The impact of the COVID-19 pandemic on unilateral inguinal hernioplasty surgery in Brazil.

OBJECTIVE: to analyze data from patients hospitalized for unilateral inguinal hernioplasty in Brazil in the year before the COVID-19 pandemic, and during the period of the pandemic. METHODS: this is a descriptive study, using data referring to hospitalizations for the surgical procedure of unilateral inguinal hernioplasty in Brazil from March 2019 to February 2020, comparing with data from March 2020 to February 2021. Data were collected from the Hospital Information System (SIH/SUS) and the selected variables were: number of hospitalizations, average hospital stay rate and mortality rate. RESULTS: in all, 119,312 hospitalizations were performed for unilateral inguinal hernioplasty in Brazil from March 2019 to February 2020. During the pandemic period, 53,445 hospitalizations were recorded for this procedure. The average hospital stay increased compared to the previous year. The mortality rate recorded in the year before the pandemic was 0.11, while in the period of the pandemic, it was 0.20. CONCLUSION: It was observed that during the period of the COVID-19 pandemic in Brazil, the number of hospitalizations for unilateral inguinal hernioplasty was reduced by 55,21%. However, there was a significant increase in the mortality rate of this procedure. These results can be explained by the increase in mortality in patients infected with the SARS-CoV-2 virus, and also by the restriction of performing elective surgeries, prioritizing emergency situations, which are more complicated, and consequently, with higher mortality.

The impact of the COVID-19 pandemic on unilateral inguinal hernioplasty surgery in Brazil / O impacto da pandemia de COVID-19 na cirurgia de hernioplastia inguinal unilateral no Brasil

ABSTRACT Objective: to analyze data from patients hospitalized for unilateral inguinal hernioplasty in Brazil in the year before the COVID-19 pandemic, and during the period of the pandemic. Methods: this is a descriptive study, using data referring to hospitalizations for the surgical procedure of unilateral inguinal hernioplasty in Brazil from March 2019 to February 2020, comparing with data from March 2020 to February 2021. Data were collected from the Hospital Information System (SIH/SUS) and the selected variables were: number of hospitalizations, average hospital stay rate and mortality rate. Results: in all, 119,312 hospitalizations were performed for unilateral inguinal hernioplasty in Brazil from March 2019 to February 2020. During the pandemic period, 53,445 hospitalizations were recorded for this procedure. The average hospital stay increased compared to the previous year. The mortality rate recorded in the year before the pandemic was 0.11, while in the period of the pandemic, it was 0.20. Conclusion: It was observed that during the period of the COVID-19 pandemic in Brazil, the number of hospitalizations for unilateral inguinal hernioplasty was reduced by 55,21%. However, there was a significant increase in the mortality rate of this procedure. These results can be explained by the increase in mortality in patients infected with the SARS-CoV-2 virus, and also by the restriction of performing elective surgeries, prioritizing emergency situations, which are more complicated, and consequently, with higher mortality.

RESUMO Objetivo: analisar os dados dos pacientes internados para realização de hernioplastia inguinal unilateral no Brasil no ano anterior à pandemia de COVID-19, e durante o período da pandemia no país. Métodos: trata-se de um estudo descritivo, utilizando dados referentes às internações para realização do procedimento cirúrgico de hernioplastia inguinal unilateral no Brasil no período de março de 2019 a fevereiro de 2020, comparando com os dados de março de 2020 até fevereiro de 2021. Os dados foram coletados do Sistema de Informações Hospitalares (SIH/SUS) e as variáveis selecionadas foram: número de internações, taxa média de permanência hospitalar e taxa de mortalidade. Resultados: ao todo, foram realizadas 119.312 internações para realização de hernioplastia inguinal unilateral no Brasil no período de março de 2019 a fevereiro de 2020. Já durante o período de pandemia no país, foram registradas 53.445 internações para este procedimento. A média de permanência hospitalar aumentou em relação ao ano anterior. A taxa de mortalidade registrada no ano anterior à pandemia foi de 0,11, já no período da pandemia, foi de 0,20. Conclusão: foi observado que durante o período de pico da pandemia de COVID-19 no Brasil, o número de internações para realização de hernioplastia inguinal unilateral foi reduzido em 55,21%. Contudo, houve um aumento significativo da taxa de mortalidade desse procedimento. Esse resultado pode ser explicado pelo aumento da mortalidade em pacientes infectados pelo vírus SARS-CoV-2, e também pela restrição da realização de procedimentos cirúrgicos eletivos nesse período, priorizando quadros emergenciais, os quais são mais complicados, e consequentemente, com maior mortalidade.

The Impact of Violence on the Anxiety Levels of Healthcare Personnel During the COVID-19 Pandemic.

Introduction: The COVID-19 pandemic stressed the importance of healthcare personnel. However, there is evidence of an increase in violence against them, which brings consequences, such as anxiety. The aim of this study was to analyze the anxiety levels of health professionals who have or not suffered violence during the COVID-19 pandemic, and verify the variables associated with the risk of starting to take medication for anxiety. Methods: We assessed the anxiety profile of health professionals in Brazil through an online questionnaire, using the Generalized Anxiety Disorder 7-item Scale (GAD-7), in relation to groups of participants who have or not suffered violence during the COVID-19 pandemic. We used Cronbach's alpha reliability coefficient to check the consistency of the responses, and the effect size using the r coefficient. Principal Component Analysis was used to verify the differences in anxiety scores between the two groups. Logistic regression analysis was also used to verify the variables associated with the risk of starting medication for anxiety and considered statistically significant when p < 0.05. Results: A total of 1,166 health professionals participated in the study, in which 34.13% had a normal anxiety profile, 40.14% mild, 15.78% moderate, and 9.95% severe. The mean score of the sum of the GAD-7 was 7.03 (SD 5.20). The group that suffered violence had a higher mean (8.40; SD 5.42) compared to the group that did not (5.70; SD 4.60). In addition, the median between both groups was significantly different (7.0 vs. 5.0; p < 0.01). Approximately 18.70% of the participants reported having started taking medication to treat anxiety during the pandemic. The factors that increased the chances of these professionals starting medication for anxiety p < 0.05 were having suffered violence during the pandemic (OR 1.97; 95% CI 1.42-2.77), being nurses (OR 1.61; 95% CI 1.04-2.47) or other types of health professionals (OR 1.58; 95% CI 1.04-2.38), and having a mild (OR 2.11; 95% CI 1.37-3.34), moderate (OR 4.05; 95% CI 2.48-6.71) or severe (OR 9.08; 95% CI 5.39-15.6) anxiety level. Conclusion: Brazilian healthcare professionals who have suffered violence during the pandemic have higher anxiety scores and higher risk to start taking anxiety medication.

Consequências da doença de Parkinson na saúde periodontal / Consequences of Parkinson's disease in periodontal health ­ a literature review

A doença de Parkinson é uma desordem neurológica, crônica e progressiva que atinge o sistema nervoso central. Nela, ocorre a degeneração dos neurônios que sintetizam a dopamina, neurotransmissor presente na substância negra do cérebro e que é responsável por transmitir estímulos para a realização de movimentos voluntários automáticos. Os sintomas da doença de Parkinson, como o tremor e a rigidez muscular, têm sido associados ao aumento da incidência de problemas bucais, como doença periodontal, perdas dentais, dor orofacial e cárie. Essa revisão da literatura teve por objetivo apresentar e discutir as evidências científicas disponíveis sobre a prevalência e severidade da doença periodontal em pacientes portadores da doença de Parkinson. Alguns estudos voltados a este assunto mostram diferenças significativas em relação ao aumento de problemas bucais entre portadores da doença de Parkinson e indivíduos saudáveis. Diante da análise da literatura, pôde-se verificar que a incidência e severidade da doença periodontal aumentam conforme a doença de Parkinson progride, e a prevalência de complicações bucais também está relacionada à evolução da doença neurológica em questão, diretamente relacionada ao comprometimento da realização adequada das manobras de higienização bucal.

Parkinson's disease is a chronic progressive neurological disorder, which affects the central nervous system. It is a degeneration of neurons that synthesize dopamine, the neurotransmitter at the substantia nigra of the brain responsible for transmitting stimuli for performing automatic volunteers movements. The symptoms of Parkinson's disease such as tremors and stiffness, have been linked to increased incidence of oral problems such as periodontal disease, dental orofacial pain loss, caries disease. This literature review aims to present and discuss the scientific evidence available about the prevalence and severity of periodontal disease in patients with Parkinson's disease. Some studies focused on this subject show significant differences in relation to the increase of oral problems among people with Parkinson's disease and healthy individuals. On the analysis of the literature, one can verify that the symptoms of Parkinson's appear to increase the incidence and severity of periodontal disease, and the prevalence of oral complications are related to evolution of neurological disease in question, directly related to the commitment of carrying out appropriate oral hygiene.

Structural and functional neuroimaging findings associated with the use of clozapine in schizophrenia: a systematic review.

OBJECTIVE: Schizophrenia is one of the most severe psychiatric disorders, and its current treatment relies on antipsychotic medications with only partial effectiveness. Clozapine is an atypical antipsychotic with a specific profile of action indicated for treatment-resistant schizophrenia. Neuroimaging studies assessing the effects of clozapine could help shed light on the neural underpinnings of the effects of this drug in the brain. The objective of this study was to review the available literature on the structural and functional neuroimaging findings associated with use of clozapine. METHOD: We conducted a systematic review of the indexed literature using the PubMed, BIREME, and ISI Web of Knowledge search engines and the following keywords: clozapine, neuroimaging, computed tomography, MRI, functional magnetic resonance, PET, SPECT, and DTI. RESULTS: A total of 23 articles were included in the review. In structural studies, the use of clozapine was associated with volume reductions in the basal ganglia, especially the caudate nucleus, where functional neuroimaging studies also found decreased perfusion. In the frontal lobe, clozapine treatment was associated with increased gray matter volume and reduced perfusion. CONCLUSION: The results of the studies reviewed suggest that the use of clozapine is associated with distinctive structural and functional neuroimaging findings that are not shared with other antipsychotics.

Structural and functional neuroimaging findings associated with the use of clozapine in schizophrenia: a systematic review

Objective: Schizophrenia is one of the most severe psychiatric disorders, and its current treatment relies on antipsychotic medications with only partial effectiveness. Clozapine is an atypical antipsychotic with a specific profile of action indicated for treatment-resistant schizophrenia. Neuroimaging studies assessing the effects of clozapine could help shed light on the neural underpinnings of the effects of this drug in the brain. The objective of this study was to review the available literature on the structural and functional neuroimaging findings associated with use of clozapine. Method: We conducted a systematic review of the indexed literature using the PubMed, BIREME, and ISI Web of Knowledge search engines and the following keywords: clozapine, neuroimaging, computed tomography, MRI, functional magnetic resonance, PET, SPECT, and DTI. Results: A total of 23 articles were included in the review. In structural studies, the use of clozapine was associated with volume reductions in the basal ganglia, especially the caudate nucleus, where functional neuroimaging studies also found decreased perfusion. In the frontal lobe, clozapine treatment was associated with increased gray matter volume and reduced perfusion. Conclusion: The results of the studies reviewed suggest that the use of clozapine is associated with distinctive structural and functional neuroimaging findings that are not shared with other antipsychotics. .

Brazilian Medical Association guidelines for the diagnosis and differential diagnosis of panic disorder

Objective: To present the most relevant findings regarding the Brazilian Medical Association guidelines for the diagnosis and differential diagnosis of panic disorder. Methods: We used the methodology proposed by the Brazilian Medical Association for the Diretrizes Project. The MEDLINE (PubMed), Scopus, Web of Science, and LILACS online databases were queried for articles published from 1980 to 2012. Searchable questions were structured using the PICO format (acronym for “patient” [or population], “intervention” [or exposure], “comparison” [or control], and “outcome”). Results: We present data on clinical manifestations and implications of panic disorder and its association with depression, drug abuse, dependence and anxiety disorders. In addition, discussions were held on the main psychiatric and clinical differential diagnoses. Conclusions: The guidelines are proposed to serve as a reference for the general practitioner and specialist to assist in and facilitate the diagnosis of panic disorder. .

Neuroimaging of depression in Parkinson's disease: a review.

BACKGROUND: Depression is the most common psychiatric manifestation in patients with Parkinson's disease (PD). In addition, depressive symptoms may be considered to be a prodromal manifestation of PD. In recent years, the association between PD and depression has been the focus of neuroimaging studies using functional and structural techniques. METHODS: The aim of this study was to review the main neuroimaging studies assessing the comorbidity between depression and PD. Literature searches were conducted to find the major neuroimaging studies that consider primarily the comorbidity between depression and PD using the indices Web of Science and Lilacs. RESULTS: In total, 296 papers were identified, and 18 of these studies were selected for the current review. The principal neuroimaging technique used was SPECT. The structural neuroimaging studies that have evaluated the impact of current or previous bouts of depression on the neurodegenerative process of PD are scarce and inclusive. The instruments that were used to evaluate depression differed among the studies. Several brain regions appear to be involved in depression, particularly the limbic system and the basal ganglia. In addition, the serotonergic, dopaminergic, and noradrenergic systems also appear to be associated with depressive symptoms in PD. CONCLUSION: Several brain regions and neurotransmitter systems are involved in depression in PD; however, the variety of criteria used to evaluate depressive symptoms precludes more specific conclusions.

Brazilian Medical Association guidelines for the diagnosis and differential diagnosis of panic disorder.

OBJECTIVE: To present the most relevant findings regarding the Brazilian Medical Association guidelines for the diagnosis and differential diagnosis of panic disorder. METHODS: We used the methodology proposed by the Brazilian Medical Association for the Diretrizes Project. The MEDLINE (PubMed), Scopus, Web of Science, and LILACS online databases were queried for articles published from 1980 to 2012. Searchable questions were structured using the PICO format (acronym for "patient" [or population], "intervention" [or exposure], "comparison" [or control], and "outcome"). RESULTS: We present data on clinical manifestations and implications of panic disorder and its association with depression, drug abuse, dependence and anxiety disorders. In addition, discussions were held on the main psychiatric and clinical differential diagnoses. CONCLUSIONS: The guidelines are proposed to serve as a reference for the general practitioner and specialist to assist in and facilitate the diagnosis of panic disorder.

Gravidez após cirurgia bariátrica / Pregnancy following bariatric surgery

A obesidade é uma condição crônica que tem se tornado prevalente ao redor do mundo. Os tratamentos clínicos incluem dieta, exercícios, alteração comportamental e uso de medicações. A cirurgia deve ser reservada para os pacientes obesos mórbidos que não respondem às terapias não invasivas para perda de peso. Durante as últimas décadas, a cirurgia bariátrica se expandiu rapidamente e cada vez mais mulheres jovens estão procurando esta forma de tratamento, o que pode causar um aumento no número de gestações após a perda de peso. A gravidez após a cirurgia bariátrica nos traz uma série de questionamentos e preocupações a respeito da gestante e de seu feto. A suplementação nutricional e a monitorização intensiva antes, durante e após a gravidez podem ajudar a evitar complicações relacionadas à nutrição e melhorar a saúde materno-fetal, e os obstetras devem estar preparados para lidar com esse tipo de paciente, que será cada vez mais freqüente na prática diária em um futuro próximo.