Biomarkers of neuropsychiatric dysfunction in intensive care unit survivors: a prospective cohort study.

OBJECTIVE: To assess factors associated with long-term neuropsychiatric outcomes, including biomarkers measured after discharge from the intensive care unit. METHODS: A prospective cohort study was performed with 65 intensive care unit survivors. The cognitive evaluation was performed through the Mini-Mental State Examination, the symptoms of anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale, and posttraumatic stress disorder was evaluated using the Impact of Event Scale-6. Plasma levels of amyloid-beta (1-42) [Aß (1-42)], Aß (1-40), interleukin (IL)-10, IL-6, IL-33, IL-4, IL-5, tumor necrosis factor alpha, C-reactive protein, and brain-derived neurotrophic factor were measured at intensive care unit discharge. RESULTS: Of the variables associated with intensive care, only delirium was independently related to the occurrence of long-term cognitive impairment. In addition, higher levels of IL-10 and IL-6 were associated with cognitive dysfunction. Only IL-6 was independently associated with depression. Mechanical ventilation, IL-33 levels, and C-reactive protein levels were independently associated with anxiety. No variables were independently associated with posttraumatic stress disorder. CONCLUSION: Cognitive dysfunction, as well as symptoms of depression, anxiety, and posttraumatic stress disorder, are present in patients who survive a critical illness, and some of these outcomes are associated with the levels of inflammatory biomarkers measured at discharge from the intensive care unit.

Analysis of possible risk predictors in patients with coronavirus disease 2019: a retrospective cohort study.

OBJECTIVE: This study aimed to analyze the clinical-epidemiological profile, possible risk predictors, and outcomes of patients with coronavirus disease 2019 admitted to the ward of a tertiary care hospital in southern Brazil. Specifically, we describe the demographic characteristics, comorbidities, baseline laboratory findings, clinical course, and survival of these patients. METHODS: This is an observational, retrospective cohort study, performed from January to March 2022, on medical records of patients hospitalized between April 2020 and December 2021 in the coronavirus disease 2019 ward of a tertiary hospital in southern Brazil. RESULTS: Data from 502 hospitalized patients were analyzed, of which 60.2% were male, with a median age of 56 years and 31.7% were over 65 years old. The main symptoms presented were dyspnea/respiratory discomfort (69.9%) and cough (63.1%). The most common comorbidities were obesity, systemic arterial hypertension, and diabetes mellitus. A proportion of 55.8% of 493 patients had PaO2/FiO2<300 mmHg in the first examination performed after admission and 46.0% had a neutrophil/lymphocyte ratio>6.8. Oxygen therapy by Venturi mask or mask with reservoir was used in 34.7% of the patients, and non-invasive ventilation was used in 10.0% of the patients. The majority of the patients (98.4%) used corticosteroids, and the outcome of 82.5% of the hospitalized patients was home discharge. CONCLUSION: After analyzing the clinical and epidemiological profile, it can be concluded that age greater than 65 years and pulmonary involvement >50% are predictors of a worse prognosis for coronavirus disease 2019, as is the need for high-flow oxygen therapy. Corticotherapy, however, proved to be beneficial in the treatment of the disease.

Avaliação das informações contidas nos encaminhamentos dos pacientes da atenção primária do município de Rio do Sul (SC) / Evaluación de las informaciones contenidas en los encaminamientos de pacientes de atención primaria en la ciudad de Rio do Sul (SC) / Evaluation of the information contained in the referrals of primary care patients in the city of Rio do Sul (SC)

Introdução: O processo de encaminhamento é um dos sistemas logísticos em atividade atualmente e tem como função interligar os diferentes níveis de atenção à saúde de determinada Rede de Atenção à Saúde (RAS). Objetivo: Avaliar as informações contidas nas guias de encaminhamento dos pacientes referenciados da atenção primária da RAS do município de Rio de Sul (SC). Métodos: Estudo observacional, analítico e transversal, em que as guias da RAS foram examinadas com base em um formulário contendo variáveis preestabelecidas. As informações coletadas receberam análise descritiva de frequências e foram representadas por n (frequência absoluta) e % (porcentagem). Resultados: Foram analisados 158 encaminhamentos. Dados demográficos estavam presentes em 158 (100%), queixa principal ou motivo da referência em 131 (82,9%), descrição da queixa principal ou do motivo da referência em 82 (51,9%), descrição dos sintomas associados em 21 (13,3%), história patológica pregressa em 61 (38,6%), lista de medicações atuais em 37 (23,4 %), alergias em dez (6,3%), achados de relevância clinica em 75 (47,5%), resultados da investigação prévia em 45 (28,5%), esboço de tratamento prévio em 42 (26,6%), diagnóstico provisório em 75 (47,5%) e declaração do que se espera do encaminhamento em 66 (41,8%). Conclusões: Revelou-se carência de informações nos encaminhamentos da RAS quando comparadas às de outros estudos, principalmente no que concerne a informações históricas do paciente, dados clínicos acerca do motivo do encaminhamento, diagnóstico provisório e declaração do que se espera do encaminhamento. No entanto, o incentivo à descrição dessas informações básicas pode ser uma medida inicial para a mudança da conjuntura atual.

Introduction: The referral process is one of the logistics systems currently in operation, and its function is to link the different levels of health care in a given health care network (HCN). Objective: To evaluate the information contained in the referral guides of patients referred from the primary care of the HCN in the Brazilian city of Rio de Sul (SC). Methods: An observational, analytical, cross-sectional study was conducted, where the HCN guides were examined from a form containing pre-established variables. The information collected was submitted to descriptive analysis of frequencies, which were represented by n (absolute frequency) and % (percentage). Results: A total of 158 referrals were analyzed, with demographic data being present in 158 (100%), main complaint or reason for referral in 131 (82.9%), description of the main complaint or reason for referral in 82 (51.9 %), description of associated symptoms in 21 (13.3%), past pathological history in 61 (38.6%), list of current medications in 37 (23.4%), allergies in 10 (6.3%), clinically relevant findings in 75 (47.5%), previous investigation results in 45 (28.5%), Prior treatment outline in 42 (26.6%), provisional diagnosis in 75 (47.5%) and declaration of what is expected of the referral in 66 (41.8%). Conclusions: There was a lack of information in HCN referrals when compared to other studies, especially concerning patient historical information, clinical data about the reason for the referral, provisional diagnosis, and declaration of what is expected of the referral. However, encouraging the description of this basic information can be an initial measure to change the current situation.

Introducción: El proceso de encaminamiento es uno de los sistemas logísticos actualmente en funcionamiento, y su función es vincular los diferentes niveles de atención en salud en una determinada Red de Atención a la Salud (RAS). Objetivo: Evaluar las informaciones contenidas en las guías de encaminamiento de pacientes derivados de la atención primaria de la RAS de la ciudad de Rio de Sul (SC). Métodos: Estudio observacional, analítico y transversal, donde se examinaron las guías de la RAS desde un formulario que contenía variables preestablecidas. La información recolectada recibió análisis descriptivo de frecuencias y fue representada por n (frecuencia absoluta) y % (porcentaje). Resultados: se analizaron 158 referencias, estando presente el dato demográfico en 158 (100%), queja principal o motivo de referencia en 131 (82,9%), descripción de la queja principal o motivo de referencia en 82 (51,9%), descripción de síntomas asociados en 21 (13,3%), antecedentes patológicos en 61 (38,6%), lista de medicamentos actuales en 37 (23,4%), alergias en 10 (6,3%), hallazgos clínicamente relevantes en 75 (47,5%), resultados de la investigación previa en 45 (28,5%), esquema de tratamiento preliminar en 42 (26,6%), diagnóstico provisional en 75 (47,5%) y declaración de lo que se espera del encaminamiento en 66 (41,8%). Conclusiones: Hubo falta de información en los encaminamientos de la RAS en comparación con otros estudios, especialmente en lo que se refiere a la información histórica del paciente, datos clínicos sobre el motivo del encaminamiento, diagnóstico provisional y declaración de lo que se espera del encaminamiento. Sin embargo, fomentar la descripción de estas informaciones básicas puede ser una medida inicial para cambiar la situación actual.

Biomarkers of neuropsychiatric dysfunction in intensive care unit survivors: a prospective cohort study / Biomarcadores de disfunção neuropsiquiátrica em sobreviventes de unidades de terapia intensiva: um estudo de coorte prospectivo

ABSTRACT Objective: To assess factors associated with long-term neuropsychiatric outcomes, including biomarkers measured after discharge from the intensive care unit. Methods: A prospective cohort study was performed with 65 intensive care unit survivors. The cognitive evaluation was performed through the Mini-Mental State Examination, the symptoms of anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale, and posttraumatic stress disorder was evaluated using the Impact of Event Scale-6. Plasma levels of amyloid-beta (1-42) [Aβ (1-42)], Aβ (1-40), interleukin (IL)-10, IL-6, IL-33, IL-4, IL-5, tumor necrosis factor alpha, C-reactive protein, and brain-derived neurotrophic factor were measured at intensive care unit discharge. Results: Of the variables associated with intensive care, only delirium was independently related to the occurrence of long-term cognitive impairment. In addition, higher levels of IL-10 and IL-6 were associated with cognitive dysfunction. Only IL-6 was independently associated with depression. Mechanical ventilation, IL-33 levels, and C-reactive protein levels were independently associated with anxiety. No variables were independently associated with posttraumatic stress disorder. Conclusion: Cognitive dysfunction, as well as symptoms of depression, anxiety, and posttraumatic stress disorder, are present in patients who survive a critical illness, and some of these outcomes are associated with the levels of inflammatory biomarkers measured at discharge from the intensive care unit.

RESUMO Objetivo: Avaliar os fatores associados aos desfechos neuropsiquiátricos de longo prazo, incluindo biomarcadores, medidos após a alta da unidade de terapia intensiva. Métodos: Foi realizado um estudo de coorte prospectivo com 65 sobreviventes de unidades de terapia intensiva. A avaliação cognitiva foi realizada por meio do Miniexame do Estado Mental; os sintomas de ansiedade e depressão foram avaliados por meio da Escala Hospitalar de Ansiedade e Depressão, e o transtorno de estresse pós-traumático foi avaliado pela Escala de Impacto do Evento-6. Os níveis plasmáticos de beta amiloide (1-42), beta amiloide (1-40), interleucina 10, interleucina 6, interleucina 33, interleucina 4, interleucina 5, fator de necrose tumoral alfa, proteína C-reativa e fator neurotrófico derivado do cérebro foram medidos na alta da unidade de terapia intensiva. Resultados: Das variáveis associadas à terapia intensiva, apenas o delirium foi relacionado de forma independente à ocorrência de comprometimento cognitivo de longo prazo. Além disso, níveis mais altos de interleucina 10 e interleucina 6 foram associados à disfunção cognitiva. Apenas a interleucina 6 foi associada de forma independente à depressão. A ventilação mecânica, os níveis de interleucina 33 e os níveis de proteína C-reativa foram associados de forma independente à ansiedade. Nenhuma variável foi associada de forma independente ao transtorno de estresse pós-traumático. Conclusão: A disfunção cognitiva, bem como os sintomas de depressão, ansiedade e transtorno de estresse pós-traumático, estão presentes em pacientes que sobrevivem a uma doença grave, e alguns desses desfechos estão associados aos níveis de biomarcadores inflamatórios medidos na alta da unidade de terapia intensiva.

Analysis of possible risk predictors in patients with coronavirus disease 2019: a retrospective cohort study

SUMMARY OBJECTIVE: This study aimed to analyze the clinical-epidemiological profile, possible risk predictors, and outcomes of patients with coronavirus disease 2019 admitted to the ward of a tertiary care hospital in southern Brazil. Specifically, we describe the demographic characteristics, comorbidities, baseline laboratory findings, clinical course, and survival of these patients. METHODS: This is an observational, retrospective cohort study, performed from January to March 2022, on medical records of patients hospitalized between April 2020 and December 2021 in the coronavirus disease 2019 ward of a tertiary hospital in southern Brazil. RESULTS: Data from 502 hospitalized patients were analyzed, of which 60.2% were male, with a median age of 56 years and 31.7% were over 65 years old. The main symptoms presented were dyspnea/respiratory discomfort (69.9%) and cough (63.1%). The most common comorbidities were obesity, systemic arterial hypertension, and diabetes mellitus. A proportion of 55.8% of 493 patients had PaO2/FiO2<300 mmHg in the first examination performed after admission and 46.0% had a neutrophil/lymphocyte ratio>6.8. Oxygen therapy by Venturi mask or mask with reservoir was used in 34.7% of the patients, and non-invasive ventilation was used in 10.0% of the patients. The majority of the patients (98.4%) used corticosteroids, and the outcome of 82.5% of the hospitalized patients was home discharge. CONCLUSION: After analyzing the clinical and epidemiological profile, it can be concluded that age greater than 65 years and pulmonary involvement >50% are predictors of a worse prognosis for coronavirus disease 2019, as is the need for high-flow oxygen therapy. Corticotherapy, however, proved to be beneficial in the treatment of the disease.

Avaliação do interesse das mulheres assistidas pelo centro de atenção à mulher de Rio do Sul em cirurgias estéticas íntimas / Evaluation of the interest of women assisted by the Centro de Atenção à Mulher (CAM) of Rio do Sul in intimate aesthetic surgeries

Introdução: O termo cirurgia genital feminina engloba várias técnicas com o objetivo de melhorar a área vulvar feminina estética e funcionalmente. Sentimentos de sofrimento emocional são comuns nas mulheres que buscam tais cirurgias, impactando significativamente em sua autoestima, sexualidade, higiene e funcionalidade vulvar. O objetivo é avaliar Avaliar o interesse das mulheres assistidas em um Centro de Atenção à Mulher em cirurgias íntimas. Métodos: Estudo observacional transversal ocorrido no Centro de Atenção à Mulher (CAM) de Rio do Sul-SC. Para coleta dos dados, foi utilizado um questionário semiestruturado elaborado pelos autores. Os dados foram tratados e agrupados no programa Microsoft Excel e realizadas as análises descritivas dos dados utilizando o programa Statistical Package for the Social Sciences (SPSS). Resultados: Os achados indicaram que houve um grande interesse geral na realização de cirurgias de estética íntima. Das 100 mulheres entrevistadas, 32 apresentavam interesse em realizar algum tipo de cirurgia de estética íntima. Conclusão: Devido à importância dada à estética íntima na interferência física, psicossocial, sexual e cotidiana, com importante impacto na qualidade de vida dessas pessoas, é imperativo que recursos adequados sejam alocados para maior fornecimento de tais procedimentos no Sistema Único de Saúde para a população do Brasil.

Introduction: The term female genital surgery encompasses several techniques to improve the female vulvar area, both aesthetically and functionally. Feelings of emotional distress are common in women who seek such surgeries, significantly impacting their self-esteem, sexuality, hygiene and vulvar functionality. The objective is to To evaluate the interest of women assisted in a Women Care Center in intimate surgery. Methods: Observational study carried out at the Women Care Center (CAM) in Rio do Sul-SC. For data collection, a semi-structured questionnaire developed by the authors was used. Data were processed and grouped in Microsoft Excel, and descriptive data analysis was performed using the Statistical Package for Social Sciences (SPSS) program. Results: The findings indicated a great general interest in performing intimate aesthetic surgeries. Of the 100 women interviewed, 32 were interested in performing some intimate aesthetic surgery. Conclusion: Due to the importance given to intimate cosmetics in physical, psychosocial, sexual and everyday interference, with a major impact on the quality of life of these people, adequate resources must be allocated to a greater supply of such procedures in the Unified Health System for the population of Brazil.

Early Use of Handgrip Exercise Associated with Dobutamine Stress Echocardiography in Women

Abstract Background Coronary artery disease (CAD) is an important cause of morbidity and mortality in women and requires early diagnosis for defining the appropriate treatment. Objective To identify the positive predictive value (PPV) and safety of the early use of handgrip exercise in pharmacological stress echocardiography using dobutamine (early-ECHO) in women. Methods Positive ischemic early-ECHO records from 111 women were evaluated from January 2012 to March 2018. Subsequently, the hospital medical records were verified to locate patients who underwent conventional coronary angiography (CCA), and we analyzed the medical conduct adopted for these patients. Statistical analyses were performed using SPSS employing one-way analysis of variance (ANOVA), Fisher's exact test, or Pearson's chi-square test. The level of statistical significance was set at p < 0.05 for all analyses. Results Four patients (4.4%) presented serious complications during the examination. Out of 90 patients who underwent CCA, 71 (78.9%) had CAD. Among these 71 patients, 58 (81.7%) had severe lesions and 13 (18.3%) presented moderate CAD. Moreover, CCA did not demonstrate relevant coronary lesions in 19 of the 90 patients (21.1%). Among patients with severe CAD, 16 (27.6%) underwent myocardial revascularization surgery; 34 (58.6%) underwent percutaneous coronary angioplasty; and 08 (13.7%) had their clinical treatments intensified. The PPV for early-ECHO was 78.9%. Conclusions Early-ECHO showed a high PPV for diagnosing myocardial ischemia in women. It presented a low complication rate and provided rapid disease identification, allowing the early treatment of injuries and potentially preventing CAD complications.