Resumen: Introducción: dentro de las cirugías laparoscópicas, se ha estimado una incidencia de lesión intestinal al momento del acceso de 0.5% y de lesiones a vasos sanguíneos importantes de 1%. Los beneficios teóricos del trócar óptico, incluyen el reconocimiento temprano de lesiones, bajo el supuesto de una mejor visibilidad. Objetivo: determinar si el trócar óptico es un método de acceso laparoscópico más seguro comparado contra trócar directo, aguja de Veress y técnica abierta-Hasson. Material y métodos: cohorte observacional, prospectiva, de cuatro brazos, de mujeres del Servicio de Ginecología y Cirugía Laparoscópica del Hospital Angeles Pedregal. Se cuantificó el número de intentos y tiempo para lograr el acceso a cavidad, así como la presencia de complicaciones. Resultados: se observaron 192 cirugías laparoscópicas, distribuidas por casos consecutivos en cuatro brazos: (90 Veress, 13 Hasson, 14 trócar directo y 75 óptico). Trócar óptico demostró ventaja tanto en el tiempo de acceso como en la frecuencia de complicaciones. El número de intentos para entrar a cavidad fue similar al de la técnica abierta. Conclusión: los datos obtenidos en este estudio orientan a apoyar la técnica de acceso a cavidad con trócar óptico, como un método más seguro que las otras técnicas.

Abstract: Introduction: within laparoscopic surgeries, an incidence of bowel injury at the time of access has been estimated at 0.5% and injury to major blood vessels at 1%. Theoretical benefits of the optical trocar include early recognition of lesions under the assumption of improved visibility. Objective: to determine whether the optical trocar is a safer laparoscopic access method than the direct trocar, Veress needle, and Hasson open technique. Material and methods: observational, prospective, four-arm cohort of women from the gynaecology and laparoscopic surgery department of the Hospital Angeles Pedregal. The number of attempts and time to achieve cavity access and the presence of complications were quantified. Results: 192 laparoscopic surgeries were observed, distributed by consecutive cases in 4 arms: (90 Veress, 13 Hasson, 14 direct trocar, and 75 optical). Optical trocar showed an advantage in both access time and complication frequency. The number of attempts to enter the cavity was similar to the open technique. Conclusion: The data obtained in this study support the optical trocar cavity access technique as a safer method than the other techniques.

ABSTRACT Objective To describe and compare the clinical characteristics and outcomes of patients admitted to intensive care units during the first and second waves of the COVID-19 pandemic. Methods In this retrospective single-center cohort study, data were retrieved from the Epimed Monitor System; all adult patients admitted to the intensive care unit between March 4, 2020, and October 1, 2021, were included in the study. We compared the clinical characteristics and outcomes of patients admitted to the intensive care unit of a quaternary private hospital in São Paulo, Brazil, during the first (May 1, 2020, to August 31, 2020) and second (March 1, 2021, to June 30, 2021) waves of the COVID-19 pandemic. Results In total, 1,427 patients with COVID-19 were admitted to the intensive care unit during the first (421 patients) and second (1,006 patients) waves. Compared with the first wave group [median (IQR)], the second wave group was younger [57 (46-70) versus 67 (52-80) years; p<0.001], had a lower SAPS 3 Score [45 (42-52) versus 49 (43-57); p<0.001], lower SOFA Score on intensive care unit admission [3 (1-6) versus 4 (2-6); p=0.018], lower Charlson Comorbidity Index [0 (0-1) versus 1 (0-2); p<0.001], and were less frequently frail (10.4% versus 18.1%; p<0.001). The second wave group used more noninvasive ventilation (81.3% versus 53.4%; p<0.001) and high-flow nasal cannula (63.2% versus 23.0%; p<0.001) during their intensive care unit stay. The intensive care unit (11.3% versus 10.5%; p=0.696) and in-hospital mortality (12.3% versus 12.1%; p=0.998) rates did not differ between both waves. Conclusion In the first and second waves, patients with severe COVID-19 exhibited similar mortality rates and need for invasive organ support, despite the second wave group being younger and less severely ill at the time of intensive care unit admission.

ABSTRACT Introduction: Risk Adjustment for Congenital Heart Surgery 1 (RACHS-1) score is a simple model that can be easily applied and has been widely used for mortality comparison among pediatric cardiovascular services. It is based on the categorization of several surgical palliative or corrective procedures, which have similar mortality in the treatment of congenital heart disease. Objective: To analyze the in-hospital mortality in pediatric patients (<18 years) submitted to cardiac surgery for congenital heart disease based on RACHS-1 score, during a 12-year period. Methods: A retrospective date analysis was performed from January 2003 to December 2014. The survey was divided in two periods of six years long each, to check for any improvement in the results. We evaluated the numbers of procedures performed, complexity of surgery and hospital mortality. Results: Three thousand and two hundred and one surgeries were performed. Of these, 3071 were able to be classified according to the score RACHS-1. Among the patients, 51.7% were male and 47.5% were younger than one year of age. The most common RACHS-1 category was 3 (35.5%). The mortality was 1.8%, 5.5%, 14.9%, 32.5% and 68.6% for category 1, 2, 3, 4 and 6, respectively. There was a significant increase in the number of surgeries (48%) and a significant reduction in the mortality in the last period analysed (13.3% in period I and 10.4% in period II; P=0.014). Conclusion: RACHS-1 score was a useful score for mortality risk in our service, although we are aware that other factors have an impact on the total mortality.

ABSTRACT The perspective of the integrated health system has a network of care with multiple integration dimensions among subsystems as nuclear representation, relating the clinical aspects and governance to the representations and collective values. The normative integration aims to ensure coherence between the system of representations and values of society simultaneously with the interfaces of clinical and functional integration. It builds a bridge with governance, which allows, through their skills, management of all system components, encouraging cooperation, communication and information, in order to ensure the population under their responsibility to access excellence services, exceeding their expectations. The integration of care consists of a durable coordination of clinical practices for those who suffer from health problems in order to ensure continuity and full range of the required professional services and organizations, coordinated in time and space, in accordance with the available knowledge. It is possible to establish the type of health equipment for each level of care for patients with congenital heart diseases. This strategy intends to offer timely care in appropriate moments and places, efficiently, operating cooperatively an interdependently, with ongoing exchange of its resources. Thus, situational integration establishes the system connection with the assessment environment that proposes to carry out value judgment, guided by an objective worldview, about an intervention or any of its components, in order to objectify the decision making.

Objetivou-se com este trabalho estudar a composição e distribuição das espécies de peixes em quatro locais ao longo do Rio Cabeça, afluente do Rio Corumbataí, tributário do Rio Tietê, visando uma melhor compreensão das influencias da geomorfologia local sobre a ocorrência das espécies ao longo do rio. Usando redes de emalhar, rede de arrasto, tarrafa e peneiras, foram realizadas cinco coletas em cada ponto, uma a cada dois meses. Os dados foram analisados utilizando-se constância de ocorrência, índice de similaridade de Jaccard, análise de rarefação e uma análise estatística descritiva de riqueza. Foram coletados 4.532 indivíduos de peixes pertencentes a seis ordens, 17 famílias e 65 espécies. Diferenças na composição, riqueza (diversidade), abundância e freqüência foram observadas nos pontos ao longo do rio. O ponto quatro, perto da foz do Rio Cabeça, apresentou maior riqueza (49 espécies) e maior abundancia, e os outros três pontos apresentaram valores menores e mais próximos entre si (entre 22 e 29 espécies). Além disso, o ponto quatro teve a maior porcentagem de espécies acessórias em comparação aos outros pontos, que apresentaram maior número de espécies constantes. A análise de agrupamento a partir da similaridade de Jaccard mostrou que cada ponto teve composição de espécies diferenciada em relação aos demais. A bacia do Rio Cabeça drena uma área caracterizada por relevo acidentado no interior do estado de São Paulo, na região de transição entre as províncias geomorfológicas Cuestas Basálticas e Depressão Periférica. Nesse cenário, cachoeiras e corredeiras ao longo de seu curso interferem na distribuição, composição e riqueza das espécies de peixes.

This work aimed to study the composition and distribution of fish species at four sites along Cabeça River, an affluent of Corumbataí River, tributary of Tietê River, intending to better understand the influence of local geomorphology on the occurrence of the species along the river. Using gill nets, trawl net, cast net and sieves, five samples were taken from each site every two months. These data were analyzed from constancy of occurrence, similarity index of Jaccard, rarefaction analysis and descriptive statistical analysis of richness. 4,532 fish individuals belonging to six different orders, 17 families and 65 species were captured. Differences in composition, richness (diversity), abundance and frequency were observed at these sites along the river. The sample site near the mouth of Cabeça River, was richer (49 species) and more abundant than the other three upstream sites, which showed fewer species and equivalent amounts each other (between 22 and 29 species). Moreover, this downstream site had the highest percentage of accessory species, whereas the other samples had a greater number of constant species. Cluster analysis from the Jaccard similarity showed that each site had distinct species composition. Cabeça River basin drains a rugged terrain in the state of São Paulo, between the Basaltic Cuestas and Peripheral Depression geomorphologic provinces. In this scenario, waterfalls and rapids influence the distribution, composition and richness of fish species.

A composição de espécies de peixes do rio Sapucaí-Mirim é registrada e discutida no âmbito do conjunto faunístico das bacias dos rios Grande e Paranaíba, ambos formadores do rio Paraná, no sudeste do Brasil. O rio Sapucaí-Mirim é um importante, mas pouco conhecido tributário deste sistema hidrográfico, desembocando na margem esquerda do rio Grande, na área atualmente ocupada pelo reservatório da Usina Hidrelétrica de Porto Colômbia, na região nordeste do estado de São Paulo. A diversidade de peixes do rio Sapucaí-Mirim é apresentada com base em dados comparativos obtidos de populações do canal principal do rio e de três córregos localizados nos trechos médio e inferior da bacia, possibilitando uma discussão comparativa entre os dois trechos a luz de informações existentes sobre a fauna de peixes das bacias dos rios Grande e Paranaíba. O estudo da fauna de peixes resultou no reconhecimento de 68 espécies de peixes distribuídas em 23 famílias e pertencentes ès sete ordens comumente encontradas na bacia do alto rio Paraná: Characiformes (32 spp.), Siluriformes (25 spp.), Labriformes (4 spp.), Gymnotiformes (3 spp.), Cyprinodontiformes (2 spp.), Perciformes (1 espécie) e Synbranchiformes (1 espécie). A maioria das espécies é representativa da ictiofauna nativa distribuída nos rios Grande e Paranaíba, mas a diversidade total também inclui espécies alóctones, registradas principalmente no trecho inferior. Algumas espécies encontradas no rio Sapucaí-Mirim requerem grandes áreas para sua manutenção, tais como aquelas de grande porte, conhecidas por apresentarem hábitos reprodutivos migratórios. Também, a diversidade de espécies de pequeno e médio porte e seus diferentes atributos biológicos exibidos, aliados ao registro de espécies ameaçadas na bacia do alto rio Paraná, permitem considerar a bacia do rio Sapucaí-Mirim como um importante local para manutenção da diversidade da ictiofauna no sistema hidrográfico do rio Grande.

The fish species composition of Sapucaí-Mirim River is herein reported and discussed in the faunistic context of Grande and Paranaíba river basins, both formers of the Paraná River. The Sapucaí-Mirim is an important tributary of this hydrographic system, flowing to the left bank of Grande River in a region occupied by the reservoir of the Porto Colombia hydroelectric power plant, at São Paulo state northeastern region, in southeastern Brazil. The poorly known fish diversity of the Sapucaí-Mirim River is presented on basis of sampling efforts conducted in the main river channel and three creeks located at the mid and lower sections of the basin, allowing comparisons of the fish fauna of these two sections in the light of available information of fish inhabiting Grande and Paranaíba river basins. The study of the fish composition resulted in the recognition of 68 species in the Sapucaí-Mirim River, belonging to 23 families distributed in seven orders, all commonly found in upper Paraná River basin: Characiformes (32 spp.), Siluriformes (25 spp.), Labriformes (4 spp.), Gymnotiformes (3 spp.), Cyprinodontiformes (2 spp.), Perciformes (one species) and Synbranchiformes (one species). Most of the species are representative of the native ichthyofauna, but the total diversity also includes allochthonous species, which were chiefly found in the lower stretch studied. Some species found in the Sapucaí-Mirim River require great areas for their maintenance, as do large-sized species, known to have migratory reproductive habits. Also, the diversity of small and medium-sized species found and their distinct morphological and biological attributes, allied to the occurrence of endangered fish species, indicate that the Sapucaí-Mirim River basin is an important place for fish diversity maintenance in the Grande River hydrographic system.