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Com o surgir da pandemia a SARS-CoV-2 no início de 2020, os serviços de saúde sofreram várias adaptações de forma a mitigar e controlar a progressão do surto a nível europeu e nacional. Estes ajustes repercutiram-se inevitavelmente na dinâmica da maioria dos serviços hospitalares, nomeadamente no nosso serviço de Cirurgia Vascular. Perante a previsível chegada de uma segunda vaga na Europa e em Portugal, com desfechos e repercussões imprevisíveis nos serviços de saúde, é fundamental aprender com as experiências anteriores e partilhar estratégias para prestar o melhor cuidado aos nossos doentes, apesar das restrições impostas pela pandemia. Através deste artigo, analisamos as adaptações no Centro Hospitalar Universitário Lisboa Norte para superar a pandemia e, em particular, no serviço de cirurgia vascular. Avaliamos ainda o impacto dessas mudanças na nossa atividade global, em comparação com a experiência vivenciada noutros centros nacionais e internacionais. Perante uma segunda vaga iminente, é crucial tirar lições desta pandemia por forma a evitar uma potencial crise na saúde.

With the onset of the SARS-CoV-2 pandemic in early 2020, health services and personnel adapted their resources to mitigate and control the outbreak. These needs inevitably led to adaptations in most medical and surgical departments, including in our Vascular Surgery department. As we are facing a second outbreak of this pandemic, with unpredictable outcomes and repercussions in health services, it is crucial to learn from previous experiences and share strategies to perform the best care to our patients, despite the restrictions that have been imposed. Through this paper, we review the adaptations in Centro Hospitalar Universitário Lisboa Norte and particularly in our department to overcome the pandemic. We also assess the impact of these changes in our activity and compare with the experience of other fellow surgeons. With an upcoming second outbreak, it is crucial to learn from this and other departments’ experiences to overcome a potential health crisis.

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Intensive support recommendations for critically-ill patients with suspected or confirmed COVID-19 infection
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Corrêa, Thiago Domingos

; Matos, Gustavo Faissol Janot de

; Bravim, Bruno de Arruda

; Cordioli, Ricardo Luiz

; Garrido, Alejandra del Pilar Gallardo

; Assuncao, Murillo Santucci Cesar de

; Barbas, Carmen Silvia Valente

; Timenetsky, Karina Tavares

; Rodrigues, Roseny dos Reis

; Guimarães, Hélio Penna

; Rabello Filho, Roberto

; Lomar, Frederico Polito

; Scarin, Farah Christina de La Cruz

; Batista, Carla Luciana

; Pereira, Adriano José

; Guerra, João Carlos de Campos

; Carneiro, Bárbara Vieira

; Nawa, Ricardo Kenji

; Brandão, Rodrigo Martins

; Pesaro, Antônio Eduardo Pereira

; Silva Júnior, Moacyr

; Carvalho, Fabricio Rodrigues Torres de

; Silva, Cilene Saghabi de Medeiros

; Almeida, Ana Claudia Ferraz de

; Franken, Marcelo

; Pesavento, Marcele Liliane

; Eid, Raquel Afonso Caserta

; Ferraz, Leonardo José Rolim

einstein (São Paulo)

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2020, Volume 18 elocation eAE5793

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Em dezembro de 2019, uma série de pacientes com pneumonia grave foi identificada em Wuhan, província de Hubei, na China. Esses pacientes evoluíram para síndrome respiratória aguda grave e síndrome do desconforto respiratório agudo. Posteriormente, a COVID-19 foi atribuída a um novo betacoronavírus, o coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2). Cerca de 20% dos pacientes com diagnóstico de COVID-19 desenvolvem formas graves da doença, incluindo insuficiência respiratória aguda hipoxêmica, síndrome respiratória aguda grave, síndrome do desconforto respiratório agudo e insuficiência renal aguda e requerem admissão em unidade de terapia intensiva. Não há nenhum ensaio clínico randomizado controlado que avalie potenciais tratamentos para pacientes com infecção confirmada pela COVID-19 no momento da publicação destas recomendações de tratamento. Dessa forma, essas recomendações são baseadas predominantemente na opinião de especialistas (grau de recomendação de nível C).

ABSTRACT In December 2019, a series of patients with severe pneumonia were identified in Wuhan, Hubei province, China, who progressed to severe acute respiratory syndrome and acute respiratory distress syndrome. Subsequently, COVID-19 was attributed to a new betacoronavirus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Approximately 20% of patients diagnosed as COVID-19 develop severe forms of the disease, including acute hypoxemic respiratory failure, severe acute respiratory syndrome, acute respiratory distress syndrome and acute renal failure and require intensive care. There is no randomized controlled clinical trial addressing potential therapies for patients with confirmed COVID-19 infection at the time of publishing these treatment recommendations. Therefore, these recommendations are based predominantly on the opinion of experts (level C of recommendation).

https://doi.org/10.31744/einstein_journal/2020ae5793 23244 downloads

Comment to: Intensive support recommendations for critically-ill patients with suspected or confirmed COVID-19 infection
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Corrêa, Thiago Domingos

; Matos, Gustavo Faissol Janot de

; Bravim, Bruno de Arruda

; Cordioli, Ricardo Luiz

; Garrido, Alejandra del Pilar Gallardo

; Assuncao, Murillo Santucci Cesar de

; Barbas, Carmen Silvia Valente

; Timenetsky, Karina Tavares

; Rodrigues, Roseny dos Reis

; Guimarães, Hélio Penna

; Rabello Filho, Roberto

; Lomar, Frederico Polito

; Scarin, Farah Christina de La Cruz

; Batista, Carla Luciana

; Pereira, Adriano José

; Guerra, João Carlos de Campos

; Carneiro, Bárbara Vieira

; Nawa, Ricardo Kenji

; Brandão, Rodrigo Martins

; Pesaro, Antônio Eduardo Pereira

; Silva Júnior, Moacyr

; Carvalho, Fabricio Rodrigues Torres de

; Silva, Cilene Saghabi de Medeiros

; Almeida, Ana Claudia Ferraz de

; Franken, Marcelo

; Pesavento, Marcele Liliane

; Eid, Raquel Afonso Caserta

; Ferraz, Leonardo José Rolim

einstein (São Paulo)

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2020, Volume 18 elocation eCE5931

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.31744/einstein_journal/2020ce5931 214 downloads

Anatomic and neuropsychological findings in low-educated cognitively intact elderly from a Brazilian cohort
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Foss, Maria Paula

; Diniz, Paula Rejane Beserra

; Roza, Daiane Leite da

; Gefen, Tamar

; Maher, Amanda Cook

; Formigheri, Paulo

; Spedo, Carina T.

; Salmon, Carlos Ernesto Garrido

; Tumas, Vitor

; Speciali, José Geraldo

; Santos, Antônio Carlos

Dementia & Neuropsychologia

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dec 2019, Volume 13 N. 4 Pages 378 - 385

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Sabe-se que baixos níveis de educação são comuns em países em desenvolvimento. Em indivíduos idosos, em particular, baixos níveis de educação podem representar um fator de risco para o desenvolvimento de demência. Objetivo: Este estudo examina os correlatos cognitivos e neuroanatômicos de escolaridade alta versus baixa, em idosos cognitivamente saudáveis,vivendo em comunidade no Brasil. Métodos: Cinquenta e três idosos (média de idade: 68±5,3) foram divididos em um grupo de “baixa escolaridade” [LE; 1-4 anos de escolaridade (N=33)] e um grupo de “alta escolaridade” [HE; >11 anos de escolaridade (N=20)]. Ambos os grupos completaram uma bateria neuropsicológica abrangente e foram submetidos à RM estrutural in vivo próximo à testagem. Resultados: O nível educacional aumentou a chance de se obter melhores pontuações em testes neuropsicológicos, incluindo evocação verbal e visual da informação, aprendizagem verbal, fluência de categoria, cognição global e vocabulário. Escores mais altos foram encontrados no grupo HE, em detrimento do LE. Apesar disso, não houve diferenças entre os grupos nas medidas de ressonância magnética in vivo. Conclusão: Idosos com maiores níveis de escolaridade apresentaram melhores pontuações nas medidas neuropsicológicas da cognição, destacando a necessidade de normas ajustadas à educação nos países em desenvolvimento. Não havendo diferenças na anatomia estrutural entre os grupos, os achados parecem ser melhor explicados pelas teorias da “reserva cognitiva”.

ABSTRACT In elderly individuals, low educational level may represent a risk factor for the development of dementia and a proxy of cognitive reserve. Objective: This study examined the cognitive and neuroanatomic correlates of high versus low educational levels in cognitively healthy community-dwelling older adults in Brazil. Methods: Fifty-three older adults (mean age: 68±5.3 years) were divided into a “low education” group [LE; 1-4 years of education (N=33)] and “high education” group [HE; >11 years of education (N=20)]. Both groups completed a comprehensive neuropsychological battery and underwent in vivo structural MRI close to the time of testing. Results: Higher educational level increased the chance of having better scores on neuropsychological tests, including verbal and visual delayed recall of information, verbal learning, category fluency, global cognition, and vocabulary. Better scores on these tests were observed in the HE group relative to the LE group. Despite this, there were no group differences between MRI measures. Conclusion: Older adults with higher educational levels showed better scores on neuropsychological measures of cognition, highlighting the need for education-adjusted norms in developing countries. Given the absence of differences in structural anatomy between the groups, these findings appear to be best explained by theories of cognitive reserve.

https://doi.org/10.1590/1980-57642018dn13-040003 1051 downloads

El huevo de traspatio: características físicas y desempeño en pruebas de incubación artificial
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Camacho-Escobar, Marco Antonio

; Vélez-Barradas, Adelina

; Jerez-Salas, Martha Patricia

; García-López, Juan Carlos

; López-Garrido, Serafín Jacobo

; Sánchez-Bernal, Edgar Iván

; Galicia-Jiménez, Monica Marcela

; Ávila-Serrano, Narciso Ysac

Acta universitaria

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2019, Volume 29 elocation e2381

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Abstract The backyard egg is small in comparison with the incubating egg. The objective was to incubate backyard eggs to know physical characteristics and performance in artificial incubation tests. 1129 eggs were incubated: 1002 creole hens’ eggs, 68 araucana hens’ eggs and 59 turkeys’ eggs. The evaluated variables were weight, longitudinal axis, maximum polar diameter, equatorial diameter, polar minimum diameter, shape index, broken shell or dirty shell, fertility, hatchability, and total early, intermediate, and late embryonic mortality. The turkey egg had greater weight, length, maximum polar diameter, equatorial diameter, minimum polar diameter and fertility (p < 0.05). They also had a lower rate of form than the eggs of the creole and araucanian hens (p < 0.05). The araucanian chicken egg showed greater hatchability and lower total embryonic mortality (p < 0.05). The characteristics and performance of the creole egg are different from the incubable egg; therefore, the criteria of uniformity and commercial incubation are not, precisely, suitable for incubation.

Resumen El huevo de traspatio es de tamaño variable, en comparación con el huevo incubable comercial. El objetivo fue incubar huevo de traspatio para conocer las características físicas y desempeño en pruebas de incubación artificial. Se incubaron 1129 huevos: 1002 de gallinas criollas, 68 de gallinas araucanas y 59 de pava. Las variables evaluadas fueron peso, eje longitudinal, diámetro máximo polar, diámetro ecuatorial, diámetro mínimo polar e índice de forma, cascarón quebrado o cascarón sucio, fertilidad, incubabilidad y mortalidad embrionaria total, temprana, intermedia y tardía. El huevo de pava tuvo mayor peso, eje longitudinal, diámetro máximo polar, diámetro ecuatorial, diámetro mínimo polar y fertilidad (p < 0.05), también tuvo menor índice de forma que los huevos de gallina criolla y gallina araucana (p < 0.05). El huevo de gallina araucana presentó mayor incubabilidad y menor mortalidad embrionaria total (p < 0.05). Las características y desempeño del huevo criollo son diferentes al huevo incubable; por ello, los criterios de uniformidad e incubación comercial no le son, precisamente, adecuados para la incubación.

https://doi.org/10.15174/au.2019.2381 1484 downloads

Multimodal quantitative magnetic resonance imaging analysis with individualized postprocessing in patients with drug-resistant focal epilepsy and conventional visual inspection negative for epileptogenic lesions
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Abud, Lucas Giansante

; Velasco, Tonicarlo Rodrigues

; Salmon, Carlos Ernesto Garrido

; Sakamoto, Americo Ceiki

; Abud, Thiago Giansante

; Pessini, Rodrigo Antonio

; Abud, Daniel Giansante

; Leite, João Pereira

; dos Santos, Antonio Carlos

Clinics

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2019, Volume 74 elocation e908

Abstract: En | Text: En | PDF: En

OBJECTIVES: Approximately one-third of candidates for epilepsy surgery have no visible abnormalities on conventional magnetic resonance imaging. This is extremely discouraging, as these patients have a less favorable prognosis. We aimed to evaluate the utility of quantitative magnetic resonance imaging in patients with drug-resistant neocortical focal epilepsy and negative imaging. METHODS: A prospective study including 46 patients evaluated through individualized postprocessing of five quantitative measures: cortical thickness, white and gray matter junction signal, relaxation rate, magnetization transfer ratio, and mean diffusivity. Scalp video-electroencephalography was used to suggest the epileptogenic zone. A volumetric fluid-attenuated inversion recovery sequence was performed to aid visual inspection. A critical assessment of follow-up was also conducted throughout the study. RESULTS: In the subgroup classified as having an epileptogenic zone, individualized postprocessing detected abnormalities within the region of electroclinical origin in 9.7% to 31.0% of patients. Abnormalities outside the epileptogenic zone were more frequent, up to 51.7%. In five patients initially included with negative imaging, an epileptogenic structural abnormality was identified when a new visual magnetic resonance imaging inspection was guided by information gleaned from postprocessing. In three patients, epileptogenic lesions were detected after visual evaluation with volumetric fluid-attenuated sequence guided by video electroencephalography. CONCLUSION: Although quantitative magnetic resonance imaging analyses may suggest hidden structural lesions, caution is warranted because of the apparent low specificity of these findings for the epileptogenic zone. Conversely, these methods can be used to prevent visible lesions from being ignored, even in referral centers. In parallel, we need to highlight the positive contribution of the volumetric fluid-attenuated sequence.

https://doi.org/10.6061/clinics/2019/e908 546 downloads

Impacto Extra-Articular do Quadril
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Barros, Antônio A. G.

; Barbosa, Victor A. K.

; Garrido, Fernando H. F.

; Ribeiro, André G.

; Costa, Lincoln P.

; Vassalo, Carlos C.

Revista Portuguesa de Ortopedia e Traumatologia

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jun 2018, Volume 26 N. 2 Pages 140 - 150

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Introdução: O impacto extra-articular do quadril envolve um grupo de lesões reconhecidas apenas recentemente, comumente subdiagnosticadas e pouco compreendidas por muitos especialistas da área ortopédica. Porém, são lesões capazes de levar a dor e declínio funcional importante nos pacientes acometidos. O correto diagnóstico dessas condições é fundamental. Envolve a necessidade de um conhecimento adequado de sua patogênese e avaliação clínica através de manobras do exame físico específicas, assim como correta interpretação dos exames de imagem. Objetivo: Atualizar profissionais médicos, fisioterapeutas, educadores físicos ou quaisquer outros que trabalhem em contato direto com os pacientes acometidos. Material e métodos: Foi realizado uma revisão da literatura nas bases de dados PubMed e Birene/Lilacs a respeito da anatomia, patogênese, achados clínicos, exames de imagem e tratamento das principais causas descritas de impacto extra-articular do quadril. Resultados: As síndromes de impacto extra-articular mais citadas na literatura são os impactos isquiofemoral, subespinhal, pélvico trocantérico e o do iliopsoas. Essas síndromes são condições dinâmicas e o diagnóstico deve ser feito observando a presença de alterações anatômicas, exame clínico positivo e confirmação por exame de imagem ou achado intra-operatório. Por serem lesões com baixa prevalência relatada, existem poucas evidências a respeito dessas condições e mais estudos são necessários. Conclusão: O conhecimento das síndromes de impacto extra-articular do quadril é essencial na avaliação de pacientes com dor no quadril e deve fazer parte do diagnóstico diferencial.

Introduction: The extra-articular hip impingement involves a group of recently recognized lesions, commonly underdiagnosed and poorly understood by many orthopedic specialists. However, these lesions are capable of leading to pain and important functional decline in the affected patients. The correct diagnosis of these conditions is primal. It involves the need for an adequate knowledge of its pathogenesis and clinical evaluation through specific physical examination maneuvers, as well as correct interpretation of the imaging exams. Objective: To update medical professionals, physiotherapists, physical educators or any others who work in direct contact with the affected patients. Material and methods: A review of the literature was conducted on the PubMed and Birene /Lilacs databases on regard of anatomy, pathogenesis, clinical findings, imaging and treatment of the main causes of extra-articular hip impingement. Results: The most cited extra-articular impingement syndromes in the literature are the ischiofemoral, subspinal, trochanteric and iliopsoas impingements. These syndromes are dynamic conditions and the diagnosis must be done observing the presence of anatomical abnormalities, positive clinical examination and confirmation by imaging exams or intraoperative finding. Because they are lesions with a low prevalence reported, there is little evidence regarding these conditions and more studies are needed. Conclusion: Knowledge of extra-articular hip impingement syndromes is essential in the evaluation of patients with hip pain and should be part of the differential diagnosis.

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Quantitative MRI data in Multiple Sclerosis patients: a pattern recognition study
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Pessini, Rodrigo Antonio

; Santos, Antonio Carlos dos

; Salmon, Carlos Ernesto Garrido

Research on Biomedical Engineering

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jun 2018, Volume 34 N. 2 Pages 138 - 146

Abstract: En | Text: En | PDF: En

Abstract Introduction Multiple Sclerosis (MS) is a neurodegenerative disease characterized by inflammatory demyelination in the central nervous system. Quantitative Magnetic Resonance Imaging (qMRI) enables a detailed characterization of brain tissue, but generates a large number of numerical results. In this study, we elucidated the main qMRI techniques and the brain regions that allow the identification of MS patients from neuroimaging data and pattern recognition techniques. Methods The data came from the combination of computational tools of image processing and neuroimaging acquired in a 3 Tesla scanner using different techniques: Diffusion, T2 Relaxometry, Magnetization Transfer Ratio (MTR) and Structural Morphometry. Data from 126 brain regions of 203 healthy individuals and 124 MS patients were separated into two groups and processed in a data-mining program using the k-nearest-neighbor (KNN) algorithm. Results The most relevant anatomical structures in the classification procedure were: corpus callosum, precuneus, left cerebellum and fusiform. Among the quantitative techniques the most relevant was the MTR, being indicated for longitudinal studies of this disease. KNN with 5 neighbors and pre-selected attributes had a better performance with an area under the ROC curve (97.3%) and accuracy (95.7%). A restricted classification considering only brain regions previously reported in the literature as affected by MS brought slightly lower scores, area: 97.1% and accuracy: 93.2%. Conclusion The use of standard recognition techniques from quantitative neuroimaging techniques has confirmed that the white matter of the brain is the most affected tissue by MS following a global pattern with greater involvement of the left hemisphere.

https://doi.org/10.1590/2446-4740.07117 1340 downloads

Efecto del consumo de quinua (Chenopodium quinoa) como coadyuvante en la intervención nutricional en sujetos prediabéticos
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Abellán Ruiz, María Salud

; Barnuevo Espinosa, María Dolores

; García Santamaría, Carlos

; Contreras Fernández, Carlos J.

; Aldeguer García, Miriam

; Soto Méndez, Fulgencio

; Guillén Guillén, Isabel

; Luque Rubia, Antonio J.

; Quinde Ràzuri, Francisco Javier

; Martínez Garrido, Antonio

; López Román, Francisco Javier

Nutrición Hospitalaria

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oct 2017, Volume 34 N. 5 Pages 1163 - 1169

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Introduction: Quinoa is a pseudocereal containing low glycemic index carbohydrates, dietary fiber, high biological value protein, phytosterols, and n-3 and n-6 fatty acids, which has generated interest in prediabetes nutritional interventions. This randomized (2:1), placebo-controlled, double-blind study evaluated the effects of processed quinoa on body mass index (BMI), glycated hemoglobin (HbA1c), fasting plasma glucose (FPG) and the satiation and fullness (complete) degree in prediabetic patients. Material and method: Thirty patients were randomized (2:1) in two study arms: Kuska Active product (processed quinoa) and placebo (maltodextrin), with an intake period of 28 days. BMI, HbA1c and FPG were determined before starting treatment and at 28-day intake. Satiety and fullness sensation were just assessed by visual analog scale (VAS) at the day 28. ANOVA was performed for repeated measures with two factors to study (within-subject factor: time; intersubject factor: product consumed) to demonstrate the effectiveness of processed quinoa on the study variables. Results: Twenty-nine patients (placebo, n = 10; quinoa, n = 19) completed the study, and the quinoa group shows a significant decrease in BMI (p < 0.05) and HbA1c values (p < 0.001), and an increase in the satiation and fullness (complete) degree (p < 0.001). No significant differences were found in FPG levels from baseline to post-intake period. Conclusions: The results show that processed quinoa intake during 28 days decreases BMI and HbA1c levels, maintains FPG levels, and increases the satiation and fullness (complete) degree in prediabetic patients.

Introducción: la quinua es un pseudocereal que contiene hidratos de carbono de bajo índice glucémico, fibra alimentaria, proteínas de alto valor biológico, fitoesteroles y ácidos grasos n-3 y n-6, y que ha suscitado interés en la intervención nutricional de la prediabetes. Este estudio aleatorizado (2:1), controlado con placebo y doble ciego, evaluó los efectos de la quinua sobre el índice de masa corporal (IMC), hemoglobina glicada (HbA1c), glucemia basal (GB) y el grado de saciedad y plenitud en pacientes prediabéticos. Material y método: se aleatorizaron (2:1) 30 pacientes en dos ramas a estudio: el producto Kuska Active (quinua procesada) y placebo (maltodextrina). El periodo de ingesta fue de 28 días. Antes de iniciar el tratamiento y a los 28 días se determinó el IMC, HbA1c y la GB. La sensación de saciedad y plenitud se evaluó mediante escala visual analógica (EVA). Para demostrar la eficacia de la quinua procesada Kuska Active sobre las variables a estudio se realizó ANOVA para medidas repetidas con dos factores a estudio (factor intrasujeto: tiempo y factor intersujeto: producto consumido). Resultados: finalizaron el estudio un total de 29 pacientes (placebo, n = 10; quinua, n = 19). Se detectó en el grupo quinua procesada una disminución significativa en los valores de IMC (p < 0,05) y HbA1c (p < 0,001) y un aumento en la sensación de saciedad y plenitud (p < 0,001). No se encontraron diferencias significativas en los niveles de GB desde el momento basal hasta el periodo postingesta. Conclusiones: los resultados muestran que la quinua procesada disminuye el IMC y los niveles de HbA1c, mantiene los niveles de GB y aumenta la sensación de saciedad y plenitud en pacientes prediabéticos.

https://doi.org/10.20960/nh.843 3248 downloads

10.

LATE EVALUATION OF DYSPHAGIA AFTER HELLER ESOPHAGEAL MYOTOMY WITH DOR FUNDOPLICATION FOR ACHALASIA
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CÂMARA, Eduardo Rodrigues Zarco

; MADUREIRA, Fernando Athayde Veloso

; MADUREIRA, Delta

; SALOMÃO, Renato Manganelli

; IGLESIAS, Antonio Carlos Ribeiro Garrido

ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

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sep 2017, Volume 30 N. 3 Pages 182 - 186

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Racional: Todos os tratamentos disponíveis para a acalásia são paliativos e visam eliminar a resistência ao fluxo causada por esfíncter esofágico inferior hipertenso. Objetivos: Avaliar os fatores prognósticos positivos e negativos na melhora da disfagia e avaliar a qualidade de vida em pacientes submetidos à cirurgia para tratar a acalásia esofágica, comparando os achados antes, imediatamente após e tardiamente à operação. Métodos : Foram estudados retrospectivamente 84 pacientes submetidos à operação de acalásia entre 2001 e 2014. O protocolo de avaliação com escores de disfagia comparou os escores pré-operatórios, do pós-operatório imediato (até três meses) e pontuação pós-operatória tardia (acima de um ano) para estimar a qualidade de vida. Resultados: O procedimento cirúrgico foi Heller-Dor em 100% dos casos, com 84 casos laparoscópicos. A redução percentual na pressão do esfíncter esofágico inferior pré e pós-operatório imediato foi de 60,35% no grupo de sucesso e de 32,49% no grupo de falha. Em relação ao período pós-operatório tardio, a redução percentual média foi de 60,15% no grupo de sucesso e 31,4% no grupo de falência. A queda média do escore de disfagia entre os períodos pré e pós-operatório imediato foi de 7,33 pontos, o que representa diminuição de 81,17%. Conclusões: A redução de mais de 60% da pressão do esfíncter esofágico inferior entre os períodos pré e pós-operatório sugere que ela é preditora de bom prognóstico cirúrgico. O tratamento cirúrgico foi capaz de contribuir na qualidade de vida e alterar em muito a disfagia em longo prazo.

ABSTRACT Background: All available treatments for achalasia are palliative and aimed to eliminate the flow resistance caused by a hypertensive lower esophageal sphincter. Aim: To analyze the positive and negative prognostic factors in the improvement of dysphagia and to evaluate quality of life in patients undergoing surgery to treat esophageal achalasia by comparing findings before, immediately after, and in long follow-up. Methods: A total of 84 patients who underwent surgery for achalasia between 2001 and 2014 were retrospectively studied. The evaluation protocol with dysphagia scores compared preoperative, immediate (up to three months) postoperative and late (over one year) postoperative scores to estimate quality of life. Results: The surgical procedure was Heller-Dor in 100% of cases, with 84 cases performed laparoscopically. The percent reduction in pre- and immediate postoperative lower esophageal sphincter pressurewas 60.35% in the success group and 32.49% in the failure group. Regarding the late postoperative period, the mean percent decrease was 60.15% in the success group and 31.4% in the failure group. The mean overall drop in dysphagia score between the pre- and immediate postoperative periods was 7.33 points, which represents a decrease of 81.17%. Conclusions: Reduction greater than 60% percent in lower esophageal sphincter pressurebetween the pre- and postoperative periods suggests that this metric is a predictor of good prognosis for surgical response. Surgical treatment was able to have a good affect in quality of life and drastically changed dysphagia over time.

https://doi.org/10.1590/0102-6720201700030005 1507 downloads

11.

Enhancing quality in Diffusion Tensor Imaging with anisotropic anomalous diffusion filter
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Senra Filho, Antonio Carlos da Silva

; Salmon, Carlos Ernesto Garrido

; Santos, Antonio Carlos dos

; Murta Junior, Luiz Otávio

Research on Biomedical Engineering

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sep 2017, Volume 33 N. 3 Pages 247 - 258

Abstract: En | Text: En | PDF: En

Abstract Introduction: Diffusion tensor imaging (DTI) is an important medical imaging modality that has been useful to the study of microstructural changes in neurological diseases. However, the image noise level is a major practical limitation, in which one simple solution could be the average signal from a sequential acquisition. Nevertheless, this approach is time-consuming and is not often applied in the clinical routine. In this study, we aim to evaluate the anisotropic anomalous diffusion (AAD) filter in order to improve the general image quality of DTI. Methods A group of 20 healthy subjects with DTI data acquired (3T MR scanner) with different numbers of averages (N=1,2,4,6,8, and 16), where they were submitted to 2-D AAD and conventional anisotropic diffusion filters. The Relative Mean Error (RME), Structural Similarity Index (SSIM), Coefficient of Variation (CV) and tractography reconstruction were evaluated on Fractional Anisotropy (FA) and Apparent Diffusion Coefficient (ADC) maps. Results The results point to an improvement of up to 30% of CV, RME, and SSIM for the AAD filter, while up to 14% was found for the conventional AD filter (p<0.05). The tractography revealed a better estimative in fiber counting, where the AAD filter resulted in less FA variability. Furthermore, the AAD filter showed a quality improvement similar to a higher average approach, i.e. achieving an image quality equivalent to what was seen in two additional acquisitions. Conclusions In general, the AAD filter showed robustness in noise attenuation and global image quality improvement even in DTI images with high noise level.

https://doi.org/10.1590/2446-4740.02017 2385 downloads

12.

Pattern recognition of abscesses and brain tumors through MR spectroscopy: Comparison of experimental conditions and radiological findings
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Vieira, Bruno Hebling

; Santos, Antonio Carlos dos

; Salmon, Carlos Ernesto Garrido

Research on Biomedical Engineering

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sep 2017, Volume 33 N. 3 Pages 185 - 194

Abstract: En | Text: En | PDF: En

Abstract Introduction The interpretation of brain tumors and abscesses MR spectra is complex and subjective. In clinical practice, different experimental conditions such as field strength or echo time (TE) reveal different metabolite information. Our study aims to show in which scenarios magnetic resonance spectroscopy can differentiate among brain tumors, normal tissue and abscesses using classification algorithms. Methods Pairwise classification between abscesses, brain tumor classes, and healthy subjects tissue spectra was performed, also the multiclass classification between meningiomas, grade I-II-III gliomas, and glioblastomas and metastases, in 1.5T short TE (n = 195), 1.5T long TE (n = 231) and 3.0T long TE (n = 59) point resolved spectroscopy setups, using LCModel metabolite concentration as input to classifiers. Results Areas under the curve of the Receiver Operating Characteristic above 0.9 were obtained for the classification between abscesses and all classes except glioblastomas, reaching 0.947 when classifying against metastases, grade I-II gliomas and glioblastomas (0.980), meningiomas and glioblastomas (0.956), grade I-II gliomas and metastases (0.989), meningiomas and metastases (0.990), and between healthy tissue and all other classes in both conditions except for anaplastic astrocytomas in short TE 1.5T setup. When the multiclass classification agrees with radiological diagnosis the accuracy reaches 96.8% for short TE and 98.9% for long TE. Conclusions The results in the three conditions were similar, highlighting comparable quality, robust quantification and good regularization and flexibility in either algorithm. Multiclass classification provides useful information to the radiologist. These findings show the potential of the development of decision support systems as well as tools for the accompaniment of treatments.

https://doi.org/10.1590/2446-4740.00617 1610 downloads

13.

Factores de riesgo asociados a la patología periapical y pulpar
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Balcázar-Nájera, Carlos Alberto

; Isidro-Olan, Laura Beatriz

; Nájera-Castro, Armando

; Hernández-Ramírez, Griselda

; Rueda-Ventura, Marco Antonio

; Garrido-Pérez, Silvia María Guadalupe

Horizonte sanitario

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aug 2017, Volume 16 N. 2 Pages 111 - 119

Résumé Objectif: Identifier les facteurs de risque associés a la pathologie périapicale et pulpaire chez les patients re<¿us a la clinique Juchimán I, DACS-UJAT. Matériaux et méthodes: Étude observationnelle et analytique de cas (n = 60) et de controles (1: 1) de patients présentant une pathologie périapicale et une pathologie pulpaire respectivement. Les résultats ont été analysés avec la statistique descriptive, en incluant les Odds Ratio (OR) avec leur intervalle de confiance pour une valeur p<0.05. Résultats: Il a été trouvé un OR de 1,14 (IC: 0,55 a 2,43) chez les sujets masculins; un OR de 2.42 (IC: 0,47 a 12,28) pour le groupe d'age 21-30; un OR de 1,66 (CI: 0.17- 2.04) pour le niveau éducatif de licence, et un OR de 2,08 (IC: 0,95 a 2,49) pour les professionnels. Le facteur prédisposant identifié est la carie dentaire avec un OR de 3,08 (IC: 1,10 a 8,58). Parmi les facteurs associés aux traumatismes, il a été observé que l’usure pathologique a un OR de 1,50 (IC: 0.72-3.11). La consommation quotidienne de soda présente un OR de 2,38 (IC: 0,47 a 3,82); la consommation occasionnelle de fritures un OR de 7,6 (IC 0,90 a 53,84) et de 2.1 (CI 0,20 a 22,32) quand elle est quotidienne. La consommation quotidienne de bonbons et d’autres friandises présente un OR de 4,96 (IC: 1,11 a 22,04). Les organes dentaires les plus touchés ont été la premiere molaire inférieure droite avec un OR de 2,0 (IC: 0,90 a 44,20) et la gauche avec un OR de 1,14 (IC: 0,54 a 23,91). Le quadrant, inférieur gauche présente un OR de 1,27 (IC: 0,38 a 4,19), et l’arcade inférieure un OR de 1,23 (IC: 0,39 a 1,68). Les seules variables qui ont obtenues une valeur statistiquement significative pour p <0,05 ont été la carie dentaire, la consommation de fritures, de bonbons et d’autres friandises. Conclusions: Avec cette étude, nous avons constaté que les facteurs de risque sont encore susceptibles de modifications pour la prévention des pathologies périapicales.

Resumo Objetivo: Identificar os fatores de risco associados a patologia periapical e pulpar em utentes que frequentam a clínica Juchiman I, DACS-UJAT. Materiais e métodos: Estudo observacional de casos (n=60) e controlo (1:1) de doentes com patologia periapical e pulpar respectivamente. Realizou- se estatística descritiva e calculou-se o Odds Ratio, intervalos de confiaba e valor de p<0.05. Resultados: Observou-se nos homens um OR: 1.14 (IC: 0.55-2.43), o grupo com idade entre 21-30 apresenta um OR: 2.42-(IC:0.47-12.28). Os licenciados tem OR:1.66 (IC:0.17-2.04), os trabalhadores apresentam OR:2.08 (IC:0.95-2.49). O factor predisponente foi a cárie dental com OR:3.08 (IC:1.10-8.58), nos factores associados a traumatismos observou-se que o desgaste patológico tem OR:1.50 (IC:0.72-3.11). Um consumo diário de refrigerante apresenta OR:2.38 (IC:0.47-3.82) o consumo ocasionais de fritos OR:7.6 (IC:0.90-53.84) e diário OR:2.1 (IC:0.20-22.32) O consumo diário de doces e guloseimas apresenta OR:4.96 (IC:1.11-22.04). O dente mais afetado foi o primeiro molar inferior direito e o esquerdo apresentando um OR: 2.0 (IC:0.90-44.20) y OR: 1.14 (IC:0.54-23.91), de acordo com o quadrante, o inferior esquerdo presenta OR: 1.27 (IC:0.38-4.19), o arco inferior presenta OR:1.23 (IC:0.39-1.68). As únicas variáveis com um valor estatisticamente significativo de p<0.05, foram a carie dental, o consumo de fritos, de doces e de guloseimas. Conclusões: ANeste estudo podemos comprovar que os factores de risco podem ser modificáveis para a prevenir a patologia periapical.

Abstract Objective: To identify risk factors associated to periapical pathology and dental pulp in patients attending the Juchimán I, DACS-UJAT clinic. Materials and methods: Analytical observational study of cases (n = 60) and controlled patients (1: 1) with periapical pathology and dental pulp respectively. It was done a Descriptive statistics and the odds ratio, confidence intervals and p value <0.05 was calculated. Results: It was observed in males an OR: 1.14 (CI: 0.55-2.43), in a group aged from 21 to 30 presents OR: 2.42- (CI 0.47-12.28). The degree is OR: 1.66 (CI: 0.17- 2.04) presented by the professional OR: 2.08 (CI: 0.95-2.49). The predisposing factor was dental caries OR: 3.08 (CI: 1.10-8.58) It was observed in the factors associated with trauma that a pathological deterioration of OR: 1.50 (CI: 0.72-3.11). A daily intake of soda presents OR: 2.38 (CI: 0.47-3.82) occasional fried food consumption OR: 7.6 (CI 0.90-53.84) and OR 2.1 (CI 0.20-22.32) Sweets and candies daily consumption shows OR: 4.96 (CI: 1.11-22.04). The most affected organ was the first right lower back tooth and the left presents an OR: 2.0 (CI: 0.90-44.20) and OR: 1.14 (CI: 0.54-23.91), according to the left lower quadrant, presents OR 1.27 (CI: 0.38-4.19), the lower arch presents OR: 1.23 (CI: 0.39-1.68) the only variables with a statistically significant value of p <0.05 were tooth decay, consumption of sweets, fried food and candies. Conclusions: We found in this study that the risk factors are still modifiable for preventing periapical disease.

Resumen Objetivo: Identificar los factores de riesgo asociados a la patología periapical y pulpar en pacientes que acuden a la clínica Juchiman I, DACS-UJAT. Materiales y métodos: Estudio observacional analítico de casos (n=60) y sus controles (1:1) de pacientes con patología periapical y pulpar respectivamente. Se realizó estadística descriptiva y se calculó el Odds Ratio, intervalos de confianza y valor de p<0.05. Resultados: Se observó en los varones un OR: 1.14 (IC: 0.55-2.43), el grupo de edad de 21-30 presenta OR: 2.42-(IC:0.47-12.28) La licenciatura tiene OR:1.66 (IC:0.17-2.04) el profesionista presenta OR:2.08 (IC:0.95-2.49). El factor predisponente fue la caries dental con OR:3.08 (IC:1.10- 8.58), en los factores asociados a traumatismos se observó que el desgaste patológico tiene OR:1.50 (IC:0.72-3.11). Un consumo diario de refresco presenta OR:2.38 (IC:0.47-3.82) el consumo de frituras ocasional OR:7.6 (IC:0.90-53.84) y diario OR:2.1 (IC:0.20-22.32) Los dulces y golosinas y su consumo diario presentan OR:4.96 (IC:1.11-22.04). El órgano dental más afectado fue el primer molar inferior derecho y el izquierdo presentando un OR: 2.0 (IC:0.90-44.20) y OR: 1.14 (IC:0.54-23.91), de acuerdo al cuadrante, el inferior izquierdo presento OR: 1.27 (IC:0.38-4.19), la arcada inferior presenta OR:1.23 (IC:0.39-1.68) Las únicas variables con un valor estadísticamente significativo de p<0.05, fueron la caries dental, el consumo de frituras dulces y golosinas. Conclusiones: En este estudio se comprobó que los factores de riesgo aún se encuentran dentro de los modificables para la prevención de la patología periapical.

https://doi.org/10.19136/hs.v16i2.1450 5960 downloads

14.

Herniorrafia inguinal convencional com tela autofixante versus videolaparoscópica totalmente extraperitoneal com tela de polipropileno: resultados no pós-operatório precoce
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Cunha-e-Silva, José Antonio

; Oliveira, Flávio Malcher Martins de

; Ayres, Antonio Felipe Santa Maria Coquillard

; Iglesias, Antonio Carlos Ribeiro Garrido

Revista do Colégio Brasileiro de Cirurgiões

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jun 2017, Volume 44 N. 3 Pages 238 - 244

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: avaliar o resultado no pós-operatório precoce do tratamento da hérnia inguinal pela técnica convencional com tela autofixante versus videolaparoscópica totalmente extraperitoneal com uso da tela de polipropileno. Foram comparados, sobretudo, dor, tempo cirúrgico e complicações precoces. Métodos: estudo prospectivo, de série de casos, realizado na Clínica Cirúrgica A, do Hospital Universitário Gaffrée e Guinle (HUGG), no qual 80 casos consecutivos foram estudados. Apenas pacientes com hérnia inguinal unilateral, não recidivada e operadas em caráter eletivo foram incluídas no estudo. Os pacientes foram divididos em dois grupos, de 40 pacientes cada; grupo AF (técnica convencional com uso de tela autofixante) e grupo VL (técnica videolaparoscópica com uso de tela de polipropileno). Os pacientes foram acompanhados até o 45º dia de pós-operatório. Resultados: dos 80 pacientes operados no estudo, 98,7% pertenciam ao sexo masculino e a maioria era portadora de hérnia inguinal direita indireta (Nyhus II). Não houve diferença entre os grupos estudados no que diz respeito à dor e tempo operatório. No entanto, ocorreram mais complicações (seroma e hematoma) no grupo da cirurgia aberta. Conclusão: as duas operações realizadas se mostraram factíveis, seguras e estão relacionadas à mínima dor pós operatório e a um baixo tempo cirúrgico.

ABSTRACT Objective: to evaluate the early postoperative results of inguinal hernia repair by the conventional technique with self-fixating mesh versus laparoscopic totally extraperitoneal repair with polypropylene mesh. We compared pain, surgical time and early complications. Methods: this is a prospective, case-series study of 80 consecutive patients treated in the surgical clinic of the Gaffrée e Guinle University Hospital (HUGG). We included patients with unilateral inguinal hernia, not relapsed and operated only on an elective basis. We divided patients into two groups of 40 patients each, SF group (conventional technique using self-fixating mesh) and LP group (laparoscopic technique with polypropylene mesh). We followed patients up until the 45th postoperative day. Results: of the 80 patients, 98.7% were male and the majority had indirect right inguinal hernias (Nyhus II). There was no difference between the groups studied in respect to pain and operative time. However, more complications occurred (seroma and hematoma) in the open surgery group. Conclusion: both operations have proved feasible, safe and with minimal postoperative pain and a low operating time.

https://doi.org/10.1590/0100-69912017003003 6967 downloads

15.

Comparación de métodos para modelizar los factores asociados con los ingresos hospitalarios en casos incidentes de insuficiencia cardíaca
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Prado-Galbarro, Francisco Javier

; del-Cura-González, Isabel

; Garrido-Elustondo, Sofía

; Gamiño-Arroyo, Ana Estela

; Sánchez-Piedra, Carlos

; Sarría-Santamera, Antonio

Revista Española de Salud Pública

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2017, Volume 91 elocation e201705034

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

ABSTRACT Background: Heart failure (HF) is an important public health problem due to its increasing prevalence, and the decompensation associated with hospital admission represents an increased risk of death. The objective of this study was to compare several methods to model the variable hospitalizations and to determine the effect of factors associated with hospital admissions in incident cases of HF. Methods: Study of a retrospective cohort of patients with information extracted from electronic medical records of PC was performed. Patients 24 year and older with at least 1 visit to PC in 2006 were included. Registered hospital admissions of HF incident cases between 2006 and 2010 or until death were analyzed and comparison of Poisson, Negative Binomial (NB), zero-inflated and Hurdle regression models were conducted to identify factors associated con hospitalizations. Results: 3,061 patients were identified in a cohort of 227,984. Regarding the factors associated with hospitalizations and according to the zero inflated NB regression model, patients who presented valvular disease (OR=2.01; CI95% 1.22-3.30), or were being treated with antithrombotics (OR=3.45; CI95%: 1.61-7.42) or diuretics (OR=2.28; CI95% 1.13-4.58) had a lower likelihood of hospitalization. Factors associated with a higher rate of hospital admissions were having valvular disease (IRR=1.37; CI95% 1.03-1.81) or diabetes mellitus (IRR=1.38; 1.07-1.78), and being treated with calcium antagonists (IRR=1.35; CI95% 1.05- 1.73) or ACE inhibitors (IRR=1.43; CI95% 1.06- 1.92). Having being referred to a cardiologist had a protective effect (IRR=0.86; CI95% 0.76- 0.97). Conclusion: The regression model that obtained the best adjustment was the zero inflated NB. According to this model, the factors associated with an increase in hospital admissions were valvulopathies, diabetes and treatment with calcium antagonists.

RESUMEN Fundamento: La insuficiencia cardiaca (IC) es un importante problema de salud pública debido a su creciente prevalencia y la descompensación que conlleva un ingreso hospitalario representa un aumento del riesgo de muerte. El objetivo de este trabajo fue comparar varios métodos para modelizar la variable hospitalizaciones y determinar el efecto de los factores asociados con los ingresos hospitalarios en casos incidentes de IC. Método: Se realizó un estudio de cohortes restrospectivo con información extraída de la historia clínica electrónica de Atención Primaria (AP). Se incluyeron pacientes mayores de 24 años que habían realizado al menos 1 consulta en AP durante el año 2006. Se analizaron las hospitalizaciones registradas de casos incidentes de IC entre 2006 y 2010 o hasta su fallecimiento y se compararon modelos de regresión de Poisson, Binomial Negativa (BN), inflados con ceros y de Hurdle para identificar factores asociados a las hospitalizaciones. Resultados: Se identificó a 3.061 personas con IC en una cohorte de 227.984 pacientes. Respecto a los factores asociados con las hospitalizaciones y según el modelo de regresión BN inflado con ceros, los pacientes con valvulopatías (OR=2,01; IC95%: 1,22-3,30) o en tratamiento con antitrombóticos (OR=3,45; IC95%: 1,61-7,42) o diuréticos (OR=2,28; IC95%:1,13-4,58) tuvieron mayor probabilidad de hospitalización. Los factores asociados a una mayor tasa de ingresos fueron tener valvulopatías (IRR=1,37; IC95%: 1,03-1,81) o diabetes mellitus (IRR=1,38, 1,07-1,78) y estar en tratamiento con calcioantagonistas (IRR=1,35; IC95%: 1,05-1,73) o IECAS (IRR=1,43; IC95%:1,06-1,92). Haber tenido derivaciones a cardiología tuvo efecto protector (IRR=0,86; IC95%: 0,76-0,97). Conclusión: El modelo de regresión que tiene mejor ajuste es el BN inflado con ceros. Según este modelo los factores asociados con un incremento en los ingresos hospitalarios son las valvulopatías, la diabetes mellitus y el tratamiento con calcioantagonistas.

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