and intraoperative radiation at a reasonable cost. Furthermore, no complications from this technology have been reported. Level of Evidence: IV

Uso de modelos de impresión 3D en Ortopedia y Traumatología: Serie de casos / Use of 3D printing models in orthopedics and traumatology. Case series

Introducción: Comprender y tratar deformidades, defectos y fracturas complejas sigue siendo un desafío en el área de la Ortopedia y Traumatología. La aplicación de modelos de impresión 3D incluye el diagnóstico, la planificación quirúrgica, la creación de guías intraoperatorias e implantes y el entrenamiento quirúrgico. Las deformidades y fracturas articulares complejas representan un reto en el tratamiento quirúrgico debido a la complejidad tridimensional. La tecnología de impresión 3D permite simular la anatomía, la reducción de trazos fracturarios, osteotomías, y la dirección y longitud de los tornillos. El objetivo de este artículo es comunicar una serie de casos en los que se implementó la impresión 3D y presentar una revisión narrativa. Se describen dos casos de fractura de acetábulo, dos de escoliosis idiopática, una fractura del pilón tibial compleja y una fractura de astrágalo en los que se crearon modelos de impresión 3D para la planificación quirúrgica que resultaron beneficiosos tanto para el paciente como para el equipo quirúrgico. Conclusiones: Con el auge de la impresión 3D en el área de la Ortopedia y Traumatología, podremos facilitar el entendimiento de fracturas y deformidades complejas y mejorar las planificaciones prequirúrgicas. El tiempo de producción del modelo puede demorarse y ser una limitación para su uso en urgencias. Aún faltan estudios para evaluar los beneficios significativos para el paciente y el equipo médico, como la reducción del tiempo operatorio, la pérdida de sangre intraoperatoria y la exposición a la radiación. Nivel de Evidencia: IV

Introduction: Understanding and treating deformities, defects and complex fractures remains a challenge in the area of orthopedics and traumatology. 3D printing models are used for diagnostics, surgical planning, the manufacturing of intraoperative guides and implants, and surgical training. The objective of our work was to report on a series of cases where 3D printing was implemented in our service and to carry out a narrative review. The case series includes two acetabular fractures, two idiopathic scoliosis, a complex tibial pilon fracture, and a talar fracture. 3D printing models were used for surgery planning, which benefited both the patient and the surgical team. Conclusions: With the rise of 3D printing in orthopedics and traumatology, we are able to better understand fractures and complex deformities, as well as improve preoperative planning. The model's production timelines may be delayed, limiting its usefulness in an emergency. There are yet insufficient studies that report substantial benefits to the patient and medical team, such as reduced surgical time, intraoperative blood loss, and radiation exposure. Level of Evidence: IV

Internal medicine consultation for high-risk surgical patients: reflection on hospital mortality and readmission rates in a low-income country

OBJECTIVE: The objective of this study was to assess the impact of internal medicine consultation on mortality, 30-day readmission, and length of stay in surgical patients. METHODS: This is a retrospective descriptive study developed in a public Brazilian teaching hospital with 850 beds. RESULTS: A total of 70,245 patients were admitted from 2010 to 2018 to the surgery departments. The main outcomes measured were patients' mortality, 30-day readmission, and length of stay. Mortality of high-risk patients was lower when followed by internal medicine consultation: patients with ASA≥3 (RR 0.89 [95% confidence interval (95%CI) 0.80­0.99], p=0.02), patients with ASA≥3 plus≥65 years (RR 0.88 [95%CI 0.78­0.99], p=0.04), patients with ASA≥3 plus high-risk surgery (RR 0.86 [95%CI 0.77­0.97], p=0.01), and patients with ASA≥4 plus age ≥65 years (RR 0.83 [95%CI 0.72­0.96], p=0.01). The 30-day readmission of high-risk patients was lower when followed by internal medicine consultation: patients with ≥65 years (RR 0.57 [95%CI 0.37­0.89], p=0.01) and patients with high-risk surgery (RR 0.63 [95%CI 0.46­0.57], p=0.005). The Poisson multivariate regression with adjustment in variances showed that all the variables (namely, age, ASA, morbidity index, surgery risk, and internal medicine consultation) were associated with higher mortality of patients; however, internal medicine consultation was associated with a reduction of mortality in high-risk patients (RR 0.72 [95%CI 0.65­0.84], p=0.02) and an increase of mortality in low-risk patients (RR 1.55 [95%CI 1.31­1.67], p=0.01). CONCLUSION: High-risk surgical patients may benefit from perioperative internal medicine consultations, which probably decrease hospital mortality and 30-day hospital readmission.

Sintomas vocais, ansiedade e depressão pré e pós-tireoidectomia / Vocal symptoms, anxiety and depression pre and post thyroidectomy / Síntomas vocales, ansiedad y depresión pre y post tiroidectomía

Introdução: Alterações na tireoide e a tireoidectomia podem levar à sintomatologia vocal e emocional.Objetivo: Correlacionar sintomas vocais e traços de ansiedade e depressão pré e pós-tireoidectomia. Métodos: Estudo observacional, longitudinal. Participaram 20 pacientes submetidos à tireoidectomia, ao exame visual laríngeo e à Escala de Sintomas Vocais (ESV) e Escala Hospitalar de Ansiedade e Depressão (HADS) no pré-operatório, pós 1 semana e pós 3 meses, com média de idade de 54,5 anos, maior prevalência do sexo feminino (85%) e tireoidectomia parcial (70%). Resultados: Os pacientes autorreferiram sintomas vocais em todos os momentos, com maior frequência após uma semana e diferença significativa entre o domínio físico pré e pós 1 semana. Na HADS, observou-se maior escore total no pré-operatório e diferença significante nos três momentos, em todos os domínios, com maior diferença entre pré e pós 1 semana. Houve correlação positiva fraca entre os domínios limitação, emocional e escore total da ESV com a subescala de ansiedade pós 1 semana, entre o escore total da ESV e o escore total da HADS e correlação positiva moderada entre os domínios limitação e emocional da ESV com o escore total da HADS após uma semana. Conclusão: Pacientes submetidos à tireoidectomia autopercebem sintomas vocais e traços de grau leve de ansiedade tanto no pré quanto pós 1 semana e após 3 meses de cirurgia com pior autorreferência após uma semana. Quanto maior a autorreferência de sintomas vocais, mais traços de ansiedade o paciente pode apresentar. (AU)

Introduction: Thyroid alterations and thyroidectomy can lead to vocal and emotional symptoms.Purpose: To correlate vocal symptoms and anxiety and depression traits pre and post-thyroidectomy. Methods: Observational, longitudinal study. Participants were 20 patients who underwent thyroidectomy, laryngeal visual examination and the Voice Symptom Scale (VoiSS) and Hospital Anxiety and Depression Scale (HADS) preoperatively, 1 week and 3 months after, with a mean age of 54.5 years, higher prevalence of female gender (85%) and partial thyroidectomy (70%). Results: The patients self-reported vocal symptoms at all times, more frequently after one week and a significant difference between the physical domain pre and post 1 week. In HADS, there was a higher total score in the preoperative period and a significant difference in the three moments, in all domains, with a greater difference between pre and post 1 week. There was a weak positive correlation between the limitation, emotional and total score of the ESV domains with the anxiety subscale after 1 week, between the total score of the ESV and the total score of the HADS, and a moderate positive correlation between the limitation and emotional domains of the ESV with the HADS total score after one week. Conclusion: Patients undergoing thyroidectomy self-perceived vocal symptoms and mild anxiety traits both before and after 1 week and after 3 months of surgery with worse self-report after one week. The greater the self-report of vocal symptoms, the more traces of anxiety the patient may present. (AU)

Introducción: Cambios en la tiroides y tiroidectomía pueden provocar síntomas vocales y emocionales. Objetivo: Correlacionar síntomas vocales y rasgos de ansiedad y depresión antes y después de tiroidectomía. Metodos: Estudio observacional/longitudinal. Participaron 20 pacientes que se les realizó tiroidectomía, examen visual laríngeo, Escala de Síntomas Vocales (ESV) y Escala Hospitalaria de Ansiedad y Depresión (HADS) en preoperatorio, 1 semana y 3 meses después, con edad media de 54,5 años, prevalencia del género femenino (85%) y tiroidectomía parcial (70%). Resultados: Los pacientes informaron síntomas vocales en todo momento, con mayor frecuencia después de una semana y una diferencia significativa entre el dominio físico antes y después de 1 semana. En HADS, hubo mayor puntaje total en el preoperatorio y diferencia significativa en los tres momentos, con mayor diferencia entre pre y post 1 semana. Hubo una correlación positiva débil entre limitación, emocional y total de los dominios de la ESV con la subescala de ansiedad después de 1 semana, entre el total de la ESV y e total de la HADS, y una correlación positiva moderada entre la puntuación de limitación y dominios emocionales de la ESV con la puntuación total de HADS después de una semana. Conclusión: Los pacientes sometidos a tiroidectomía autopercibieron síntomas vocales y rasgos de ansiedad leve tanto antes como después de 1 semana y después de 3 meses de la cirugía con peor autoinforme después de una semana. Cuanto mayor es el autoinforme de síntomas vocales, más rastros de ansiedad puede presentar el paciente. (AU)

A Comparison Between Preoperative and Intraoperative Measurement and Classification of the Size of Rotator Cuff Tears / Uma comparação entre a medição e a classificação da ruptura do manguito rotador no pré-operatório e no intraoperatório

Abstract Purpose To evaluate the agreement in tear size obtained through preoperative imaging and intraoperative measurement, and to determine the accuracy of preoper-ative imaging in the classification of tear size and identification of tears in each rotator cuff tendon. Methods Data from 44 patients recruited to a randomized controlled trial were reviewed retrospectively. Size and location of the rotator cuff tears were confirmed by either ultrasound or magnetic resonance imaging scans preoperatively and evaluated during surgery. A t-test and Bland and Altman plot were used to determine the agreement between the preoperative and intraoperative measurements. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for tear size and involvement of the rotator cuff tendon. Results There was good agreement in terms of the measurements (91%) and classification (89%) of the tear size preoperatively and during surgery. When classifying tear size, the sensitivity and PPV were high for medium-sized tears (100%) and lower for large tears (75%), reflecting that all medium-sized tears but not all large tears were identified preoperatively. For the preoperative identification of the tears, the sensitivity and PPV were highest for the supraspinatus (84%), with progressively lower sensitivities and PPV for the infraspinatus (57%), subscapularis (17%) and teres minor (0%). Conclusions Through preoperative imaging, the measurement or classification of the tear size can be accurately performed. Where there is disagreement, it is unclear whether the tear size is either underestimated on the scan or overestimated during surgery. The high sensitivity demonstrates that a supraspinatus tear is usually detected by scan. The lower sensitivities for the infraspinatus and subscapularis indicate that the identification of tears in these tendons is less accurate.

Resumo Objetivo Avaliar a concordância no tamanho de ruptura obtido por imagem préoperatória e por medição intraoperatória, e determinar a precisão da imagem préoperatória na classificação do tamanho da ruptura e na identificação de rupturas em cada tendão do manguito rotador. Métodos Os dados de 44 pacientes recrutados para um ensaio controlado randomizado foram revisados retrospectivamente. O tamanho e a localização do manguito rotador foram confirmados por ultrassom ou ressonância magnética préoperatórios, e avaliados durante a cirurgia. Um teste t e o gráfico de Bland e Altman foram usados para determinar a concordância entre as medições pré-operatória e intraoperatória. Sensibilidade, especificidade, valor preditivo positivo (VPP) e valor preditivo negativo (VPN) foram calculados para o tamanho do rompimento e o envolvimento do tendão do manguito rotador. Resultados Houve boa concordância para medidas de tamanho da ruptura (91%) e classificação (89%) pré-operatória e durante a cirurgia. Ao classificar o tamanho da ruptura, a sensibilidade e o VPP foram elevados para rupturas de tamanho médio (100%), e menor para rupturas grandes (75%), o que indica que todas as rupturas de tamanho médio, mas nem todas as grandes, foram identificadas pré-operatoriamente. Para a identificação de rupturas, a sensibilidade pré-operatória e o VPP foram maiores para o supraespinal (84%), com sensibilidade e VPP progressivamente menores para o infraespinal (57%), o subescapular (17%), e o redondo menor (0%). Conclusões Por meio da imagem pré-operatória, pode-se medir ou classificar com precisão o tamanho da ruptura. Quando há discordância, não está claro se o tamanho da ruptura é subestimado no exame ou superestimado durante a cirurgia. A alta sensibilidade demonstra que uma ruptura do supraespinal é geralmente detectada por escaneamento. As sensibilidades mais baixas para o infraespinal e o subescapular indicam que a identificação de rupturas nestes tendões é menos precisa.