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1.
Rev Col Bras Cir ; 48: e20202633, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33470369

RESUMO

OBJECTIVE: to compare the use of 0.5% alcoholic chlorhexidine and 70% alcohol in skin antisepsis for neuraxial blocks. METHOD: this is a non-inferiority randomized clinical trial, with two parallel arms. Seventy patients who were candidates for neuraxial block were randomly allocated to group A (n = 35), in whom antisepsis was performed with 0.5% alcoholic chlorhexidine, or to group B (n = 35), in whom we used 70% hydrated ethyl alcohol. Swabs were harvested for culture at three times: before antisepsis, two minutes after application of the antiseptic, and immediately after puncture. The samples were sown in three culture media and the number of colony forming units (CFU) per cm² was counted. RESULTS: there was no difference between the groups regarding age, sex, body mass index, time to perform the block or type of block. There were no differences between groups in the CFU/cm² counts before antisepsis. There was less bacterial growth in group B two minutes after application of the antiseptic (p = 0.048), but there was no difference between the groups regarding the number of CFU/cm² at the end of the puncture. CONCLUSION: 70% alcohol was more effective in reducing the number of CFU/cm² after two minutes, and there was no difference between the two groups regarding skin colonization at the end of the procedure. These results suggest that 70% alcohol may be an option for skin antisepsis before neuraxial blocks. Trial registration: ClinicalTrials.gov, NCT02833376.


Assuntos
Anti-Infecciosos Locais/farmacologia , Antissepsia/métodos , Clorexidina/farmacologia , Etanol/farmacologia , Pele/microbiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Anestesia Epidural , Raquianestesia , Anti-Infecciosos Locais/administração & dosagem , Etanol/administração & dosagem , Humanos
2.
Rev. Col. Bras. Cir ; 48: e20202633, 2021. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1155374

RESUMO

ABSTRACT Objective: to compare the use of 0.5% alcoholic chlorhexidine and 70% alcohol in skin antisepsis for neuraxial blocks. Method: this is a non-inferiority randomized clinical trial, with two parallel arms. Seventy patients who were candidates for neuraxial block were randomly allocated to group A (n = 35), in whom antisepsis was performed with 0.5% alcoholic chlorhexidine, or to group B (n = 35), in whom we used 70% hydrated ethyl alcohol. Swabs were harvested for culture at three times: before antisepsis, two minutes after application of the antiseptic, and immediately after puncture. The samples were sown in three culture media and the number of colony forming units (CFU) per cm² was counted. Results: there was no difference between the groups regarding age, sex, body mass index, time to perform the block or type of block. There were no differences between groups in the CFU/cm² counts before antisepsis. There was less bacterial growth in group B two minutes after application of the antiseptic (p = 0.048), but there was no difference between the groups regarding the number of CFU/cm² at the end of the puncture. Conclusion: 70% alcohol was more effective in reducing the number of CFU/cm² after two minutes, and there was no difference between the two groups regarding skin colonization at the end of the procedure. These results suggest that 70% alcohol may be an option for skin antisepsis before neuraxial blocks. Trial registration: ClinicalTrials.gov, NCT02833376.


RESUMO Objetivo: comparar o uso de solução alcoólica de clorexidina 0,5% e de álcool 70% na antissepsia da pele para bloqueios do neuroeixo. Método: ensaio clínico randomizado de não inferioridade, com dois braços paralelos. Foram selecionados 70 pacientes candidatos à bloqueio do neuroeixo, randomicamente alocados para o grupo A (n=35), em que a antissepsia foi realizada com clorexidina alcoólica 0,5%, ou para o grupo B (n=35), em que se utilizou álcool etílico hidratado 70%. Foram coletadas, com swab, amostras para cultura em três momentos: antes da antissepsia, dois minutos após aplicação do antisséptico, e imediatamente após a punção. As amostras foram semeadas em três meios de cultura e foi contabilizado o número de unidades formadoras de colônias (UFC) por cm². Resultados: não houve diferença entre os grupos quanto à idade, ao sexo, ao índice de massa corporal, ao tempo para realização do bloqueio ou tipo de bloqueio. Também não houve diferenças entre os grupos na contagem de UFC/cm² antes da antissepsia. Constatou-se menor crescimento bacteriano no grupo B dois minutos após aplicação do antisséptico (p=0,048), mas não houve diferença entre os grupos quanto ao número de UFC/cm² ao final da punção. Conclusão: o álcool 70% mostrou-se mais efetivo em reduzir o número de UFC/cm² após dois minutos, e não houve diferença entre os dois grupos quanto à colonização da pele ao final do procedimento. Esses resultados sugerem que o álcool 70% pode ser opção para antissepsia da pele antes de bloqueios do neuroeixo. Registro ensaio clínico: ClinicalTrials.gov, NCT02833376.

3.
Clinics (Sao Paulo) ; 75: e1731, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32785568

RESUMO

OBJECTIVES: Although child mortality has declined significantly in recent decades, the reduction of neonatal mortality remains a major challenge as neonatal mortality represents 2/3 of the mortality rate in this population. The objective of this study was to evaluate the utility of the Score for Neonatal Acute Physiology Perinatal Extension II (SNAP-PE II) score for evaluating the survival prognosis of newborns admitted to a neonatal intensive care unit (NICU). METHODS: The study design involved an observational cross-sectional retrospective collection, as well as a prospective component. The sample included all newborns admitted to the NICU validated by the SNAP-PE II tool from January 1 to December 31, 2014. RESULTS: A predominance of young mothers (25.4 years), underwent prenatal care (86.2%), however a considerable percentage (49.4%) of mothers received insufficient medical consultation (less than six consults during their pregnancy). A prevalence of male admissions (62.4%) were noted in the NICU. Premature (61.7%) and underweight (weight <2,500 grams) newborns were also prevalent. The SNAP-PE II score showed an association between the infants who were discharged from the neonatal unit and the non-survivors. An increased prevalence of low birth weight and hypothermia was noted in the group of non-survivors. The mean arterial pressure appears to be a significant risk factor in the newborn group that progressed to death. Hypothermia, mean arterial pressure, and birth weight were the most significant variables associated with death. CONCLUSION: The SNAP-PE II was a beneficial indicator of neonatal mortality. The prevention of prematurity and hypothermia by improving maternity care and newborn care can decisively influence neonatal mortality.


Assuntos
Serviços de Saúde Materna , Criança , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
4.
Trials ; 21(1): 605, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32616026

RESUMO

BACKGROUND: Reduction mammaplasty is among the most commonly performed procedures in plastic surgery. Antibiotics are widely prescribed, on an empirical basis, to prevent surgical site infections. However, there is a lack of evidence to support its use. This trial aims to compare the influence of the use of prophylatic antibiotics as a single dose or for 24 h on surgical site infection rates following reduction mammaplasty. METHODS: Randomized trial of non-inferiority, with two parallel groups. A total of 146 breast hypertrophy patients, with reduction mammaplasty already scheduled, will be enrolled. Patients will be randomly allocated to the placebo group that will receive antibiotics only at the anesthesia induction (n = 73) or to the antibiotics group that will receive antibiotics at the anesthesia induction and for 24 h (n = 73). None of the patients will receive antibiotics after hospital discharge. Patients will be followed-up weekly, for 30 days, regarding surgical site infection. The Centers for Disease Control and Prevention criteria will be applied. A statistical analysis of the data will be performed. DISCUSSION: Previous studies have demonstrated a decrease in infection rates after reduction mammaplasty when antibiotic prophylaxis was used, compared to the use of no antibiotics. However, the duration of antibiotic prophylaxis remains a point to be clarified. This study will test the hypothesis that maintaining the use of antibiotics for 24 h does not reduce infection rates compared to the use of a single preoperative dose. TRIAL REGISTRATION: Clinicaltrials.gov NCT04079686 . Registered on September 6, 2019.

5.
Sao Paulo Med J ; 138(3): 253-258, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32578744

RESUMO

BACKGROUND: Suicide is one of the leading causes of death worldwide, accounting for one million deaths annually. Greater understanding of the causal risk factors is needed, especially in large urban centers. OBJECTIVE: To ascertain the epidemiological profile and temporal trend of suicides over two decades and correlate prevalence with social indicators. DESIGN AND SETTING: Descriptive population-based longitudinal retrospective study conducted in the city of São Paulo, Brazil. METHODS: A temporal trend series for suicide mortality in this city was constructed based on data from the Ministry of Health's mortality notification system, covering 2000-2017. It was analyzed using classic demographic variables relating to social factors. RESULTS: Suicide rates were high throughout this period, increasing from 4.6/100,000 inhabitants in the 2000s to 4.9/100,000 in 2017 (mean: 4.7/100,000). The increase in mortality was mainly due to increased male suicide, which went from 6.0/100,000 to the current 8.0/100,000. Other higher coefficients corresponded to social risk factors, such as being a young adult (25-44 years old), being more educated (eight years of schooling) and having white ethnicity (67.2%). Suicide was also twice as likely to occur at home (47.8%). CONCLUSION: High suicide rates were seen over the period 2000-2017, especially among young adults and males. High schooling levels and white ethnicity were risk factors. The home environment is the crucial arena for preventive action. One special aspect of primary prevention is the internet and especially social media, which provides a multitude of information for suicide prevention.


Assuntos
Suicídio , Adulto , Brasil/epidemiologia , Grupos Étnicos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
6.
Säo Paulo med. j ; 138(3): 253-258, May-June 2020. tab
Artigo em Inglês | LILACS-Express | LILACS, Sec. Est. Saúde SP | ID: biblio-1139683

RESUMO

ABSTRACT BACKGROUND: Suicide is one of the leading causes of death worldwide, accounting for one million deaths annually. Greater understanding of the causal risk factors is needed, especially in large urban centers. OBJECTIVE: To ascertain the epidemiological profile and temporal trend of suicides over two decades and correlate prevalence with social indicators. DESIGN AND SETTING: Descriptive population-based longitudinal retrospective study conducted in the city of São Paulo, Brazil. METHODS: A temporal trend series for suicide mortality in this city was constructed based on data from the Ministry of Health's mortality notification system, covering 2000-2017. It was analyzed using classic demographic variables relating to social factors. RESULTS: Suicide rates were high throughout this period, increasing from 4.6/100,000 inhabitants in the 2000s to 4.9/100,000 in 2017 (mean: 4.7/100,000). The increase in mortality was mainly due to increased male suicide, which went from 6.0/100,000 to the current 8.0/100,000. Other higher coefficients corresponded to social risk factors, such as being a young adult (25-44 years old), being more educated (eight years of schooling) and having white ethnicity (67.2%). Suicide was also twice as likely to occur at home (47.8%). CONCLUSION: High suicide rates were seen over the period 2000-2017, especially among young adults and males. High schooling levels and white ethnicity were risk factors. The home environment is the crucial arena for preventive action. One special aspect of primary prevention is the internet and especially social media, which provides a multitude of information for suicide prevention.

7.
Clinics ; 75: e1731, 2020. tab
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1133382

RESUMO

OBJECTIVES: Although child mortality has declined significantly in recent decades, the reduction of neonatal mortality remains a major challenge as neonatal mortality represents 2/3 of the mortality rate in this population. The objective of this study was to evaluate the utility of the Score for Neonatal Acute Physiology Perinatal Extension II (SNAP-PE II) score for evaluating the survival prognosis of newborns admitted to a neonatal intensive care unit (NICU). METHODS: The study design involved an observational cross-sectional retrospective collection, as well as a prospective component. The sample included all newborns admitted to the NICU validated by the SNAP-PE II tool from January 1 to December 31, 2014. RESULTS: A predominance of young mothers (25.4 years), underwent prenatal care (86.2%), however a considerable percentage (49.4%) of mothers received insufficient medical consultation (less than six consults during their pregnancy). A prevalence of male admissions (62.4%) were noted in the NICU. Premature (61.7%) and underweight (weight <2,500 grams) newborns were also prevalent. The SNAP-PE II score showed an association between the infants who were discharged from the neonatal unit and the non-survivors. An increased prevalence of low birth weight and hypothermia was noted in the group of non-survivors. The mean arterial pressure appears to be a significant risk factor in the newborn group that progressed to death. Hypothermia, mean arterial pressure, and birth weight were the most significant variables associated with death. CONCLUSION: The SNAP-PE II was a beneficial indicator of neonatal mortality. The prevention of prematurity and hypothermia by improving maternity care and newborn care can decisively influence neonatal mortality.

8.
Acta Cir Bras ; 34(10): e201901007, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31826150

RESUMO

PURPOSE: To conduct a scope review of the experimental model described by Walker and Mason, by identifying and analyzing the details of the method. METHODS: The authors searched Pubmed-Medline, Cochrane-Bireme and PEDro databases for articles published between January 2016 and December 2018, using the following search queries: burns, burn injuries, models animal, and animal experimentation. All articles whose authors used Walker and Mason's model - with or without changes to the method in Wistar rats - were included in this study. RESULTS: The search identified 45 mentions of Walker and Mason's model; however, after reading each summary, 20 were excluded (of which 5 due to duplicity). The inconsistencies observed after the scope review were: water temperature, length of time of exposure of the experimental model's skin to water, extent of the burnt area, and the description of the thickness/depth of the injury. CONCLUSIONS: Reproducibility of a scientific method is the basis to prove the veracity of the observed results. Thus, it is necessary to have a greater number of publications that adopt a reproducible scientific method, for this review found inconsistencies in the description of Walker and Mason's model.


Assuntos
Queimaduras/etiologia , Modelos Animais de Doenças , Temperatura Alta , Animais , Reprodutibilidade dos Testes , Pele/lesões , Fatores de Tempo , Água
9.
Acta cir. bras ; 34(10): e201901007, Oct. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1054673

RESUMO

Abstract Purpose: To conduct a scope review of the experimental model described by Walker and Mason, by identifying and analyzing the details of the method. Methods: The authors searched Pubmed-Medline, Cochrane-Bireme and PEDro databases for articles published between January 2016 and December 2018, using the following search queries: burns, burn injuries, models animal, and animal experimentation. All articles whose authors used Walker and Mason's model - with or without changes to the method in Wistar rats - were included in this study. Results: The search identified 45 mentions of Walker and Mason's model; however, after reading each summary, 20 were excluded (of which 5 due to duplicity). The inconsistencies observed after the scope review were: water temperature, length of time of exposure of the experimental model's skin to water, extent of the burnt area, and the description of the thickness/depth of the injury. Conclusions: Reproducibility of a scientific method is the basis to prove the veracity of the observed results. Thus, it is necessary to have a greater number of publications that adopt a reproducible scientific method, for this review found inconsistencies in the description of Walker and Mason's model.


Assuntos
Animais , Queimaduras/etiologia , Modelos Animais de Doenças , Temperatura Alta , Pele/lesões , Fatores de Tempo , Água , Reprodutibilidade dos Testes
10.
Rev Col Bras Cir ; 46(2): e2108, 2019 May 09.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31090866

RESUMO

OBJECTIVE: to evaluate the accuracy of ultrasonography in the diagnosis of inguinal hernia in the preoperative period of patients submitted to inguinal herniorrhaphy. METHODS: we conducted a retrospective, descriptive, analytical study, based on data obtained from the charts of patients submitted to inguinal herniorrhaphy between January 2016 and December 2017 and who underwent ultrasonography in the preoperative period. The sample consisted of 232 patients, and we compared the results of the ultrasonography with the complaints, physical examination and intraoperative findings. RESULTS: ultrasonography was in agreement with inguinal hernia complaint in 52% of patients (p=0.019). There was a disagreement between the percentage of patients who presented a hernia at the physical examination not confirmed by the ultrasound examination (28.57%) and the percentage of hernias identified only by the complementary examination (8.93%), with statistical significance (p=0.0291). When comparing the ultrasound findings with the intraoperative ones, 32.70% of patients presenting with hernia had normal ultrasonography, with statistical significance for discordance (p=0.001). CONCLUSION: ultrasound was an unreliable method to help diagnosis in dubious cases of inguinal hernia, and dispensable when the diagnosis was confirmed by typical complaints and compatible physical examination.


Assuntos
Hérnia Inguinal/diagnóstico por imagem , Ultrassonografia/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Autoavaliação Diagnóstica , Feminino , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Padrões de Referência , Reprodutibilidade dos Testes , Estudos Retrospectivos , Adulto Jovem
11.
Aesthetic Plast Surg ; 43(3): 866-873, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30968210

RESUMO

INTRODUCTION: In two previous studies, the quality of randomized controlled trials (RCTs) with the participation of at least one plastic surgeon was evaluated in two periods: 1966-2003 and 2004-2008. OBJECTIVE: To evaluate the evolution of the quality of RCT publications by plastic surgeons in the subsequent 5-year period, from 2009 to 2013. METHODS: RCTs published from 2009 to 2013 in English with the participation of at least one plastic surgeon were identified by electronic search and classified for concealment of allocation by two independent evaluators. The studies with adequate allocation concealment had their quality evaluated by two evaluators using the Delphi List and the Jadad Quality Scale. RESULTS: Of the 6997 identified studies, 261 were classified as to concealment of allocation. Of these, 43 (16.47%) had adequate allocation concealment. According to the evaluation in the Delphi List, there was an improvement, in relation to 1966-2003, in the items "most important characteristics of the prognosis" (p < 0.001), "use of independent evaluator" (p = 0.0029), and "measures of variability and point estimate for the primary variable" (p = 0.0057); there was no difference in relation to 2004-2008. Regarding the Jadad Quality Scale, there was an increase in scores in relation to 1966-2003 (p < 0.0004) but not in relation to the 2004-2008 period. CONCLUSION: There was no difference in the quality of publications of RCTs by plastic surgeons in the period 2009-2013 compared to the previous 5 years (2004-2008), but both periods presented higher quality than the period 1966-2003. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .


Assuntos
Editoração , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Cirurgia Plástica , Fatores de Tempo
12.
Clinics (Sao Paulo) ; 74: e421, 2019 03 25.
Artigo em Inglês | MEDLINE | ID: mdl-30916210

RESUMO

OBJECTIVE: To assess work ability and productivity in patients with diabetic foot. METHODS: This investigation was a cross-sectional controlled study. A total of 117 individuals were selected from March to June 2014 and allocated to group A (patients without diabetes, n=43), group B (diabetes patients without foot ulcers, n=43), or group C (patients with diabetic foot, n=31). Two validated instruments, the Work Limitations Questionnaire (WLQ) and the Work Productivity and Activity Impairment Questionnaire General Health v2.0 (WPAI-GH), were used to assess work ability and productivity. RESULTS: The groups were homogeneous regarding age and sex; however, patients in group C had a lower education level than the other participants (p=0.006). The median WLQ scores for groups A, B, and C were 0.0121, 0.0146, and 0.0852, respectively (p<0.0001). The WPAI-GH scores revealed a mean productivity loss of 20% for groups A and B and 100% for group C (p<0.0001). CONCLUSIONS: Patients with diabetic foot showed decreased work ability and productivity.


Assuntos
Pé Diabético/psicologia , Eficiência/classificação , Inquéritos e Questionários , Avaliação da Capacidade de Trabalho , Absenteísmo , Atividades Cotidianas/psicologia , Adulto , Aptidão/classificação , Estudos Transversais , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Fatores de Tempo
13.
Aesthet Surg J ; 39(4): NP68-NP75, 2019 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-30204832

RESUMO

BACKGROUND: Rhinophyma results in nasal deformity, which may lead to significant distress, embarrassment, social isolation, and low self-esteem. Fractional carbon dioxide (CO2) laser treatment is a simple, noninvasive, outpatient procedure with a low complication rate that has proved useful in rhinophyma treatment. OBJECTIVES: The aim of this study was to assess the impact of fractional ablative CO2 laser treatment on self-esteem in patients with rhinophyma. METHODS: Twelve patients with rhinophyma, between 50 and 80 years of age, received 4 monthly treatment sessions with a fractional ablative CO2 laser. The laser parameters were chosen based on the severity of the condition of each patient. Patient satisfaction was assessed through a study-specific questionnaire administered 1 month after treatment. Self-esteem was assessed by the Rosenberg Self-Esteem (RSE) Scale, which was administered before treatment, and at 1, 6, and 12 months after treatment. RESULTS: A decrease in RSE scores was observed in the post-treatment period, indicating an improvement in self-esteem among patients. All patients were satisfied with the aesthetic results and would recommend the treatment to a friend. CONCLUSIONS: Fractional ablative CO2 laser treatment is associated with high levels of rhinophyma patient satisfaction, and significant improvements in self-esteem.


Assuntos
Lasers de Gás/uso terapêutico , Satisfação do Paciente , Rinofima/cirurgia , Autoimagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e Questionários , Resultado do Tratamento
14.
Rev. Col. Bras. Cir ; 46(2): e2108, 2019. tab
Artigo em Português | LILACS | ID: biblio-1003089

RESUMO

RESUMO Objetivo: avaliar a acurácia da ultrassonografia no diagnóstico de hérnia inguinal no pré-operatório de pacientes submetidos à herniorrafia inguinal. Métodos: estudo retrospectivo descritivo, analítico, baseado em dados obtidos dos prontuários de pacientes submetidos à herniorrafia inguinal entre janeiro de 2016 e dezembro de 2017 e que realizaram ultrassonografia no período pré-operatório. A amostra foi composta por 232 pacientes e foram comparados os resultados da ultrassonografia com as queixas, exame físico e achados intraoperatórios desses pacientes. Resultados: a ultrassonografia apresentou concordância com a queixa de hérnia inguinal em 52% dos pacientes (p=0,019). Houve discordância entre a porcentagem de pacientes que apresentaram hérnia ao exame físico não confirmada pelo exame ultrassonográfico (28,57%) e a porcentagem de hérnias identificadas somente ao exame complementar (8,93%), com significância estatística (p=0,0291). Quando comparados os resultados ultrassonográficos com achados intraoperatórios, 32,70% dos pacientes que apresentavam hérnia tinham ultrassonografia normal com significância estatística para discordância (p=0,001). Conclusão: a ultrassonografia mostrou-se método não confiável para auxiliar no diagnóstico em casos duvidosos de hérnia inguinal e dispensável quando o diagnóstico era confirmado por queixas típicas e exame físico compatível.


ABSTRACT Objective: to evaluate the accuracy of ultrasonography in the diagnosis of inguinal hernia in the preoperative period of patients submitted to inguinal herniorrhaphy. Methods: we conducted a retrospective, descriptive, analytical study, based on data obtained from the charts of patients submitted to inguinal herniorrhaphy between January 2016 and December 2017 and who underwent ultrasonography in the preoperative period. The sample consisted of 232 patients, and we compared the results of the ultrasonography with the complaints, physical examination and intraoperative findings. Results: ultrasonography was in agreement with inguinal hernia complaint in 52% of patients (p=0.019). There was a disagreement between the percentage of patients who presented a hernia at the physical examination not confirmed by the ultrasound examination (28.57%) and the percentage of hernias identified only by the complementary examination (8.93%), with statistical significance (p=0.0291). When comparing the ultrasound findings with the intraoperative ones, 32.70% of patients presenting with hernia had normal ultrasonography, with statistical significance for discordance (p=0.001). Conclusion: ultrasound was an unreliable method to help diagnosis in dubious cases of inguinal hernia, and dispensable when the diagnosis was confirmed by typical complaints and compatible physical examination.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Ultrassonografia/normas , Hérnia Inguinal/diagnóstico por imagem , Padrões de Referência , Reprodutibilidade dos Testes , Estudos Retrospectivos , Período Pré-Operatório , Autoavaliação Diagnóstica , Período Intraoperatório , Pessoa de Meia-Idade
15.
Rev. bras. geriatr. gerontol. (Online) ; 22(2): e180122, 2019. tab
Artigo em Inglês, Português | LILACS | ID: biblio-1020592

RESUMO

Abstract Objective: to verify if the prevalence of dementia differs between widowed and non-widowed elderly persons and between genders, and to analyse if there is an association with sociodemographic and clinical characteristics. Method: a retrospective cross-sectional observational study of patients treated at a Behavioral Neurology outpatient clinic from 1999 to 2009 was carried out, employing anamnesis, physical and neurological examination, the Clinical Dementia Rating Scale (CDR) and the Mini Mental State Examination (MMSE). Sociodemographic (schooling and age) and clinical (age of onset of symptoms and time since onset of symptoms, MMSE and CDR) variables were analyzed. The differences were evaluated by the Mann Whitney test, using a significance value of p<0.05. Results: of 208 patients diagnosed with dementia, 73 (35.1%) were widowed and 135 (64.9%) were non-widowed. Those who were widowed were older than those who were non-widowed (p<0.001) when diagnosed with dementia. This difference in age remained when gender (p<0.001), widowed and widowed women (p<0.001) and widowed and non-widowed men (p<0.001) were compared. The time from onset of symptoms to diagnosis was greater in widowed than in non-widowed men [55.6 (± 86.3) vs. 43.4 (± 44.8) months], although the difference was not statistically significant. Widowed patients with dementia had lower schooling, regardless of gender (p<0.05). Conclusion: the prevalence of dementia differed between widowed and non-widowed individuals, being higher among non-widows. There was an association between widowhood and the clinical and sociodemographic characteristics, with differences between the genders. The loss of a spouse can generate different outcomes among men and women, necessitating measures with a specific focus on prevention and strategies of care in dementia.


Resumo Objetivo: Verificar se a prevalência de demência difere entre viúvos e não viúvos, e analisar se há associação com características sociodemográficas e clínicas, bem como diferenças entre os sexos. Método: Estudo observacional transversal retrospectivo que analisou prontuários de pacientes atendidos em um ambulatório de Neurologia do Comportamento de 1999 a 2009 através de anamnese, exame físico e neurológico, Clinical Dementia Rating Scale (CDR) e Miniexame do Estado Mental (MEEM). Avaliou-se variáveis sociodemográficas (escolaridade e idade) e clínicas (idade e tempo do início dos sintomas, MEEM e CDR). As diferenças foram avaliadas pelo teste de Mann Whitney, admitindo-se p<0,05. Resultados: Dos 208 pacientes com diagnóstico de demência, 73 (35,1%) eram viúvos e 135 (64,9%) não viúvos. Os viúvos eram mais velhos que os não viúvos (p<0,001) quando foram diagnosticados com demência. Essa diferença na idade manteve-se comparando os sexos (p<0,001), mulheres viúvas e não viúvas (p<0,001) e homens viúvos e não viúvos (p<0,001). O tempo do início dos sintomas até o diagnóstico foi maior em homens viúvos quando comparado aos não viúvos [55,6 (±86,3) vs 43,4 (±44,8) meses] mas sem significância estatística. Os viúvos com demência tinham menor escolaridade, independente do sexo (p<0,05). Conclusão: A prevalência de demência diferiu entre viúvos e não viúvos, sendo maior nos não viúvos. Houve associação da viuvez com características clínicas e sociodemográficas com diferença entre os sexos. A perda do cônjuge pode gerar diferentes desfechos entre homens e mulheres, necessitando de medidas com enfoque específico na prevenção e estratégias de cuidado na demência.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Epidemiologia , Viuvez , Demência , Doença de Alzheimer
16.
Clinics ; 74: e421, 2019. tab
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-989645

RESUMO

OBJECTIVE: To assess work ability and productivity in patients with diabetic foot. METHODS: This investigation was a cross-sectional controlled study. A total of 117 individuals were selected from March to June 2014 and allocated to group A (patients without diabetes, n=43), group B (diabetes patients without foot ulcers, n=43), or group C (patients with diabetic foot, n=31). Two validated instruments, the Work Limitations Questionnaire (WLQ) and the Work Productivity and Activity Impairment Questionnaire General Health v2.0 (WPAI-GH), were used to assess work ability and productivity. RESULTS: The groups were homogeneous regarding age and sex; however, patients in group C had a lower education level than the other participants (p=0.006). The median WLQ scores for groups A, B, and C were 0.0121, 0.0146, and 0.0852, respectively (p<0.0001). The WPAI-GH scores revealed a mean productivity loss of 20% for groups A and B and 100% for group C (p<0.0001). CONCLUSIONS: Patients with diabetic foot showed decreased work ability and productivity.

17.
Säo Paulo med. j ; 136(6): 551-556, Nov.-Dec. 2018. tab
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-991691

RESUMO

ABSTRACT BACKGROUND: Breast cancer is the second most frequent type of cancer worldwide and the most common type among women. The treatment for this condition has evolved over recent decades with therapeutic and technological advances. Breast reconstruction techniques using musculocutaneous flaps from the latissimus dorsi and rectus abdominis have aroused interest regarding patients' quality of life. Our goal here was to compare patients' satisfaction scores after they underwent breast reconstruction using musculocutaneous flaps from either the latissimus dorsi or the rectus abdominis. DESIGN AND SETTING: Primary, clinical, analytical, observational and cross-sectional study conducted in a federal university and a public hospital. METHODS: Demographic and clinical data were collected. The Mini-Mental State Examination was then applied, with testing for specificity and sensitivity. Lastly, a breast evaluation questionnaire was applied to evaluate breast satisfaction among 90 women, who were divided into three groups: mastectomy (control; n = 30); breast reconstruction using flap from the latissimus dorsi (n = 30); and reconstruction using flap from the rectus abdominis (n = 30). RESULTS: The groups were homogeneous regarding the main demographic data and the questionnaire responses (P < 0.05). Compared with the control group, the reconstruction groups showed significant improvement in satisfaction (P < 0.0002) after one year. CONCLUSION: Within our sample, women who underwent breast reconstruction with flaps from either the latissimus dorsi or the rectus abdominis had similar satisfaction scores.

18.
Rev. bras. anestesiol ; 68(6): 543-548, Nov.-Dec. 2018. tab
Artigo em Inglês | LILACS | ID: biblio-977392

RESUMO

Abstract Introduction: ENT patients with obstructive sleep apnea syndrome have a tendency of collapsing the upper airways in addition to anatomical obstacles. Obstructive sleep apnea syndrome is related to the increased risk of difficult airway and also increased perioperative complications. In order to identify these patients in the preoperative period, the STOP Bang questionnaire has been highlighted because it is summarized and easy to apply. Objectives: Evaluate through the STOP Bang questionnaire whether patients undergoing ENT surgery with a diagnosis of obstructive sleep apnea syndrome have a higher risk of complications, particularly the occurrence of difficult airway. Casuistry and methods: Measurements of anatomical parameters for difficult airway and questionnaire application for clinical prediction of obstructive sleep apnea syndrome were performed in 48 patients with a previous polysomnographic study. Results: The sample detected difficult airway in about 18.7% of patients, all of them with obstructive sleep apnea syndrome. This group had older age, cervical circumference > 40 cm, ASA II and Cormack III/IV. Patients with obstructive sleep apnea syndrome had higher body mass index, cervical circumference, and frequent apnea. In subgroup analysis, the group with severe obstructive sleep apnea syndrome showed a significantly higher SB score compared to patients without this syndrome or with a mild/moderate obstructive sleep apnea syndrome. Conclusions: The STOP Bang questionnaire was not able to predict difficult airway and mild obstructive sleep apnea syndrome, but it identified marked obstructive sleep apnea syndrome. All patients with difficult airway had moderate and marked obstructive sleep apnea syndrome, although this syndrome did not involve difficult airway. The variables Cormack III/IV and BMI greater than 35 kg.m−2 were able to predict difficult airway and obstructive sleep apnea syndrome, respectively.


Resumo Introdução: Os pacientes cirúrgicos otorrinolaringológicos portadores da síndrome da apneia obstrutiva do sono apresentam, além de obstáculos anatômicos, tendência ao colapso das vias aéreas superiores. Síndrome da apneia obstrutiva do sono está relacionada ao maior risco de via aérea difícil e também aumento de complicações perioperatórias. A fim de se identificar esses pacientes no período pré-operatório, tem se destacado o questionário STOP Bang, por ser resumido e de fácil aplicação. Objetivos: Avaliar se pacientes submetidos à cirurgia otorrinolaringológica com diagnóstico de síndrome da apneia obstrutiva do sono pelo questionário STOP Bang apresentariam maior risco de complicações, particularmente ocorrência de via aérea difícil. Casuística e métodos: Feitas medidas de parâmetros anatômicos para via aérea difícil e administrado questionário para predição clínica de síndrome da apneia obstrutiva do sono em 48 pacientes com estudo polissonográfico prévio. Resultados: A amostra detectou via aérea difícil em 18,7% dos pacientes, todos portadores de síndrome da apneia obstrutiva do sono. Esse grupo apresentava maior idade, circunferência cervical > 40 cm, ASA II e Cormack III/IV. Os pacientes com síndrome da apneia obstrutiva do sono apresentaram maior índice de massa corpórea, circunferência cervical e frequência de apneia observada. Na análise de subgrupos, o grupo com síndrome da apneia obstrutiva do sono acentuada mostrou significantemente maior pontuação no SB quando comparado com pacientes sem síndrome da apneia obstrutiva do sono ou com síndrome da apneia obstrutiva do sono leve/moderada. Conclusões: O questionário STOP Bang não foi capaz de predizer via aérea difícil e nem síndrome da apneia obstrutiva do sono leve e moderada, mas identificou síndrome da apneia obstrutiva do sono acentuada. Todos pacientes com via aérea difícil apresentaram síndrome da apneia obstrutiva do sono moderada e acentuada, apesar desta síndrome não implicar em via aérea difícil. As variáveis Cormack III/IV e IMC maior do que 35 Kg.m-2 foram capazes de predizer via aérea difícil e síndrome da apneia obstrutiva do sono respectivamente.


Assuntos
Humanos , Masculino , Feminino , Adulto , Procedimentos Cirúrgicos Otorrinolaringológicos , Apneia Obstrutiva do Sono/complicações , Obstrução das Vias Respiratórias/complicações , Obstrução das Vias Respiratórias/diagnóstico , Estudos Prospectivos , Medição de Risco , Apneia Obstrutiva do Sono/diagnóstico , Correlação de Dados , Pessoa de Meia-Idade
19.
Ann Plast Surg ; 81(4): 398-401, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30028756

RESUMO

OBJECTIVE: The aim of this study was to evaluate work ability and productivity in women who had undergone different types of surgical treatment for breast cancer, as well as breast reconstruction after mastectomy. METHODS: This cross-sectional study assessed 152 women between 30 and 60 years of age, who worked outside the home in formal or informal jobs, or as self-employed. Thirty-eight of them had no history of breast cancer (control group), and 114 had undergone surgical treatment for breast cancer at least 1 year before their enrollment in the study, and were allocated as follows: mastectomy group (n = 38), breast-conserving surgery group (n = 38), or breast reconstruction breast reconstruction group (n = 38). The validated Brazilian versions of the Work Productivity and Activity Impairment-General Health questionnaire and Work Limitations Questionnaire were self-administered. RESULTS: The groups were homogeneous regarding age, education level, and other sociodemographic characteristics. Patients in the mastectomy and breast-conserving surgery groups showed reduced work performance and productivity compared with women in the breast reconstruction and control groups (P = 0.0004 and P = 0.0006, respectively). In addition, women in the mastectomy group had more difficulty in performing activities of daily living compared with those in other groups (P = 0.0121). CONCLUSIONS: Women who had undergone mastectomy or breast-conserving surgery had decreased work ability and productivity compared with women without a history of breast cancer and to those who had undergone breast reconstruction.


Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia/métodos , Avaliação da Capacidade de Trabalho , Atividades Cotidianas , Adulto , Brasil , Estudos Transversais , Feminino , Humanos , Mastectomia , Mastectomia Segmentar , Pessoa de Meia-Idade , Qualidade de Vida , Inquéritos e Questionários
20.
Clinics (Sao Paulo) ; 73: e313, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29924186

RESUMO

OBJECTIVE: The aim of this study was to analyse patient-reported outcomes of reduction mammoplasty among Brazilian women. METHODS: A total of 100 women were enrolled in this cross-sectional controlled study, 50 with breast hypertrophy (Hypertrophy Group) and 50 who had undergone breast reduction at least six and up to 12 months before (Mammoplasty Group). The Brazilian version of the BREAST-Q® was applied to assess patient-reported outcomes. The module reduction/mastopexy was used, and the preoperative and postoperative versions were applied to the hypertrophy and mammoplasty groups, respectively. RESULTS: The mammoplasty group presented higher scores for the subscales satisfaction with breasts, psychosocial well-being, sexual well-being and physical well-being (p=0.0001 for all of these subscales). CONCLUSION: These results suggest that patients submitted to reduction mammoplasty are satisfied with the outcomes and present better quality of life scores compared with women with breast hypertrophy.


Assuntos
Mama/cirurgia , Mamoplastia/psicologia , Satisfação do Paciente/estatística & dados numéricos , Inquéritos e Questionários , Adolescente , Adulto , Índice de Massa Corporal , Brasil , Estudos Transversais , Feminino , Humanos , Mamoplastia/métodos , Pessoa de Meia-Idade , Período Pós-Operatório , Qualidade de Vida/psicologia , Resultado do Tratamento , Adulto Jovem
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