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Is the Bland-Altman plot method useful without inferences for accuracy, precision, and agreement?
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Silveira, Paulo Sergio Panse

; Vieira, Joaquim Edson

; Siqueira, José de Oliveira

Revista de Saúde Pública

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2024, Volume 58 elocation 01

Abstract: En | Text: En | PDF: En

ABSTRACT OBJECTIVE This study aims to propose a comprehensive alternative to the Bland-Altman plot method, addressing its limitations and providing a statistical framework for evaluating the equivalences of measurement techniques. This involves introducing an innovative three-step approach for assessing accuracy, precision, and agreement between techniques, which enhances objectivity in equivalence assessment. Additionally, the development of an R package that is easy to use enables researchers to efficiently analyze and interpret technique equivalences. METHODS Inferential statistics support for equivalence between measurement techniques was proposed in three nested tests. These were based on structural regressions with the goal to assess the equivalence of structural means (accuracy), the equivalence of structural variances (precision), and concordance with the structural bisector line (agreement in measurements obtained from the same subject), using analytical methods and robust approach by bootstrapping. To promote better understanding, graphical outputs following Bland and Altman’s principles were also implemented. RESULTS The performance of this method was shown and confronted by five data sets from previously published articles that used Bland and Altman’s method. One case demonstrated strict equivalence, three cases showed partial equivalence, and one showed poor equivalence. The developed R package containing open codes and data are available for free and with installation instructions at Harvard Dataverse at https://doi.org/10.7910/DVN/AGJPZH. CONCLUSION Although easy to communicate, the widely cited and applied Bland and Altman plot method is often misinterpreted, since it lacks suitable inferential statistical support. Common alternatives, such as Pearson’s correlation or ordinal least-square linear regression, also fail to locate the weakness of each measurement technique. It may be possible to test whether two techniques have full equivalence by preserving graphical communication, in accordance with Bland and Altman’s principles, but also adding robust and suitable inferential statistics. Decomposing equivalence into three features (accuracy, precision, and agreement) helps to locate the sources of the problem when fixing a new technique.

https://doi.org/10.11606/s1518-8787.2024058005430

Renal osteodystrophy and clinical outcomes: a prospective cohort study
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Carbonara, Cinthia Esbrile Moraes

; Barreto, Joaquim

; Roza, Noemi Angelica Vieira

; Quadros, KélciaRosana da Silva

; Reis, Luciene Machado dos

; Carvalho, Aluízio Barbosa de

; Sposito, Andrei C.

; Jorgetti, Vanda

; Oliveira, Rodrigo Bueno de

Brazilian Journal of Nephrology

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2023, N. ahead

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

Abstract Introduction: Renal osteodystrophy (ROD) refers to a group of bone morphological patterns that derive from distinct pathophysiological mechanisms. Whether the ROD subtypes influence long-term outcomes is unknown. Our objective was to explore the relationship between ROD and clinical outcomes. Methods: This study is a subanalysis of the Brazilian Registry of Bone Biopsies (REBRABO). Samples from individual patients were classified as having osteitis fibrosa (OF), mixed uremic osteodystrophy (MUO), adynamic bone disease (ABD), osteomalacia (OM), normal/minor alterations, and according to turnover/mineralization/volume (TMV) system. Patients were followed for 3.4 yrs. Clinical outcomes were: bone fractures, hospitalization, major adverse cardiovascular events (MACE), and death. Results: We enrolled 275 participants, of which 248 (90%) were on dialysis. At follow-up, 28 bone fractures, 97 hospitalizations, 44 MACE, and 70 deaths were recorded. ROD subtypes were not related to outcomes. Conclusion: The incidence of clinical outcomes did not differ between the types of ROD.

Resumo Introdução: Osteodistrofia renal (OR) refere-se a um grupo de padrões morfológicos ósseos que decorrem de mecanismos fisiopatológicos distintos. É desconhecido se os subtipos de OR influenciam desfechos em longo prazo. Nosso objetivo foi explorar as relações entre OR e desfechos. Métodos: Este estudo é uma subanálise do Registro Brasileiro de Biópsias Ósseas (REBRABO). As amostras de cada paciente foram classificadas em osteíte fibrosa (OF), osteodistrofia urêmica mista (MUO), doença óssea adinâmica (ABD), osteomalácia (OM), alterações normais/menores, e pelo sistema Remodelação / Mineralização / Volume (RMV). Os pacientes foram acompanhados por 3,4 anos. Os eventos clínicos foram: fraturas ósseas, hospitalizações, eventos cardiovasculares adversos maiores (MACE), e óbito. Resultados: Analisamos 275 indivíduos, 248 (90%) deles estavam em diálise. No acompanhamento, 28 fraturas ósseas, 97 hospitalizações, 44 MACE e 70 óbitos foram registrados. Os subtipos de OR não foram relacionados aos desfechos clínicos. Conclusão: A incidência de desfechos clínicos não diferiu entre os tipos de OR.

https://doi.org/10.1590/2175-8239-jbn-2023-0119en

Factors associated with complications after percutaneous nephrolithotomy: an analysis of 1,066 cases
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Said, Danniel Frade

; Ferreira, Daniel Beltrame

; Hayek, Kayann Kaled Reda El

; Perrella, Rodrigo

; Mota, Priscila Kuriki Vieira

; Cohen, David Jacques

; Batagello, Carlos Alfredo

; Murta, Claudio Bovolenta

; Claro, Joaquim Francisco de A.

; Vicentini, Fabio Carvalho

Revista da Associação Médica Brasileira

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2023, Volume 69 N. 5 elocation e20221089

Abstract: En | Text: En | PDF: En

SUMMARY OBJECTIVE: The aim of this study was to identify predictive factors for complications after percutaneous nephrolithotomy. METHODS: We prospectively analyzed patients who underwent percutaneous nephrolithotomy from June 2011 to October 2018. The association of preoperative and intraoperative factors with the presence of complications was assessed using univariate and multivariate analyses. The significance level was set at p<0.05. RESULTS: A total of 1,066 surgeries were evaluated, and the overall complication rate was 14.9%. In all, 105 (9.8%) surgeries were performed in the prone position, and 961 (90.2%) were performed in the supine position. Univariate analysis demonstrated that surgical position, upper pole puncture, surgical time, number of tracts, and Guys Stone Score were associated with complications. In multivariate analyses, prone position (odds ratio [OR] 2.10; p=0.003), surgical time ≥90 min (OR 1.76; p=0.014), upper pole puncture (OR 2.48; p<0.001), and Guys Stone Score 3 or 4 (OR 1.90; p=0.033) were independent predictive factors for complications after percutaneous nephrolithotomy. CONCLUSION: Performing percutaneous nephrolithotomy in the supine position, in under 90 min, and avoiding upper pole punctures may reduce complications during the treatment of large kidney stones.

https://doi.org/10.1590/1806-9282.20221089

Ensino da anatomia: dissecção em associação com a tecnologia no curso de Medicina
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Vieira, Joaquim Edson

; Akamatsu, Flávia Emi

; Jácomo, Alfredo Luiz

Revista Brasileira de Educação Médica

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2023, Volume 47 N. 2 elocation e072

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

Abstract: Introduction: A 2010 study pointed out the future needs of medical education, with integrated contents and practices, fostered by virtual educational technology and by prioritizing competence, not time. Anatomy, indistinguishable from other fundamentals of medicine, faces restrictions on cadaver dissection. Objective: Essay on the teaching of anatomy in clinical contexts and the use of technologies Method: The “pubmed” platform of the National Library of Medicine and descriptors ((anatomy[MeSH Terms]) AND (method, teaching[MeSH Terms])) AND (surgery[MeSH Terms]) were used. Result: There are indications of 316 articles in the period 2000-2022 (June 2022). The main question about the teaching of Anatomy is the replacement of the dissection technique and, consequently, the use of the cadaver. Studies suggest maintaining the use of dissection, prosection and greater use of digital and model means. Conclusion: Cadaveric material should be secured with greater use of prosection and dissection being directed or elective. Virtual reality and permanent material must be assimilated as instrumental and supervised by qualified anatomists and enriched by interpretation and clinical applicability.

Resumo: Introdução: Um estudo de 2010 apontou as necessidades futuras da educação médica, com conteúdos e práticas integrados, fomentada pela tecnologia educacional virtual e pela prioridade na competência, não no tempo. A anatomia, indistinta de outros fundamentos da medicina, enfrenta restrições à dissecção de cadáveres. Objetivo: Ensaio sobre o ensino da anatomia em contextos clínicos e com emprego de tecnologias. Método: Utilizaram-se a plataforma PubMed da National Library of Medicine e os descritores ((anatomy [MeSH Terms]) AND (method, teaching [MeSH Terms])) AND (surgery [MeSH Terms]). Resultado: Há indicação de 316 artigos no período 2000-2022 (junho de 2022). A principal pergunta sobre o ensino de anatomia refere-se à substituição da técnica de dissecção e, por consequência, do uso do cadáver. Estudos sugerem a manutenção do uso da dissecção, da prossecção e de maior uso de meios digitais e modelares. Conclusão: O material cadavérico deve ser garantido com maior uso da prossecção, com a dissecção sendo dirigida ou eletiva. Realidade virtual e material de prossecção devem ser assimilados como instrumentais e supervisionados por anatomistas qualificados e enriquecidos pela interpretação e aplicabilidade clínica.

https://doi.org/10.1590/1981-5271v47.2-20220290

Home-based Virtual Reality Exercise Program During the Maintenance Stage of Cardiac Rehabilitation: A Randomized Controlled Trial
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Vieira, Ágata

; Melo, Cristina

; Noites, Andreia

; Machado, Jorge

; Mendes, Joaquim

International Journal of Cardiovascular Sciences

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2023, Volume 36 elocation e20190177

Abstract: En | Text: En | PDF: En

Abstract Background: Home-based virtual reality technology may become an alternative to cardiac rehabilitation. Objectives: To evaluate the effects of a specific, home-based exercise program, performed either through a virtual reality (Kinect) or a conventional format (booklet) in the maintenance stage of cardiac rehabilitation for six months on functional muscle strength of the lower limbs, physical activity and exercise tolerance. Methodology: This is a randomized clinical trial (ClinicalTrials.gov — NCT02753829) with individuals with coronary artery disease from a hospital in Porto, Portugal, randomly allocated to an experimental group “1” (EG1; n = 11), submitted to a virtual reality exercise program (Kinect); an experimental group “2” (EG2; n = 11), submitted to an exercise program described in a booklet (conventional format); or a control group (CG) (n=11), submitted to routine care. Parameters of functional muscle strength of the lower limbs (sit-to-stand test), physical activity (accelerometer) and exercise tolerance (stress test) were assessed and compared between the groups. Descriptive and inferential statistics were applied, with 95% with a significance level of 0.05. Results: Significant improvements in functional muscle strength of the lower limbs were observed in EG1 compared to EG2, at three months (19.5 ± 7.7 versus 11.9 ± 4.7, p = 0.042), and at six months (23.0 ± 7.7 versus 14.6 ± 4.6, p = 0.027) of intervention. Conclusions: The program did not demonstrate superior results, in relation to the control group and among the different formats, in physical activity and effort tolerance. In relation to the functional muscle strength of the lower limbs, the virtual reality format showed significantly better results when compared to the conventional format only.

https://doi.org/10.36660/ijcs.20190177

BRS 438: Sugary cassava cultivar for diversification of the use of storage roots
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Vieira, Eduardo Alano

; Fialho, Josefino de Freitas

; Carvalho, Luiz Joaquim Castelo Branco

; Gonçalves, Silvia Belem

; Fernandes, Francisco Duarte

; Oliveira, Charles Martins de

; Antonini, Jorge Cesar dos Anjos

; Rinaldi, Maria Madalena

; Malaquias, Juaci Vitoria

Crop Breeding and Applied Biotechnology

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2023, Volume 23 N. 4 elocation e46122342

Abstract: En | Text: En | PDF: En

Abstract The sugary cassava cultivar BRS 438 has high roots yield (with expressive concentration of free sugars), adaptation to mechanized planting, and moderate resistance to bacterial diseases. These characteristics make it an option for production of sugars, alcohol, and animal feed (additive in forage grass silage), among other possibilities.

https://doi.org/10.1590/1984-70332023v23n4c37

Predictive factors for success after supine percutaneous nephrolithotomy: an analysis of 961 patients
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El Hayek, Kayann Kaled Reda

; Perrella, Rodrigo

; Ferreira, Daniel Beltrame

; Batagello, Carlos Alfredo

; Mota, Priscila Kuriki Vieira

; Cohen, David Jacques

; Murta, Claudio Bovolenta

; Claro, Joaquim Francisco de Almeida

; Vicentini, Fabio Carvalho

Revista da Associação Médica Brasileira

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jun 2022, Volume 68 N. 6 Pages 780 - 784

Abstract: En | Text: En | PDF: En

SUMMARY OBJECTIVE: The aim of this study was to evaluate the predictive factors for success following percutaneous nephrolithotomy in the supine position. METHODS: Patients who underwent percutaneous nephrolithotomy in the supine position from June 2011 to October 2018 were evaluated. Age, sex, body mass index, the American Society of Anesthesiologists physical status classification, hemoglobin level, number of previous surgeries, stone size, and the Guy’s Stone Score were analyzed. Success was considered if no fragments were observed on the computed tomography scan on the first postoperative day. Univariate and multivariate analyses were performed to determine significant parameters. RESULTS: We evaluated 961 patients; of them, 483 (50.2%) underwent previous stone-related surgery, and 499 (51.9%) had Guy’s Stone Score 3 or 4. The overall success rate in a single procedure was 40.7%, and complication rate was 13.7%. The univariate analysis showed that the maximum diameter of the stone (25.10±10 mm; p<0.001), previous percutaneous nephrolithotomy (OR 0.52; p<0.001), number of previous percutaneous nephrolithotomy (OR 0.15; p<0.001), the Guy’s Stone Score (OR 0.28; p<0.001), and the number of tracts (OR 0.32; p<0.001) were significant. In the multivariate analysis, the number of previous percutaneous nephrolithotomy (OR 0.54; p<0.001) and the Guy’s Stone Score (OR 0.25; p<0.001) were statically significant. CONCLUSIONS: Guy’s Stone Score and the number of previous percutaneous nephrolithotomy are predictors of success with the supine position. Complex cases and with previous percutaneous interventions may require technical improvements to achieve higher stone-free rates.

https://doi.org/10.1590/1806-9282.20211340

Assessment of a digital game as a neuropsychological test for postoperative cognitive dysfunction
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Lucatelli, André

; Goulart, Ananaira Alves

; Silveira, Paulo Sergio Panse

; Siqueira, José de Oliveira

; Carmona, Maria José Carvalho

; Pereira, Valéria Fontenelle Angelim

; Valentin, Livia Stocco Sanches

; Vieira, Joaquim Edson

Brazilian Journal of Anesthesiology

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feb 2022, Volume 72 N. 1 Pages 7 - 12

Abstract: En | Text: En | PDF: En

Abstract Objective: Postoperative cognitive dysfunction may result from worsening in a condition of previous impairment. It causes greater difficulty in recovery, longer hospital stays, and consequent delay in returning to work activities. Digital games have a potential neuromodulatory and rehabilitation effect. In this study, a digital game was used as a neuropsychological test to assess postoperative cognitive dysfunction, with preoperative patient performance as control. Methods: It was a non-controlled study, with patients selected among candidates for elective non-cardiac surgery, evaluated in the preand postoperative periods. The digital game used has six phases developed to evaluate selective attention, alternating attention, visuoperception, inhibitory control, short-term memory, and long-term memory. The digital game takes about 25 minutes. Scores are the sum of correct answers in each cognitive domain. Statistical analysis compared these cognitive functions preand post-surgery using a generalized linear mixed model (ANCOVA). Results: Sixty patients were evaluated, 40% male and 60% female, with a mean age of 52.7 ± 13.5 years. Except for visuoperception, a reduction in post-surgery scores was found in all phases of the digital game. Conclusion: The digital game was able to detect decline in several cognitive functions postoperatively. As its completion is faster than in conventional tests on paper, this digital game may be a potentially recommended tool for assessing patients, especially the elderly and in the early postoperative period.

https://doi.org/10.1016/j.bjane.2021.06.025

Comparison of digital games as a cognitive function assessment tool for current standardized neuropsychological tests
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Goulart, Ananaira Alves

; Lucatelli, André

; Silveira, Paulo Sergio Panse

; Siqueira, José de Oliveira

; Pereira, Valéria Fontanelle Angelim

; Carmona, Maria José Carvalho

; Valentin, Livia Stocco Sanches

; Vieira, Joaquim Edson

Brazilian Journal of Anesthesiology

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feb 2022, Volume 72 N. 1 Pages 13 - 20

Abstract: En | Text: En | PDF: En

Abstract Objective: Cognitive dysfunction may occur postoperatively. Fast and efficient assessment of Postoperative Cognitive Dysfunction (POCD) can minimize loss of quality of life, and therefore, a study comparing a digital game with standard neuropsychological tests to assess executive, mnemonic, and attention functions to evaluate POCD seems to be relevant both for research and clinical practice. Methods: A battery of standardized tests and a digital game (MentalPlus®) were administered to 60 patients at the Central Institute of Hospital das Clínicas in São Paulo (36 women and 24 men), with ages between 29 and 82 years, preand post-surgery performed under anesthesia. Correlation and linear regression model were used to compare the scores obtained from the standardized tests to the scores of the six executive and cognitive functions evaluated by the game (shortand long-term memory, selective and alternating attention, inhibitory control, and visual perception). Results: After correlation analysis, a statistically significant result was found mainly for the correlation between the scores from the phase of the digital game assessing the visuoperception function and the scores from the A and B cards of the Stroop Test (p < 0.001, r = 0.99 and r = 0.64, respectively), and the scores from TMTA (p = 0.0046, r = 0.51). We also found a moderate correlation between the phase of the game assessing short-memory function and VVLT (p < 0.001, r = 0.41). No statistically significant correlations were found for the other functions assessed. Conclusion: The digital game provided scores in agreement with standardized tests for evaluating visual perception and possibly short-term memory cognitive functions. Further studies are necessary to verify the correlation of other phases of the digital game with standardized tests assessing cognitive functions.

https://doi.org/10.1016/j.bjane.2021.06.027

10.

A 6-year field monitoring of fall armyworm, Spodoptera frugiperda, in transgenic Bt maize in Brazil
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Valicente, Fernando Hercos

; Dantas, Caio Leão

; Resende, Joaquim Pedro Vieira

; Paiva, Priscila Marques de

; Souza, Camila Fernandes de

; Nascimento, Priscilla Tavares

; Oliveira, Cleidiane Rodrigues de

; Boregas, Kátia Gisele Brasil

; Rodriguez-Dimaté, Francisco Andrés

; Aguiar, Frederick Mendes

Revista Brasileira de Entomologia

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2022, Volume 66 N. 2 elocation e20210121

Abstract: En | Text: En | PDF: En

ABSTRACT A 6-year field monitoring study was designed to compare the presence of fall armyworm Spodoptera frugiperda (J. E. Smith), leaf injury, its parasitoids, 100 seed weight, and seed yield of Bt maize hybrids approved for commercialization in the Brazilian market. Field trials were planted in two municipalities, divided into two periods, from 2011 to 2014 (period I), and due to the approval of different Bt hybrids, from 2015 to 2016 (period II). Treatments were Bt, non-Bt maize and all non-Bt maize sprayed with insecticide methomyl. Six Bt-maize hybrids were planted, expressing the following proteins: Cry1Ab, Cry1F, Cry1A.105 (Cry1Ab +Cry1Ac +Cry1F), Cry2Ab2a and Vip3. In 2015 and 2016 Bt Powercore was planted due to its commercial approval. The number of S. frugiperda larvae for most Bt hybrids was lower than on non-Bt hybrids, except for Fórmula TL and Herculex in period II, in both municipalities. In period I, Bt hybrids VT, VT 2 and Viptera showed almost no injury on their leaves, despite the high number of fall armyworm larvae found in plants. Different parasitoids emerged from larvae from Bt and non Bt hybrids: Archytas sp., Campoletis sp., Chelonus sp., Eiphosoma sp. and Ophion luteus. The average 100 seed weight was higher in municipality from Sete Lagoas for all Bt hybrids, non-Bt hybrids and non-Bt hybrids sprayed with methomyl, when compared to Nova Porteirinha during period I. Fórmula TL, non-Bt Fórmula TL sprayed with methomyl, and non-Bt Fórmula TL showed the lowest seed yield in both municipalities and periods.

https://doi.org/10.1590/1806-9665-rbent-2021-0121

11.

Potential impacts of climate change on agriculture and the economy in different regions of Brazil
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Santos, Cárliton Vieira dos

; Oliveira, Aryeverton Fortes de

; Ferreira Filho, Joaquim Bento de Souza

Revista de Economia e Sociologia Rural

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2022, Volume 60 N. 1 elocation e220611

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

Abstract: This paper investigates the potential socioeconomic impacts of the climate change projected for 2040 may have on agriculture and on the Brazilian economy, in its different regions. Thus, we used a recursive dynamic interregional CGE model calibrated for 2010. We considered two scenarios of climate change, an Intermediate Scenario (RCP4.5) - less severe - and a Pessimistic Scenario (RCP8.5) - more severe. The main distinction in relation to previous studies performed in Brazil is the estimates of areas that become unviable for agricultural crops, based on projections for the regional pattern of climate change of the 5th and most recent IPCC report. Results suggest that climate change should cause Brazil's real GDP to shrink in both simulated scenarios, but this should be more intense in the Intermediate Scenario. Results also point out that the losses will be greater for poorer households and for regions whose economy is more dependent on agriculture and, in particular, on soybean; and that the actual consumption and well-being of households in the Midwest and part of the Northeast (in the part where the soybean crop is most representative) will be more affected than in other regions of Brazil.

Resumo: Este artigo investiga os impactos socioeconômicos potenciais que as mudanças climáticas projetadas para 2040 podem ter sobre a agricultura e a economia brasileira nas suas diferentes regiões. Para isso, é usado um modelo de EGC inter-regional dinâmico recursivo, calibrado para o ano de 2010. São considerados dois cenários de mudança climática: um Intermediário (RCP4.5) – menos severo – e outro Pessimista (RCP8.5) – mais severo. A principal distinção em relação aos estudos anteriores para o Brasil é o uso de estimativas de perda de área apta para culturas agrícolas, baseadas em projeções para o padrão regional de mudanças climáticas do 5º relatório do IPCC (o mais recente). Os resultados sugerem que as mudanças climáticas deverão provocar retração no PIB real do Brasil em ambos os cenários, mas esta deverá ser mais intensa no cenário Intermediário; sinalizam também que as perdas serão maiores para as famílias mais pobres e para as regiões cuja economia é mais dependente da agricultura, em particular do cultivo da soja, e que o consumo real e o bem-estar das famílias da região Centro-Oeste e parte do Nordeste (onde a cultura da soja é mais representativa) serão mais afetados do que em outras regiões do Brasil.

https://doi.org/10.1590/1806-9479.2021.220611 495 downloads

12.

COVID-19 in the Perioperative Period of Cardiovascular Surgery: the Brazilian Experience
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Gomes, Walter J.

; Rocco, Isadora

; Pimentel, Wallace S.

; Pinheiro, Aislan H. B.

; Souza, Paulo M. S.

; Costa, Luiz A. A.

; Teixeira, Marjory M. P.

; Ohashi, Leonardo P.

; Bublitz, Caroline

; Begot, Isis

; Moreira, Rita Simone L

; Hossne Jr, Nelson A.

; Vargas, Guilherme F.

; Branco, João Nelson R.

; Teles, Carlos A.

; Medeiros, Eduardo A. S.

; Sáfadi, Camila

; Rampinelli, Amândio

; Moratelli Neto, Leopoldo

; Rosado, Anderson Rosa

; Mesacasa, Franciele Kuhn

; Capriata, Ismael Escobar

; Segalote, Rodrigo Coelho

; Palmieri, Deborah Louize da Rocha Vianna

; Jardim, Amanda Cristina Mendes

; Vianna, Diego Sarty

; Coutinho, Joaquim Henrique de Souza Aguiar

; Jazbik, João Carlos

; Coutinho, Henrique Madureira da Rocha

; Kikuta, Gustavo

; Almeida, Zely Sant'Anna Marotti de

; Feguri, Gibran Roder

; Lima, Paulo Ruiz Lucio de

; Franco, Anna Carolina

; Borges, Danilo de Cerqueira

; Cruz, Felipe Ramos Honorato De La

; Croti, Ulisses Alexandre

; Borim, Bruna Cury

; Marchi, Carlos Henrique De

; Goraieb, Lilian

; Postigo, Karolyne Barroca Sanches

; Jucá, Fabiano Gonçalves

; Oliveira, Fátima Rosane de Almeida

; Souza, Rafael Bezerra de

; Zilli, Alexandre Cabral

; Mas, Raul Gaston Sanchez

; Bettiati Junior, Luiz Carlos

; Tranchesi, Ricardo

; Bertini Jr, Ayrton

; Franco, Leandro Vieira

; Fernandes, Priscila

; Oliveira, Fabiana

; Moraes Jr, Roberto

; Araújo, Thiago Cavalcanti Vila Nova de

; Braga, Otávio Penna

; Pedrosa Sobrinho, Antônio Cavalcanti

; Teixeira, Roberta Tavares Barreto

; Camboim, Irla Lavor Lucena

; Gomes, Eduardo Nascimento

; Reis, Pedro Horigushi

; Garcia, Luara Piovan

; Scorsioni, Nelson Henrique Goes

; Lago, Roberto

; Guizilini, Solange

Brazilian Journal of Cardiovascular Surgery

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dec 2021, Volume 36 N. 6 Pages 725 - 735

Abstract: En | Text: En | PDF: En

Abstract Introduction: We investigated the clinical course and outcomes of patients submitted to cardiovascular surgery in Brazil and who had developed symptoms/signs of coronavirus disease 2019 (COVID-19) in the perioperative period. Methods: A retrospective multicenter study including 104 patients who were allocated in three groups according to time of positive real time reverse transcriptase-polymerase chain reaction (RT-PCR) for the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2): group 1, patients who underwent cardiac surgery > 10 days after positive RT-PCR; group 2, patients with a positive RT-PCR within 10 days before or after surgery; group 3, patients who presented positive RT-PCR > 10 days after surgery. The primary outcome was mortality and secondary outcomes were postoperative complications, intensive care unit (ICU) length of stay, and postoperative days of hospitalization. Results: The three groups were similar with respect to age, the European System of Cardiac Operative Risk Evaluation score, and comorbidities, except hypertension. Postoperative complications and death were significantly higher in groups 2 and 3 than in group 1, and no significant difference between groups 2 and 3 was seen. Group 2 showed a high prevalence of surgery performed as an urgent procedure. Although no significant differences were observed in ICU length of stay, total postoperative hospitalization time was significantly higher in group 3 than in groups 1 and 2. Conclusion: COVID-19 affecting the postoperative period of patients who underwent cardiovascular surgery is associated with a higher rate of morbidity and mortality. Delaying procedures in RT-PCR-positive patients may help reduce risks of perioperative complications and death.

https://doi.org/10.21470/1678-9741-2021-0960

13.

Analgesic effect of magnesium sulfate during total intravenous anesthesia: randomized clinical study
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Silva Filho, Sebastião E.

; Sandes, Carlson S.

; Vieira, Joaquim E.

; Cavalcanti, Ismar L.

Brazilian Journal of Anesthesiology

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oct 2021, Volume 71 N. 5 Pages 550 - 557

Abstract: En | Text: En | PDF: En

Abstract Introduction and objective Opioids have usually been used as intraoperative analgesic components, regardless of the many adverse effects they are associated with, such as nausea, vomiting, respiratory depression, and hyperalgesia. Several approaches have been investigated to reduce doses used, and magnesium sulfate has been shown to be a valuable analgesic adjunct. The main objective of the present trial was to evaluate the effectiveness of magnesium sulfate as the chief intraoperative analgesic, and the secondary objectives were to assess propofol consumption, postoperative analgesia, and intraoperative hemodynamic stability. Methods In this prospective, double-blind trial, 50 patients scheduled to undergo post-bariatric abdominoplasty under general intravenous anesthesia were divided into two groups, to receive remifentanil or magnesium sulfate as intraoperative analgesic. Fentanyl 1 µg kg-1 was the rescue analgesic. Results Among the patients in the group receiving Magnesium Sulfate (MSG), 64% did not need supplemental analgesia and none of the patients in the Remifentanil Group (RG) required fentanyl. MSG patients showed propofol consumption 36.6% higher (guided by the Bispectral Index – BIS). MSG patients consumed significantly less ephedrine (mean ± SD) than RG patients, respectively 1.52 ± 4.38 mg and 10 ± 10.39 mg, p< 0.001. Mean values of blood concentrations of magnesium were comparable to values previously described in the literature. Conclusion Magnesium sulfate is a safe and effective option for intraoperative analgesia, when avoiding or decreasing opioid use is required.

https://doi.org/10.1016/j.bjane.2021.02.008 427 downloads

14.

Ultrasound-guided peripheral abdominal wall blocks
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Fernandes, Hermann dos Santos

; Azevedo, Artur Salgado de

; Ferreira, Thiago Camargo

; Santos, Shirley Andrade

; Rocha-Filho, Joel Avancini

; Vieira, Joaquim Edson

Clinics

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2021, Volume 76 elocation e2170

Abstract: En | Text: En | PDF: En

The practice of regional anesthesia is in a state of progressive evolution, mainly due to the advent of ultrasound as an anesthesiologist's instrument. Alternative techniques for postoperative analgesia of abdominal surgeries, such as transversus abdominis plane block, oblique subcostal transversus abdominis plane block, rectus abdominis muscle sheath block, ilioinguinal and iliohypogastric nerve block, and quadratus lumborum plane block, have proven useful, with good analgesic efficacy, especially when neuroaxial techniques (spinal anesthesia or epidural anesthesia) are not possible. This review discusses such blockades in detail, including the anatomical principles, indications, techniques, and potential complications.

https://doi.org/10.6061/clinics/2021/e2170 1277 downloads

15.

BRAZILIAN GASTRIC CANCER ASSOCIATION GUIDELINES (PART 2): UPDATE ON TREATMENT
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BARCHI, Leandro Cardoso

; RAMOS, Marcus Fernando Kodama Pertille

; DIAS, André Roncon

; FORONES, Nora Manoukian

; CARVALHO, Marineide Prudêncio de

; CASTRO, Osvaldo Antonio Prado

; KASSAB, Paulo

; COSTA-JÚNIOR, Wilson Luiz da

; WESTON, Antônio Carlos

; ZILBERSTEIN, Bruno

; Ferraz, Álvaro Antônio Bandeira

; ZeideCharruf, Amir

; Brandalise, André

; Silva, André Maciel da

; Alves, Barlon

; Marins, Carlos Augusto Martinez

; Malheiros, Carlos Alberto

; Leite, Celso Vieira

; Bresciani, Claudio José Caldas

; Szor, Daniel

; Mucerino, Donato Roberto

; Wohnrath, Durval R.

; JirjossIlias, Elias

; Martins Filho, Euclides Dias

; PinatelLopasso, Fabio

; Coimbra, Felipe José Fernandez

; Felippe, Fernando E. Cruz

; Tomasisch, Flávio Daniel Saavedra

; Takeda, Flavio Roberto

; Ishak, Geraldo

; Laporte, Gustavo Andreazza

; Silva, Herbeth José Toledo

; Cecconello, Ivan

; Rodrigues, Joaquim José Gama

; Grande, José Carlos Del

; Lourenço, Laércio Gomes

; Motta, Leonardo Milhomem da

; Ferraz, Leonardo Rocha

; Moreira, Luis Fernando

; Lopes, Luis Roberto

; Toneto, Marcelo Garcia

; Mester, Marcelo

; Rodrigues, Marco Antônio Gonçalves

; Franciss, Maurice Youssef

; AdamiAndreollo, Nelson

; Corletta, Oly Campos

; Yagi, Osmar Kenji

; Malafaia, Osvaldo

; Assumpção, Paulo Pimentel

; Savassi-Rocha, Paulo Roberto

; Colleoni Neto, Ramiro

; Oliveira, Rodrigo Jose de

; AissarSallun, Rubens Antonio

; Weschenfelder, Rui

; Oliveira, Saint Clair Vieira de

; Abreu, Thiago Boechat de

; Castria, Tiago Biachi de

; Ribeiro Junior, Ulysses

; Barra, Williams

; Freitas Júnior, Wilson Rodrigues de

ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

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2021, Volume 34 N. 1 elocation e1563

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

RESUMO Racional: O II Consenso Brasileiro de Câncer Gástrico da Associação Brasileira de Câncer Gástrico ABCG (Parte 1) foi recentemente publicado. Nesta ocasião inúmeros especialistas que atuam no tratamento desta doença expressaram suas opiniões diante declarações apresentadas. Objetivo: Apresentar as Diretrizes da ABCG (Parte 2) quanto às indicações de tratamento cirúrgico, técnicas operatórias, extensão de ressecção e terapia combinada. Métodos: Para formulação destas diretrizes os autores realizaram extensa e atual revisão referente a cada declaração presente no II Consenso, utilizando as bases Medline/PubMed, Cochrane Library e SciELO, inicialmente com os seguintes descritores: câncer gástrico, gastrectomia, linfadenectomia, terapia combinada. Ainda, cada declaração foi classificada de acordo com o nível de evidência e grau de recomendação. Resultados: Das 43 declarações presentes neste estudo, 11 (25,6%) foram classificadas com nível de evidência A, 20 (46,5%) B e 12 (27,9%) C. Quanto ao grau de recomendação, 18 (41,9%) declarações obtiveram grau de recomendação 1, 14 (32,6%) 2a, 10 (23,3%) 2b e um (2,3%) 3. Conclusão: O complemento das diretrizes aqui presentes possibilita que cirurgiões e oncologistas que atuam no combate ao câncer gástrico possam oferecer o melhor tratamento possível, de acordo com as condições locais disponíveis.

ABSTRACT Background : The II Brazilian Consensus on Gastric Cancer of the Brazilian Gastric Cancer Association BGCA (Part 1) was recently published. On this occasion, countless specialists working in the treatment of this disease expressed their opinion in the face of the statements presented. Aim : To present the BGCA Guidelines (Part 2) regarding indications for surgical treatment, operative techniques, extension of resection and multimodal treatment. Methods: To formulate these guidelines, the authors carried out an extensive and current review regarding each declaration present in the II Consensus, using the Medline/PubMed, Cochrane Library and SciELO databases initially with the following descriptors: gastric cancer, gastrectomy, lymphadenectomy, multimodal treatment. In addition, each statement was classified according to the level of evidence and degree of recommendation. Results : Of the 43 statements present in this study, 11 (25,6%) were classified with level of evidence A, 20 (46,5%) B and 12 (27,9%) C. Regarding the degree of recommendation, 18 (41,9%) statements obtained grade of recommendation 1, 14 (32,6%) 2a, 10 (23,3%) 2b e one (2,3%) 3. Conclusion : The guidelines complement of the guidelines presented here allows surgeons and oncologists who work to combat gastric cancer to offer the best possible treatment, according to the local conditions available.

https://doi.org/10.1590/0102-672020210001e1563 768 downloads

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