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Calciphylaxis: a rare cause of limb ulcer - a case report
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Cunha, Roberto

; Silva, Manuel

; Carneiro, Vitor

; Sousa, Pedro

; Correia, Mafalda

; Vieira, Isabel

; Cássio, Isabel

; Oliveira, Nelson

; Dias, Emanuel

Angiologia e Cirurgia Vascular

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dec 2023, Volume 19 N. 4 Pages 235 - 238

Abstract: En | Text: En | PDF: En

Abstract Background: Calciphylaxis is a rare disease with a poor prognosis predominantly found in end-stage renal disease patients treated with dialysis. This pathology most commonly presents with painful non-healing ulcers, predisposing to high risk of sepsis and death. The authors present a case of bilateral leg ulcers due to calciphylaxis. Case report: A 40-year-old female patient presented with painful ulcers in both lower limbs, for two months. She had a history of end-stage renal disease, morbid obesity, severe hypertension, arterial fibrillation and secondary hyperparathyroidism. Duplex examination releveled biphasic curves in the foot arteries. The ankle-brachial index was carried out with a result of 1.1, obtaining a WIFi stage of 3 (2/0/2). Venous disease was excluded. A biopsy was obtained, revealing small thick-walled vessels with dystrophic calcification of the intima and media. After surgical debridement, antibiotics directed at the superimposed infection were administered and local wound care with chemical debridement was performed. The ulcers healed completely after 8 weeks and there was no recurrence after 6 months. Conclusion: The diagnosis is made by clinical and histological findings. Treatment involves a multidisciplinary approach with medical treatment and wound care. Drugs such as sodium thiosulphate and cinacalcet have shown good results in the healing of ulcers. Vascular surgeons, as they often deal with patients with leg ulcers, should be aware of calciphylaxis as a differential diagnosis when vascular disease is excluded.

https://doi.org/10.48750/acv.546

Pseudoaneurysm after partial nephrectomy managed by selective angiographic embolization - a case report
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Cunha, Roberto

; Silva, Manuel

; Sousa, Pedro

; Correia, Mafalda

; Vieira, Isabel

; Cássio, Isabel

; Oliveira, Nelson

; Dias, Emanuel

Angiologia e Cirurgia Vascular

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dec 2023, Volume 19 N. 4 Pages 244 - 245

Abstract: En | Text: En | PDF: En

Abstract Introduction: Partial nephrectomy is considered the gold standard treatment for many renal tumors when technically feasible. Renal artery pseudoaneurysm and arteriovenous fistulas are rare life-threatening complications that occur more frequently after laparoscopic rather than open partial nephrectomy. Case report: The authors present a case of a 67-year-old female patient with persistent hematuria due to a renal pseudoaneurysm after partial laparoscopic nephrectomy is presented. The patient underwent selective embolization of the pseudoaneurysm using Conclusion: Arterial lesions after partial nephrectomy may be amenable to embolization with the advantage of renal parenchyma and function preservation, by comparison with more invasive interventions such as total nephrectomy. Active surveillance of patients after laparoscopic partial nephrectomy should be performed.

https://doi.org/10.48750/acv.557

Correlation of ulcerated plaque image with intraoperative findings
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Cunha, Roberto

; Silva, Manuel

; Sousa, Pedro

; Correia, Mafalda

; Vieira, Isabel

; Cássio, Isabel

; Oliveira, Nelson

; Dias, Emanuel

Angiologia e Cirurgia Vascular

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sep 2023, Volume 19 N. 3 Pages 201 - 201

Abstract: En | Text: En | PDF: En

https://doi.org/10.48750/acv.545

Fat embolism in the femoral veins
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Cunha, Roberto

; Silva, Manuel

; Sousa, Pedro

; Correia, Mafalda

; Vieira, Isabel

; Cássio, Isabel

; Oliveira, Nelson

; Dias, Emanuel

Angiologia e Cirurgia Vascular

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jun 2023, Volume 19 N. 2 Pages 106 - 106

Abstract: En | Text: En | PDF: En

https://doi.org/10.48750/acv.528

Newborn Screening Program for Cystic Fibrosis in Cuba: Three Years’ Experience
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Castells, Elisa M.

; Sánchez, Aramis

; Frómeta, Amarilys

; Moksde, Yanin

; Silva, Eladio

; Ozunas, Nelson

; Licourt, Tania

; Arteaga, Ana L.

; Collazo, Teresa

; Rodríguez, Fidel

; Martín, Odalys

; Espinosa, Maryeris

; Río, Lesley del

; Pérez, Pedro L.

; Morejón, Greilys

; Almira, Claudia

; Núñez, Zoe

; Melchor, Antonio

; González, Ernesto C.

Journal of Inborn Errors of Metabolism and Screening

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2023, Volume 11 elocation e20220012

Abstract: En | Text: En | PDF: En

ABSTRACT In Cuba, newborn screening (NBS) for cystic fibrosis (CF) was introduced in January 2019. The results from the first three years of the CF NBS program are presented. An IRT/IRT protocol was followed using a cut-off value of 50 ng/mL. In this period 281,717 neonates were screened, 2,197 samples had increased IRT values, and a second sample was necessary (recall rate=0.78%). In 686 (0.24%) neonates, IRT was still elevated, and they were referred for clinical evaluation. Twenty-one children were confirmed by sweat test and molecular biology. Eighteen newborns presented variant F508del. A false negative case was reported. Demographic data of 32,764 neonates were collected. The average age of sampling was six days with results available at 11 days of life, but 1.7% of the samples were collected 20 days after birth. The mean IRT value was 12.7±11.7 ng/mL (ranging 0-283 ng/mL) with a calculated 98.5 percentile value of 42.4 ng/mL. On average, the samples were processed five days after collection and two days after they were received at the laboratory. Although CF NBS program in Cuba is just beginning, it can be predicted that CF will be one of the most frequent inherited-metabolic diseases in the Cuban population.

https://doi.org/10.1590/2326-4594-jiems-2022-0012

Shared decision-making and specific informed consent in patients with aortic aneurysms
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Cunha, Marcela Juliano Silva

; Teivelis, Marcelo Passos

; Mendes, Cynthia de Almeida

; Baptistella, Conrado Dias Pacheco Annicchino

; Sant´Anna, Pedro Vasconcelos Henry

; Wolosker, Nelson

einstein (São Paulo)

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2023, Volume 21 elocation eAO0197

Abstract: En | Text: En | PDF: En

ABSTRACT Objective To analyze the refusal rate of elective aortic aneurysm surgery in asymptomatic patients after the presentation of a detailed informed consent form followed by a meeting where patient and their families can analyze each item. Methods We conducted a retrospective analysis of 49 patients who had aneurysms and were offered surgical treatment between June 2017 and February 2019. The patients were divided into two groups: the Rejected Surgery Group, which was composed of patients who refused the proposed surgical treatment, and the Accepted Surgery Group, comprising patients who accepted the proposed surgeries and subsequently underwent them. Results Of the 49 patients, 13 (26.5%) refused surgery after reading the informed consent and attending the comprehensive meeting. We observed that patients who refused surgery had statistically smaller aneurysms than those who accepted surgery (9% versus 26%). These smaller aneurysms were above the indication size, according to the literature. Conclusion One-quarter of patients who were indicated for elective surgical repair of aortic aneurysms rejected surgery after shared decision-making, which involved presenting patients with an informed consent form followed by a clarification meeting for them and their families to analyze each item. The only factor that significantly influenced a rejection of the procedure was the size of the aneurysm; patients who rejected surgery had smaller aneurysms than those who accepted surgery.

https://doi.org/10.31744/einstein_journal/2023ao0197

NOVAS POSSIBILIDADES HISTÓRICAS PARA A DEMOCRACIA E PARA A EDUCAÇÃO PÚBLICA
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Leher, Roberto

; Pino, Ivany Rodrigues

; Zuin, Antônio Alvaro Soares

; Almeida, Luana Costa

; Silveira, Adriana Aparecida Dragone

; Dalbosco, Claudio Almir

; Moraes, Carmen Sylvia Vidigal

; Mazza, Débora

; Amaral, Nelson Cardoso

; Souza, Sandra Maria Zákia Lian

; Almeida, Ana Maria Fonseca de

; Ferretti, Celso João

; Sisto, Vicente

; Goergen, Pedro

; Ximenes, Salomão

; Lima, Licínio Carlos Viana da Silva

; Trevisan, Anderson Ricardo

; Rambla, Xavier

Educação & Sociedade

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2023, Volume 44 elocation e271371

Abstract: Pt | Text: Pt | PDF: Pt

https://doi.org/10.1590/es.271371

O que mudou entre os períodos de pico e de platô durante a primeira onda do SARS-CoV-2? Estudo multicêntrico português em unidades de cuidados intensivos
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Pereira, Rui Antunes

; Sousa, Marta

; Cidade, José Pedro

; Melo, Luís

; Lopes, Diogo

; Ventura, Sara

; Aragão, Irene

; Lima Neto, Raul Miguel de Freitas

; Molinos, Elena

; Marques, Ana

; Cardoso, Nelson

; Marino, Flávio

; Monteiro, Filipa Brás

; Oliveira, Ana Pinho

; Silva, Rogério C

; Real, André Miguel Neto

; Banheiro, Bruno Sarmento

; Reis, Renato

; Adão-Serrano, Maria

; Cracium, Ana

; Valadas, Ana

; Ribeiro, João Miguel

; Póvoa, Pedro

; Tapadinhas, Camila

; Mendes, Vítor

; Coelho, Luís

; Maia, Raquel

; Freitas, Paulo Telles

; Ferreira, Isabel Amorim

; Ramires, Tiago

; Val-Flores, Luís Silva

; Cascão, Mariana

; Alves, Rita

; Rodeia, Simão C

; Barrigoto, Cleide

; Cardiga, Rosa

; Silva, Maria João Ferreira da

; Vale, Bruno

; Fonseca, Tatiana

; Rios, Ana Lúcia

; Camões, João

; Pérez, Danay

; Cabral, Susana

; Ribeiro, Maria Inês

; Mendes, João João

; Gouveia, João

; Fernandes, Susana Mendes

Revista Brasileira de Terapia Intensiva

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dec 2022, Volume 34 N. 4 Pages 433 - 442

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

ABSTRACT Objective: To analyze and compare COVID-19 patient characteristics, clinical management and outcomes between the peak and plateau periods of the first pandemic wave in Portugal. Methods: This was a multicentric ambispective cohort study including consecutive severe COVID-19 patients between March and August 2020 from 16 Portuguese intensive care units. The peak and plateau periods, respectively, weeks 10 - 16 and 17 - 34, were defined. Results: Five hundred forty-one adult patients with a median age of 65 [57 - 74] years, mostly male (71.2%), were included. There were no significant differences in median age (p = 0.3), Simplified Acute Physiology Score II (40 versus 39; p = 0.8), partial arterial oxygen pressure/fraction of inspired oxygen ratio (139 versus 136; p = 0.6), antibiotic therapy (57% versus 64%; p = 0.2) at admission, or 28-day mortality (24.4% versus 22.8%; p = 0.7) between the peak and plateau periods. During the peak period, patients had fewer comorbidities (1 [0 - 3] versus 2 [0 - 5]; p = 0.002) and presented a higher use of vasopressors (47% versus 36%; p < 0.001) and invasive mechanical ventilation (58.1 versus 49.2%; p < 0.001) at admission, prone positioning (45% versus 36%; p = 0.04), and hydroxychloroquine (59% versus 10%; p < 0.001) and lopinavir/ritonavir (41% versus 10%; p < 0.001) prescriptions. However, a greater use of high-flow nasal cannulas (5% versus 16%, p < 0.001) on admission, remdesivir (0.3% versus 15%; p < 0.001) and corticosteroid (29% versus 52%, p < 0.001) therapy, and a shorter ICU length of stay (12 days versus 8, p < 0.001) were observed during the plateau. Conclusion: There were significant changes in patient comorbidities, intensive care unit therapies and length of stay between the peak and plateau periods of the first COVID-19 wave.

RESUMO Objetivo: Analisar e comparar as características de pacientes críticos com a COVID-19, a abordagem clínica e os resultados entre os períodos de pico e de platô na primeira onda pandêmica em Portugal. Métodos: Este foi um estudo de coorte multicêntrico ambispectivo, que incluiu pacientes consecutivos com a forma grave da COVID-19 entre março e agosto de 2020 de 16 unidades de terapia intensiva portuguesas. Definiram-se as semanas 10 - 16 e 17 - 34 como os períodos de pico e platô. Resultados: Incluíram-se 541 pacientes adultos com mediana de idade de 65 [57 - 74] anos, a maioria do sexo masculino (71,2%). Não houve diferenças significativas na mediana de idade (p = 0,3), no Simplified Acute Physiology Score II (40 versus 39; p = 0,8), na pressão parcial de oxigênio/fração inspirada de oxigênio (139 versus 136; p = 0,6), na terapia com antibióticos na admissão (57% versus 64%; p = 0,2) ou na mortalidade aos 28 dias (24,4% versus 22,8%; p = 0,7) entre o período de pico e platô. Durante o período de pico, os pacientes tiveram menos comorbidades (1 [0 - 3] versus 2 [0 - 5]; p = 0,002); fizeram mais uso de vasopressores (47% versus 36%; p < 0,001) e ventilação mecânica invasiva na admissão (58,1% versus 49,2%; p < 0,001), e tiveram mais prescrição de hidroxicloroquina (59% versus 10%; p < 0,001), lopinavir/ritonavir (41% versus 10%; p < 0,001) e posição prona (45% versus 36%; p = 0,04). Entretanto, durante o platô, observou-se maior uso de cânulas nasais de alto fluxo (5% versus 16%; p < 0,001) na admissão, remdesivir (0,3% versus 15%; p < 0,001) e corticosteroides (29% versus 52%; p < 0,001), além de menor tempo de internação na unidade de terapia intensiva (12 versus 8 dias; p < 0,001). Conclusão: Houve mudanças significativas nas comorbidades dos pacientes, nos tratamentos da unidade de terapia intensiva e no tempo de internação entre os períodos de pico e platô na primeira onda da COVID-19.

https://doi.org/10.5935/0103-507x.20210037-pt

Invisibilidade pública das Práticas Integrativas e Complementares e humilhação social dos trabalhadores que as ofertam na Atenção Primária à Saúde
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Silva, Pedro Henrique Brito da

; Oliveira, Ellen Synthia Fernandes de

; Barros, Nelson Filice de

; Barros, Leylaine Christina Nunes de

; Zambelli, Janaína da Câmara

New Trends in Qualitative Research

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sep 2022, Volume 13 elocation e645

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

Resumo: Introdução: “(R)existir” perante a hegemonia biomédica torna a oferta das Práticas Integrativas e Complementares na Atenção Primária à Saúde ainda mais desafiadora, mesmo com a vigência de uma política nacional que estabelece a sua implementação. O atual cenário político e institucional desfavorece aquilo que se afasta do “convencional”. A primazia pela manutenção do status quo resulta em resistência ao “diferente”. Isso influencia as práticas assistenciais, de modo que as Práticas Integrativas e Complementares podem sofrer entraves e revelar tensionamentos quanto a sua realização. Objetivo: Compreender, na perspectiva dos profissionais, os fatores que contribuem para a produção de humilhação social e invisibilidade pública das Práticas Integrativas e Complementares na Atenção Primária à Saúde. Métodos: Trata-se de um estudo descritivo, exploratório, com abordagem qualitativa. Realizaram-se entrevistas semiestruturadas com 20 profissionais, de 14 serviços de Atenção Primária à Saúde, em três cidades da Região Metropolitana de Goiânia, entre os meses de janeiro a agosto de 2018. As entrevistas foram gravadas, transcritas e tratadas com a análise de conteúdo temática. Resultadols: Da análise, emergiram duas categorias: a humilhação social dos profissionais das Práticas Integrativas e Complementares na Atenção Primária à Saúde e a produção de invisibilidade pública das Práticas Integrativas e Complementares na Atenção Primária à Saúde. Os profissionais sofrem diferentes formas de humilhação social com o desapoio do seu trabalho e as Práticas Integrativas e Complementares padecem de invisibilidade pública pela discussão insuficiente sobre a sua oferta nas reuniões de equipe e inconsistência do registro nos prontuários dos usuários. Conclusão: As Práticas Integrativas e Complementares têm enfrentado uma inclusão parcial e precária na Atenção Primária à Saúde.

Abstract: Introduction: “(R)existing” in the face of biomedical hegemony makes the offer of Integrative and Complementary Practices in Primary Health Care even more challenging, even with the existence of a national policy that establishes its implementation. The current political and institutional scenario disfavors what moves away from the “conventional”. The primacy of maintaining the status quo results in resistance to the “different”. This influences care practices, so that Integrative and Complementary Practices can suffer obstacles and reveal tensions regarding their realization. Objective: To understand, from the perspective of professionals, the factors that contribute to the production of social humiliation and public invisibility of Integrative and Complementary Practices in Primary Health Care. Methods: This is a descriptive, exploratory study with a qualitative approach. Semi- structured interviews were carried out with 20 professionals from 14 Primary Health Care services in three cities in the Metropolitan Region of Goiânia, between January and August 2018. The interviews recorded, transcribed, and treated with thematic content analysis. Results: From the analysis, two categories emerged: the social humiliation of professionals in Integrative and Complementary Practices in Primary Health Care and the production of public invisibility of Integrative and Complementary Practices in Primary Health Care. Professionals suffer different forms of social humiliation with the lack of support for their work and the Integrative and Complementary Practices suffer from public invisibility due to insufficient discussion about their offer in team meetings and inconsistency in the registration in the users' charts. Conclusion: Integrative and Complementary Practices have faced a partial and precarious inclusion in Primary Health Care.

https://doi.org/10.36367/ntqr.13.2022.e645

10.

Entrevistas por telefone: perspectivas e usos durante a pandemia de COVID-19
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Ferreira Júnior, Antônio Rodrigues

; Oliveira, Ellen Synthia Fernandes de

; Silva, Pedro Henrique Brito da

; Teixeira, Ricardo Antônio Gonçalves

; Silva, Maria Rocineide Ferreira da

; Amaral Júnior, Alpheu Ferreira do

; Barros, Nelson Filice de

New Trends in Qualitative Research

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jun 2022, Volume 10 elocation e556

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

Abstract: The interviews, using digital devices, have been characterized as an important aspect of qualitative studies. However, the pandemic context amplified the challenges for the implementation of this information gathering technique. This chapter aimed to discuss the perspectives and uses telephone interviews during the COVID-19 pandemic. he chapter is initially organized with an overview of the electronic interview, the possibilities of its use and limitations. Then, the report on the experience of a group of Brazilian researchers in the development of a multicenter study on Integrative and Complementary Practices in Primary Health Care is presented. Next, the conduct of the interviews in this pandemic scenario is described as challenge. Several times, they were interrupted so that the respondent could attend to any pending issue to be resolved at the health unit. This circumstance is not a peculiarity of moments of pandemic since studies with themes similar to this one already reports the occurrence of similar experiences. However, COVID-19 was added to the priority processes of Primary Health Care. The Basic Health Units are close to users, playing an indispensable role in the health care of the population affected by the new coronavirus. Thus, it would be natural and expected that these cuts occurred during the interview. It is concluded that all the steps for conducting interviews were conditioned by the COVID19 pandemic and conditioned prior planning, maintenance of the ethical component, the choice of participants, interviewers, the moment for conducting them and the way to access their driving.

Resumo: As entrevistas, utilizando meios digitais, têm se caracterizado como importante vertente nos estudos qualitativos. No entanto, o contexto pandêmico ampliou os desafios para a implementação desta técnica de coleta de informações. Este capítulo objetivou discutir as perspetivas e os usos das entrevistas por telefone durante a pandemia de COVID-19. O capítulo está organizado inicialmente com uma visão geral da realização da entrevista eletrônica, as possibilidades de sua utilização e limitações. Em seguida, apresenta-se o relato da experiência de um grupo de pesquisadores brasileiros no desenvolvimento de um estudo multicêntrico sobre as Práticas Integrativas e Complementares na Atenção Primária a Saúde. Na sequência, descreve-se a condução das entrevistas neste cenário pandêmico que está sendo um grande desafio. Por diversas vezes, elas são interrompidas para que o entrevistado atendesse à alguma pendência a ser resolvida na unidade de saúde. Essa circunstância não é uma peculiaridade dos momentos de pandemia visto que estudos com temática similar a esta já relatam a ocorrência de experiências congêneres. Entretanto, a COVID-19 foi adicionada aos processos prioritários da Atenção Primária à Saúde. As Unidades Básicas de Saúde estão próximas aos usuários, tendo papel indispensável na assistência à saúde da população acometida pelo novo coronavírus. Assim, seria natural e esperado que esses cortes ocorressem no decorrer da entrevista. Conclui-se que todos os passos para a realização de entrevistas foram condicionados pela pandemia da COVID19, desde o planejamento, a manutenção do componente ético, a escolha dos participantes, dos entrevistadores, do momento para sua realização e do modo de acesso de sua condução.

https://doi.org/10.36367/ntqr.10.2022.e556

11.

Cohort study on 20 years’ experience of bilateral video-assisted thoracic sympathectomy (VATS) for treatment of hyperhidrosis in 2431 patients
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Wolosker, Nelson

; de Campos, José Ribas Milanez

; Kauffman, Paulo

; da Silva, Marcelo Fiorelli Alexandrino

; Faustino, Carolina Brito

; Tedde, Miguel Lia

; Puech-Leão, Pedro

; Pêgo Fernandes, Paulo Manuel

Sao Paulo Medical Journal

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feb 2022, Volume 140 N. 2 Pages 284 - 289

Abstract: En | Text: En | PDF: En

Abstract BACKGROUND: Primary hyperhidrosis is a condition characterized by excessive sweating, inconsistent with the needs for thermoregulation. OBJECTIVE: To assess the effectiveness and the change in the quality of life of patients undergoing bilateral VATS (video-assisted thoracoscopic sympathectomy) for treatment of hyperhidrosis, in a large case series. DESIGN AND SETTING: Cohort study conducted in a tertiary hospital specializing in hyperhidrosis located in São Paulo, Brazil. METHODS: A total of 2,431 patients who underwent surgery consisting of bilateral video-assisted thoracoscopic sympathectomy between January 2000 and February 2017 were retrospectively assessed in an outpatient clinic specializing in hyperhidrosis. The patients underwent clinical and quality of life assessments on two occasions: firstly, prior to surgery, and subsequently, one month after the operation. The presence or absence of compensatory hyperhidrosis (CH) and general satisfaction after the first postoperative month were also evaluated. RESULTS: All the patients operated had poor or very poor quality of life before surgery. In the postoperative period, an improvement in the quality of life was observed in more than 90% of the patients. Only 10.7% of the patients did not present CH, and severe CH occurred in 22.1% of the patients in this sample. CONCLUSION: Bilateral VATS is a therapeutic method that decreases the degree of sweating more than 90% of patients with palmar and axillary hyperhidrosis. It improves the quality of life for more than 90% of the patients, at the expense of development of CH in approximately 90% of the patients, but not intensely.

https://doi.org/10.1590/1516-3180.2021.0078.r1.23072021

12.

REFORMA DO ENSINO MÉDIO: A INSTITUCIONALIZAÇÃO DO APARTHEID SOCIAL NA EDUCAÇÃO
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Moraes, Carmen Sylvia Vidigal

; Ferretti, Celso João

; Pino, Ivany Rodrigues

; Leher, Roberto

; Almeida, Luana Costa

; Ximenes, Salomão Barros

; Dalbosco, Claudio Almir

; Souza, Sandra Maria Zákia Lian

; Zuin, Antônio Alvaro Soares

; Silveira, Adriana Aparecida Dragone

; Almeida, Ana Maria Fonseca de

; Trevisan, Anderson Ricardo

; Mazza, Débora

; Lima, Licínio Carlos Viana da Silva

; Amaral, Nelson Cardoso

; Goergen, Pedro

; Rambla, Xavier

; Sisto, Vicente

Educação & Sociedade

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2022, Volume 43 elocation e261875

Abstract: Pt | Text: Pt | PDF: Pt

https://doi.org/10.1590/es.261875

13.

IMPACT OF SURGERY ON AMBULATORY STATUS IN PATIENTS WITH SYMPTOMATIC NEOPLASTIC SPINAL CORD COMPRESSION IN SOUTHERN BRAZIL
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Silva, Guilherme Gago da

; Britz, João Pedro Einsfeld

; Martins, Otávio Garcia

; Ferreira, Nelson Pires

; Ferreira, Marcelo Paglioli

; Worm, Paulo Valdeci

Coluna/Columna

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2022, Volume 21 N. 3 elocation e263573

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

Resumo: Introdução: A compressão medular é uma complicação comum de metástases da coluna vertebral e de mieloma múltiplo. Cerca de 30% dos pacientes com câncer desenvolvem metástases sintomáticas na coluna no decorrer da doença. O diagnóstico imediato e o tratamento cirúrgico dessas lesões, embora paliativos, em geral reduzema morbidade e melhoram a qualidade de vidaao ampliar a capacidade de deambular. Desenho do estudo: Revisão retrospectiva de prontuários médicos. Objetivo: Avaliar a recuperação funcional pós-operatória e o perfil epidemiológico da compressão medular neoplásica em dois centros de neurocirurgia do sul do Brasil. Métodos: Analisamos retrospectivamente os dados de todos os pacientes submetidos à cirurgia paliativa de lesão neoplásica sintomática da coluna decorrente decâncer metastático, em dois centros neurocirúrgicos entre janeiro de 2003 e julho de 2021. Foram analisadas as variáveis idade, sexo, estado neurológico, tipo histológico, segmento acometido, complicações e tempo de internação. Resultados: Foram incluídos 82 pacientes no estudo. As lesões ocorreram na coluna torácica em 60 casos. À internação, 95% dos pacientes apresentavam déficits neurológicos, sendoa maioria classificada como Frankel C (37%). Na análise histopatológica, o câncer de mama foi o sítio primário mais comum. Depois da cirurgia, 46 pacientes (56%) tiveram o estado neurológico reclassificado pela escala de Frankel. Entre eles, 22 (47%) recuperaram a capacidade de deambular. Conclusões: O tratamento cirúrgico da compressão medular metastática melhorou o estado neurológico e a capacidade de deambulação em nossa amostra. Nível de evidência II; Estudo retrospectivo.

ABSTRACT Background: Spinal cord compression is a common complication of spine metastasis and multiple myeloma. About 30% of patients with cancer develop symptomatic spinal metastases during their illness. Prompt diagnosis and surgical treatment of these lesions, although palliative, are likely to reduce the morbidity and improve quality of life by improving ambulatory function. Study Design: Retrospective review of medical records. Objective: To evaluate postoperative functional recovery and the epidemiological profile of neoplastic spinal cord compression in two neurosurgical centers in southern Brazil. Methods: We retrospectively analyzed the data of all patients who underwent palliative surgery for symptomatic neoplastic spine lesion from metastatic cancer, in two neurosurgical centers, between January 2003 and July 2021. The variables age, sex, neurological status, histological type, affected segment, complications and length of hospitalization were analyzed. Results: A total of 82 patients were included. The lesions occurred in the thoracic spine in 60 cases. At admission, 95% of the patients had neurological deficits, most of which were Frankel C (37%). At histopathological analysis, breast cancer was the most common primary site. After surgery, the neurological status of 46 patients (56%) was reclassified according to the Frankel scale. Of these, 22 (47%) regained ambulatory capacity. Conclusion: Surgical treatment of metastatic spinal cord compression improved neurological status and ambulatory ability in our sample. Level of evidence II; Retrospective study.

Resumen: Introducción: La compresión de la médula espinal es una complicación común de la metástasis de la columna vertebral y el mieloma múltiple. Aproximadamente el 30% de los pacientes con cáncer desarrollan metástasis espinales sintomáticas en el curso de la enfermedad. El diagnóstico precoz y el tratamiento quirúrgico de estas lesiones, aunque son paliativos, suelen reducir la morbilidad y mejor en lacalidad de vida al aumentar la de ambulación. Diseño del estudio: Revisión retrospectiva de registros médicos. Objetivo: Evaluarla recuperación funcional postoperatoria y el perfil epidemiológico de la compresión medular neoplásica en dos centros neuroquirúrgicos del sur de Brasil. Métodos: Analizamos retrospectivamente los datos de todos los pacientes sometidos a cirugía paliativa por lesión vertebral neoplásica sintomática por cáncer metastásico, en dos centros neuroquirúrgicos entre enero de 2003 y julio de 2021. Se analizaron las variables edad, sexo, estado neurológico, tipo histológico, segmento afectado, complicaciones y duración de la hospitalización. Resultados: Se incluyeron 82 pacientes en el estudio. Las lesiones se produjeron en la columna torácica en 60 casos. Al ingreso, el 95% de los pacientes presentaban déficits neurológicos y la mayoría de ellos eran clasificados como Frankel C (37%). En el análisis histopatológico, elcáncer de mama fue el sitio primario más común. Después de la cirugía, se reclasificó el estado neurológico de 46 pacientes (56%) por la escala de Frankel. Entre ellos, 22 (47%) recuperaron la capacidadde deambulación. Conclusiones: El tratamiento quirúrgico de la compresión medular metastásica mejoró el estado neurológico y la capacidad de deambulación en nuestra muestra. Nivel de evidencia II; Estudio retrospectivo.

https://doi.org/10.1590/s1808-185120222103263573

14.

Compreensões e incompreensões sobre a oferta e ausência das Práticas Integrativas e Complementares por parte dos gestores na Atenção Primária à Saúde
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Silva, Pedro Henrique Brito da

; de Barros, Leylaine Christina Nunes

; Zambelli, Janaína da Câmara

; Barros, Nelson Filice de

; Oliveira, Ellen Synthia Fernandes de

New Trends in Qualitative Research

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jun 2021, Volume 8 Pages 245 - 253

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

Resumo: Introdução: Nenhum estudo qualitativo foi conduzido junto aos gestores de serviços de Atenção Primária à Saúde visando entender se a presença ou a ausência de Práticas Integrativas e Complementares nas unidades básicas de saúde contribuem para o conhecimento sobre elas; Objetivo: compreender as percepções dos gestores de saúde sobre as PIC, com ou sem a sua oferta, na Atenção Primária à Saúde; Métodos: Trata-se de um estudo descritivo, exploratório e de natureza qualitativa, com 45 coordenadores de Unidades Básicas de Saúde, mediante utilização de entrevistas semiestruturadas que foram gravadas, transcritas e analisadas com a técnicas de análise de conteúdo temática; Resultados: Emergiram duas categorias temáticas: o desconhecimento dos gestores sobre as Práticas Integrativas e Complementares na Atenção Primária à Saúde; e concepções de cuidado por parte dos gestores dos serviços de Atenção Primária à Saúde. Em conjunto, os resultados evidenciam mesmo com a oferta, existe uma falta de conhecimento tanto dos gestores dessas Unidades de Saúde quanto daqueles que gerem serviços com ausência de Práticas Integrativas e Complementares. Do mesmo modo, as concepções de cuidado também são semelhantes. Esperava-se encontrar definições predominantemente holísticas entres os gestores ofertantes de terapias complementares. Porém, nota-se ainda um forte predomínio do cuidado cartesiano; Conclusões: O contexto biomédico, fragmentado e hopistalocêntrico guiam a assistência na Atenção Primária à Saúde. Portanto, a oferta das Práticas Integrativas e Complementares sozinha não consegue fazer uma “revolução espistemológica e assistencial”. É necessário medidas de educação permanente e abrir espaços de reflexão de pluralidade terapêutica para ampliação da oferta das Práticas Integrativas e Complementares na Atenção Primária à Saúde.

Abstract: Introduction: No qualitative study was conducted with managers of Primary Health Care services to understand whether the presence or absence of Integrative and Complementary Practices in basic health units contributes to knowledge about them; Goals: to understand the perceptions of health managers about the PIC, with or without its offer, in Primary Health Care; Methods: This is a descriptive, exploratory and qualitative study, with 45 coordinators from Basic Health Units, using semi-structured interviews that were recorded, transcribed and analysed using thematic content analysis techniques; Results: Two thematic categories emerged: the managers' lack of knowledge about the Integrative and Complementary Practices in Primary Health Care; and conceptions of care on the part of the managers of the Primary Health Care services. Together, the results show even with the offer, there is a lack of knowledge both managers of these Health Units and of those who manage services with the absence of Integrative Practices and Complementary. Likewise, the conceptions of care are also similar. It was expected to find predominantly holistic definitions among the managers offering complementary therapies. However, there is still a strong predominance of Cartesian care; Conclusions: The biomedical, fragmented and hopistalocentric context guides assistance in Primary Health Care. Therefore, the offer of Integrative and Complementary Practices alone fails in making a “epistemological and assistance revolution”. There is a need for permanent education measures and to open spaces for reflection on therapeutic plurality to expand the offer of Integrative and Complementary Practices in Primary Health Care.

https://doi.org/10.36367/ntqr.8.2021.245-253 7 downloads

15.

Formação profissional em Práticas Integrativas e Complementares: o sentido atribuído por trabalhadores da Atenção Primária à Saúde
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Silva, Pedro Henrique Brito da

; Barros, Leylaine Christina Nunes de

; Barros, Nelson Filice de

; Teixeira, Ricardo Antônio Gonçalves

; Oliveira, Ellen Synthia Fernandes de

Ciência & Saúde Coletiva

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feb 2021, Volume 26 N. 2 Pages 399 - 408

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

Resumo O objetivo deste artigo é compreender os sentidos atribuídos por trabalhadores da Atenção Primária à Saúde ao processo de formação profissional nas Práticas Integrativas e Complementares. Estudo descritivo, exploratório, com abordagem qualitativa, com 20 profissionais, de 14 unidades de saúde de três municípios na Região Metropolitana de Goiânia. Os dados foram coletados com entrevistas semiestruturadas, transcritas e analisadas por meio da Análise de Conteúdo Temática. Da análise, emergiu a categoria temática sobre as trajetórias de formação nas Práticas Integrativas e Complementares. Nela discute-se que a formação se dá por capacitações proporcionadas pela gestão federal, municipal ou conselhos de categoria profissional, via educação à distância, semipresencial ou presencial. Além disso, são realizadas formações em instituições privadas de ensino custeadas pelos próprios profissionais. Também, fontes informais de informações são usadas para obtenção de conhecimento (internet, livros e revistas). Os resultados revelam, por um lado, a formação insuficiente e difusa, com limitação na oferta e na qualidade, por outro, a necessidade de ampliação de estratégias educacionais que melhorem a formação dos profissionais de saúde para a oferta das diferentes Práticas Integrativas e Complementares na Atenção Primária à Saúde.

Abstract Objective: To understand the meanings attributed by Primary Health Care workers to the professional training process in Integrative and Complementary Practices. Method: Descriptive, exploratory study with a qualitative approach, carried out with 20 professionals from 14 health units in three municipalities in the Metropolitan Region of Goiânia, state of Goiás, Brazil. Data were collected through semi-structured interviews, transcribed and analyzed using the thematic content analysis. Results: Based on the analysis, the thematic category about training trajectories in Integrative and Complementary Practices emerged. It discusses that the training takes place through training provided by federal and municipal management or professional councils, via distance, semi-presential learning or in-person training. Furthermore, training courses are held at private educational institutions funded by the professionals themselves. Additionally, informal sources of information are used to obtain knowledge (internet, books and magazines). Conclusion: The results show, on the one hand, insufficient and diffuse training, with limited supply and quality and, on the other hand, the need to increase educational strategies to improve the training of health professionals aiming at providing different Integrative and Complementary Practices in the Primary Health Care.

https://doi.org/10.1590/1413-81232021262.40732020

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