RISK FACTORS ASSOCIATED WITH FRACTURE OF THE LUMBOSACRAL SPINE AND ITS COMPROMISE IN THE QUALITY OF LIFE OF CIRRHOTICS.

BACKGROUND: Chronic hepatic disease is associated with osteoporosis, osteopenia or osteomalacia. Osteoporosis and fractures due to bone fragility present high prevalences and are more frequent in patients with liver cirrhosis than in the general population. The search for a diagnosis of osteopenia and osteoporosis in this population may allow early intervention and modify unfavorable outcomes. OBJECTIVE: To know the prevalence of osteopenia or osteoporosis and of fracture due to bone fragility in individuals with liver cirrhosis, the associated risk factors, and its compromise in their quality of life (QoL). METHODS: Observational, transversal study performed with 71 liver cirrhosis patients of the Hepatology Service of the Hospital de Base do Distrito Federal, Brasília, DF, Brazil, between July 2017 and December 2018. The patients were submitted to bone densitometry (DXA) of the lumbar spine and of the femoral neck, to x-ray of the lumbosacral spine and to the Chronic Liver Disease Questionnaire (CLDQ) for the evaluation of quality of life (QoL). The Fracture Risk Assessment (FRAX) major was calculated for patients >50 years old. The analyses were performed for the evaluation of the risk factors associated with lumbosacral spine fracture. RESULTS: The majority (62%) of the 71 evaluated patients was diagnosed with osteoporosis or osteopenia on DXA. Of the 44 patients with osteopenia or osteoporosis, 52.3% were female, with a mean age of 62.6±9.51 years old, with the majority (72.7%) being Child A, cirrhotics of alcoholic etiology (36.4%), and with an intermediate QoL according to the CLDQ (3.3). Regarding the patients with lumbosacral spine fracture, the mean age was 61.6±11.1 years old, 60% were female, most of them Child A (66.7%), of alcoholic etiology (46.7%), and with an intermediary QoL according to the CLDQ (3.5). The presence of osteopenia and/or osteoporosis was associated with lumbosacral fracture (P<0.001), without correlation with the other analyzed variables: age, body mass index, gender, presence and absence of ascites, Child-Pugh classification, vitamin D, calcium, and phosphorus serum concentration, cirrhosis etiology and FRAX major. CONCLUSION: The prevalence of hepatic osteodystrophy was high, and the occurrence of lumbosacral spine fracture was more associated with osteoporosis and/or osteopenia among the cirrhotic patients studied. The QoL was intermediate and with no differences between cirrhotics with and without fracture.

Fatores de risco associados à fratura de coluna lombossacra e seu comprometimento na qualidade de vida em cirróticos / Risk factors associated with fracture of the lumbosacral spine and its compromise in the quality of life of cirrhotics

ABSTRACT Background Chronic hepatic disease is associated with osteoporosis, osteopenia or osteomalacia. Osteoporosis and fractures due to bone fragility present high prevalences and are more frequent in patients with liver cirrhosis than in the general population. The search for a diagnosis of osteopenia and osteoporosis in this population may allow early intervention and modify unfavorable outcomes. Objective To know the prevalence of osteopenia or osteoporosis and of fracture due to bone fragility in individuals with liver cirrhosis, the associated risk factors, and its compromise in their quality of life (QoL). Methods Observational, transversal study performed with 71 liver cirrhosis patients of the Hepatology Service of the Hospital de Base do Distrito Federal, Brasília, DF, Brazil, between July 2017 and December 2018. The patients were submitted to bone densitometry (DXA) of the lumbar spine and of the femoral neck, to x-ray of the lumbosacral spine and to the Chronic Liver Disease Questionnaire (CLDQ) for the evaluation of quality of life (QoL). The Fracture Risk Assessment (FRAX) major was calculated for patients >50 years old. The analyses were performed for the evaluation of the risk factors associated with lumbosacral spine fracture. Results The majority (62%) of the 71 evaluated patients was diagnosed with osteoporosis or osteopenia on DXA. Of the 44 patients with osteopenia or osteoporosis, 52.3% were female, with a mean age of 62.6±9.51 years old, with the majority (72.7%) being Child A, cirrhotics of alcoholic etiology (36.4%), and with an intermediate QoL according to the CLDQ (3.3). Regarding the patients with lumbosacral spine fracture, the mean age was 61.6±11.1 years old, 60% were female, most of them Child A (66.7%), of alcoholic etiology (46.7%), and with an intermediary QoL according to the CLDQ (3.5). The presence of osteopenia and/or osteoporosis was associated with lumbosacral fracture (P<0.001), without correlation with the other analyzed variables: age, body mass index, gender, presence and absence of ascites, Child-Pugh classification, vitamin D, calcium, and phosphorus serum concentration, cirrhosis etiology and FRAX major. Conclusion The prevalence of hepatic osteodystrophy was high, and the occurrence of lumbosacral spine fracture was more associated with osteoporosis and/or osteopenia among the cirrhotic patients studied. The QoL was intermediate and with no differences between cirrhotics with and without fracture.

RESUMO Contexto A doença hepática crônica associa-se com osteoporose, osteopenia ou osteomalácia. A osteoporose e as fraturas por fragilidade óssea têm altas prevalências e são mais frequentes em pacientes com cirrose hepática do que na população geral. A busca por osteopenia e osteoporose nesta população pode permitir a intervenção precoce e modificar os desfechos desfavoráveis. Objetivo Conhecer a prevalência de osteopenia ou osteoporose e de fraturas por fragilidade óssea em portadores de cirrose hepática, fatores de risco associados e seu comprometimento na qualidade de vida. Métodos Estudo observacional e transversal realizado com 71 pacientes portadores de cirrose hepática do Serviço de Hepatologia do Hospital de Base do Distrito Federal, Brasília, DF, Brasil, no período de julho de 2017 a dezembro de 2018. Os pacientes foram submetidos à densitometria óssea de coluna lombar e colo de fêmur, raio-x de coluna lombo sacra e ao questionário Chronic Liver Disease Questionnaire (CLDQ, na sigla em inglês) para avaliação de qualidade de vida. Foi calculado o escore de Fracture Risk Assessment Tool "FRAX Maior" nos pacientes >50 anos. As análises foram realizadas para a avaliação dos fatores de risco associados à fratura de coluna lombo sacra. Resultados Dos 71 pacientes avaliados, a maioria (62%) foi diagnosticada com osteoporose ou osteopenia à densitometria. Dos 44 portadores de osteopenia ou osteoporose, 52,3% eram do sexo feminino, com idade média de 62,6±9,51 anos, sendo a maioria (72,7%) Child A, cirróticos de etiologia alcoólica (36,4%) e com qualidade de vida intermediária ao CLDQ (3,3). Dos pacientes com fratura de coluna lombo sacra, a média de idade foi de 61,6±11,1 anos, 60% eram do sexo feminino, a maioria Child A (66,7%), de etiologia alcoólica (46,7%), e apresentaram qualidade de vida intermediária ao CLDQ (3,5). A presença de osteopenia e/ou osteoporose esteve associada à fratura lombo sacra (P<0,001), sem correlação com as demais variáveis analisadas: idade, índice de massa corporal (IMC), gênero, presença e ausência de ascite, classificação de Child-Pugh, concentrações séricas de vitamina D, cálcio e fósforo, etiologia da cirrose e "FRAX maior". Conclusão A prevalência de osteodistrofia hepática foi elevada, e a ocorrência de fratura de coluna lombo sacra esteve mais associada à osteoporose e/ou osteopenia entre cirróticos estudados. A qualidade de vida se mostrou intermediária e sem diferença entre cirróticos com e sem fratura.

Safety culture in the perception of public-hospital health professionals.

OBJECTIVE: Evaluating safety culture in the perception of professionals working in public hospitals of the Unified Health System (SUS) of Distrito Federal, Brazil, three years after the implementation of the National Patient Safety Program (PNSP). METHODS: Analytical cross-sectional study conducted in eleven public hospitals using the Safety Attitudes Questionnaire (SAQ) in electronic format. Stratified sampling was estimated according to the proportion of the total number of professionals in each hospital, as well as the representativeness of each professional group. The results of the total score and domains equal to or greater than 75 were considered positive. Descriptive and inferential analyses of professional groups and hospitals were carried out. RESULTS: 909 professionals participated. The total score by professional group was negative (62.5 to 69.5) and the domains differed statistically in all cases. The eleven hospitals had a negative total score (61.5 to 68.6). The domains to attain positive performance were job satisfaction, stress recognition and teamwork climate. The lowest results were in working conditions and management perception domains, for which none of the hospitals had an average above 75. Differences were also found for domain means across hospitals, except in management perception. DISCUSSION: Three years after the implementation of PNSP, the safety culture in eleven hospitals evaluated was weak, although the domains of job satisfaction, stress recognition and teamwork climate had positive results. The results can contribute to decision-making by managers, as safety culture is an essential element in the implementation of patient safety policy.

Implementation and Monitoring of a Telemedicine Model in Acromegalic Outpatients in a Low-Income Country During the COVID-19 Pandemic.

Background: Telemedicine is a resource to provide health care to patients social distancing and prevent their exposure to the risk of contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in medical-hospital settings. This study evaluated a virtual model of care in acromegalic patients. Methods: We recruited 78 acromegalic patients, 65% female, median age 63 years. Outpatient management was remodeled to simplify access to care by (1) adoption of virtual meetings; (2) collection of blood samples at home; (3) abolishment of printed prescription and provision of electronic files directly to central pharmacy; and (4) drugs delivered to patients' home. Patients and physicians filled electronic surveys 48 h after each consultation. Results: The patients expressed satisfaction with convenience (91.1%), decreased wait time (85.1%), and saving money (79.2%) compared to face-to-face visits. Most patients felt supported by the medical team (89.1%) and kept the prescriptions updated (84.8%). The physicians reported resolutive appointments in 92.2% of cases, despite longer time to reach the patients and subsequent calls to complement missing information. Satisfaction and patient-provider relationship were maintained during the study, but the choice for virtual appointment for the next appointment fell from 78.7% to 34.8% after 6 months. Coronavirus disease 2019 (COVID-19) was confirmed in 13% of patients, mostly mild and moderate manifestations. Conclusion: Telemedicine is a tool for medical care in underserved populations, feasible even in low-income countries. This study suggests that it is difficult to sustain exclusive remote care for more than 6 months. The method could be adopted interchangeably with in-person consultations in acromegalic patients with stable disease.

Safety culture in the perception of public-hospital health professionals / Cultura de segurança na percepção dos profissionais de saúde de hospitais públicos

ABSTRACT OBJECTIVE Evaluating safety culture in the perception of professionals working in public hospitals of the Unified Health System (SUS) of Distrito Federal, Brazil, three years after the implementation of the National Patient Safety Program (PNSP). METHODS Analytical cross-sectional study conducted in eleven public hospitals using the Safety Attitudes Questionnaire (SAQ) in electronic format. Stratified sampling was estimated according to the proportion of the total number of professionals in each hospital, as well as the representativeness of each professional group. The results of the total score and domains equal to or greater than 75 were considered positive. Descriptive and inferential analyses of professional groups and hospitals were carried out. RESULTS 909 professionals participated. The total score by professional group was negative (62.5 to 69.5) and the domains differed statistically in all cases. The eleven hospitals had a negative total score (61.5 to 68.6). The domains to attain positive performance were job satisfaction, stress recognition and teamwork climate. The lowest results were in working conditions and management perception domains, for which none of the hospitals had an average above 75. Differences were also found for domain means across hospitals, except in management perception. DISCUSSION Three years after the implementation of PNSP, the safety culture in eleven hospitals evaluated was weak, although the domains of job satisfaction, stress recognition and teamwork climate had positive results. The results can contribute to decision-making by managers, as safety culture is an essential element in the implementation of patient safety policy.

RESUMO OBJETIVO Avaliar a cultura de segurança na percepção dos profissionais que trabalham nos hospitais públicos do Sistema Único de Saúde (SUS) do Distrito Federal, Brasil, três anos após a implantação do Programa Nacional de Segurança do Paciente (PNSP). MÉTODOS estudo transversal analítico realizado em onze hospitais públicos por meio do Safety Attitudes Questionnaire em formato eletrônico. A amostragem estratificada foi calculada, obedecendo à proporção do total de profissionais em cada hospital, assim como a representatividade de cada grupo profissional. Os resultados do escore total e dos domínios iguais ou maiores que 75 foram considerados positivos. Realizadas análises descritivas e inferenciais dos grupos profissionais e dos hospitais. RESULTADOS Participaram 909 profissionais. O escore total por grupo profissional foi negativo (62,5 a 69,5) e por domínio diferiram estatisticamente entre si em todos. Os onze hospitais tiveram escore total negativo (61,5 a 68,6). Os domínios com desempenho positivo foram satisfação no trabalho, percepção do estresse e clima de trabalho em equipe. Os resultados mais baixos foram condições de trabalho e percepção da gerência, e nenhum dos hospitais obteve média superior à 75 nesses domínios. Também foram encontradas diferenças nas médias dos domínios entre os hospitais, exceto em percepção da gerência. DISCUSSÃO Após três anos de implantação no PNSP, a cultura de segurança nos onze hospitais avaliados se mostrou fragilizada, embora os domínios satisfação no trabalho, percepção do estresse e clima de trabalho em equipe tiveram resultados positivos. Os resultados podem contribuir para a tomada de decisão dos gestores, pois a cultura de segurança é um elemento essencial na implementação da política de segurança do paciente.

Entropy and uniformity as additional parameters to optimize the effectiveness of bone CT in the evaluation of acromegalic patients.

PURPOSE: Acromegaly is considered an important cause of secondary osteoporosis. However, studies on bone mineral density (BMD) have yielded conflicting results and there are few studies that evaluate an accurate imaging method for early diagnosis of osteoporosis in these patients. The objective of this study was to assess whether entropy and uniformity on computed tomography (CT) scans are useful parameters for optimization of assessment of bone fragility in patients with acromegaly. METHODS: We included 34 patients and 36 controls matched for age and sex in a cross-sectional study. Patients and controls underwent CT scan of the lumbosacral spine, dual-energy x-ray absorptiometry (DXA) and blood tests. A software was developed to calculate the entropy and uniformity by a region of interest (ROI) of the trabecular bone of the first lumbar vertebra (L1). RESULTS: The acromegalic group presented higher mean bone entropy (6.87 ± 0.98 vs. 6.03 ± 1.68, p = 0.013) and lower mean bone uniformity (0.035 ± 0.704 vs. 0.113 ± 0.205, p = 0.035) than control group. Analyzing only acromegalics, mean bone entropy was higher and bone uniformity was lower in patients with hypogonadism than patients without hypogonadism (7.28 ± 0.36 vs. 6.74 ± 1.08, p = 0.038 and 0.008 ± 0.002 vs. 0.043 ± 0.079, p = 0.031) respectively. Patients with acromegaly presented higher BMD and Z-score in the femoral neck than control group (1.156 ± 0.108 vs. 0.925 ± 0.326 g/cm2, p = 0.043 and 0.6 ± 0.6 vs. -0.05 ± 0.8, p = 0.041, respectively). Entropy was negatively correlated with T-score of the lumbar spine (rp = -0.357, p = 0.033) in control group and uniformity was positively correlated with T-score of the lumbar spine, neck, and total hip, respectively (rp = 0.371, p = 0.031; rp = 0.348, p = 0.043 and rp = 0.341, p = 0.049) in acromegalic group. CONCLUSIONS: The study identified that entropy and uniformity are a relevant parameters data in bone fragility assessment in acromegalic patients.

What Is the Impact of Residual Obesity on the Risk for Postoperative Body-Contouring Surgery Complications in Postbariatric Patients?

BACKGROUND: There are an increasing number of patients presenting for plastic surgery after massive weight loss, and many of these patients have residual obesity that may compromise outcomes. The impact of residual obesity on the development of postoperative complications in postbariatric patients undergoing plastic surgery procedures is unclear. METHODS: We report the outcomes of 207 patients who underwent plastic surgery following RYGB from January 2011 to December 2018. RESULTS: Two hundred and seven patients (196 females, 11 males) with a mean age of 42 years underwent 335 separate operations. The average BMI at the time of plastic surgery was 27.43 kg/m2. The average weight loss was 47.08 kg. The prevalence of comorbidities was 26.6% and the most important presurgery comorbidities were arterial hypertension (10.1%) and diabetes mellitus (4.8%). Of the 207 patients who underwent surgery, 78.3% (168/207) underwent abdominoplasty and 45.0% underwent mammoplasty. The overall rate of complications was 27.5%. The prevalence of postoperative complications was not significantly different between patients with a BMI ≥ 30 kg/m2 and patients with a BMI < 30 kg/m2 (33.3% vs 25.9%, respectively; p = 0.344). CONCLUSION: In this group of patients, with specified anthropometric and clinical profiles, the residual obesity did not influence the incidence of postoperative complications in postbariatric patients after plastic surgery.

Long-term real-life outcomes in a georrefered cohort of acromegalic patients in Brazil.

PURPOSE: Epidemiological data on acromegaly therapeutic outcomes in real-life conditions are scarce in Brazil. Information on the geographical accessibility to the dispensation of medicines and its impact on biochemical control is also poorly known. We aimed to describe the clinical outcomes of long-term therapy in patients with acromegaly at a referral medical centre in Brazil and to perform a spatial analysis of patients according to the distance from home to the drug-dispensing pharmacies aiming to evaluate its impact on biochemical control. METHODS: Global retrospective data analysis of 111 patients followed at the University Hospital of Brasília from January 1980 to March 2015 was performed, as well as a separate review of 17 new cases operated on from April 2015 to June 2019 according to surgery results. Spatial analysis of patients under pharmacological treatment applying Geographic Information System (GIS) software (ArcGIS, ESRI, Redlands, CA) was performed. RESULTS: Considering surgery alone, the cure rate was 23% from 1980 to 2015 and 29.4% from 2015 to 2019. In the long-term follow-up of the 111 patients from 1980 to 2015, 25.2% (n = 29) were cured, 40.6% (n = 44) presented controlled disease and 34.2% (n = 38) were biochemically uncontrolled after a period of follow-up of 8.9 ± 6.4 years. Biochemical control obtained in patients on pharmacological treatment (n = 76) was 58% (n = 44) after 5.8 ± 3.8 years. The distance from home to the drug-dispensing pharmacy did not influence biochemical control (p = 0.7616). CONCLUSIONS: Most patients presented with disease under control. No evidence on the effect of the distance between home and drug-dispensing pharmacies on biochemical control was obtained.

The Effect of Cognitive-Behavioral Therapy on Acromegalics After a 9-Month Follow-Up.

Introduction: The quality of life of acromegalics is compromised. Treatment with the "Think healthy and feel the difference" technique has been described as effective in the improvement of the quality of life of these patients in the short term. However, its effectiveness in the long term needs to be evaluated. Objective: The purpose of this study was to evaluate whether the good results obtained from the "Think healthy and feel the difference" technique in the short term persists in the long term, after the end of the treatment. Method: This is a non-randomized longitudinal study with 23 acromegalic divided into two groups: an intervention group with 10 patients and a control group with 13 patients. The intervention itself covered nine group sessions, organized weekly, using a technique called "Think healthy and feel the difference." The control group did not receive the aforementioned treatment. The Short Form 36 Question Health Survey (SF-36) and the Beck Depression Inventory were administered before the sessions began, at the end of the nine therapy sessions and at the 9-month follow-up. Results: At the end of the treatment, the results of the SF-36 showed improvement in the mental health of the intervention group compared to the control group. The effects of therapy were maintained at the 9 month follow-up. Conclusion: Cognitive-behavioral therapy, applied in a group format, can improve the quality of life of acromegalic patients in the short- and long-term.

Giant cabergoline-resistant prolactinoma in a man who presented with a psychotic episode during treatment: a case report.

BACKGROUND: Prolactinomas are tumors of the pituitary gland that usually respond very well to treatment with cabergoline. Resistance to cabergoline is very rare, but when it occurs, it is a difficult problem to resolve if the tumor is inoperable. CASE PRESENTATION: A 62-year-old white man was treated for a giant macroprolactinoma detected during investigation of a subacute subdural hematoma of the left frontal lobe. The patient was treated with cabergoline for 17 years with a dose ranging from 1.0 mg to 3.5 mg per week. We were not able to normalize his prolactin level, which initially was 14,992 ng/ml and ultimately 1754 ng/ml. The tumor significantly shrank during the follow-up period but persisted. The patient had cardiac valvulopathies that did not worsen. He had an ischemic stroke and developed a psychotic condition that was successfully treated by lowering the cabergoline and administering quetiapine and mirtazapine together. This regimen led to a small increase in the patient's prolactin that returned to previous levels and remained as such until the last medical evaluation. The tumor continued to shrink and had a cystic degeneration in the last evaluation. CONCLUSIONS: Combined use of cabergoline with quetiapine and mirtazapine to treat a psychotic crisis may have contributed to shrinking the tumor in our patient because these antipsychotics have action mediated by growth factors that interfere with growth of pituitary tumors.

Assessment of safety culture in a public hospital in the Federal District, Brazil.

OBJECTIVE: to assess the perception of health professionals regarding safety culture of a high complexity public hospital of the Federal District, Brazil. METHOD: cross-sectional and descriptive study. The Safety Attitudes Questionnaire was used in electronic format. Descriptive and inferential analyses were carried out. RESULTS: 358 professionals participated, with 242 (67.6%) being female. Of these, 224 (62.6%) worked directly or indirectly with patients in assistance activities; 79 (22.1%) in administrative activities; 14 (3.9%) in management; and 41 (11.5%) in others. The total score was 57.1. Job satisfaction factors and stress perception had the most expressive results, 76.2 and 68.8, respectively. The category "working conditions" presented the lowest result, 40.7. CONCLUSION: the results are below the score of 75, value recommended as indicative of a positive safety atmosphere. We suggest the implementation of actions for the promotion of safety culture and new studies with representative samples of all segments of workers.

Quality of life and predictive factors for complications in patients undergoing abdominoplasty after gastric bypass: A retrospective cohort.

BACKGROUND: Obesity is a major health risk factor associated with medical complications, such as cardiovascular disease, that may compromise outcomes. Furthermore, obesity may lead to difficulties in daily life, altering the quality of life and generating psychological disorders such as devalued self-image and depression. OBJECTIVES: This study evaluated the quality of life and predictive factors of postoperative complications in patients who underwent abdominoplasty after Roux-en-Y gastric bypass. SETTING: Bariatric and postbariatric center, North Wing Regional Hospital, Brasília, Brazil. METHODS: Data were analyzed from a prospective registry of postbariatric patients who underwent abdominoplasty from January 2011 to December 2016. Variables examined included age, sex, body mass index (BMI), complications, and comorbidities. Multivariate analyses were performed to assess outcome measures. The quality-of-life assessment was measured with the Moorehead-Ardelt quality-of-life questionnaire. RESULTS: One hundred and seven postbariatric patients were included. The mean age of the patients was 41 years. BMI at the time of abdominoplasty (current BMI) was 27.6 ± 3.7 kg/m2, and the average weight loss before abdominoplasty was 47.7 ± 17.3 kg. Pre-weight loss BMI (max BMI) was 45.5 ± 7.6 kg/m2, and ∆BMI was 18.6 ± 9.3 kg/m2. The overall rate of complications was 23.4%. Among the studied factors in the multivariate analysis, amount of removed tissue in the abdomen >2000 g, ∆BMI >20 kg/m2, and age >40 years significantly increased the rates of postoperative complications. In our study, abdominoplasty improved the quality of life of patients (mean quality-of-life scores, 2.1 ± 0.9). CONCLUSION: The amount of removed tissue in the abdomen, ∆BMI >20 kg/m2, and age >40 years led to significantly more complications in patients undergoing abdominoplasty after gastroplasty. In addition, this study demonstrated that abdominoplasty should be proposed to patients with massive weight loss to improve quality of life.

Assessment of safety culture in a public hospital in the Federal District, Brazil / Evaluación de la cultura de seguridad en un hospital público en el Distrito Federal, Brasil / Avaliação da cultura de segurança em um hospital público no Distrito Federal, Brasil

ABSTRACT Objective: to assess the perception of health professionals regarding safety culture of a high complexity public hospital of the Federal District, Brazil. Method: cross-sectional and descriptive study. The Safety Attitudes Questionnaire was used in electronic format. Descriptive and inferential analyses were carried out. Results: 358 professionals participated, with 242 (67.6%) being female. Of these, 224 (62.6%) worked directly or indirectly with patients in assistance activities; 79 (22.1%) in administrative activities; 14 (3.9%) in management; and 41 (11.5%) in others. The total score was 57.1. Job satisfaction factors and stress perception had the most expressive results, 76.2 and 68.8, respectively. The category "working conditions" presented the lowest result, 40.7. Conclusion: the results are below the score of 75, value recommended as indicative of a positive safety atmosphere. We suggest the implementation of actions for the promotion of safety culture and new studies with representative samples of all segments of workers.

RESUMEN Objetivo: evaluar la percepción de los profesionales de salud sobre la cultura de seguridad de un hospital público de alta complejidad del Distrito Federal, Brasil. Método: estudio transversal y descriptivo. Se utilizó el Cuestionario Actitudes de Seguridad en el formato electrónico. Se realizaron análisis descriptivos e inferenciales. Resultados: participaron 358 profesionales, siendo 242 (67,6%) mujeres. De estos, 224 (62,6%) trabajaban directa o indirectamente con el paciente en actividades asistenciales; 79 (22,1%) en administrativas; 14 (3,9%) en gerenciales; y 41 (11,5%) en otras. La puntuación total fue de 57,1; los factores de satisfacción en el trabajo y percepción del estrés tuvieron los resultados más expresivos, 76,2 y 68,8, respectivamente. La categoría de las condiciones de trabajo tuvo el resultado más bajo, 40,7. Conclusión: los resultados están por debajo de la puntuación 75, valor recomendado como indicativo de un clima de seguridad positivo. Se sugiere la implementación de acciones para la promoción de la cultura de seguridad y nuevos estudios con muestra representativa de todos los segmentos de trabajadores.

RESUMO Objetivo: avaliar a percepção dos profissionais de saúde sobre a cultura de segurança de um hospital público de alta complexidade do Distrito Federal, Brasil. Método: estudo transversal e descritivo. Utilizou-se o Questionário Atitudes de Segurança no formato eletrônico. Foram realizadas análises descritivas e inferenciais. Resultados: participaram 358 profissionais, sendo 242 (67,6%) do sexo feminino. Destes, 224 (62,6%) trabalhavam direta ou indiretamente com o paciente em atividades assistenciais; 79 (22,1%) em administrativas; 14 (3,9%) em gerenciais; e 41 (11,5%) em outras. O escore total foi de 57,1; os fatores satisfação no trabalho e percepção do estresse tiveram os resultados mais expressivos, 76,2 e 68,8, respectivamente. O quesito condições de trabalho teve o resultado mais baixo, 40,7. Conclusão: os resultados estão abaixo do escore 75, valor recomendado como indicativo de um clima de segurança positivo. Sugere-se a implementação de ações para a promoção da cultura de segurança e novos estudos com amostra representativa de todos os segmentos de trabalhadores.

What Is the Impact of Comorbidities on the Risk for Postoperative Body-Contouring Surgery Complications in Postbariatric Patients?

BACKGROUND: There is an increasing number of patients presenting after massive weight loss for plastic surgery, and many of these patients have residual diseases that may compromise outcomes. This study aims to evaluate the impact of comorbidities on the development of postoperative complications in postbariatric patients undergoing plastic surgery procedures at the Federal District North Wing Regional Hospital, Brasília, Brazil. METHODS: Descriptive, analytical, and prospective study was performed on patients who underwent plastic surgery following RYGB from January 2011 to December 2016. Measures included BMI (body mass index) before RYGB and before plastic surgery, medical complications and comorbidities. RESULTS: One hundred thirty-nine patients (130 female, 9 male) with a mean age of 41 years underwent 233 separate operations. The average BMI at the time of plastic surgery was 27.44 kg/m2. The average weight loss was 47.02 kg, and the mean pre-weight-loss BMI (max BMI) was 45.17 kg/m2. The most important pre-plastic comorbidities were arterial hypertension (11.5%), degenerative arthropathy (5.4%), diabetes mellitus (5.0%), and metabolic syndrome (4.3%). Of the 139 patients operated upon, 76.97% underwent abdominoplasty followed by mammoplasty (42.46%). The overall rate of complications was 26.65%. Initially, on univariate regression analyses, comorbidities influenced the development of postoperative complications. However, after multiple logistic regression, the most important comorbidities failed to predict an increased risk of complications. CONCLUSION: In this group of patients, with these anthropometric and clinical profiles, the most important comorbidities (diabetes, arterial hypertension, and metabolic syndrome) failed to influence the incidence of postoperative complications in postbariatric patients after plastic surgery.

Prolactinomas Resistant to Treatment With Dopamine Agonists: Long-Term Follow-Up of Six Cases.

Introduction: Prolactinomas are preferentially treated with dopamine agonists. However, a few adenomas are resistant to this treatment. Objective: To evaluate the characteristics of patients with resistance to dopamine agonists in the long-term. Method: A retrospective study of six cases was made. Patients who did not achieve normalized prolactin blood concentrations and a reduction of more than 50% of the tumor volume with the minimum dose of 3.5 mg per week of cabergoline for 3 months or the maximum supported dose of bromocriptine for 6 months were considered resistant to dopamine agonists. Patients were followed up at the Clinic of Neurology and Endocrinology or the University Hospital of Brasilia. Results: Six patients were selected. Three patients were initially treated with bromocriptine prior to treatment with cabergoline. Four patients were men, and two were women. At the time of diagnosis, ages ranged from 9 to 62 years. Initial prolactin concentrations ranged from 430 to 14,992 ng/mL and in the last assessment ranged from 29.6 to 2,169 ng/mL. The tumor volume ranged from 0.77 to 24.0 mm3. Tumor regression occurred in all patients, ranging from 20 to 100%, but total disappearance of the adenoma with an empty sella occurred in one patient. The maximum weekly doses of cabergoline ranged from 3.0 to 4.5 mg. Follow-up time ranged from seven to 17 years. Normalization of prolactin concentrations occurred only in one woman after 17 years of treatment. Three patients also underwent surgery, but only one woman was cured of the disease. Conclusion: This study confirms that tumors resistant to dopamine agonists are more aggressive, since we did not have any microadenoma; treatment with high dose of cabergoline may reduce the size of the tumor without its disappearance, and that normalization of prolactin concentration rarely occurs. To our knowledge, this is the longest follow-up of a series of cases with resistance to dopamine agonists.

Abdominoplastia em pacientes pós-bariátricos: perfil antropométrico, comorbidades e complicações / Abdominoplasty in gastric bypass patients: anthropometric profile, comorbidities, and complications

Introdução: Os pacientes submetidos à gastroplastia apresentam importante perda de peso e a cirurgia plástica representa um importante meio de tratamento do excesso de pele. Método: Estudo prospectivo foi realizado em pacientes submetidos à abdominoplastia pós-gastroplastia no período de janeiro de 2011 a dezembro de 2016 em hospital público. As variáveis analisadas foram: IMC (Índice de Massa Corporal) antes da gastroplastia e antes da cirurgia plástica, perda de peso, peso do retalho retirado, comorbidades e complicações. Resultados: 107 pacientes que realizaram abdominoplastia foram incluídos. Média de idade foi 41 anos. O IMC médio antes da cirurgia plástica foi 27,6 ± 3,7 Kg/m2. Perda de peso médio foi 47,7 ± 17,3 Kg. O IMC máximo antes da gastroplastia foi 45,5 ± 7,5 Kg/m2 e o IMC foi 18,6 ± 9,3 Kg/m2. Comorbidades presentes antes da plástica foram: hipertensão arterial (11,1%), artropatia (4,6%), diabete melito (5,6%) e síndrome metabólica (5,6%). Catorze (13,1%) pacientes realizaram herniorrafia durante a abdominoplastia. A taxa de complicações foi 31,5%. O peso antes da gastroplastia, IMC antes da gastroplastia, perda de peso médio, comorbidades, peso do retalho do abdome e IMC > 20Kg/m2 foram fatores associados significativamente a complicações pós-operatórias. Conclusões: A gastroplastia em Y de Roux foi uma terapêutica efetiva na resolução de comorbidades em obesos. Comorbidades, peso antes da gastroplastia, perda de peso médio, quantidade de tecido retirado do abdome e IMC > 20Kg/m2 levaram significativamente a mais complicações em pacientes pósbariátricos submetidos à abdominoplastia. A cirurgia plástica é importante no cuidado integral ao paciente obeso e otimizou os resultados alcançados com a cirurgia bariátrica.

Introduction: Patients who undergo vertical-banded gastroplasty- Roux-en-Y gastric bypass (VBG-RYGB) have significant weight loss, and abdominoplasty (AP) is an effective corrective surgery for removing excess skin. Methods: A prospective study conducted from January 2011 to December 2016 in a public hospital evaluated patients who underwent AP after VBG-RYGB. The analyzed variables were body mass index (BMI) before VBG-RYGB, BMI before AP, weight loss, weight of the excised abdominal flap, comorbidities, and complications. Results: For this study, 107 patients who underwent AP were included. The patients' mean age was 41 years; BMI before AP, 27.6 ± 3.7 kg/m2; and mean weight loss, 47.7 ± 17.3 kg. The maximum BMI before bariatric surgery was 45.5 ± 7.5 kg/m2, and the difference between the maximum BMI before VBG-RYGB and before corrective surgery was 18.6 ± 9.3 kg/m2. The comorbidities observed before VBG-RYGB were arterial hypertension (11.1%), arthropathy (4.6%), diabetes mellitus (5.6%), and metabolic syndrome (5.6%). Fourteen patients (13.1%) underwent herniorrhaphy during AP. The overall complication rate was 31.5%. Weight before VBGRYGB, BMI before VBG-RYGB, mean weight loss, comorbidities, abdominal flap weight, and BMI of >20 kg/m2 were significantly associated with postoperative complications. Conclusions: VBGRYGB was an effective approach to reduce comorbidities in obese patients. Comorbidities, weight before VBG-RYGB, mean weight loss, amount of tissue removed from the abdomen, and BMI of >20 kg/m2 significantly increased the complication rate in the gastric bypass patients who underwent AP. Furthermore, AP is fundamental for the comprehensive care of obese patients and has optimized the results achieved with VBG-RYGB.