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1.
RMD Open ; 7(1)2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33542047

RESUMO

OBJECTIVE: To evaluate whether the addition of colchicine to standard treatment for COVID-19 results in better outcomes. DESIGN: We present the results of a randomised, double-blinded, placebo-controlled clinical trial of colchicine for the treatment of moderate to severe COVID-19, with 75 patients allocated 1:1 from 11 April to 30 August 2020. Colchicine regimen was 0.5 mg thrice daily for 5 days, then 0.5 mg twice daily for 5 days. The primary endpoints were the need for supplemental oxygen, time of hospitalisation, need for admission and length of stay in intensive care unit and death rate. RESULTS: Seventy-two patients (36 for placebo and 36 for colchicine) completed the study. Median (and IQR) time of need for supplemental oxygen was 4.0 (2.0-6.0) days for the colchicine group and 6.5 (4.0-9.0) days for the placebo group (p<0.001). Median (IQR) time of hospitalisation was 7.0 (5.0-9.0) days for the colchicine group and 9.0 (7.0-12.0) days for the placebo group (p=0.003). At day 2, 67% versus 86% of patients maintained the need for supplemental oxygen, while at day 7, the values were 9% versus 42%, in the colchicine and the placebo groups, respectively (log rank; p=0.001). Two patients died, both in placebo group. Diarrhoea was more frequent in the colchicine group (p=0.26). CONCLUSION: Colchicine reduced the length of both, supplemental oxygen therapy and hospitalisation. The drug was safe and well tolerated. Once death was an uncommon event, it is not possible to ensure that colchicine reduced mortality of COVID-19. TRIAL REGISTRATION NUMBER: RBR-8jyhxh.


Assuntos
/tratamento farmacológico , Colchicina/administração & dosagem , Tempo de Internação , Oxigenoterapia , Índice de Gravidade de Doença , Adulto , Idoso , /virologia , Colchicina/efeitos adversos , Diarreia/induzido quimicamente , Método Duplo-Cego , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Fatores de Tempo , Resultado do Tratamento
3.
Arq Bras Cardiol ; 115(5): 809-818, 2020 Nov.
Artigo em Português, Inglês | MEDLINE | ID: mdl-33295442

RESUMO

BACKGROUND: Acute pulmonary embolism (APE) has a variable clinical outcome. Computed tomography pulmonary angiography (CTPA) is the gold standard for this diagnosis. OBJECTIVE: To evaluate if the pulmonary vascular volume (PVV) quantified by automated software is a mortality predictor after APE. METHODS: Retrospective cohort study where the CTPA imaging of 61 patients with APE was reanalyzed. Pulmonary vascular volume (PVV) and pulmonary volume (PV) were automatically estimated using the Yacta software. We calculated the adjusted PVV by the ratio: PVV(cm3)/PV(liters). Classical prognostic CTPA parameters (clot load index, right ventricle/left ventricle diameter ratio, pulmonary artery/aorta diameter ratio, ventricular septal bowing, pulmonary infarction and reflux of contrast into the hepatic vein) were assessed. The outcome assessed was one-month mortality. We considered a p-value <0.05 as statistically significant. RESULTS: Seven deaths (11%) occurred at one month among these 61 patients. PVV<23cm3/L was an independent predictor of one-month mortality in the univariate [odds ratio (OR): 26; 95% confidence interval (CI): 3-244; p=0.004] and multivariate analyses [adjusted OR: 19; 95%CI: 1.3-270; p=0.03]. The classical CTPA parameters were not associated with one-month mortality in this sample. The PVV<23cm3/L showed a sensitivity of 86%, a specificity of 82%, a negative predictive value of 94% and a positive predictive value of 64% to identify the patients who died. CONCLUSION: PVV<23cm3/L was an independent predictor of one-month mortality after APE. This parameter showed better prognostic performance than other classical CTPA findings. (Arq Bras Cardiol. 2020; 115(5):809-818).

4.
Arq. bras. cardiol ; 115(5): 809-818, nov. 2020. tab, graf
Artigo em Português | LILACS, Sec. Est. Saúde SP | ID: biblio-1142259

RESUMO

Resumo Fundamento: A embolia pulmonar aguda (EPA) tem desfecho clínico variável. A angiotomografia computadorizada (angio-CT) é considerada o padrão-ouro para o diagnóstico. Objetivo: Avaliar se o volume vascular pulmonar (VVP) quantificado por software automatizado é um preditor de mortalidade após EPA. Métodos: Estudo de coorte retrospectivo no qual a imagem da angio-CT de 61 pacientes com EPA foi reanalisada. O VVP e o volume pulmonar (VP) foram estimados automaticamente pelo software Yacta. Calculamos o VVP ajustado pela razão: VVP(cm3)/VP(litros). Parâmetros prognósticos clássicos da angio-CT (carga embólica; razão do diâmetro do ventrículo direito/ventrículo esquerdo; razão do diâmetro da artéria pulmonar/aorta; desvio do septo interventricular; infarto pulmonar e refluxo de contraste na veia hepática) foram avaliados. A mortalidade em 1 mês foi o desfecho analisado. Consideramos um valor de p <0,05 como estatisticamente significativo. Resultados: Sete mortes (11%) ocorreram entre os 61 pacientes durante 1 mês de seguimento. O VVP ajustado <23cm3/L foi um preditor independente de mortalidade na análise univariada (odds ratio [OR]: 26; intervalo de confiança de 95% [IC95%]: 3-244; p=0,004) e na análise multivariada (OR ajustado: 19 [IC95%: 1,3-270]; p=0,03). Os parâmetros clássicos da angio-CT não foram associados à mortalidade em 1 mês nesta amostra. O VVP ajustado <23cm3/L apresentou sensibilidade de 86%, especificidade de 82%, valor preditivo negativo de 94% e valor preditivo positivo de 64% para identificação dos pacientes que morreram. Conclusão: VVP ajustado <23cm3/L foi um preditor independente de mortalidade após EPA. Esse parâmetro mostrou melhor desempenho prognóstico do que os outros achados clássicos da angio-CT. (Arq Bras Cardiol. 2020; 115(5):809-818)


Abstract Background: Acute pulmonary embolism (APE) has a variable clinical outcome. Computed tomography pulmonary angiography (CTPA) is the gold standard for this diagnosis. Objective: To evaluate if the pulmonary vascular volume (PVV) quantified by automated software is a mortality predictor after APE. Methods: Retrospective cohort study where the CTPA imaging of 61 patients with APE was reanalyzed. Pulmonary vascular volume (PVV) and pulmonary volume (PV) were automatically estimated using the Yacta software. We calculated the adjusted PVV by the ratio: PVV(cm3)/PV(liters). Classical prognostic CTPA parameters (clot load index, right ventricle/left ventricle diameter ratio, pulmonary artery/aorta diameter ratio, ventricular septal bowing, pulmonary infarction and reflux of contrast into the hepatic vein) were assessed. The outcome assessed was one-month mortality. We considered a p-value <0.05 as statistically significant. Results: Seven deaths (11%) occurred at one month among these 61 patients. PVV<23cm3/L was an independent predictor of one-month mortality in the univariate [odds ratio (OR): 26; 95% confidence interval (CI): 3-244; p=0.004] and multivariate analyses [adjusted OR: 19; 95%CI: 1.3-270; p=0.03]. The classical CTPA parameters were not associated with one-month mortality in this sample. The PVV<23cm3/L showed a sensitivity of 86%, a specificity of 82%, a negative predictive value of 94% and a positive predictive value of 64% to identify the patients who died. Conclusion: PVV<23cm3/L was an independent predictor of one-month mortality after APE. This parameter showed better prognostic performance than other classical CTPA findings. (Arq Bras Cardiol. 2020; 115(5):809-818)


Assuntos
Humanos , Embolia Pulmonar/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Software , Angiografia , Doença Aguda , Estudos Retrospectivos
5.
Int J Stroke ; : 1747493020968435, 2020 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-33115383

RESUMO

BACKGROUND: Assessment of the impact of the thrombectomy learning curve on clinical outcomes is essential for developing healthcare system protocols. AIMS: The aim of this study was to assess the effect of thrombectomy case volume on procedural and clinical outcomes in a Brazilian registry. METHODS: A total of 645 patients with acute ischemic stroke treated by thrombectomy were included in the analysis. Patients were divided into two groups regarding the period of treatment: the early period group and the late period group. RESULTS: In the adjusted analysis, treatment in the late period was an independent predictor of recanalization (odds ratio 1.91, 95% CI 1.28-2.86) and excellent neurologic outcomes at three months (odds ratio 1.77, 95% CI 1.04-3.01). Treatment in the late period had no significant association with mortality (odds ratio 0.88, 95% CI 0.55-1.41). CONCLUSIONS: An increase in thrombectomy case volume for the treatment of AIS over time was an independent predictor of recanalization and excellent neurologic outcome.

6.
AJR Am J Roentgenol ; 215(6): 1398-1402, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33021834

RESUMO

OBJECTIVE. The purpose of this study was to describe the prevalence of vas deferens (VD) calcifications on abdominal CT examinations and the associations between VD calcifications and several systemic conditions. MATERIALS AND METHODS. The CT examinations of male patients from January 2010 to December 2011 were retrospectively reviewed. After exclusions, the records of 1915 consecutively identified patients were analyzed. Five readers, 3rd- and 4th-year radiology residents, recorded the presence and laterality of VD calcifications and of vascular calcifications presumed due to atherosclerosis. A sixth reader parsed the patient records for diagnoses of type 2 diabetes mellitus (DM) and chronic kidney disease (CKD). RESULTS. The mean age of the entire sample population was 52.9 ± 18.9 years (range, 1-93 years). The mean age of patients with VD calcifications was 59.3 ± 12.0 (SD) years and of the group without VD calcifications was 52.9 ± 19.1 years (p = 0.17). The prevalence of VD calcification was 1.61% (31 patients): 21 (67.7%) of the patients had bilateral calcification; seven (22.6%), right-sided only; and three, (9.7%) left-sided. The frequency of DM was 28.8% (551/1915), of CKD was 7.58% (150/1915), and of atherosclerosis, 60.4% (1156/1915). The mean caliber of calcified VDs was 5.31 ± 1.29 mm versus 3.63 ± 0.63 mm for patients without calcification or any chronic condition (p < 0.0001). Among age, atherosclerosis, DM, and CKD in univariate regression analysis, only DM was associated with VD calcification (p = 0.006). However, because age (p = 0.063) and atherosclerosis (p = 0.057) were close to significant, they were included in the multivariate analysis, which also showed only DM associated with VD calcification (odds ratio, 2.14 ± 0.85). CONCLUSION. In the large cohort in this study, the prevalence of VD calcification was 1.61%. VD calcification was strongly associated with DM. The pathologic implications of VD calcification remain unclear and warrant further investigation in prospective longitudinal studies.

7.
JACC Clin Electrophysiol ; 6(10): 1238-1245, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33092749

RESUMO

OBJECTIVES: This study of patients with Chagas heart disease (CHD) with an implantable cardioverter-defibrillator (ICD) for secondary prevention of sudden cardiac death sought to compare the characteristics of those with or without electrical storm (ES) during long-term follow-up. BACKGROUND: ES is a common problem in patients with CHD harboring an ICD, but data on clinical predictors and outcomes are limited. METHODS: The authors retrospectively evaluated 110 patients with CHD with a mean follow-up of 1,949 ± 1,271 days. Demographic, clinical, arrhythmia characteristics, ICD treatment, and death data were collected. Descriptive statistics included mean ± SD and Fisher exact tests used for comparisons. A p value <0.05 was considered significant. RESULTS: The ES group (n = 57; 43 men; age 62 ± 10 years) and the non-ES group (n = 53; 43 men; age 57 ± 14 years) had similar baseline demographic and clinical parameters, but left ventricular ejection fraction was higher in the ES group (44 ± 14% vs. 37 ± 14%; p = 0.02) and QRS duration was shorter (109 ± 35 ms vs. 134 ± 36 ms; p = 0.0027). Mortality rates were comparable in the 2 groups (odds ratio: 1.2; 95% confidence interval: 0.79 to 1.85; p = 0.44). The ES group presented 116 ES (2.03 ±1.47, 1 to 6). A total of 2,953 (61%) arrhythmic events required ICD therapy. No deaths occurred directly caused by ES, but clinical triggers were reported in 20 patients. CONCLUSIONS: ES is frequent in CHD but in itself does not carry a worse prognosis in this study population and was not associated with a more depressed left ventricular systolic function or a longer QRS.

8.
Thromb Res ; 196: 359-366, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32977137

RESUMO

INTRODUCTION: Coronavirus disease 2019 (COVID-19) causes a hypercoagulable state. Several autopsy studies have found microthrombi in pulmonary circulation. METHODS: In this randomized, open-label, phase II study, we randomized COVID-19 patients requiring mechanical ventilation to receive either therapeutic enoxaparin or the standard anticoagulant thromboprophylaxis. We evaluated the gas exchange over time through the ratio of partial pressure of arterial oxygen (PaO2) to the fraction of inspired oxygen (FiO2) at baseline, 7, and 14 days after randomization, the time until successful liberation from mechanical ventilation, and the ventilator-free days. RESULTS: Ten patients were assigned to the therapeutic enoxaparin and ten patients to prophylactic anticoagulation. There was a statistically significant increase in the PaO2/FiO2 ratio over time in the therapeutic group (163 [95% confidence interval - CI 133-193] at baseline, 209 [95% CI 171-247] after 7 days, and 261 [95% CI 230-293] after 14 days), p = 0.0004. In contrast, we did not observe this improvement over time in the prophylactic group (184 [95% CI 146-222] at baseline, 168 [95% CI 142-195] after 7 days, and 195 [95% CI 128-262] after 14 days), p = 0.487. Patients of the therapeutic group had a higher ratio of successful liberation from mechanical ventilation (hazard ratio: 4.0 [95% CI 1.035-15.053]), p = 0.031 and more ventilator-free days (15 days [interquartile range IQR 6-16] versus 0 days [IQR 0-11]), p = 0.028 when compared to the prophylactic group. CONCLUSION: Therapeutic enoxaparin improves gas exchange and decreases the need for mechanical ventilation in severe COVID-19. TRIAL REGISTRATION: REBEC RBR-949z6v.

9.
J Exp Med ; 217(12)2020 12 07.
Artigo em Inglês | MEDLINE | ID: mdl-32926098

RESUMO

Severe COVID-19 patients develop acute respiratory distress syndrome that may progress to cytokine storm syndrome, organ dysfunction, and death. Considering that neutrophil extracellular traps (NETs) have been described as important mediators of tissue damage in inflammatory diseases, we investigated whether NETs would be involved in COVID-19 pathophysiology. A cohort of 32 hospitalized patients with a confirmed diagnosis of COVID-19 and healthy controls were enrolled. The concentration of NETs was augmented in plasma, tracheal aspirate, and lung autopsies tissues from COVID-19 patients, and their neutrophils released higher levels of NETs. Notably, we found that viable SARS-CoV-2 can directly induce the release of NETs by healthy neutrophils. Mechanistically, NETs triggered by SARS-CoV-2 depend on angiotensin-converting enzyme 2, serine protease, virus replication, and PAD-4. Finally, NETs released by SARS-CoV-2-activated neutrophils promote lung epithelial cell death in vitro. These results unravel a possible detrimental role of NETs in the pathophysiology of COVID-19. Therefore, the inhibition of NETs represents a potential therapeutic target for COVID-19.


Assuntos
Betacoronavirus/fisiologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/virologia , Armadilhas Extracelulares/fisiologia , Pneumonia Viral/imunologia , Pneumonia Viral/virologia , Células A549 , Adulto , Morte Celular , Infecções por Coronavirus/sangue , Infecções por Coronavirus/patologia , Células Epiteliais/patologia , Células Epiteliais/virologia , Feminino , Células HeLa , Humanos , Masculino , Ativação de Neutrófilo , Pandemias , Peptidil Dipeptidase A/metabolismo , Pneumonia Viral/sangue , Pneumonia Viral/patologia , Serina Proteases/metabolismo , Sucção , Traqueia/imunologia
10.
Chest ; 158(2): e85-e87, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32768081
11.
J Intensive Care Med ; 35(1): 95-103, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28931365

RESUMO

PURPOSE: Over 170 biomarkers are being investigated regarding their prognostic and diagnostic accuracy in sepsis in order to find new tools to reduce morbidity and mortality. Matrix metalloproteinases (MMPs) and their inhibitors have been recently studied as promising new prognostic biomarkers in patients with sepsis. This study is aimed at determining the utility of several cutoff points of these biomarkers to predict mortality in patients with sepsis. MATERIALS AND METHODS: A multicenter, prospective, analytic cohort study was performed in the metropolitan area of Bucaramanga, Colombia. A total of 289 patients with sepsis and septic shock were included. MMP-9, MMP-2, tissue inhibitor of metalloproteinase 1 (TIMP-1), TIMP-2, TIMP-1/MMP-9 ratio, and TIMP-2/MMP-2 ratio were determined in blood samples. Value ranges were correlated with mortality to estimate sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiving operating characteristic curve. RESULTS: Sensitivity ranged from 33.3% (MMP-9/TIMP-1 ratio) to 60.6% (TIMP-1) and specificity varied from 38.8% (MMP-2/TIMP-2 ratio) to 58.5% (TIMP-1). As for predictive values, positive predictive value range was from 17.5% (MMP-9/TIMP-1 ratio) to 70.4% (MMP-2/TIMP-2 ratio), whereas negative predictive values were between 23.2% (MMP-2/TIMP-2 ratio) and 80.9% (TIMP-1). Finally, area under the curve scores ranged from 0.31 (MMP-9/TIMP-1 ratio) to 0.623 (TIMP-1). CONCLUSION: Although TIMP-1 showed higher sensitivity, specificity, and negative predictive value, with a representative population sample, we conclude that none of the evaluated biomarkers had significant predictive value for mortality.


Assuntos
Sepse/sangue , Choque Séptico/sangue , Inibidor Tecidual de Metaloproteinase-1/sangue , Inibidores Teciduais de Metaloproteinases/sangue , Adulto , Idoso , Biomarcadores/sangue , Feminino , Humanos , Masculino , Metaloproteinases da Matriz , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade , Sepse/mortalidade
12.
Int J Emerg Med ; 12(1): 36, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752664

RESUMO

BACKGROUND: Sepsis is a major public health problem, with a growing incidence and mortality rates still close to 30% in severe cases. The speed and adequacy of the treatment administered in the first hours of sepsis, particularly access to intensive care, are important to reduce mortality. This study compared the triage strategies and intensive care rationing between septic patients and patients with other indications of intensive care. This study included all patients with signs for intensive care, enrolled in the intensive care management system of a Brazilian tertiary public emergency hospital, from January 1, 2010, to December 31, 2016. The intensivist periodically evaluated the requests, prioritizing them according to a semi-quantitative scale. Demographic data, Charlson Comorbidity Index (CCI), Sequential Organ Failure Assessment (SOFA), and quick SOFA (qSOFA), as well as surgical interventions, were used as possible confounding factors in the construction of incremental logistic regression models for prioritization and admission to intensive care outcomes. RESULTS: The study analyzed 9195 ICU requests; septic patients accounted for 1076 cases (11.7%), 293 (27.2%) of which were regarded as priority 1. Priority 1 septic patients were more frequently hospitalized in the ICU than nonseptic patients (52.2% vs. 34.9%, p <  0.01). Septic patients waited longer for the vacancy, with a median delay time of 43.9 h (interquartile range 18.2-108.0), whereas nonseptic patients waited 32.5 h (interquartile range 11.5-75.8)-p <  0.01. Overall mortality was significantly higher in the septic group than in the group of patients with other indications for intensive care (72.3% vs. 39.8%, p <  0.01). This trend became more evident after the multivariate analysis, and the mortality odds ratio was almost three times higher in septic patients (2.7, 2.3-3.1). CONCLUSION: Septic patients had a lower priority for ICU admission and longer waiting times for an ICU vacancy than patients with other critical conditions. Overall, this implied a 2.7-fold increased risk of mortality in septic patients.

13.
Arq Bras Cardiol ; 113(3): 449-663, 2019 10 10.
Artigo em Português | MEDLINE | ID: mdl-31621787
15.
Biomark Insights ; 14: 1177271919847951, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31205414

RESUMO

Introduction: Matrix metalloproteinase-9 (MMP-9) plays an important role in the pathophysiology of sepsis. A single-nucleotide polymorphism (SNP) at position -1562 (C/T) in the MMP-9 gene has been associated with differential MMP-9 expression, being higher when the -1562 T allele is present. We evaluated the association of the SNP MMP9 -1562 C/T with severity and mortality in patients with sepsis to establish whether the prognosis of the disease is affected. Materials and Methods: A case-control study exploratory was carried out in a cohort of infected patients. 540 individuals were selected in total, 270 patients with sepsis and 270 controls (infected but non-septic), classified according to the 2016 consensus (Sepsis-3). The presence of the single-nucleotide polymorphism (SNP; allele T and/or allele C) was determined through analyses of restriction fragment length polymorphism and plasma levels of MMP-9 were determined through enzyme-linked immunosorbent assay immunoassay. Results: SNP MMP-9 -1562 has two known alleles (T and C), with predominance of the C over the T allele; in the group of patients with sepsis, T allele was found in 7.2% of cases, while C allele in the rest (92.8%); in comparison, in the group of infected but non-septic patients, frequencies were 9.4% for T allele and 90.6% for the C allele (P = .33). Also, the presence of the polymorphic T allele was not related to the levels of MMP-9 in patients with sepsis in comparison with infected but non-septic patients 780 (397-1375) ng/mL vs 646 (172-1249) ng/mL (P = .64). There was also no association between the SNP and sepsis mortality (P = .78). Conclusions: We concluded that there was no association between the SNP MMP9 -1562 C/T and sepsis or between the SNP MMP9 -1562 C/T and sepsis mortality in the Northeastern Colombian septic patient cohort. Further research is needed to clarify the correlation among sepsis, genetic factors with allele T and MMP-9 plasma concentration.

17.
Medicina (Ribeiräo Preto) ; 52(1)jan.-mar.,2019.
Artigo em Português | LILACS | ID: biblio-1024829

RESUMO

RESUMO Introdução: O Núcleo Interno de Regulação (NIR) é uma das estratégias de gestão criadas pela Política Nacional de Atenção Hospitalar do Ministério da Saúde em 2013. Visa a organização do acesso à consultas, serviços diagnósticos e terapêuticos e aos leitos de internação, sendo fundamental o conhecimento do perfil epidemiológico e ajuste de seus processos de trabalho de modo a garantir o fluxo no sistema de saúde. Como as normas para implantação só foram realizadas em 2018, vários serviços implantaram o NIR sem diretrizes e há necessidade de se avaliar o grau de implantação. Objetivo: Avaliar o nível de implantação do NIR em duas unidades de um complexo hospitalar público terciário. Metodologia: Estudo de avaliação, exploratório, descritivo e longitudinal, realizado em duas unidades de internação hospitalar público terciário implantadas no primeiro semestre de 2016 (Unidade de Emergência) e no primeiro semestre de 2017 (Unidade Campus). Resultados: Devido à natureza de sua vocação (eletivo ou urgência), observou-se perfil epidemiológico distinto nas unidades, embora tenha sido possível a construção de processo e análise de SWOT integrada para efeitos de tomada de decisão e planejamento. De acordo com os pilares propostos pelo Manual, ambas em maior ou menor grau apresentam iniciativas recomendadas. Mas, por outro lado, os entrevistados reforçam a necessidade de maior investimento para aprimorar o processo. Conclusão: É necessário o estabelecimento de uma política de implantação dos NIR's com referenciais objetivos que possam ser pontuados e permitam o acompanhamento temporal do seu desenvolvimento. (AU)


ABSTRACT Introduction: The Internal Regulation Committee (IRC) is one of the management strategies created by the National Health Care Policy of the Ministry of Health in 2013. It aims to organize the access to consultations, diagnostic and therapeutic services and to hospital beds. It is necessary to know the epidemiological profile to adjust its processes to guarantee the flow in the healthcare system. As the standards for implementation were only established in 2018, several services implemented the ICR without guidelines, and there is a need to evaluate the degree of implementation. Objective: To evaluate the level of NIR implantation in two units of a public tertiary hospital complex. Methodology: Exploratory, descriptive and longitudinal study, carried out in two tertiary public hospitalization units implanted in the first half of 2016 (Emergency Unit) and the first half of 2017 (Campus Unit). Results:Due to the nature of their vocation (elective or emergency), a distinct epidemiological profile was observed, although it was possible to construct an integrated SWOT process and analysis for decision--making and planning purposes. According to the principles proposed by the Manual, both presented recommended initiatives to a greater or lesser degree. However, on the other hand, the units inter-viewed reinforce the need for more investment to improve the process. Conclusion: It is necessary to establish a policy for the implementation of NIRs with objective checklists that can be set and allow the temporal monitoring of their development (AU)


Assuntos
Gestão em Saúde , Sistemas Nacionais de Saúde , Legislação de Dispositivos Médicos , Administração Hospitalar
18.
J Bras Pneumol ; 45(1): e20170251, 2019 Feb 25.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30810642

RESUMO

OBJECTIVE: To validate the Pulmonary Embolism Severity Index (PESI), which was developed for risk stratification after acute pulmonary embolism (PE), for use in Brazil. METHODS: This was a single-center retrospective study involving patients admitted to the emergency department with acute PE. The original and simplified versions of the PESI were calculated using hospital admission data from medical records. The outcome measure was the overall 30-day mortality rate. RESULTS: We included 123 patients. The mean age was 57 ± 17 years, and there was a predominance of females, who accounted for 60% of the cohort. There were 28 deaths, translating to an overall 30-day mortality rate of 23%. In the cluster analysis by risk class, overall 30-day mortality was 2.40% for classes I-II, compared with 20.00% for classes III-IV-V (relative risk [RR] = 5.9; 95% CI: 1.88-18.51; p = 0.0002). When we calculated overall 30-day mortality using the simplified version (0 points vs. ≥ 1 point), we found it to be 3.25% for 0 points and 19.51% for ≥ 1 point (RR = 2.38; 95% CI: 0.89-6.38; p = 0.06). Using the original version, a survival analysis showed that risk classes I and II presented similar Kaplan-Meier curves (p = 0.59), as did risk classes III, IV, and V (p = 0.25). However, the curve of the clusters based on the original version, showed significantly higher mortality in the III-IV-V classes than in the I-II classes (RR = 7.63; 95% CI: 2.29-25.21; p = 0.0001). The cluster analysis based on the original version showed a greater area under the ROC curve than did the analysis based on the simplified version (0.70; 95% CI: 0.62-0.77 vs. 0.60; 95% CI: 0.51-0.67; p = 0.05). CONCLUSIONS: The PESI adequately predicted the prognosis after acute PE in this sample of the population of Brazil. The cluster analysis based on the original version is the most appropriate analysis in this setting.


Assuntos
Embolia Pulmonar/diagnóstico , Embolia Pulmonar/epidemiologia , Medição de Risco/métodos , Doença Aguda , Adulto , Idoso , Brasil/epidemiologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Embolia Pulmonar/complicações , Valores de Referência , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Fatores de Tempo
19.
J. bras. pneumol ; 45(1): e20170251, 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-984624

RESUMO

ABSTRACT Objective: To validate the Pulmonary Embolism Severity Index (PESI), which was developed for risk stratification after acute pulmonary embolism (PE), for use in Brazil. Methods: This was a single-center retrospective study involving patients admitted to the emergency department with acute PE. The original and simplified versions of the PESI were calculated using hospital admission data from medical records. The outcome measure was the overall 30-day mortality rate. Results: We included 123 patients. The mean age was 57 ± 17 years, and there was a predominance of females, who accounted for 60% of the cohort. There were 28 deaths, translating to an overall 30-day mortality rate of 23%. In the cluster analysis by risk class, overall 30-day mortality was 2.40% for classes I-II, compared with 20.00% for classes III-IV-V (relative risk [RR] = 5.9; 95% CI: 1.88-18.51; p = 0.0002). When we calculated overall 30-day mortality using the simplified version (0 points vs. ≥ 1 point), we found it to be 3.25% for 0 points and 19.51% for ≥ 1 point (RR = 2.38; 95% CI: 0.89-6.38; p = 0.06). Using the original version, a survival analysis showed that risk classes I and II presented similar Kaplan-Meier curves (p = 0.59), as did risk classes III, IV, and V (p = 0.25). However, the curve of the clusters based on the original version, showed significantly higher mortality in the III-IV-V classes than in the I-II classes (RR = 7.63; 95% CI: 2.29-25.21; p = 0.0001). The cluster analysis based on the original version showed a greater area under the ROC curve than did the analysis based on the simplified version (0.70; 95% CI: 0.62-0.77 vs. 0.60; 95% CI: 0.51-0.67; p = 0.05). Conclusions: The PESI adequately predicted the prognosis after acute PE in this sample of the population of Brazil. The cluster analysis based on the original version is the most appropriate analysis in this setting.


RESUMO Objetivo: Pulmonary Embolism Severity Index (PESI) foi desenvolvido para a estratificação de risco após tromboembolia pulmonar (TEP) aguda. Nosso objetivo foi validá-lo para uso no Brasil. Métodos: Estudo retrospectivo unicêntrico incluindo pacientes com TEP admitidos numa unidade de emergência. O PESI (versão original e simplificada) foi calculado utilizando-se dados dos prontuários na admissão hospitalar. O desfecho analisado foi mortalidade geral em 30 dias (MG30). Resultados: Foram incluídos 123 pacientes, com média de idade de 57 ± 17 anos, predomínio do sexo feminino (60%) e MG30 de 28 óbitos (23%). Na análise agrupada, a MG30 (classes I-II vs. III-IV-V) foi de 2,40% vs. 20,00% (risco relativo [RR] = 5,9; IC95%: 1,88-18,51; p = 0,0002). A MG30 na versão simplificada (0 vs. ≥ 1 ponto) foi de 3,25% vs. 19,51% (RR = 2,38; IC95%: 0,89-6,38; p = 0,06). A análise da sobrevida mostrou que as curvas de Kaplan-Meier foram semelhantes nas classes I e II (p = 0,59) e entre as classes III, IV e V (p = 0,25). A curva da versão original agrupada mostrou que a MG30 foi significativamente maior no grupo III-IV-V que no grupo I-II (RR = 7,63; IC95%: 2,29-25,21; p = 0,0001). A análise agrupada da versão original mostrou área sob a curva ROC maior que a da versão simplificada (0,70; IC95%: 0,62-0,77 vs. 0,60; IC95%: 0,51-0,67; p = 0,05). Conclusões: O PESI mensurou adequadamente o prognóstico de MG30 após TEP aguda nesta amostra da população brasileira. A utilização da versão original agrupada foi a mais adequada nesse cenário.


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Idoso , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/epidemiologia , Medição de Risco/métodos , Prognóstico , Embolia Pulmonar/complicações , Valores de Referência , Fatores de Tempo , Índice de Gravidade de Doença , Brasil/epidemiologia , Doença Aguda , Prevalência , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade , Estimativa de Kaplan-Meier , Hospitalização/estatística & dados numéricos
20.
Rev. bras. educ. méd ; 42(4): 134-143, out.-dez. 2018. tab, graf
Artigo em Português | LILACS-Express | LILACS | ID: biblio-977545

RESUMO

RESUMO A saúde da população privada de liberdade possui aspectos peculiares dada a elevada prevalência de infecções sexualmente transmissíveis, lesões dermatológicas e transtornos mentais agravados pela superlotação e precárias condições das unidades penitenciárias. O atendimento à saúde oferecido é de baixa resolutividade, baseado na abordagem de queixas pontuais, com dificuldade de acesso a outros serviços de saúde. A integração ensino-serviço é uma das diretrizes para os cursos de medicina, que tem o papel de formar médicos críticos e reflexivos a partir das necessidades sociais. É dentro dessa aproximação da universidade ao sistema prisional, que nasceu em 2011, a disciplina Medicina do Confinamento na Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. O presente relato descreve o processo de concepção dessa disciplina, sua estrutura teórico-prática, assim como oferece uma reflexão sobre o aprendizado e suas particularidades no confinamento. A disciplina, de caráter optativo, tem 30 horas de duração, sendo ofertada duas vezes ao ano, com disponibilidade para 40 vagas anuais. Até 2016, 188 estudantes de medicina participaram da disciplina, que possui além da programação teórica, atividades práticas realizadas em penitenciárias na região de Ribeirão Preto. As distintas realidades experimentadas pelo aluno de graduação no cenário da universidade e das penitenciárias possibilitaram a reflexão sobre a importância da integração destes dois mundos que quando em contato contribuem tanto para qualificação da assistência prestada, quanto para a responsabilidade do estudante como cidadão e do seu papel como profissional. A disciplina promoveu a aproximação da sociedade às populações marginalizadas, participando da ressocialização das pessoas desprovidas de liberdade, além de suscitar reflexões sobre as dimensões do adoecimento, e sua influência no contexto de vida desses pacientes permitindo, portanto, refletir de que maneira a construção de projetos de cuidado adequados a realidade dessas pessoas possa garantir os princípios da universalidade, equidade e integralidade da atenção.


ABSTRACT The health of the population deprived of liberty has unusual aspects, due to the high prevalence of sexually transmitted diseases, dermatological injuries, and mental disorders aggravated by the overcrowding and precarious conditions in the penitentiary units. The health care offered is of poor quality, based on resolving specific complaints, but with difficulty accessing other health services. Integration between teaching and service is one of the guidelines for medical courses, which have the role of training critical and reflective physicians who are aware of the social needs. It was out of this approach of the university to the prison system that the discipline of Confinement Medicine emerged, in 2011, at the Ribeirão Preto Medical School of the University of São Paulo. The present report describes the process of conception and formation of the discipline and its theoretical-practical structure, and offers a reflection on the learning and its particular characteristics in confinement. This optional discipline has 30 hours and is offered twice a year, with places for forty students per year. Up until 2016, 188 medical students took this discipline. Besides the academic program, the discipline also includes practical activities, carried out in penitentiaries in the region of Ribeirão Preto. The different realities experienced by the undergraduate students in the university and penitentiary scenarios enables them to reflect on the importance of integrating these two worlds that, when in contact, contribute both to the qualification of the medical care provided and to students' sense of responsibility as citizens, and their role as professionals. The discipline helps strengthen ties between society and marginalized populations, promoting the resocialization of people deprived of liberty. It also prompts reflections about the dimensions of illness, and their influence on the life context of these patients, enabling us to reflect on how the construction of a proper project based on these social realities can guarantee the principles of universality, equity and integrally of care.

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