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1.
Rev. bras. cir. cardiovasc ; 37(4): 511-516, Jul.-Aug. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1394735

ABSTRACT

Abstract Introduction: In developing countries like India, it is common for late presentation of Tetralogy of Fallot (TOF) patients to a hospital as compared to that of developed countries. The objective of this study is to analyze the surgical outcome of TOF patients with age > 15 years. Methods: This is a retrospective descriptive study of the surgical outcomes of 45 adult patients undergoing correction for TOF. Epidemiology, symptomology, and preoperative evaluation were performed. Results: Most of the patients were male (33 [73%]). The median age was 21 years. A total of 42 (93.33%) patients had subaortic ventricular septal defect (VSD), while three (6.6%) patients presented with doubly committed VSD. The most common type of right ventricular outflow tract (RVOT) obstruction was combined infundibular and valvular types, accounting for 34 cases (75.5%). Six patients had infundibular RVOT obstruction, while three patients (6.6%) had predominantly valvular pulmonary stenosis. We performed trans-right atrial repair in 33 patients. Right atrium-pulmonary artery approach was used in five patients (11.1%). The most common postoperative complication was right bundle branch block, seen in 14 patients, with a mortality rate of 2% in the early postoperative period. We achieved excellent early and midterm survival results and significant improvement in functions and disease-free quality of life. Conclusion: Intracardiac repair in adult TOF can be performed with low mortality, less residual RVOT obstruction, and need for revision of RVOT far less frequent by using the Jhajhria Infundibular Resection Adequacy Assessment technique (JIRAAT) to assess for adequacy of infundibular resection.

2.
Rev. bras. cir. cardiovasc ; 37(3): 281-291, May-June 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1376534

ABSTRACT

ABSTRACT Introduction: Pediatric heart transplantation is the definitive therapy for children with end-stage heart failure. This paper describes our initial experience in pediatric heart transplantation in a tertiary center in Brazil Methods: This is a historical prospective descriptive cohort study based on a review of the medical records of children undergoing heart transplantation at Hospital de Base and Hospital da Criança e Maternidade de São José do Rio Preto. Variables were displayed as frequency, mean, or median. Statistical analysis and Kaplan-Meier actuarial curve were obtained with the aid of Microsoft® Excel® 2019 and STATSDirect version 3.3.5. Results: Between January 2010 and December 2020, ten children underwent bicaval orthotopic heart transplantation, 30% of which were under one year of age. Nine patients had end-stage heart failure (International Society for Heart and Lung Transplantation-Heart Failure D) and 50% of the recipients were transplanted under conditions of progressive clinical deterioration (Interagency Registry for Mechanically Assisted Circulatory Support ≤ 2). Forty percent of the recipients had a panel-reactive antibody > 20% on virtual crossmatch. In the postoperative period, 80% of patients required high dose of inotropic support (vasoactive-inotropic score > 10) for > 48 hours. The death-free survival rate at 131 months was 77.1±14.4%. Most patients (88.9%) in late follow-up had an episode of active cytomegalovirus infection. Cellular rejection, with or without clinical repercussion, was present in 44.4% of the patients. Conclusion: Pediatric heart transplantation produces acceptable and feasible outcomes as definitive therapy for children with end-stage heart failure.

3.
Rev. bras. cir. cardiovasc ; 37(3): 385-393, May-June 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1376541

ABSTRACT

ABSTRACT Introduction: Tuberculous aortic aneurysm (TBAA) is an exceedingly rare but severe manifestation of tuberculosis, with a high risk of sudden rupture of the aorta in absence of medical or surgical intervention. This review aimed to provide a detailed understanding of TBAA, including its associated complications, affected population, treatment measures, and outcomes. Methods: Case studies and relevant research articles were analyzed to understand the recent advances in medical scientific knowledge on TBAA. Recent clinical case reports on TBAA were searched from the year 2010 to 2020. Results: Case reports indicated a higher prevalence of TBAA in the male population. The most affected age group was 15 to 79 years. The most common treatment for TBAA included surgery followed by antituberculous medication. The case reports discussed in this review reflected open surgery, endovascular repair, coil embolization, laparotomy, aortic valve and root replacement as some of the surgical procedures used depending on the complication and type of aneurysm. The treatment outcome was considered effective in most cases. Conclusion: Postoperative chemotherapy and medications reduce the risk of severity. Early diagnosis of TBAA is imperative, followed by surgical resection and postoperative antituberculous medication with careful follow-up to prevent relapse.

4.
Cogit. Enferm. (Online) ; 27: e80768, Curitiba: UFPR, 2022. tab, graf
Article in Portuguese | LILACS-Express | LILACS, BDENF | ID: biblio-1384633

ABSTRACT

RESUMO Objetivo: sintetizar evidências sobre efeitos das intervenções breves na redução do consumo de bebidas alcóolicas entre adultos. Método: estudo de revisão sistemática, cadastrado protocolo na International Prospective Register of Systematic Reviews, registro nº CRD42020153034. A busca foi realizada em 2020, em bases de dados eletrônicas e foram incluídos ensaios clínicos randomizados que avaliavam os efeitos de Intervenções Breve em adultos bebedores de álcool. Resultados: foram avaliados 11 artigos. Todos os estudos realizaram, nos grupos controle e experimental, teste de identificação do padrão de consumo de álcool, com oferta de feedback para o usuário em seguida. As intervenções utilizam metodologias que incitam o usuário à tomada de decisão, bem como manter a decisão tomada e evitar recaídas. Conclusão: esta pesquisa contribui para o ensino e assistência em saúde, por meio de reflexões sobre a identificação do abuso de álcool e compilado sobre a aplicação e impacto das Intervenções Breves.


ABSTRACT Objective: to synthesize evidence on the effects of brief interventions on reducing alcohol consumption among adults. Method: systematic review study, protocol registered in the International Prospective Register of Systematic Reviews, registration no. CRD42020153034. The search was conducted in 2020, in electronic databases and randomized clinical trials that evaluated the effects of Brief Interventions in adult alcohol drinkers were included. Results: 11 articles were evaluated. All studies performed, in the control and experimental groups, a test to identify the pattern of alcohol consumption, with feedback offered to the user afterwards. The interventions use methodologies that encourage the user to make a decision, as well as maintain the decision made and avoid relapse. Conclusion: this research contributes to health care teaching and assistance, through reflections on the identification of alcohol abuse and compiled on the application and impact of Brief Interventions.


RESUMEN Objetivo: sintetizar las pruebas sobre los efectos de las intervenciones breves para reducir el consumo de alcohol entre los adultos. Método: estudio de revisión sistemática, protocolo registrado en el Registro Internacional Prospectivo de Revisiones Sistemáticas, número de registro CRD42020153034. La búsqueda se realizó en 2020, en bases de datos electrónicas y se incluyeron ensayos clínicos aleatorios que evaluaron los efectos de las Intervenciones Breves en bebedores de alcohol adultos. Resultados: Se evaluaron 11 artículos. Todos los estudios realizaron, en los grupos de control y experimental, una prueba para identificar el patrón de consumo de alcohol, con una retroalimentación ofrecida al usuario después. Las intervenciones utilizan metodologías que incitan al usuario a tomar una decisión, así como a mantener la decisión tomada y evitar recaídas. Conclusión: esta investigación contribuye a la docencia y a la atención sanitaria, a través de reflexiones sobre la identificación del abuso de alcohol y recopiladas sobre la aplicación y el impacto de las Intervenciones Breves.

5.
Medicina (B.Aires) ; 82(2): 262-274, mayo 2022. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1375870

ABSTRACT

Resumen Esta guía de práctica clínica de tratamiento de la polineuropatía amiloidótica familiar se basa en la mejor evidencia disponible de efectividad clínica. Se generó un listado de preguntas con formato PICO centradas en efectividad y seguridad del tratamiento de polineuropatía amiloidótica familiar. Se realizó la búsqueda en PubMed, Cochrane y Epistemonikos. Los niveles de evidencia y los grados de recomendación se basaron en el sistema GRADE. Las recomendaciones se graduaron según dirección y fuerza y se evaluaron con la herramienta GLIA para su implementación. Resumen de recomendaciones: En pacientes con polineuropatía amiloidótica familiar y neuropatía estadio I y II, se sugiere el tratamiento con inotersen 300 mg subcutáneo semanal o patisirán 0.3 mg/kg endovenoso una vez cada 3 semanas, dado que, probablemente, estabilicen o enlentezcan el avance de la neuropatía y el empeoramiento de la calidad de vida (calidad de la evidencia moderada; fuerza de la recomendación débil). En pacientes con polineruropatía amiloidótica familiar y neuropatía estadio I, se sugiere el tratamiento con tafamidis 20 mg vía oral, una vez por día, ya que podría enlentecer el avance de la neuropatía y el empeoramiento en la calidad de vida (calidad de la evidencia baja; fuerza de la recomendación débil), y aquellos con polineuropatía amiloidótica familiar y neuropatía sintomática y en ausencia de otros tratamientos con eficacia aprobada, se sugiere el tratamiento con diflunisal 250 mg dos veces al día, vía oral, ya que podría evitar la progresión de la neuropatía (calidad de la evidencia baja; fuerza de la recomendación débil).


Abstract. This clinical practice guideline for the treatment of familial amyloid polyneuropathy is based on the best available evi dence of clinical effectiveness. A list of questions was generated with a PICO format focused on the effectiveness and safety of the treatment of familial amyloid polyneuropathy. The search was carried out in PubMed, Cochrane and Epistemonikos. The levels of evidence and grades of recommendation were based on the GRADE system. Recommendations were graded according to their direction and their strength and were evaluated with the GLIA tool for their implementation. In patients with familial amyloid polyneuropathy and stage I and II neuropathy, it is suggested: inotersen 300 mg subcutaneous weekly or patisirán 0.3 mg/kg intravenously once every 3 weeks, since they probably stabilize or slow the progression of neuropathy and worsening quality of life (moderate qual ity of evidence; strength of recommendation weak). In patients with familial amyloid polyneuropathy and stage I neuropathy, treatment with tafamidis 20 mg orally, once a day, is suggested, as it could slow the progression of neuropathy and worsen quality of life (low quality of evidence; strength of recommendation weak). In patients with familial amyloid polyneuropathy and symptomatic neuropathy and in the absence of other treatments with approved efficacy, treatment with oral diflunisal 250 mg twice daily is suggested, as it could prevent the progres sion of neuropathy (quality evidence low; strength of recommendation weak).

6.
Rev. bras. cir. cardiovasc ; 37(2): 185-193, Apr. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1376509

ABSTRACT

Abstract Introduction: Type A acute aortic dissection (AAD) remains a challenging cardiac emergency despite the availability of various management strategies. This study compared the outcomes of supracoronary ascending aortic replacement (SCAAR) with aortic valve (AV) resuspension with those of modified Bentall's operation for type A AAD and the progression of aortic regurgitation (AR), long-term dilatation of aortic root and proximal arch, and long-term mortality in SCAAR patients. Methods: Sixty patients underwent surgery for type A AAD (January 2005 to December 2015). Forty-three patients underwent SCAAR with AV resuspension and 17 underwent modified Bentall's operation. All patients were followed up. Results: Upon follow-up of SCAAR patients (n=40), there was significant reduction in aortic root size (preoperative 39.3 mm [9.4] vs. postoperative 33.1 mm [9.1]; P<0.001). Three of these patients worsened to severe AR while others had similar or lesser degree of AR. On comparison between preoperative and postoperative dimensions of all patients (n=53), there was no significant difference in distal ascending aorta size (35.7 mm [8.1] vs. 34.4 mm [8.9]; P=0.52). However, an increase in descending thoracic aorta size (28.8 mm [7.8] vs. 33.7 mm [9.9]; P<0.001) was observed. In-hospital and late mortalities for SCAAR vs. modified Bentall's procedure were 11.7% (seven patients) (7% [3] vs. 23.5% [4]) and 28% (15 patients) (15% [6] vs. 69% [9]), respectively. Conclusion: SCAAR with AV resuspension is a safe surgical option for type A AAD. Preservation of AV is associated with better long-term outcomes and reduced mortality. Modified Bentall's operation may be associated with long-term mortality.

7.
J. bras. nefrol ; 44(1): 48-57, Jan-Mar. 2022. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1365024

ABSTRACT

Abstract Introduction Henoch-Schönlein purpura nephritis (HSN) is defined as Henoch-Schönlein purpura with kidney involvement, including hematuria and/or proteinuria. The aim of this study was to evaluate the data of HSN patients who underwent renal biopsy, and compare the main clinical and laboratory parameters that may affect renal biopsy findings, treatment protocols, and short- and long-term outcome of those patients. Methods Biopsies performed in 72 HSN patients between January 2007 to January 2017 were retrospectively evaluated. They were divided into two groups according to renal biopsy classification of the International Study of Kidney Disease in Children. Renal outcome, clinical and laboratory parameters, treatment protocols, and outcome were compared between groups. Short- and long-term follow-up of patients were evaluated. Results Of 72 patients, 47 were male (65.3%) and 44 (61.1%) were ≤10 years of age. Neutrophil-lymphocyte ratio was found higher in patients with scrotal involvement (p=0.042). Short-term unfavorable outcome was significantly higher in patients with scrotal involvement (p=0.038). Patients with hypertension and decreased creatinine clearance were found to have more unfavorable outcomes in long-term follow-up (p=0.029, p=0.040). Conclusion Cyclosporin-A and cyclophosphamide could be effective in steroid unresponsive HSN patients. Patients with scrotal involvement, decreased creatinine clearance, and hypertension should be closely monitored for sequelae of HSN.


Resumo Introdução A nefrite da púrpura de Henoch-Schönlein (NPHS) é definida como púrpura de Henoch-Schönlein com envolvimento renal, incluindo hematúria e/ou proteinúria. O objetivo deste estudo foi avaliar os dados de pacientes com NPHS que foram submetidos à biópsia renal e comparar os principais parâmetros clínicos e laboratoriais que podem afetar os achados da biópsia renal, os protocolos de tratamento e o desfecho de curto e longo prazo desses pacientes. Métodos Foram avaliadas retrospectivamente biópsias realizadas em 72 pacientes com NPHS entre Janeiro de 2007 e Janeiro de 2017. Eles foram divididos em dois grupos de acordo com a classificação de biópsia renal do Estudo Internacional de Doenças Renais em Crianças. O desfecho renal, parâmetros clínicos e laboratoriais, protocolos de tratamento e desfechos foram comparados entre os grupos. Foi avaliado o acompanhamento de pacientes de curto e longo prazo. Resultados De 72 pacientes, 47 eram homens (65,3%) e 44 (61,1%) tinham ≤10 anos de idade. A razão neutrófilo-linfócito foi encontrada mais alta em pacientes com envolvimento escrotal (p=0,042). O desfecho desfavorável de curto prazo foi significativamente maior em pacientes com envolvimento escrotal (p=0,038). Constatou-se que pacientes com hipertensão e diminuição da depuração de creatinina apresentaram desfechos mais desfavoráveis no acompanhamento de longo prazo (p=0,029, p=0,040). Conclusão A ciclosporina-A e a ciclofosfamida podem ser eficazes em pacientes com NPHS não responsivos a esteroides. Pacientes com envolvimento escrotal, diminuição da depuração de creatinina e hipertensão devem ser monitorados de perto para sequelas de NPHS.

8.
Rev. bioét. (Impr.) ; 30(1): 27-35, jan.-mar. 2022.
Article in Portuguese | LILACS | ID: biblio-1376497

ABSTRACT

Resumo Este artigo se propõe a refletir sobre a obrigação médica em decorrência da violação das regras éticas de publicidade em medicina, em especial quando veiculada nas mídias sociais. Por meio do método dedutivo, será discutida a natureza jurídica da obrigação do profissional, que, via de regra, se dá como obrigação de meio. Entretanto, a discussão surge quando o conteúdo da mensagem publicitária e a forma como é veiculada possibilitam transformar essa obrigação em obrigação de resultado, alterando então a natureza jurídica de essência do médico. Para viabilizar o debate, com base em revisão bibliográfica, este artigo expõe a possibilidade de o profissional responder civilmente por violações éticas relativas à publicidade médica e ao comprometimento do consentimento informado, ou seja, se o médico induz resultado, que ele seja responsabilizado por não alcançar o desfecho proposto.


Abstract This article reflects on medical obligation due to the violation of the ethical rules of advertising in medicine, especially when published on social media. Using the deductive method, the legal nature of a professional's obligation will be discussed, which, as a rule, is an obligation of means. However, the discussion arises when the content of the advertising message and how it is conveyed make it possible to transform this obligation into an obligation of result, thus changing the legal nature of the physician's essence. To enable the debate, based on a literature review, this article exposes the possibility of the professional being civilly responsible for ethical violations related to medical advertising and the impairment of informed consent, that is, if the physician induces results, that he is liable for not achieving the proposed outcome.


Resumen Este artículo se propone reflexionar sobre la obligación médica derivada de la violación de las normas éticas de la publicidad en medicina, especialmente cuando se difunde por las redes sociales. Con base en el método deductivo se discutirá la naturaleza jurídica de la obligación del profesional que, en general, se da como obligación de medios. Sin embargo, se plantea la discusión cuando el contenido del mensaje publicitario y la forma como se difunde permiten convertir esta obligación en una obligación de resultado, modificando así la naturaleza jurídica de la esencia del médico. Para facilitar el debate, y con base en una revisión bibliográfica, este artículo expone la posibilidad de que el profesional sea civilmente responsable de las violaciones éticas relacionadas con la publicidad médica y con el compromiso del consentimiento informado, es decir, si el médico induce un resultado, debe ser responsable de no lograr el resultado propuesto.


Subject(s)
Evaluation of Results of Therapeutic Interventions , Liability, Legal , Treatment Outcome , Advertising , Damage Liability , Ethics, Medical , Social Media
9.
Surg. cosmet. dermatol. (Impr.) ; 14: e20220058, jan.-dez. 2022.
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1369830

ABSTRACT

O pênfigo vegetante é considerado uma rara variante clínica do pênfigo vulgar e cursa com lesões recorrentes que podem evoluir para placas vegetantes extensas de difícil resolução. A cirurgia pode ser uma alternativa no tratamento complementar de lesões resistentes à terapêutica clássica. Há escassez de literatura que evidencie a técnica cirúrgica e os resultados pós-operatórios da abordagem do pênfigo vegetante, tornando relevante a comunicação deste caso. Apresentamos o caso de um paciente com pênfigo vegetante de Hallopeau, tratado com sucesso por meio da exérese tangencial seguida da cicatrização por segunda intenção de grandes projeções retroauriculares


Pemphigus vegetans is considered a rare clinical variant of pemphigus vulgaris and is associated with recurrent lesions that can evolve into extensive vegetative plaques that are difficult to resolve. Surgery may be an alternative in the complementary treatment of lesions resistant to classical therapy. There is a shortage of literature that shows the surgical technique and the postoperative results of the approach to pemphigus vegetans, making the communication of this case relevant. We present the case of a patient with the Hallopeau type of pemphigus vegetans successfully treated with tangential exeresis followed by secondary intention healing of large retroauricular projections.

10.
Surg. cosmet. dermatol. (Impr.) ; 14: e20220074, jan.-dez. 2022.
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1369138

ABSTRACT

O microagulhamento tem sido tradicionalmente usado para induzir a formação de colágeno. No couro cabeludo, foi observado que estimula a fase anágena e o ciclo capilar, mas faltam estudos que demonstrem as alterações histopatológicas após o procedimento. Relatamos o caso de uma mulher de 37 anos com história de alopecia de padrão feminino há 15 anos, com rarefação difusa proeminente na região fronto-parietal e miniaturização capilar observada à dermatoscopia. A condição permaneceu estável por 7 anos com uso de espironolactona e minoxidil tópico. A paciente foi submetida a três sessões de microagulhamento no couro cabeludo em intervalos mensais. A análise histopatológica foi realizada antes das sessões e um mês após a última sessão. O padrão de alopecia permaneceu o mesmo, sem alterações significativas na contagem de folículos após as intervenções, apesar de discreta melhora clínica e dermatoscópica. Não foram observados tratos fibrosos ou inflamação após o procedimento. A análise histopatológica é importante para avaliar a segurança do microagulhamento do couro cabeludo em curto e longo prazo, para investigar sinais como inflamação e fibrose, bem como para determinar a eficácia deste procedimento no tratamento da alopecia, e estudos com maior número de casos são necessários


Microneedling has traditionally been used to induce collagen formation. Scalp microneedling has been seen to stimulate the capillary cycle and anagen phase, but studies demonstrating histopathological changes after this procedure are lacking. Here we present the case of a 37-year-old woman with a 15-year history of female pattern alopecia, with diffuse hair thinning prominent in the frontoparietal region and hair miniaturization seen in dermoscopy. The patient's condition remained stable for seven years with use of spironolactone and topical minoxidil. The patient underwent three scalp microneedling sessions at monthly intervals. Histopathological analysis was conducted before the sessions and one month after the last session. Despite slight clinical and dermoscopic improvement, the alopecia pattern remained the same, without significant changes in follicle count after the interventions. Neither inflammation nor fibrous tracts were observed after the procedure. The histopathological analysis is essential to assess the safety of scalp microneedling in the short and long term, investigate signs such as inflammation and fibrosis, and determine the effectiveness of this procedure in treating alopecia. Studies with a more significant number of cases are necessary

11.
Rev. estomatol. Hered ; 32(1): 52-60, ene.-mar 2022. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1389062

ABSTRACT

RESUMEN Tradicionalmente, el hidróxido de calcio (HC) era considerado el material de elección para el recubrimiento pulpar directo (RPD); pero esto ha cambiado con los años debido a las distintas desventajas que presenta. Los cementos a base de silicato de calcio (CSC) tienen propiedades ventajosas al compararlos con el HC como: bioactividad, biocompatibilidad, menor tiempo de fraguado, capacidad de sellado y resistencia, por lo que son usados en una variedad de procedimientos endodónticos, entre ellos el RPD. El presente artículo de revisión recopila información a partir de la búsqueda manual de artículos originales de investigación científica y revisiones de literatura de la base de datos de Medline/PubMed. Se describen las variedades de CSC, su mecanismo de acción, desventajas, factores relacionados y tasas de éxito clínico en su aplicación en casos de RPD.


ABSTRACT Traditionally, calcium hydroxide (HC) was considered the material of choice for direct pulp capping (RPD); but this has changed over the years due to the various disadvantages it presents. Calcium silicate-based cements (CSC) have properties that are advantageous to HC such as: bioactivity, biocompatibility, shorter setting time, sealing capacity and resistance, which they are used in a variety of endodontic procedures, including RPD.This review article compiles information from the manual search of original scientific research articles and literature reviews of the Medline / PubMed database. The varieties of CSC, their mechanism of action, disadvantages, related factors and rates of clinical success in their application in cases of RPD are described.

12.
Ethiop. med. j. (Online) ; 60(3): 265-273, 2022. tables
Article in English | AIM | ID: biblio-1378407

ABSTRACT

Introduction Bitter Kola (Garcinia Kola) and kola nut, contains substances attributed to numerous effects on humans including anti-inflammatory, anti-allergic properties, anti-infective and caffeinism. This study explores Bitter kola and kola nut use and its impact on treatment outcome on People Living with HIV (PLWHIV). Methods: The study was conducted at a Military Hospital in Nigeria. An analytical cross-sectional study was done using questionnaire among 700 HIV-positive clients selected using simple random sampling. Data were collected by researcher and three trained assistants. Chi-square test and binary logistic regression were used for identifying associations and predictors, respectively. The level of significance was set at p < 0.05. Results: Findings show that 260 (63.6%) and 179 (25.6%) have ever and currently used Bitter kola/Kola nut, respectively. Also, 14 (7.8%) used Bitter kola/Kola nut alone while 165 (92.2%) used it in addition to other substances, especially with alcohol 123 (68.7%). Bitter kola use was associated with age (p = 0.037), gender (p < 0.001), occupation (p = 0.001), and number of children (p < 0.011). Identified predictors were being a female (AOR 0.79; 95% CI 0.08-0.92) and earning <18,000 Naira (AOR 2.91; 95% CI 2.03-21.54). There was no association of Bitter kola/kola nut use with CD4 count and viral load suppression. Conclusion: Though Kola nut and Bitter kola use was high as in the general population we have not found any effect on treatment outcome among PLWHIV. This calls for more research to ascertain if there are other possible beneficial effects on PLWHIV.


Subject(s)
HIV Infections , HIV Seropositivity , Treatment Outcome , Anti-Allergic Agents , Cola , Garcinia kola , Anti-Infective Agents , Anti-Inflammatory Agents
13.
Ethiop. j. health dev. (Online) ; 36(2): 1-9, 2022. tables, figures
Article in English | AIM | ID: biblio-1380275

ABSTRACT

Background: Type 1 diabetes mellitus (T1DM) is a common autoimmune disorder that often presents in children.In these patients, diabetic ketoacidosis (DKA) is one of the most common and serious acute complications, which is associated with significant morbidity and mortality. The study aimed to assess the clinical profiles and outcomes of children admitted with DKA. Objective: To assess the clinical manifestations and treatment outcomes of DKA patients in two tertiary hospitals in Addis Ababa. Methods: A hospital-based retrospective analysis was conducted on 175 pediatric diabetic ketoacidosis children,who were admitted to the emergency units of two hospitals in Addis Ababa from September 2015 to February 2020 and whose medical records contained complete pertinent data. Patients were between the ages of 0 to 12 years. Proportional samples were taken from each hospital and data was collected retrospectively using a formatted checklist. The data was checked for its inclusiveness and entered Epi Info. version 4.6 and then transferred into SPSS version 25 software for further analysis. Result: DKA was the presenting manifestation of Diabetes in 78.3% of patients and 21.7% were already known cases of Diabetes. Half (50.9%) of the study participants were diagnosed with DKA in the age range of 5 to 10 years and almost one-third (30.9%) were above the age of 10. A high-income level of the caretakers was found to be protective against DKA during the diagnosis of T1DM. Out of the 175 children admitted, 12 passed on, resulting in a mortality rate of 6.9%. Conclusion: The majority of the known DM patients presented with DKA after the omission of insulin and a newly diagnosed T1DM at first presentation. The age of presentation and clinical symptoms of the studied participants were like other international studies. Community education regarding the signs and symptoms of childhood DM can further prevent the development of DKA. [Ethiop. J. Health Dev. 2022; 36(2):000-000]


Subject(s)
Humans , Male , Female , Child , Diabetic Ketoacidosis , Therapeutics , Precipitating Factors , Treatment Outcome , Diabetes Mellitus , Hospitals
14.
Ethiop. j. health dev. (Online) ; 36(2): 1-9, 2022-06-07. Tables
Article in English | AIM | ID: biblio-1380447

ABSTRACT

Type 1 diabetes mellitus(T1DM)is a common autoimmune disorder that often presents in children. In these patients, diabetic ketoacidosis(DKA)is one of the most common and serious acute complications, which isassociated with significant morbidity and mortality. The study aimed to assess the clinical profilesand outcomesof children admitted with DKA.Objective:To assess the clinical manifestationsand treatment outcomesof DKA patients in two tertiary hospitals in Addis Ababa. Methods: A hospital-based retrospective analysis was conductedon175 pediatric diabetic ketoacidosis children, who wereadmitted to the emergency units of two hospitalsin Addis Ababafrom September 2015 to February 2020andwhose medical records contained complete pertinent data. Patients were between theages of0 to 12 years.Proportional samples were taken from each hospitaland data wascollected retrospectively using a formatted checklist. The data waschecked for its inclusiveness and enteredEpi Info. version4.6 andthen transferred into SPSS version 25 software for further analysis. Result:DKA was the presenting manifestation of Diabetes in 78.3% of patients and 21.7% were already known cases of Diabetes. Half (50.9%) of the study participants were diagnosed with DKA in the age range of 5 to 10 years and almost one-third (30.9%) were abovethe age of 10. A high-incomelevel of the caretakers wasfound to be protective against DKA during thediagnosis of T1DM. Out of the 175 children admitted, 12 passed on, resulting ina mortality rate of 6.9%.Conclusion: The majority of the known DM patients presented with DKA after the omission of insulin and a newly diagnosed T1DMat first presentation.The age of presentation and clinical symptoms of the studied participantswere likeother international studies. Community education regardingthe signs and symptoms of childhood DM can further prevent the development of DKA.[Ethiop. J. Health Dev. 2022; 36(2):000-000]Keywords: Diabetic ketoacidosis, Treatment outcome, and precipitating factors


Subject(s)
Diabetic Ketoacidosis , Child Mortality , Diabetes Mellitus, Type 1 , Pediatric Obesity , Signs and Symptoms , Precipitating Factors , Morbidity
15.
Niger. j. clin. pract. (Online) ; 25(6): 923-930, 2022. figures, tables
Article in English | AIM | ID: biblio-1373631

ABSTRACT

Background: Colorectal cancer (CRC) is one of the most common malignancies seen in the Western World. It is increasing in developing countries due to adaptation of the western lifestyle with an incidence of 6% in Nigeria. Treatment options are dependent on the stage of disease at presentation, the performance status of the patient, and increasingly the molecular makeup of the tumor. There is a dearth of data on the treatment options obtainable for the management and outcome of CRC cases in Northwestern, Nigeria. Aim: The study assessed the treatment options and outcome of colorectal cancer patients in a tertiary institution, in Northwestern, Nigeria over a 10-year period. Patients and Methods: Between January 2006 and December 2015, data of one-hundred and twenty-two histologically confirmed colorectal cancer cases seen at the Surgery, Radiotherapy and Oncology Departments, ABUTH Zaria, were retrieved retrospectively from the case files and treatment cards of the patients at the health information unit of the hospital. The stage at disease presentation, treatment received, and outcome were analyzed. Results: Nearly a quarter of the patients fell within the age bracket 31­40 years with the median age being 41 years. While only 41% of the patients had their disease staged, 30.4% of the patients presented with advanced disease (Dukes'C + D). Only 95 cases received a form of surgery or the other. Colostomy however accounted for 28.4%. Eighty-nine of the patients received chemotherapy either as neoadjuvant, adjuvant or with palliative intent. External beam radiotherapy either with radical or palliative intent was received by 60 patients (49.2%). At 1-year follow-up sixty cases had been lost to follow up, and thirty-six cases had defaulted on one form of treatment. Conclusion: The study showed that stage at presentation and the available treatment options in the hospital informed treatment offered to the patients. However, surgery was readily performed due to the pattern of presentation and most patients benefited from just a diverting colostomy. Majority of the patients presented with rectal tumor which required radiotherapy as part of its treatment modality, although this is still a luxury in this part of the world. Chemotherapy is also readily available and often prescribed. Cost and limited facility for biomarker (K-ras) testing restrict the use of targeted therapy. Outcome at 1-year follow-up was poor with whereabouts of nearly half of the patients unknown.


Subject(s)
Humans , Radiotherapy , Socioeconomic Factors , Colorectal Neoplasms , Disease Management , Drug Therapy , Hospitals, Teaching
16.
Rev. Col. Bras. Cir ; 49: e20223320, 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1394616

ABSTRACT

ABSTRACT Introduction: treating benign (hormonally active or nonfunctional) and malignant adrenal cancer includes adrenalectomy. The expertise of surgeons and surgery performed by high-volume surgeons were associated with fewer complications and lower cost. We aimed to describe and compare the number of surgeries, mortality rate, and length of hospital stay for adrenalectomies performed between 2008 and 2019 in the public health system of São Paulo. Methods: this was an ecological study. The data were collected using the TabNet Platform of the Unified Health System Department of Informatics. Outcomes analyzed included the number of surgeries performed, mortality rate during hospital stay, and length of hospital stay. Public hospitals in Sao Paulo were divided into three subgroups according to the surgical volume of adrenalectomies performed as well as hospitals with and without a residency program in Urology, and the results were compared among them. Results: a total of 943 adrenalectomies were performed in Sao Paulo between 2008 and 2019. Mortality rates during hospital stay according to hospital surgical volume were no reported deaths in low-volume, 0.015% in intermediate-volume, and 0.004% in high-volume hospitals. The average length of the ICU stay was 1.03 days in low-volume, 2.8 in intermediate-volume, and 1.12 in high-volume hospitals (analysis between intermediate and high volume centers with statistical significance, p=0.016). Conclusions: despite no statistically significant differences among the groups analyzed, mortality rates were very low in all groups. ICU stay was shorter in high-volume centers than in intermediate-volume centers.


RESUMO Introdução: o tratamento do câncer de adrenal benigno (hormonalmente ativo ou não funcional) e maligno inclui a adrenalectomia. A experiência dos cirurgiões e a cirurgia realizada por cirurgiões de alto volume foram associadas a menos complicações e menor custo. O objetivo do estudo foi descrever e comparar o número de cirurgias, a taxa de mortalidade e o tempo de internação para adrenalectomias realizadas entre 2008 e 2019 na rede pública de saúde de São Paulo. Métodos: trata-se de um estudo ecológico. Os dados foram coletados da Plataforma TabNet do Departamento de Informática do Sistema Único de Saúde. Os hospitais foram divididos em três subgrupos de acordo com o volume cirúrgico e hospitais com e sem programa de residência médica em Urologia. Os resultados foram comparados entre os grupos. Resultados: no período estudado, 943 adrenalectomias foram realizadas em São Paulo. As taxas de mortalidade durante a internação de acordo com o volume cirúrgico hospitalar foram: não foram relatados óbitos em hospitais de baixo volume; 0,015% em hospitais de volume intermediário e 0,004% em alto volume. O tempo médio de permanência na UTI foi de 1,03 dias nos hospitais de baixo volume; 2,8 nos de médio volume e 1,12 nos de alto volume (análise entre centros de médio e alto volume com significância estatística, p=0,016). Conclusão: as taxas de mortalidade foram muito baixas em todos os grupos. A permanência na UTI foi menor em centros de alto volume do que em centros de volume intermediário.

17.
Einstein (Säo Paulo) ; 20: eAO5791, 2022. tab, graf
Article in English | LILACS | ID: biblio-1364808

ABSTRACT

ABSTRACT Objective To analyze pain, functional capacity, quality of life, anxiety and depression outcomes in patients undergoing lumbar spine surgery following use of the Second Opinion Program, and to present disagreements regarding diagnoses and therapeutic indications between the first and second opinions. Methods A prospective, observational cohort study with 100 patients enrolled in the Second Opinion Program who underwent lumbar spine surgery. Questionnaires addressing pain intensity, level of disability, quality of life, anxiety and depression were applied prior to and within 1, 3, 6 and 12 months of surgery. Descriptive and comparative statistical analyses were performed. The following clinical outcomes were analyzed: pain intensity, level of disability, quality of life, anxiety, and depression. Results In this sample, 88% and 12% out of 100 patients were submitted to lumbar decompression and arthrodesis, respectively. Patients reported improvements in function, pain intensity, and quality of life factors following surgery and were able to attain the minimal clinically important difference relative to the preoperative period. Agreement between the first and second opinions was observed in 44% of diagnoses, and in 27% of therapeutic indications. Conclusion Patients had favorable postoperative outcomes regarding pain, disability, and quality of life. These findings and the high rates of diagnostic and therapeutic indication disagreements corroborate the need of a second opinion in cases of spine disease with surgical indications.


Subject(s)
Humans , Quality of Life , Lumbar Vertebrae/surgery , Pain , Referral and Consultation , Prospective Studies , Treatment Outcome , Disability Evaluation
18.
Cogitare Enferm. (Impr.) ; 27: e80768, 2022. tab, graf
Article in Portuguese | LILACS-Express | LILACS, BDENF | ID: biblio-1375214

ABSTRACT

RESUMO Objetivo: sintetizar evidências sobre efeitos das intervenções breves na redução do consumo de bebidas alcóolicas entre adultos. Método: estudo de revisão sistemática, cadastrado protocolo na International Prospective Register of Systematic Reviews, registro nº CRD42020153034. A busca foi realizada em 2020, em bases de dados eletrônicas e foram incluídos ensaios clínicos randomizados que avaliavam os efeitos de Intervenções Breve em adultos bebedores de álcool. Resultados: foram avaliados 11 artigos. Todos os estudos realizaram, nos grupos controle e experimental, teste de identificação do padrão de consumo de álcool, com oferta de feedback para o usuário em seguida. As intervenções utilizam metodologias que incitam o usuário à tomada de decisão, bem como manter a decisão tomada e evitar recaídas. Conclusão: esta pesquisa contribui para o ensino e assistência em saúde, por meio de reflexões sobre a identificação do abuso de álcool e compilado sobre a aplicação e impacto das Intervenções Breves.


ABSTRACT Objective: to synthesize evidence on the effects of brief interventions on reducing alcohol consumption among adults. Method: systematic review study, protocol registered in the International Prospective Register of Systematic Reviews, registration no. CRD42020153034. The search was conducted in 2020, in electronic databases and randomized clinical trials that evaluated the effects of Brief Interventions in adult alcohol drinkers were included. Results: 11 articles were evaluated. All studies performed, in the control and experimental groups, a test to identify the pattern of alcohol consumption, with feedback offered to the user afterwards. The interventions use methodologies that encourage the user to make a decision, as well as maintain the decision made and avoid relapse. Conclusion: this research contributes to health care teaching and assistance, through reflections on the identification of alcohol abuse and compiled on the application and impact of Brief Interventions.


RESUMEN Objetivo: sintetizar las pruebas sobre los efectos de las intervenciones breves para reducir el consumo de alcohol entre los adultos. Método: estudio de revisión sistemática, protocolo registrado en el Registro Internacional Prospectivo de Revisiones Sistemáticas, número de registro CRD42020153034. La búsqueda se realizó en 2020, en bases de datos electrónicas y se incluyeron ensayos clínicos aleatorios que evaluaron los efectos de las Intervenciones Breves en bebedores de alcohol adultos. Resultados: Se evaluaron 11 artículos. Todos los estudios realizaron, en los grupos de control y experimental, una prueba para identificar el patrón de consumo de alcohol, con una retroalimentación ofrecida al usuario después. Las intervenciones utilizan metodologías que incitan al usuario a tomar una decisión, así como a mantener la decisión tomada y evitar recaídas. Conclusión: esta investigación contribuye a la docencia y a la atención sanitaria, a través de reflexiones sobre la identificación del abuso de alcohol y recopiladas sobre la aplicación y el impacto de las Intervenciones Breves.

19.
Article in Portuguese | LILACS, ColecionaSUS, CONASS, SES-GO | ID: biblio-1367185

ABSTRACT

Lisdexanfetamina e drogas disponíveis no SUS (metilfenidato, bupropiona, amitriptilina, clomipramina, nortriptilina). Indicação: Transtorno do Déficit de Atenção e Hiperatividade (TDAH) em crianças e adolescentes. Pergunta: Lisdexanfetamina é eficaz e segura para melhoria de sintomática, comparada ao placebo e medicações disponíveis no SUS, no tratamento de crianças e adolescentes com TDAH? Métodos: Revisão rápida de evidências (overview) de revisões sistemáticas, com levantamento bibliográfico realizado na base de dados PUBMED, utilizando estratégia estruturada de busca. A qualidade metodológica das revisões sistemáticas foi avaliada com AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews). Resultados: Foram selecionadas 3 revisões sistemáticas, que atenderam aos critérios de inclusão. Conclusão: Lisdexanfetamina e metilfenidato são mais eficazes que placebo, e similares entre si, para reduzir sintomas em escalas de avaliação. Lisdexanfetamina e metilfenidato têm risco similar ao placebo de abandono do tratamento devido a efeitos adversos. Bupropiona não é mais eficaz que placebo para alívio sintomático. Lisdexanfetamina tem efeitos adversos de redução do apetite e insônia/ dificuldades do sono. Não foram encontradas evidências na literatura sobre os efeitos terapêuticos de amitriptilina, clomipramina e nortriptilina no tratamento de crianças e adolescentes com TDAH


Lisdexamfetamine and drugs available in the Brazilian Public Health System (BPHS) (methylphenidate, bupropion, amitriptyline, clomipramine, nortriptyline, bupropion). Indication: Children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD). Question: Lisdexamfetamine is effective and safe for symptomatic improvement, compared to placebo and drugs available in the BPHS, for treatment of children and adolescents with ADHD? Methods: Rapid response review of evidence (overview) of systematic reviews, with bibliographic search in the PUBMED database, using a structured strategy. The methodological quality of systematic reviews was assessed with AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews). Results: 3 systematic reviews met the inclusion criteria and were selected. Conclusion: Lisdexamfetamine and methylphenidate are more effective than placebo, and similar to each other, to reduce symptoms on rating scales. Lisdexamfetamine and methylphenidate are not different from placebo in the risk of treatment discontinuation due to adverse effects. Bupropion is no more effective than placebo for symptomatic relief. Lisdexamfetamine has adverse effects of decreased appetite and insomnia/sleep troubles. No evidence was found in the literature about therapeutic effects of amitriptyline, clomipramine and nortriptyline for treatment of children and adolescents with ADHD


Subject(s)
Humans , Child, Preschool , Child , Adolescent , Attention Deficit Disorder with Hyperactivity/drug therapy , Bupropion , Lisdexamfetamine Dimesylate/therapeutic use , Methylphenidate/therapeutic use , Placebos , Clomipramine , Evidence-Informed Policy , Amitriptyline , Antidepressive Agents/therapeutic use , Nortriptyline
20.
Article in Portuguese | LILACS, ColecionaSUS, CONASS, SES-GO | ID: biblio-1390959

ABSTRACT

Liraglutida e terapia padrão (modificação no estilo de vida, com dieta e prática regular de exercícios), como opção disponível no Sistema Único de Saúde. Indicação: Tratamento da obesidade. Pergunta: Liraglutida, comparada à terapia padrão, é mais eficaz e segura para promover redução do peso em pessoas adultas com obesidade? Métodos: Revisão rápida de evidências, revisão de revisões sistemáticas, com levantamento bibliográfico realizado na base de dados PUBMED, utilizando estratégia estruturada de busca. A qualidade metodológica das revisões sistemáticas foi avaliada com AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews version 2). Resultados: Foi selecionada uma revisão sistemática que atendeu aos critérios de inclusão. Conclusão: Liraglutida em dose ≤ 1,8 mg e em dose > 1,8 mg, comparadas a placebo (com terapia padrão) promoveram redução estatisticamente significativa de peso (-2,99 kg e -4,55 kg, respectivamente) e maior risco relativo de descontinuação do tratamento devido a efeitos adversos, com alta certeza de evidência para esses desfechos, além de maior risco relativo de náusea e de vômitos


Liraglutide and standard therapy (lifestyle modification, diet and regular exercise), as a option available in the Brazilian Public Health System. Indication: Treatment of obesity. Question: Is Liraglutide, compared to standard therapy, more effective and safer for weight reduction in obese adults? Methods: Rapid review of evidence, overview of systematic reviews, with a bibliographic search in the PUBMED database, using a structured search strategy. The methodological quality of systematic reviews was assessed with AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews version 2). Results: A unique systematic review that met the inclusion criteria was selected. Conclusion: Liraglutide at a dose ≤ 1.8 mg and at a dose > 1.8 mg, compared to placebo (and standard therapy) induced statistically significant weight reduction (-2.99 kg and -4.55 kg, respectively) and greater relative risk of treatment discontinuation due to adverse effects, with high certainty of evidence, and greater relative risk of nausea and vomiting


Subject(s)
Humans , Male , Female , Liraglutide/therapeutic use , Obesity/drug therapy , Anti-Obesity Agents , Liraglutide/adverse effects
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