Tempos de atendimento e desfechos no infarto agudo do miocárdio com supradesnivelamento ST / Time of care and outcomes in ST-segment elevation myocardial infarction

Objetivo: Comparar os tempos de tratamento dor-porta e porta-balão em indivíduos com infarto agudo do miocárdio com supradesnivelamento ST com os desfechos cardiovasculares em 30 dias. Métodos: Trata-se de uma coorte histórica, realizada por meio da pesquisa de prontuários eletrônicos e dos bancos de dados já existentes dos serviços de hemodinâmica de todos os indivíduos atendidos com diagnóstico de infarto agudo do miocárdio com supradesnivelamento ST e submetidos à angioplastia, no período de março de 2015 a setembro de 2016, em dois hospitais públicos de grande porte de Porto Alegre (RS). Os desfechos foram o óbito intra-hospitalar e em 30 dias e os eventos cardíacos maiores hospitalares e em 30 dias. Resultados: Foram avaliadas as informações de 808 indivíduos, sendo 26,9% provenientes do Hospital de Clínicas de Porto Alegre e 73,1% do Instituto de Cardiologia ­ Fundação Universitária de Cardiologia. Não houve diferença significativa na caracterização da amostra. Um terço dos indivíduos analisados apresentou tempo dor- -porta menor ou igual a 180 minutos, e 72% tiveram tempo porta-balão menor que 90 minutos. A mediana do tempo total de isquemia foi de 338 minutos. Na avaliação dos tempos não houve diferença significativa entre os dois hospitais. Para eventos cardíacos maiores e óbitos intra- -hospitalares, o único tempo que se mostrou significativo, após o ajuste multivariado, foi o porta-balão, em que os indivíduos com tempo maior que 90 minutos apresentaram razão de risco de 1,06 (IC95% 1,02-1,11) e 5,78 (IC95% 1,44-23,2), respectivamente, para eventos cardíacos maiores e óbitos intra-hospitalares. Para eventos cardíacos maiores total e óbito total, nenhum dos três tempos se associou significativamente com o desfecho após ajuste. Contudo, o tempo porta-balão maior ou igual a 90 minutos também foi significativo para razão de risco bruto para ambos, assim como a dor-porta para óbito total. Conclusão: Os dados da pesquisa corroboram as recomendações internacionais para cumprimento dos menores tempos de atendimento, em especial do tempo porta-balão, para o bom prognóstico. Infelizmente, no país, o tempo de isquemia miocárdica ainda está muito aquém do ótimo, necessitando de melhorias na área para melhorar os desfechos nesses indivíduos.

Objective: To compare symptom-onset-to-door and door- -to-balloon times in individuals with ST-segment elevation myocardial infarction to the 30-day cardiovascular outcomes. Methods: This is a historical cohort, using electronic medical records and the existing databases of hemodynamic services of all individuals diagnosed with ST-segment elevation myocardial infarction undergoing angioplasty between March 2015 and September 2016, in two large public hospitals in Porto Alegre. The outcomes were in-hospital death and death in 30 days, and major adverse cardiac events in hospital and in 30 days. Results: The information of 808 patients was evaluated, with 26.9% from Hospital de Clínicas de Porto Alegre, and 73.1% from the Instituto de Cardiologia ­ Fundação Universitária de Cardiologia. There was no significant difference in the characterization of the sample. One-third of the individuals evaluated presented symptom-onset-to-door of 180 minutes or less, and 72% had door-to- -balloon time below 90 minutes. The median total ischemic time was 338 minutes. In the evaluation of the times, there was no significant difference between the two hospitals. For more major cardiac events and intra-hospital deaths, the only time that proved to be significant after the multivariate adjustment was the door-to-balloon time, in which individuals with time higher than 90 minutes had a risk ratio of 1.06 (95% CI 1.02-1.11) for major cardiac events and 5.78 (95% CI 1.44-23.2), for intra-hospital deaths. For total major adverse cardiac events and total death, none of the 3 times was significantly associated with the outcome after adjustment; however, door-to-balloon of 90 minutes or more was also significant for crude risk ratio for both, as well as symptom-onset-to-door for total death. Conclusion: The research data corroborate the international recommendations to meet shorter service times, especially door-to-balloon time, for a good prognosis. Unfortunately, in the country, the time of myocardial ischemia is still far from optimal, requiring improvement in the area to improve the outcomes in these individuals.

Impacto na qualidade de vida em pacientes usuários de medicação retroviral e submetidos à gluteoplastia: estudo de coorte histórica / Gluteal contour restoration in antiretroviral users and its quality-of-life related impacts: a historical cohort study

INTRODUÇÃO: Desde a introdução do tratamento do HIV com uso da terapia antirretroviral altamente ativa, a mortalidade por essa doença foi reduzida drasticamente em todo o mundo. Um dos parefeitos relacionados à utilização desses fármacos é a lipodistrofia glútea. O objetivo deste trabalho é verificar o impacto da correção dessa deformidade na qualidade de vida de pacientes com HIV. MÉTODOS: Foi conduzido um estudo de coorte histórica com 23 pacientes submetidos à gluteoplastia com implante intramuscular, entre janeiro de 2010 e dezembro de 2014, avaliando a qualidade de vida por meio do em Nottingham Health Profile em. As informações foram coletadas de julho a agosto de 2015. A análise estatística foi feita utilizando-se o em Related-Samples McNemar Test em. RESULTADOS: strong Houve diferença significativa entre o pré-operatório e pós-operatório em 19 das 38 perguntas. CONCLUSÃO: É possível afirmar que a reconstrução glútea melhora a qualidade de vida de pacientes HIV positivos acometidos por lipodistrofia glútea relacionada a antirretrovirais.

INTRODUCTION: Since the introduction of highly active antiretroviral therapy for the treatment of human immunodeficiency virus (HIV), disease mortality has been dramatically reduced worldwide. One related side effect from the use of these drugs is gluteal lipodystrophy. The aim of this study is to assess the quality-of-life impact of correcting this deformity in HIV patients. METHODS: A historical cohort study was conducted between January 2010 and December 2014 with 23 patients, assessing the quality of their lives using the Nottingham Health Profile. A statistical analysis was performed using the McNemar test for related samples. RESULTS: There was a significant difference between preoperative and postoperative response in 19 of the 38 questions. CONCLUSION: We may say that gluteal reconstruction plays a role in improving quality of life for HIV patients who have been affected by antiretroviral related gluteal lipodystrophy.

Incidence and factors associated with pericardial effusion after cardiac valve surgery

Introduction: Pericardial effusion (PE) is a postoperative complication of cardiac valve surgery, related to early hospital readmissions and death. We aimed to describe its incidence and to identify predictive factors of moderate-to-severe PE in a contemporary cohort. Methods: We retrospectively reviewed medical records of all consecutive patients submitted to cardiac valve surgery in a tertiary teaching hospital from January 2012 to July 2014, where echocardiography was routinely performed before patient discharge. Moderate-to-severe PE was defined as ≥ 10 mm of thickness, or signs of cardiac tamponade on echocardiography. Additional clinical and perioperative data were extracted from medical records using a standardized protocol. Results: Of 353 patients, 335 underwent a predischarge echocardiography. From these, 27 patients (8%; mean age: 62 years; standard deviation 12 years; 70% male) had moderate-to-severe PE. These patients had a higher prevalence of previous stroke (22% vs. 8%; p = 0.009) and oral anticoagulation (international normalized ratio > 2) prior to the surgery (11 vs. 2%; P = 0.002). In patients with moderate-to-severe PE, surgeries had longer ischemia (p < 0.001) and cardiopulmonary bypass (p < 0.001) times, and the prevalence of postoperative atrial fibrillation was higher (56% vs. 32%; p = 0.011) than in patients with absent or small PE. Hospital mortality was also higher (15% vs. 3%; p = 0.002) in patients with moderate-to-severe PE. Conclusions: Eight percent of patients submitted to cardiac valve surgery developed moderate-to-severe PE. Moreover, PE was associated with pre- and post-surgery conditions likely related to the coagulation state, though a cause-effect relationship could not be inferred. Noteworthy, this condition was associated with higher in-hospital morbidity and mortality(AU)

O impacto de ações assistenciais na percepção da qualidade do Sistema Único de Saúde (SUS), Brasil: um estudo transversal / The impact of care actions on the perception of the quality of the Single Health System (SUS), Brazil: a cross-sectional study

INTRODUÇÃO: O tumor de pele não melanoma é o câncer mais frequente no Brasil. A ressecção cirúrgica é um dos pilares do manejo e ações assistenciais como mutirões de cirurgias são formas de reduzir o tempo de espera por tratamento. MÉTODOS: Nesse trabalho, conduziu-se um estudo transversal com 40 pacientes, 20 deles participantes de mutirão e 20 controles. Coletaram-se dados epidemiológicos, além de nove perguntas relacionadas à qualidade do Sistema Único de Saúde (SUS). RESULTADOS: Observou-se diferença significativa entre as respostas relacionadas ao tempo de espera por cirurgias no SUS (p < 0,05). CONCLUSÃO: Pode-se verificar melhora na impressão dos pacientes em relação ao SUS quando incluídos em ações assistenciais.

INTRODUCTION: Non-melanoma skin cancer is the most prevalent cancer in Brazil. Surgical resection is one of the pillars of management, and care actions, such as surgical task forces, are one way to reduce treatment waiting time. METHODS: In this research, we conducted a cross-sectional study with 40 patients; 20 of whom were treated by a surgical task force and 20 were controls. Epidemiological data were collected in addition to answers to nine questions related to the quality of the Single Health System (SUS in Portuguese). RESULTS: A significant difference was observed in responses related to the waiting time for surgery in the SUS (p < 0.05). CONCLUSION: One can observe an improvement in the perception of patients, with regard to the SUS, when included in care actions.