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Indian J Ophthalmol ; 2023 May; 71(5): 2094-2099
Article | IMSEAR | ID: sea-225031


Purpose: To compare visual outcomes of standard occlusion therapy at home versus clinic in amblyopic children. Methods: A retrospective study of case records of children aged <15 years with diagnosis of strabismic or anisometropic amblyopia or both was conducted at a tertiary eye hospital located in rural North India between Jan 2017–Jan 2020. Those with at least 1 follow?up visit were included. Children with ocular co?morbidities were excluded. Treatment in clinic by admission or at home was based on the parents’ discretion. Children in clinic group underwent part time occlusion & near work exercises for minimum 1 month, in classroom format which we called amblyopia school. Those in home group underwent part time occlusion as per PEDIG recommendations. Primary outcome measure was improvement in number of Snellen’s lines at the end of 1 month & at final follow?up. Results: We included 219 children with mean age of 8.8±3.23 years, out of which clinic group had 122 (56%) children. At one?month, visual improvement in clinic group (2.1±1.1 lines) was significantly greater than home group (mean=1.1±0.8 lines) (P < 0.001). Both groups continued to improve vision on follow?up, however the vision in the clinic group (2.9±1.2 lines improvement at mean follow?up of 4.1±1.6 months), continued to be better than home group (2.3±1.1 lines improvement at mean follow?up 5.1±0.9 months) (P = 0.05). Conclusion: Clinic based amblyopia therapy in the form of an amblyopia school can help expedite visual rehabilitation. Thus, it may be a better option for rural settings where patients in general tend to be poorly compliant.

Rev. argent. cir ; 115(1): 11-18, mayo 2023. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1441165


RESUMEN Antecedentes: Aun en estado de cuarentena, las patologías de urgencia de Cirugía General requieren una evaluación y resolución inmediata. Objetivo: Analizar los ingresos, los resultados quirúrgicos y la gravedad de la enfermedad en los ingresos sin COVID-19, durante los primeros meses de la pandemia. Objetivos secundarios, subanálisis de patologías quirúrgicas habituales, como apendicitis, enfermedad de las vías biliares, diverticulitis y tumores complicados. Materiales y métodos: Se realizó un estudio observacional, ambispectivo, sobre una cohorte prospectiva de pacientes que consultaron por patología quirúrgica de guardia y requirieron hospitalización entre el 20 de marzo y el 31 de julio de 2020 correspondiente al Grupo Pandemia (GP), analizados y comparados con una cohorte del mismo período de 2019, Grupo Control (GC). Resultados: En el GP, en comparación con el GC, se registró un aumento en el número de pacientes ingresados (346 versus 305, p = 0,157), un aumento en el porcentaje de casos moderados-graves (58,1% versus 48,8%, p= 0,018), en el tiempo transcurrido desde el inicio de la presentación de los síntomas hasta la consulta (48 versus 24 horas, p< 0,001, en el tiempo desde el diagnóstico hasta la cirugía (23 versus 7 horas, p< 0,001), y en el tiempo operatorio (75 versus 60 minutos, p< 0,001). No hubo diferencias significativas en las complicaciones posoperatorias. Conclusión: Durante la pandemia se observaron cambios desfavorables en las características de la población analizada en relación a la pre pandemia, pero sin impacto en la morbimortalidad posoperatoria, demostrando que fue posible mantener los resultados quirúrgicos a pesar del retraso en la consulta.

ABSTRACT Background: Emergency general surgery conditions require immediate evaluation and timely resolution, even during quarantine. Objective: to analyze variations in admissions, surgical outcomes and severity of the disease in non- COVID-19 emergency admissions during the first months of the pandemic. Secondary objectives, to performed a sub-analysis of common surgical conditions, as appendicitis, biliary tract disease, diverticulitis and complicated tumors. Material and methods: An observational, ambispective study was carried out on a prospective cohort of patients who consulted with on-call surgical pathology and required hospitalization from March 20th, 2020 until July 31, 2020 referred to as Pandemic Group (PG), analyzed and compared with the same period of 2019, Control Group (CG). Results: We experienced an increase in the number of patients admitted at the ED during the pandemic PG vs CG (346 versus 305, p 0.157). Patients in the PG were found to be significantly more ill (58.1% versus 48,8%, p 0.018). A significant delay was found globally in both, time from onset of symptoms presentation to consultation (48 hours versus 24 hours, p < 0.001), and time from diagnosis to surgery (23 hours versus 7 hours, p < 0.001) in the PG, and an increase in the mean operative time (75 versus 60 minutes, p= 0,001). There was no significant difference in postoperative complications. Conclusion: During the pandemic we observed an increase in urgent surgical procedures due to biliary pathology and gastrointestinal tumors. The patients consulted with more advanced stages of disease, but this had no impact on postoperative morbidity or mortality, demonstrating that it was possible to maintain surgical outcomes despite delayed consultation.

Int. arch. otorhinolaryngol. (Impr.) ; 27(1): 43-49, Jan.-Mar. 2023. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1421685


Abstract Introduction Upper airway stimulation (UAS) with electric activation of the hypo-glossal nerve has emerged as a promising treatment for patients with moderate-to-severe obstructive sleep apnea. Objective To retrospectively analyze objective and subjective outcome measures after long-term follow-up in obstructive sleep apnea patients receiving upper airway stimulation. Methods An observational retrospective single-center cohort study including a consecutive series of patients diagnosed with obstructive sleep apnea receiving upper airway stimulation. Results Twenty-five patients were included. The total median apnea-hypopnea index (AHI) significantly decreased from 37.4 to 8.7 events per hour at the 12-month follow-up (p < 0.001). The surgical success rate was 96%. Adverse events were reported by 28% of the patients. Conclusion Upper airway stimulation is an effective and safe treatment for obstructive sleep apnea in patients with continuous positive airway pressure (CPAP) failure or intolerance. However, it is possible that the existing in and exclusion criteria for UAS therapy in the Netherlands have positively influenced our results.

Rev. bras. cir. cardiovasc ; 38(1): 110-123, Jan.-Feb. 2023. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1423076


ABSTRACT Introduction: According to the American Heart Association guideline for coronary artery bypass grafting (CABG), female patients undergoing on-pump CABG (ONCAB) are at higher risk of short-term adverse outcomes than male patients. However, whether off-pump CABG (OPCAB) can improve the short-term outcome of female patients compared to ONCAB remains unclear. Methods: We conducted a meta-analysis to study the effect of the female sex on short-term outcomes of OPCAB vs. ONCAB. A total of 31,115 patients were enrolled in 12 studies, including 20,245 females who underwent ONCAB and 10,910 females who underwent OPCAB. Results: The in-hospital mortality in female patients who underwent OPCAB was significantly lower than in those in the ONCAB group with (2.7% vs. 3.4%; odds ratio [OR] 0.76; 95% confidence interval [CI] 0.65-0.89) and without (OR 0.68; 95% CI 0.52-0.89) adjustment for cardiovascular risk factor. The incidence of postoperative stroke in female patients who underwent OPCAB was lower than in those in the ONCAB group (1.2% vs. 2.1%; OR 0.59; 95% CI 0.48-0.73) before cardiovascular risk factor adjustment but was not significant (OR 0.87; 95% CI 0,66-1.16) after adjustment. There was no significant difference in the incidence of postoperative myocardial infarction between women who underwent OPCAB and those in the ONCAB group (1.3% vs. 2.3%; OR 0.88; 95% CI 0.54-1.43). Conclusion: In contrast to the American Heart Association CABG guideline, female patients who had OPCAB don't have unfavorable outcomes compared with the ONCAB group.

Rev. bras. cir. cardiovasc ; 38(1): 183-190, Jan.-Feb. 2023. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1423080


ABSTRACT Introduction: Acute type A aortic dissection (AAAD) in late pregnancy is a rare but severe disease. Lack of clinical experience is the main cause of high mortality. This study tries to investigate the multidisciplinary therapeutic strategy for these patients. Case presentation: We reported three patients with AAAD in late pregnancy. Sudden chest pain was the main clinical symptom before operation. All three patients and their newborns survived through multidisciplinary approach in diagnosis and treatment. No serious complications occurred during the mid-term follow-up. Conclusion: Multidisciplinary diagnosis and treatment strategy play a crucial role in saving the lives of pregnant women with AAAD.

Rev. bras. ortop ; 58(1): 42-47, Jan.-Feb. 2023. tab, graf
Article in English | LILACS | ID: biblio-1441348


Abstract Objective To compare the clinical results between conservative (CS) and surgical treatment (CXS) of A3 and A4 fractures without neurological deficit. Methods Prospective observational study of patients with thoracolumbar fractures type A3 and A4. These patients were separated between the surgical and conservative groups, and evaluated sequentially through the numeric rating scale (NRS), Roland-Morris disability questionnaire (RMDQ), EuroQol-5D (EQ-5D) quality of life questionnaire, and Denis work scale (DWS) up to 2.5 years of follow-up. Results Both groups showed significant improvement, with no statistical difference in pain questionnaires (NRS: CXS 2.4 ± 2.6; CS 3.5 ± 2.6; p> 0.05), functionality (RMDQ: CS 7 ± 6.4; CXS 5.5 ± 5.2; p> 0.05), quality of life (EQ-5D), and return to work (DWS). Conclusion Both treatments are viable options with equivalent clinical results. There is a tendency toward better results in the surgical treatment of A4 fractures.

Resumo Objetivo Comparar os resultados clínicos entre os tratamentos conservador (CS) e cirúrgico (CXS) das fraturas A3 e A4 sem déficit neurológico. Métodos Estudo prospectivo observacional de paciente com fraturas toracolombares tipo A3 e A4. Esses pacientes foram separados entre os grupos cirúrgico e conservador e avaliados sequencialmente através da escala numérica de dor (NRS), do questionário de incapacidade de Roland-Morris (RMDQ), do EuroQol-5D (EQ-5D) e da escala de trabalho de Denis (DWS) até 2,5 anos de acompanhamento. Resultados Ambos os grupos apresentaram melhora significante, sem diferença estatística nos questionários de dor (NRS: CXS 2,4 ± 2,6; CS 3,5 ± 2,6; p> 0,05), funcionalidade (RMDQ: CS 7 ± 6,4; CXS 5,5 ± 5,2; p> 0,05), qualidade de vida (EQ-5D) e retorno ao trabalho (DWS). Conclusão Ambos os tratamentos são opções viáveis e com resultados clínicos equivalentes. Há uma tendência a melhores resultados no tratamento cirúrgico das fraturas A4.

Humans , Spinal Fractures/surgery , Treatment Outcome , Conservative Treatment , Fracture Fixation, Internal
Horiz. meÌud. (Impresa) ; 23(1)ene. 2023.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1430483


El asma es una enfermedad inflamatoria crónica de las vías respiratorias que acarrea elevados costos en salud, afecta sustancialmente la calidad de vida y, dependiendo de ciertos factores de riesgo asociados, disminuye la capacidad funcional de quien lo padece. Para el 2019, el asma afectó a 262 millones de personas (4,3 % de la población mundial) y causó 461 000 muertes. Se estima que habrá 100 millones de personas adicionales con asma para el año 2025. El asma severa es un fenotipo resistente a corticoides que ocasiona mayor número de exacerbaciones, afecta sustancialmente la calidad de vida y capacidad funcional del afectado. Su manejo inicialmente se encamina a suprimir los síntomas, y este ha ido evolucionando hasta la comprensión, aún no completa, de los sistemas intrínsecos de su generación, con lo cual se han estudiado nuevas formas de incidir en su manejo, mediante la modulación de la respuesta inmune y la cascada inflamatoria, con la generación de medicamentos biológicos. A raíz del estudio e identificación de endotipos y fenotipos variados, se han diseñado este tipo de medicamentos, con distintos mecanismos de acción, que han demostrado una utilidad sólida en los últimos años. No obstante, existe evidencia de que se ha encontrado resistencia incluso a estos medicamentos, por lo que ha sido necesario seguir investigando nuevas dianas terapéuticas. El astegolimab es un novedoso anticuerpo monoclonal Ig G2 humano que bloquea la señalización de IL-33 al dirigirse a ST2, su receptor, por consiguiente, controla la respuesta inflamatoria en el asma severa. Actualmente, se encuentra en realización de ensayo clínico fase 2b, aunque experimentaciones previas han encontrado resultados positivos y significativos respecto a la inmunomodulación, función pulmonar, sintomatología y calidad de vida. En la actualidad, casi no existe literatura que haya analizado el potencial del astegolimab en el asma grave, y están disponibles prácticamente solo los ensayos que lo han evaluado y algunas revisiones que han compartido su farmacocinética y farmacodinamia. Sobre la base de lo anterior, el objetivo de esta revisión consiste en sintetizar evidencia relacionada con los resultados del uso del astegolimab en asma severa, discutiendo aspectos epidemiológicos y fisiopatológicos que resalten la necesidad del desarrollo de un fármaco seguro, eficaz y eficiente.

Asthma is a chronic inflammatory disease of the respiratory tract which causes high health costs, substantially affects the quality of life and, depending on certain associated risk factors, reduces the functional capacity of the sufferer. By 2019, asthma affected 262 million people (4.3 % of the world's population) and caused 461,000 deaths. It is estimated that there will be an additional 100 million people with asthma by 2025. Severe asthma is a phenotype resistant to corticosteroids which causes a greater number of exacerbations and substantially affects the quality of life and functional capacity of the affected person. Its management was initially aimed at suppressing the symptoms and then evolved to understand, although not completely, the intrinsic systems of its generation. Thus, new ways of influencing its management have been studied by modulating the immune response and the inflammatory cascade with the generation of biological drugs. As a result of the study and identification of various endotypes and phenotypes, drugs with different mechanisms of action have been designed and have demonstrated to be considerably useful in recent years. However, there is evidence that resistance even to these drugs has occurred, being necessary to continue researching new therapeutic targets. Astegolimab is a novel human IgG2 monoclonal antibody that blocks IL-33 signaling by targeting ST2, its receptor, thus controlling the inflammatory response in severe asthma. A phase 2b clinical trial is currently undergoing, although previous results have found positive and significant results regarding immunomodulation, pulmonary function, symptomatology and quality of life. At present, there is almost no literature that has analyzed the potential of astegolimab in severe asthma, and practically only trials that have evaluated it and some reviews that have shared its pharmacokinetics and pharmacodynamics are available. Based on the above, the aim of this review is to synthesize evidence related to the results of the use of astegolimab in severe asthma and discuss epidemiological and pathophysiological aspects that highlight the need for the development of a safe, effective and efficient drug.

Rev. bras. med. esporte ; 29: e2022_0492, 2023. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1423343


ABSTRACT Introduction: Total internal arthroscopic anterior cruciate ligament reconstruction is one of the new technologies in recent years. The main advantage is the need for only one tendon for the surgical procedure. Objective: Compare the clinical effects of total internal and traditional anterior cruciate ligament reconstruction techniques. Methods: From January 2019 to January 2022, the clinical data of 45 patients with anterior cruciate ligament reconstruction were retrospectively analyzed, including 32 males and 13 females aged 18-33 years, mean of 24.2 ± 3.3 years. Total internal reconstruction was performed in 22 cases (total internal group) and traditional reconstruction in 23 cases (traditional group). The two groups recorded and compared the time of injury, duration of surgical procedure, postoperative VAS score, and recovery of knee function. The International Knee Literature Committee (IKDC) and the Lysholm scoring system were used to evaluate clinical efficacy. Results: 45 patients were followed for 14 to 18 months, mean (15.4 ± 1.3) months. There were no significant differences between the two groups in time between operation and injury, duration of operation, IKDC, and Lysholm score of the affected knee at the last follow-up. However, there were significant differences in the VAS score on day one, day three, day seven, two weeks, and one month after the operation (P < 0.05), with no significant difference at three months, six months, and one year after the operation. Conclusion: The effect of total internal reconstruction of the anterior cruciate ligament is equivalent to that of traditional methods, with less postoperative pain, making it the ideal choice for this treatment. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: A reconstrução artroscópica interna total do ligamento cruzado anterior é uma das novas tecnologias dos últimos anos. A principal vantagem é a necessidade de apenas um tendão para o procedimento cirúrgico. Objetivo: Comparar os efeitos clínicos da técnica interna total e da técnica tradicional na reconstrução do ligamento cruzado anterior. Métodos: Entre janeiro de 2019 a janeiro de 2022, os dados clínicos de 45 pacientes com reconstrução do ligamento cruzado anterior foram analisados retrospectivamente, incluindo 32 homens e 13 mulheres, com idades entre 18-33 anos, média de 24,2 ± 3,3 anos. A reconstrução interna total foi realizada em 22 casos (grupo interno total) e a reconstrução tradicional em 23 casos (grupo tradicional). O tempo da lesão, duração do procedimento cirúrgico, escore de VAS pós-operatório e recuperação da função do joelho dos dois grupos foram registrados e comparados. O Comitê Internacional de Literatura de Joelho (IKDC) e o sistema de pontuação de Lysholm foram utilizados para avaliar a eficácia clínica. Resultados: 45 pacientes foram acompanhados durante 14 a 18 meses, média de (15,4 ± 1,3) meses. Não houve diferença significativa entre os dois grupos no tempo entre a operação e a lesão, a duração da operação, a pontuação do IKDC e Lysholm do joelho afetado no último acompanhamento. Porém, houveram diferenças significativas na pontuação do VAS no primeiro dia, terceiro dia, sétimo dia, duas semanas e um mês após a operação (P < 0,05), sem diferença significativa em três meses, seis meses e um ano após a operação. Conclusão: O efeito da reconstrução interna total do ligamento cruzado anterior é equivalente ao dos métodos tradicionais, com menor dor pós-operatória, sendo a escolha ideal para esse tratamento. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: La reconstrucción artroscópica interna total del ligamento cruzado anterior es una de las nuevas tecnologías de los últimos años. La principal ventaja es la necesidad de un solo tendón para el procedimiento quirúrgico. Objetivo: Comparar los efectos clínicos de la técnica interna total y la técnica tradicional en la reconstrucción del ligamento cruzado anterior. Métodos: Desde enero de 2019 hasta enero de 2022, se analizaron retrospectivamente los datos clínicos de 45 pacientes con reconstrucción del ligamento cruzado anterior, incluidos 32 hombres y 13 mujeres, de entre 18 y 33 años, con una media de 24,2 ± 3,3 años. Se realizó una reconstrucción interna total en 22 casos (grupo interno total) y una reconstrucción tradicional en 23 casos (grupo tradicional). Se registraron y compararon el momento de la lesión, la duración del procedimiento quirúrgico, la puntuación postoperatoria de la VAS y la recuperación de la función de la rodilla de los dos grupos. Se utilizaron el Comité Internacional de Literatura sobre la Rodilla (IKDC) y el sistema de puntuación de Lysholm para evaluar la eficacia clínica. Resultados: 45 pacientes fueron seguidos durante 14 a 18 meses, con una media de (15,4 ± 1,3) meses. No hubo diferencias significativas entre los dos grupos en cuanto al tiempo transcurrido entre la operación y la lesión, la duración de la operación, la puntuación IKDC y Lysholm de la rodilla afectada en el último seguimiento. Sin embargo, hubo diferencias significativas en la puntuación de la VAS al primer día, al tercer día, al séptimo día, a las dos semanas y al mes después de la operación (p < 0,05), sin que hubiera diferencias significativas a los tres meses, a los seis meses y al año después de la operación. Conclusión: El efecto de la reconstrucción interna total del ligamento cruzado anterior es equivalente al de los métodos tradicionales, con menos dolor postoperatorio, lo que la convierte en la opción ideal para este tratamiento. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Hepatología ; 4(1): 25-36, 2023. tab, fig
Article in Spanish | LILACS, COLNAL | ID: biblio-1415973


Introducción. La cirrosis constituye la etapa final de la enfermedad hepática crónica, con una alta mortalidad, y puede deberse a diferentes etiologías. La albúmina tiene tres indicaciones bien establecidas: la prevención de la disfunción circulatoria inducida por paracentesis, la peritonitis bacteriana espontánea y el síndrome hepatorrenal, sin embargo, su uso a largo plazo es controvertido. El objetivo de esta revisión fue identificar si el uso prolongado de la albúmina tiene efectos beneficiosos en el tratamiento de pacientes cirróticos. Metodología. Se realizaron búsquedas en la base de datos de PubMed, empleando los siguientes términos: ("Liver Cirrhosis"[Mesh]) AND ("Serum Albumin"[Mesh] OR "Serum Albumin, Human"[Mesh]). Se excluyeron los artículos que no cumplieron con la temática y aquellos que tenían más de 5 años de antigüedad, a excepción de aquellos relevantes para la revisión. Resultados. Se ha demos-trado en varios estudios realizados en los últimos 4 años, que la administración prolongada de albúmina reduce la mortalidad en el paciente cirrótico. Además, resulta en una disminución en ingresos hospitalarios por complicaciones de la cirrosis, disminución de la necesidad de para-centesis y menor uso de albúmina para otras indicaciones ya establecidas, lo que contrarresta los costos derivados de la terapia. Conclusión. Se concluye con base en la evidencia presenta-da, que el uso de albúmina a largo plazo podría resultar beneficioso en pacientes con cirrosis hepática descompensada. No obstante, es necesario abordar otros aspectos de la terapia en estudios posteriores

Introduction. Cirrhosis is the final stage of chronic liver disease, has a high mortality and can be due to different etiologies. Albumin has three well-established indications: prevention of circulatorydysfunction induced by paracentesis, spontaneous bacterial peritonitis, and hepatorenal syndrome, however, its long-term use is controversial. The objective of this review was to identify if the prolonged use of albumin has beneficial effects in the treatment of cirrhotic patients. Methodology. PubMed database was searched using the following terms: ("Liver Cirrhosis"[Mesh]) AND ("Serum Albumin"[Mesh] OR "Serum Albumin, Human"[Mesh]). Articles that did not meet the topic and those that were more than 5 years old were excluded, except for those relevant to the review. Results.It has been shown in several studies within the previous 4 years, that prolonged administration of albumin reduces mortality in cirrhotic patients. In addition, it results in a decrease in hospital ad-missions due to complications of cirrhosis, a decrease in the need for paracentesis and less use of albumin for other established indications, which offsets the costs derived from therapy. Conclusion. It is concluded based on the evidence presented, that the long-term use of albumin could be beneficial in patients with decompensated liver cirrhosis. However, other aspects of the therapy need to be addressed in further studies

Humans , Serum Albumin , Serum Albumin, Human , Liver Cirrhosis , Liver Diseases , Fibrosis
Article in Portuguese | LILACS, CONASS, ColecionaSUS, SES-GO | ID: biblio-1428092


Tecnologia: Insulinas análogas de liberação prolongada versus insulina NPH (protamina neutra de Hagedorn). Indicação: Tratamento de adultos com diabetes mellitus tipo 2. Pergunta: Há diferenças de efeito nos principais desfechos de eficácia e segurança entre insulinas análogas de liberação prolongada versus insulina NPH no tratamento de pacientes com DM2? 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 (Assessing the Methodological Quality of Systematic Reviews). Resultados: Foi selecionada e incluída uma revisão sistemática. Conclusão: As insulinas análogas (glargina e detemir) não demonstraram superioridade nos desfechos de eficácia e segurança quando comparadas à insulina NPH, não demonstraram redução significativa em relação à mortalidade por todas as causas e complicações secundárias ao DM2. Quando comparadas à insulina NPH, foi observado redução na hipoglicemia confirmada e hipoglicemia noturna a favor das insulinas análogas e na hipoglicemia grave a favor da insulina detemir

Technology: Long-acting insulin analogues versus NPH insulin (human isophane insulin). Indication: Treatment of adults with type 2 diabetes mellitus. Question: Are there effect differences in key efficacy and safety outcomes between long-acting insulin analogues versus NPH insulin in the treatment of DM2 patients? Methods: Rapid review of evidence (overview) of systematic reviews, with a bibliographic survey carried out in the PUBMED database, using a structured search strategy. The methodological quality of systematic reviews was assessed with AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews). Results: A systematic review was selected and included. Conclusion: Analog insulins (glargine and detemir) did not demonstrate superiority in efficacy and safety outcomes when compared to NPH insulin, did not demonstrate a significant reduction in all-cause mortality and complications secondary to DM2. When compared to NPH insulin, a reduction in confirmed hypoglycemia and nocturnal hypoglycemia in favor of analogue insulins and in severe hypoglycemia in favor of insulin detemir was observed

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Diabetes Mellitus, Type 2/drug therapy , Insulin Detemir/therapeutic use , Insulin Glargine/therapeutic use , Insulin, Isophane/therapeutic use , Comparative Effectiveness Research , Hypoglycemia/complications
Arq. neuropsiquiatr ; 81(2): 173-185, 2023. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1439435


Abstract Background Implementing stroke care protocols has intended to provide better care quality, favor early functional recovery, and achieving long-term results for the rehabilitation of the patient. Objective To analyze the effect of implementing care protocols on the outcomes of acute ischemic stroke. Methods Primary studies published from 2011 to 2020 and which met the following criteria were included: population should be people with acute ischemic stroke; studies should present results on the outcomes of using protocols in the therapeutic approach to acute ischemic stroke. The bibliographic search was carried out in June 2020 in 7 databases. The article selection was conducted by two independent reviewers and the results were narratively synthesized. Results A total of 11,226 publications were retrieved in the databases, of which 30 were included in the study. After implementing the protocol, 70.8% of the publications found an increase in the rate of performing reperfusion therapy, such as thrombolysis and thrombectomy; 45.5% identified an improvement in the clinical prognosis of the patient; and 25.0% of the studies identified a decrease in the length of hospital stay. Out of 19 studies that addressed the rate of symptomatic intracranial hemorrhage, 2 (10.5%) identified a decrease. A decrease in mortality was mentioned in 3 (25.0%) articles out of 12 that evaluated this outcome. Conclusions We have identified the importance of implementing protocols in increasing the performance of reperfusion therapies, and a good functional outcome with improved prognosis after discharge. However, there is still a need to invest in reducing post-thrombolysis complications and mortality.

Resumo Antecedentes A implementação de protocolos de acidente vascular cerebral (AVC) visa proporcionar uma melhor qualidade da assistência, favorecer a recuperação funcional precoce e alcançar resultados para a reabilitação do paciente. Objetivo Analisar o efeito da implantação de protocolos nos desfechos do AVC isquêmico agudo. Métodos Foram incluídos estudos primários publicados entre 2011 e 2020 e que atendiam aos seguintes critérios: população deveria ser constituída de pessoas com AVC isquêmico agudo; apresentar resultados sobre os desfechos do uso de protocolos na abordagem terapêutica ao AVC isquêmico agudo. A busca bibliográfica foi realizada em junho de 2020 em 7 bases de dados. A seleção dos artigos foi feita por dois revisores independentes e a síntese dos resultados foi feita de forma narrativa. Resultados Foram recuperadas 11.226 publicações, das quais 30 foram incluídas no estudo. Após a implementação do protocolo, 70,8% das publicações constataram aumento na taxa de realização de terapia de reperfusão, como a trombólise e a trombectomia; 45,5% identificaram melhora no prognóstico clínico do paciente; e 25,0% dos estudos identificaram diminuição no tempo de internação hospitalar. De 19 estudos que abordaram a taxa de hemorragia intracraniana sintomática, 2 (10,5%) identificaram diminuição nesta taxa. A diminuição da mortalidade foi citada em 3 (25,0%) artigos de 12 que avaliaram tal desfecho. Conclusões Identificou-se a importância da implantação de protocolos no aumento da realização das terapias de reperfusão, e ao bom desfecho funcional com melhora do prognóstico após a alta. No entanto, ainda há que se investir na diminuição das complicações pós trombólise e da mortalidade.

Estud. Psicol. (Campinas, Online) ; 40: e210170, 2023. tab, graf
Article in Portuguese | LILACS-Express | LILACS, INDEXPSI | ID: biblio-1440114


Resumo Objetivo Entre as diretrizes do Ministério da Saúde para controle do tabagismo está o Programa de Cessação do Tabagismo, desenvolvido pelo Instituto Nacional do Câncer. Esta revisão objetiva descrever as pesquisas que aplicaram o Programa de Cessação do Tabagismo, analisando seus procedimentos, efeitos, potencialidades e limitadores. Método Foram avaliados artigos das bases PubMed, PsycINFO, Biblioteca Virtual da Saúde e Biblioteca Eletrônica Científica Online publicados entre 2002 e 2019 e encontrados através de busca que usou os descritores: "Programa Nacional de Controle do Tabagismo" e "cessação do tabagismo" em português, espanhol e inglês. Foram pré-selecionados 1670 artigos, dos quais 15 foram elegíveis para análise final. Resultados Os resultados mostraram taxas de adesão ao tratamento de 33% a 100%, taxas de sucesso de 15% a 85% após a intervenção e de 21% a 51% seis meses após o final do tratamento. Essa variabilidade pode estar relacionada à falta de padronização e baixa fidelidade na aplicação do Programa, que propõe tratar as dependências física, psicológica e comportamental. Conclusão Recomenda-se investimento em capacitação técnica e monitoramento dos registros.

Abstract Objective Brazil Health Ministry's guidelines for tobacco control include the Smoking Cessation Program, developed by the Instituto Nacional de Câncer of Brazil. This review aims to describe the studies in which this Program has been applied, reviewing its procedures, effects, potential and limitations. Method Articles from PubMed, PsycINFO, Virtual Health Library and Scientific Electronic Library Online, published between 2002 and 2019, were evaluated, using the descriptors "Smoking Cessation Program" and "smoking cessation" in Portuguese, Spanish and English. A total of 1670 articles were pre-selected, of which 15 resulted eligible for final assessment. Results The results showed adherence rates from 33% to 100%, success rates from 15% to 85% after the intervention and 21% to 51% six months after treatment completion. This variability may be related to the lack of standardization and poor fidelity in the application of the Program, which intends to treat physical, psychological and behavioral dependence. Conclusion Investment in technical training and record monitoring is suggested.

Rev. bras. cir. cardiovasc ; 38(3): 360-366, 2023. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1441212


ABSTRACT Introduction: The objective of this study was to develop a radiofrequency ablation technique to create a homogeneous scar tissue in the atrial myocardium. Methods: In the double-blinded morphological stage of the study, the left atrial appendage was used as an anatomical model to investigate the efficacy of one experimental and two conventional techniques to create ablation lines. Then, these lines were studied by morphologists. The clinical stage involved investigation of the outcomes of the developed technique for creation of ablation lines. During thoracoscopic radiofrequency fragmentation of the left atrium, all ablation lines were created using the experimental radiofrequency technique. Results: In all histological sections of ablation lines created using the criterion of "steady decrease in the time to transmurality", there were no intact (viable) cells, in contrast to the other two conventional methods, i.e., a homogeneous scar of the atrial wall. Investigation of clinical efficacy of this developed technique revealed recurrent atrial fibrillation only in six of 137 patients (4.4%) at median follow-up time of 36 (10; 58) months. None of the patients developed specific complications (wall perforation or bleeding). According to intracardiac mapping performed after the end of the blind period, the sources of atrial fibrillation in these six patients were outside the radiofrequency ablation zone (perimitral or in the right atrium). Conclusion: A steady decrease in the time to transmurality should be considered as the priority intraoperative criterion for the formation of a homogeneous scar during radiofrequency ablation of the left atrium wall using a bipolar ablation clamp.

Rev. bras. cir. cardiovasc ; 38(3): 381-388, 2023. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1441215


ABSTRACT Introduction: The objective of this study is to investigate the possible impact of coronary artery disease (CAD) on clinical outcomes of catheter ablation in patients with atrial fibrillation (AF). Methods: Patients with AF who underwent coronary computed tomography and catheter ablation were enrolled. The presence of stenotic severity and plaque, characteristics of coronary arteries, clinical data, and adverse outcomes of catheter ablation were analysed. Results: A total of 243 patients were enrolled, 100 (41%) patients with CAD. The CHA2DS2-VASc (congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65-74 years, and sex category) score of AF patients with CAD was significantly (P<0.001) higher than of those without CAD. Presence of stenotic artery and plaques increased significantly with increase of CHA2DS2-VASc score (P<0.05). There was no significant (P=0.342) difference in AF recurrence between patients with and without CAD (30% versus 24%). Age, AF type, duration of AF, heart failure, CHA2DS2-VASc score, left ventricular ejection fraction, and left atrial diameter were significantly (P<0.05) correlated with AF recurrence in univariant analysis. Multivariable analysis revealed that duration of AF (hazard ratio [HR] 1.769), heart failure (HR 1.821), and left atrial diameter (HR 1.487, P=0.022) remained significant independent predictors of AF recurrence. Patients with AF and concomitant CAD were significantly (P=0.030) associated with a worse outcome. Conclusion: CAD concomitant with AF may be associated with a worse clinical outcome even though CAD does not significantly affect the risk of AF recurrence after ablation therapy.

Rev. bras. oftalmol ; 82: e0019, 2023. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1441322


ABSTRACT Objective To analyze the short, medium and long-term efficacy and stability in 46 eyes with keratoconus, operated with Ferrara intrastromal corneal ring segments. Methods The primary endpoint was the mean keratometry of total corneal refractive power. We also studied the effects of age, degree of keratoconus and clinical phenotype on the results, as well as the following keratometry variations and aberrometry variations: flattest, most curved, mean, maximum, astigmatism, root mean square of primary coma aberration and root mean square of secondary coma aberration. Results The immediate postoperative reduction in mean keratometry of total corneal refractive power was 3.08±1.51 diopters (D) (p<0.001). At 4 years, the mean keratometry of total corneal refractive power increased to 0.57±0.96D (p=0.005). Between 4 and 7 years, there was no change in mean keratometry of total corneal refractive power (p=0.727). The degree of keratoconus was a factor affecting the efficacy of the intrastromal corneal ring segments, achieving a greater effect in those with a greater degree of keratoconus (p=0.012 between groups). The immediate postoperative reduction was 1.77±1.88D for the flattest, 3.91±2.30D for the most curved, 2.76±1.63D for the mean, 4.42±3.26D for the maximum, 2.15±2.68D for astigmatism, 1.03±0.83µm for root mean square of primary coma aberration and root mean square of secondary coma aberration (p<.001 in all cases). At 4 years, most curved increased by 0.42±0.78D (p=0.001), mean increased by 0.54±0.64 (p<0.001) and root mean square of primary coma aberration decreased 0.14±0.27µm (p=0.020). Conclusion Ferrara intrastromal corneal ring segment implantation is an effective and stable long-term treatment for patients with keratoconus. There is, however, partial regression in the medium term.

RESUMO Objetivo Analisar a eficácia e a estabilidade a curto, médio e longo prazo em 46 olhos com ceratocone, operados com segmentos de anel intrastromal corneano de Ferrara. Métodos A meta primária foi a ceratometria média de poder refrativo total da córnea. Também estudamos os efeitos da idade, grau de ceratocone e fenótipo clínico nos resultados, bem como as seguintes variações de ceratometria e variações de aberrometria: mais plana, mais curva, média, máxima, astigmatismo, raiz quadrada média da aberração comática primária e raiz quadrada média da aberração comática secundária. Resultados A redução pós-operatória imediata da ceratometria média do poder refrativo total da córnea foi de 3,08±1,51 dioptrias (D) (p<0,001). Aos 4 anos, a ceratometria média do poder refrativo total da córnea aumentou para 0,57±0,96D (p=0,005). Entre 4 e 7 anos, não houve mudança na ceratometria média da potência refrativa total da córnea (p=0,727). O grau de ceratocone foi um fator que afetou a eficácia dos segmentos do anel intrastromal da córnea, alcançando um efeito maior naqueles com maior grau de ceratocone (p=0,012 entre grupos). A redução pós-operatória imediata foi de 1,77±1,88D para a mais plana, 3,91±2,30D para a mais curva, 2,76±1,63D para a média, 4,42±3,26D para a máxima, 2,15±2,68D para o astigmatismo, 1,03±0,83µm para a raiz quadrada média da aberração comática primária e raiz quadrada média da aberração comática secundária (p<0,001 em todos os casos). Aos 4 anos, a maioria das curvas aumentou 0,42±0,78D (p=0,001), a média aumentou 0,54±0,64 (p<0,001) e a raiz quadrada média da aberração comática primária diminuiu 0,14±0,27µm (p=0,020). Conclusão O implante de anel intrastromal corneano Ferrara é um tratamento eficaz e estável a longo prazo para pacientes com ceratocone. Há, no entanto, uma regressão parcial a médio prazo.

Arq. bras. cardiol ; 120(3): e20220431, 2023. tab, graf
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1429790


Resumo Fundamento Estudos anteriores revelaram alto risco de eventos tromboembólicos arteriais e venosos como consequência de danos virais diretos do SARS-CoV-2 em células endoteliais e um meio procoagulante devido ao aumento de biomarcadores como o D-dímero, fibrinogênio, fator VIII. Foram realizados ensaios controlados randomizados de terapias antitrombóticas em pacientes internados, no entanto, poucos estudos avaliaram o papel da tromboprofilaxia no ambiente ambulatorial. Objetivo Avaliar se a profilaxia antitrombótica com rivaroxabana reduz o risco de eventos trombóticos venosos ou arteriais, suporte ventilatório invasivo e morte em pacientes ambulatoriais com COVID-19. Métodos O estudo CARE é um ensaio randomizado, aberto, multicêntrico e controlado por rivaroxabana 10 mg uma vez por dia durante 14 dias ou tratamento local padrão isolado, para a prevenção de resultados adversos, registrado no (NCT04757857). Os critérios de inclusão são adultos com infecção confirmada ou suspeita do SARS-CoV-2, com sintomas leves ou moderados, sem indicação de hospitalização, no prazo de 7 dias após o início dos sintomas e um fator de risco de complicação da COVID-19 (>65 anos, hipertensão, diabetes, asma, doença pulmonar obstrutiva crônica ou outras doenças pulmonares crônicas, tabagismo, imunossupressão ou obesidade). O desfecho primário composto inclui tromboembolismo venoso, necessidade de ventilação mecânica invasiva, eventos cardiovasculares agudos maiores e mortalidade no prazo de 30 dias após a randomização, sendo avaliado segundo o princípio da intenção de tratar. Todos os pacientes assinaram termo de consentimento. Foi estabelecido um nível de significância de 5% para todos os testes estatísticos. Resultados Os principais desfechos trombóticos e hemorrágicos, hospitalizações e mortes serão avaliados centralmente por um comitê de eventos clínicos independente, sob a condição cega para a alocação dos grupos de tratamento. Conclusão O estudo CARE fornecerá informação relevante e contemporânea sobre o possível papel da tromboprofilaxia em pacientes ambulatoriais com COVID-19.

Abstract Background Previous studies have demonstrated a high risk of arterial and venous thromboembolic events as a consequence of direct viral damage to endothelial cells by SARS-CoV-2 and a procoagulant milieu due to increased biomarkers, such as D-dimer, fibrinogen, and factor VIII. Although randomized controlled trials of antithrombotic therapies have been conducted in hospitalized patients, few have evaluated the role of thromboprophylaxis in an outpatient setting. Objective To assess whether antithrombotic prophylaxis with rivaroxaban reduces the risk of venous or arterial thrombotic events, invasive ventilatory support, and death in COVID-19 outpatients. Methods The COVID Antithrombotic Rivaroxaban Evaluation (CARE) study, a multicenter, randomized, open-label, controlled trial of rivaroxaban 10 mg once daily for 14 days or local standard treatment alone to prevent adverse outcomes, is registered in (NCT04757857). The inclusion criteria are adults with confirmed or suspected SARS-CoV-2 infection and mild or moderate symptoms without indication for hospitalization, within 7 days of symptom onset, and 1 risk factor for COVID-19 complication (> 65 years, hypertension, diabetes mellitus, asthma, chronic obstructive pulmonary disease or other chronic lung diseases, smoking, immunosuppression, or obesity). The primary composite endpoint, which includes venous thromboembolism, invasive mechanical ventilation, major acute cardiovascular events, and mortality within 30 days of randomization, will be assessed according to the intention-to-treat principle. All patients will provide informed consent. A significance level of 5% will be used for all statistical tests. Results Major thrombotic and bleeding outcomes, hospitalizations, and deaths will be centrally adjudicated by an independent clinical events committee blinded to the assigned treatment groups. Conclusion The CARE study will provide relevant and contemporary information about the potential role of thromboprophylaxis in outpatients with COVID-19.

Rev. bras. cir. cardiovasc ; 38(5): e20210333, 2023. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1449566


ABSTRACT Introduction: This study was aimed to evaluate the sex-based differences in baseline characteristics and one-year outcomes of men and women undergoing mitral valve repair for infective endocarditis. Methods: This cross-sectional study was performed at Imam Ali Hospital affiliated with the Kermanshah University of Medical Science. From March 21, 2014, to October 21, 2021, all patients who underwent mitral valve repair for infective endocarditis were enrolled in this study. Data were obtained using a checklist developed based on the study's objectives. Independent samples t-tests, paired samples t-tests, and chi-squared test (or Fisher's exact test) were used to assess the differences between subgroups. Results: Of 75 patients, 26 were women (34.7%) and 49 were men (65.3%). Women were more likely to have diabetes mellitus (20.4% vs. 57.7%, P=0.0001), hypertension (49% vs. 80.8%, P=0.007), and hypercholesterolemia (55.1% vs. 80.8%, P=0.027). Conversely, men were more likely to have a history of smoking (38.8% vs. 7.7%, P=0.004). After one year, women had significantly higher mortality (0% vs. 7.7%, P=0.049), major adverse cardiac and cerebrovascular events (51.0 vs. 76.9, P=0.029), mitral valve reoperation (8.1% vs. 34.6%, P=0.003), and treatment failure (30.6% vs. 61.5%, P=0.009) rates than men. Conclusion: Mortality, major adverse cardiac and cerebrovascular events, mitral valve reoperation, and treatment failure rates were higher in women than in men. The worse outcomes in women may be explained by their more adverse clinical risk profile.

Rev. bras. cir. cardiovasc ; 38(5): e20220026, 2023. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1449569


ABSTRACT Introduction: The coronary artery bypass grafting (CABG) data provided by the Brazilian Registry of Cardiovascular Surgeries in Adults (BYPASS) Registry is a Brazilian reality. Objective: To carry out a comparative exercise between the BYPASS Registry published data and data from patients operated on in a randomly chosen period (2013-2015) at Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP). Methods: This is a retrospective study reviewing 173 electronic medical records of CABG patients from the HCFMRP-USP. These data were compared with the BYPASS Registry published data. Chi-square test was used to verify the changes within the prevalence of adequate/inadequate biochemical tests before and after surgery. The sample was divided into groups consistent with cardiopulmonary bypass (CPB) time (CPB ≤ 120 minutes and CPB > 120 minutes). For the complications, prevalence by the chi-square test was adopted. Significant P-values are < 0.05. Results: The comparative operative data of the BYPASS Registry and the HCFMRP-USP patients were quite similar, except for the isolate use of only arterial grafts, which was more frequent on HCFMRP-USP patients (30.8% vs. 15.9%), and the use of radial artery, also more frequent on HCFMRP-USP patients (48.8% vs. 1.1%) Conclusion: The comparative study suggested that the BYPASS Registry should be a reference for CABG quality control.

Article in Spanish | LILACS, UY-BNMED, BNUY | ID: biblio-1429605


Introducción: A pesar de su baja incidencia, las infecciones osteoarticulares pueden generar complicaciones y secuelas devastadoras para el niño en desarrollo con su esqueleto en crecimiento. El manejo general de la patología debe ser multidisciplinario, asociando la terapia antibiótica y un tratamiento quirúrgico adecuado si se requiere. El objetivo de nuestro trabajo es analizar los resultados sobre las diferentes opciones terapéuticas quirúrgicas (punción-aspiración, lavado artroscópico o lavado abierto) en el tratamiento de la artritis séptica en la edad, mediante la realización de revisión sistematizada de la bibliografía. Metodología: Realizamos una búsqueda bibliográfica online en los buscador PubMed y en la Biblioteca Virtual en Salud (BVS) utilizando los siguientes términos MESH: ("Arthritis, Infectious/surgery"(Mesh) OR "Arthritis, Infectious/therapy"(Mesh)), utilizando filtros de búsqueda y aplicando criterios de inclusión y exclusión según nuestro objetivo. De los artículos incluidos se obtuvieron entre otros los siguiente datos: país, año, nivel de evidencia, número de pacientes con artritis séptica, articulación afectada, edad media, seguimiento promedio, tipo de tratamiento quirúrgico realizado de inicio y sus resultados según cada autor : complicaciones (de la enfermedad y del procedimiento ) y/o secuelas (en base a evolución clínica y radiológica), necesidad de un tratamiento quirúrgico adicional ante la falla del método terapéutico inicial y además de conclusiones relevantes de cada autor. Resultados: Se incluyeron un total de 22 artículos: 8 para el lavado por artroscopia, 6 para el lavado por artrocentesis, 4 para el lavado por artrotomía, ademas de otros 4 artículos que realizaba un análisis comparativo: dos de ellos entre lavado artroscópico y lavado por artrotomía y los otros dos entre lavado por artrocentesis y lavado abierto. El lavado artroscópico se encuentra en lo más alto de nuestra revisión ya que presenta los mejores resultados con solo un 6% complicaciones y/o secuelas (en solo 4 de los 8 artículos incluidos), con un total de 13 pacientes (8,7% ) que requirieron un tratamiento adicional (5 artrotomías y 8 un nueva lavado artroscópico ) y se destacan ademas 3 artículos con un 100% de buenos resultados, en los que no se presentaron complicaciones y/o secuelas, ni se requirió un segundo lavado, mientras que solo en 3 trabajos, de los 8, se necesitó de la artrotomía adicional para la resolución final. Para el lavado por artrocentesis se obtuvo el menor porcentaje de complicaciones y/o secuelas con un 2%, (reportado en tres de los 6 trabajos), y solo el 9,7% necesitaron de un segundo método terapéutico diferente a la aspiración articular (23 artrotomías y 2 artroscopias), destacando ademas la repetición de la punción (hasta 4 veces) como dentro de la directiva terapéutica del autor en dos artículos, y que para éste método se encontró el mayor número de pacientes. El lavado por artrotomía como método inicial obtuvo los peores resultados, con un 12% de complicaciones y/o secuelas y un 22,6% de lavados adicionales. Conclusiones: A pesar de que el lavado abierto por artrotomía se toma como el ¨ gold-standard ¨, teniendo indicaciones absolutas en el tratamiento quirúrgico de la artritis séptica en niños (especialmente en cadera), de nuestro análisis se desprende que ésta opción arroja los peores porcentajes de resultados, duplicando el porcentaje de necesidad de lavado adicional y el de complicaciones, en comparación con el lavado artroscópico. Existen otros métodos terapéuticos que se presentan como procedimientos menos invasivos, seguros y eficaces, respaldados por buenos resultados en la biografiaría, como son: el lavado por artroscopia (que presentó el porcentaje más bajo de pacientes con necesidad de lavado adicional, con el mayor número de artículos con buenos resultados en general, con un porcentaje de complicaciones por debajo del lavado por artrotomía) y el lavado por artrocentesis (que presentó el porcentaje de compilaciones más bajo de las 3 opciones analizadas.

Introduction: Despite its low incidence, osteoarticular infections can generate devastating complications and sequelae for the developing child with his growing skeleton. The general management of the pathology must be multidisciplinary, associating antibiotic therapy and adequate surgical treatment if required. The objective of our work is to analyze the results on the different surgical therapeutic options (puncture-aspiration, arthroscopic lavage or open lavage) in the treatment of septic arthritis in the pediatric age, by carrying out a systematic review of the bibliography. Methodology: We conducted an online bibliographic search in the PubMed search engine and in the Virtual Health Library (VHL) using the following MESH terms: ("Arthritis, Infectious/surgery"(Mesh) OR "Arthritis, Infectious/therapy"(Mesh)), using search filters and applying inclusion and exclusion criteria according to our objective. The following data were obtained from the included articles, among others: country, year, level of evidence, number of patients with septic arthritis, affected joint, mean age, average follow-up, type of initial surgical treatment and its results according to each author: complications (of the disease and of the procedure) and/or sequelae (based on clinical and radiological evolution), the need for additional surgical treatment in the event of failure of the initial therapeutic method, and in addition to relevant conclusions of each author. Results: A total of 22 articles were included: 8 for arthroscopic lavage, 6 for arthrocentesis lavage, 4 for arthrotomy lavage, in addition to another 4 articles that performed a comparative analysis: two of them between arthroscopic lavage and lavage. by arthrotomy and the other two between lavage by arthrocentesis and open lavage. Arthroscopic lavage is at the top of our review as it presents the best results with only 6% complications and/or sequelae (in only 4 of the 8 articles included), with a total of 13 patients (8.7% ) that required additional treatment (5 arthrotomies and 8 a new arthroscopic lavage) and also highlight 3 articles with 100% good results, in which there were no complications and/or sequelae, nor did a second lavage be required, while that only 3 of the 8 studies required an additional arthrotomy for the final resolution. For lavage by arthrocentesis, the lowest percentage of complications and/or sequelae was obtained with 2% (reported in three of the 6 works), and only 9.7% required a second therapeutic method other than joint aspiration (23 arthrotomies and 2 arthroscopies), also highlighting the repetition of the puncture (up to 4 times) as within the author's therapeutic directive in two articles, and that the largest number of patients was found for this method. Arthrotomy lavage as the initial method obtained the worst results, with 12% complications and/or sequelae and 22.6% additional lavages. Conclusions: Even though open lavage by arthrotomy is taken as the ¨ gold-standard ¨, having absolute indications in the surgical treatment of septic arthritis in children (especially in the hip), from our analysis it can be deduced that this option yields the worse percentages of results, doubling the percentage of need for additional lavage and the percentage of complications, compared to arthroscopic lavage. There are other therapeutic methods that are presented as less invasive, safe and effective procedures, supported by good results in the biography, such as: arthroscopic lavage (which presented the lowest percentage of patients requiring additional lavage, with the highest number of articles with good results in general, with a percentage of complications below lavage by arthrotomy) and lavage by arthrocentesis (which presented the lowest percentage of compilations of the 3 options analyzed).

Introdução: Apesar de sua baixa incidência, as infecções osteoarticulares podem gerar complicações e sequelas devastadoras para a criança em desenvolvimento com seu esqueleto em crescimento. O manejo geral da patologia deve ser multidisciplinar, associando antibioticoterapia e tratamento cirúrgico adequado, se necessário. O objetivo do nosso trabalho é analisar os resultados das diferentes opções terapêuticas cirúrgicas (punção-aspiração, lavagem artroscópica ou lavagem aberta) no tratamento da artrite séptica em idade pediátrica, através da realização de uma revisão sistemática da bibliografia. Metodologia: Foi realizada uma busca bibliográfica online no buscador PubMed e na Biblioteca Virtual em Saúde (BVS) utilizando os seguintes termos MESH: ( "Arthritis, Infectious/surgery"(Mesh) OR "Arthritis, Infectious/therapy"(Mesh) ), utilizando filtros de busca e aplicando critérios de inclusão e exclusão de acordo com nosso objetivo. Os seguintes dados foram obtidos dos artigos incluídos, entre outros: país, ano, nível de evidência, número de pacientes com artrite séptica, articulação afetada, idade média, seguimento médio, tipo de tratamento cirúrgico inicial e seus resultados de acordo com cada autor: complicações (da doença e do procedimento) e/ou sequelas (com base na evolução clínica e radiológica), necessidade de tratamento cirúrgico adicional em caso de falha do método terapêutico inicial e, além das conclusões relevantes de cada autor. Resultados: Foram incluídos 22 artigos: 8 para lavagem artroscópica, 6 para lavagem artrocentese, 4 para lavagem artrotômica, além de outros 4 artigos que realizaram uma análise comparativa: dois deles entre lavagem artroscópica e lavagem por artrotomia e a outros dois entre lavagem por artrocentese e lavagem aberta. A lavagem artroscópica está no topo da nossa revisão por apresentar os melhores resultados com apenas 6% de complicações e/ou sequelas (em apenas 4 dos 8 artigos incluídos), com um total de 13 doentes (8,7%) que necessitaram de tratamento adicional (5 artrotomias e 8 uma nova lavagem artroscópica) e também destacam 3 artigos com 100% de bons resultados, nos quais não houve complicações e/ou sequelas, nem foi necessária uma segunda lavagem, enquanto que apenas 3 dos 8 estudos necessitaram de uma artrotomia para a resolução final. Para a lavagem por artrocentese, o menor percentual de complicações e/ou sequelas foi obtido com 2% (relatado em três dos 6 trabalhos), e apenas 9,7% necessitaram de um segundo método terapêutico diferente da aspiração articular (23 artrotomias e 2 artroscopias), destacando também a repetição da punção (até 4 vezes) conforme diretriz terapêutica do autor em dois artigos, e que o maior número de pacientes foi encontrado para este método. A lavagem por artrotomia como método inicial obteve os piores resultados, com 12% de complicações e/ou sequelas e 22,6% de lavagens adicionais. Conclusões: Apesar de a lavagem aberta por artrotomia ser tida como ¨padrão-ouro¨, tendo indicações absolutas no tratamento cirúrgico da artrite séptica em crianças (especialmente no quadril), da nossa análise pode-se deduzir que esta opção rende os piores percentuais de resultados, dobrando o percentual de necessidade de lavagem adicional e o percentual de complicações, em comparação com a lavagem artroscópica. Existem outros métodos terapêuticos que se apresentam como procedimentos menos invasivos, seguros e eficazes, corroborados por bons resultados na biografia, tais como: a lavagem artroscópica (que apresentou a menor percentagem de doentes que necessitaram de lavagem adicional, com o maior número de artigos com boa resultados em geral, com percentual de complicações abaixo da lavagem por artrotomia) e lavagem por artrocentese (que apresentou o menor percentual de compilações das 3 opções analisadas).

Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Arthroscopy , Arthritis, Infectious/surgery , Arthrocentesis , Therapeutic Irrigation , Joints/surgery , Treatment Outcome , Patient Safety , Systematic Review
Coluna/Columna ; 22(2): e268880, 2023. tab, graf
Article in English | LILACS | ID: biblio-1448036


ABSTRACT Objective: Evaluate the prognostic factors associated with therapeutic failure and recurrence in pyogenic spondylodiscitis (PS). Methods: A historical cohort study was conducted in a reference Brazilian hospital for locomotor system and neurodevelopmental diseases. All patients with PS treated between January 1999 and December 2018 and followed for at least one year were included. PS was defined based on clinical, laboratory, and radiological criteria. Microbiological data and clinical outcomes at the end of follow-up were also collected and analyzed. Results: Fifty patients (mean age 50.94 ± 15.84 years, men 76.00%) were included. After twelve months of follow-up, therapeutic failure was observed in 24.00% (n = 12) and recurrence in 18.00% (n = 09) patients. Among those who were cured, residual symptoms were found in 50.00% (19/38). No deaths were observed. After multivariate analysis, therapeutic failure was associated with the prescription of antibiotic therapy before culture results (p = 0.0153), spinal cord compression (p = 0.0053), and sensory deficits (p = 0.0341). Furthermore, recurrence was associated with previous nonspinal surgeries (p = 0.0350) and spinal cord compression (p = 0.0447). Conclusion: PS causes significant morbidity. The prognosis depends mainly on the clinical presentation at admission, especially when associated with spinal cord compression, which reinforces the importance of early diagnosis. Level of Evidence II; Prognostic Studies.

RESUMO: Objetivo: Avaliar os fatores prognósticos associados à falha terapêutica e à recorrência na espondilodiscite piogênica (EP). Métodos: Um estudo de coorte histórica foi conduzido em um hospital brasileiro de referência nas doenças do sistema locomotor e do neurodesenvolvimento. Todos os pacientes com EP tratados entre janeiro de 1999 e dezembro de 2018 e acompanhados por pelo menos um ano foram incluídos. A EP foi definida com base em critérios clínicos, laboratoriais e radiológicos. Dados microbiológicos e desfechos clínicos ao final do tempo de seguimento também foram coletados e analisados. Resultados: Cinquenta pacientes (idade média 50,94 ± 15,84 anos, homem 76,00%) foram incluídos. Depois de doze meses de seguimento, a falha terapêutica foi observada em 24,00% (n = 12) e a recorrência em 18,00% (n = 09) dos pacientes. Entre os que curaram, sintomas residuais foram constatados em 50,00% (19/38). Nenhuma morte foi observada. Após análise multivariada, a falha terapêutica foi associada à prescrição de antibioticoterapia antes dos resultados de cultura (p = 0,0153), compressão medular (p = 0,0053) e déficits sensoriais (p = 0,0341). Além disso, a recorrência esteve associada a cirurgias não espinhais prévias (p = 0,0350) e à compressão medular (p = 0,0447). Conclusão: A EP causa morbidade significativa. O prognóstico depende principalmente da apresentação clínica na admissão, especialmente da existência de compressão medular, o que reforça a importância do diagnóstico precoce. Nível de Evidência II; Estudos de Prognóstico.

RESUMEN: Objetivo: Evaluar los factores pronósticos asociados con el fracaso terapéutico y la recurrencia en la espondilodiscitis piógena (EP). Métodos: Se realizó un estudio de cohorte histórica en un hospital de referencia brasileño para enfermedades del aparato locomotor y del neurodesarrollo. Se incluyeron todos los pacientes con EP tratados entre enero de 1999 y diciembre de 2018 y seguidos durante al menos un año. La EP se definió en base a criterios clínicos, de laboratorio y radiológicos. También se recopilaron y analizaron los datos microbiológicos y los resultados clínicos al final del tiempo de seguimiento. Resultados: Se incluyeron 50 pacientes (edad media 50,94 ± 15,84 años, sexo masculino 76,00%). A los doce meses de seguimiento, se observó fracaso terapéutico en el 24,00% (n=12) y recurrencia en el 18,00% (n=09) de los pacientes. Entre los que se curaron, se encontraron síntomas residuales en el 50,00% (19/38). No se observaron muertes. Tras el análisis multivariante, el fracaso terapéutico se asoció a la prescripción de antibioticoterapia antes de los resultados del cultivo (p = 0,0153), compresión medular (p = 0,0053) y déficits sensitivos (p = 0,0341). Además, la recurrencia se asoció con cirugías previas no espinales (p = 0,0350) y compresión medular (p = 0,0447). Se incluyeron 50 pacientes (edad media 50,94 ± 15,84 años, sexo masculino 76,00%). A los doce meses de seguimiento, se observó fracaso terapéutico en el 24,00% (n=12) y recurrencia en el 18,00% (n=09) de los pacientes. Entre los que se curaron, se encontraron síntomas residuales en el 50,00% (19/38). No se observaron muertes. Tras el análisis multivariante, el fracaso terapéutico se asoció a la prescripción de antibioticoterapia antes de los resultados del cultivo (p = 0,0153), compresión medular (p = 0,0053) y déficits sensitivos (p = 0,0341). Además, la recurrencia se asoció con cirugías previas no espinales (p = 0,0350) y compresión medular (p = 0,0447). Conclusión: La EP causa una morbilidad significativa. El pronóstico depende principalmente de la presentación clínica al ingreso, especialmente de la existencia de compresión medular, lo que refuerza la importancia del diagnóstico precoz. Nivel de Evidencia II; Estudios de Pronóstico.

Humans , Adult , Middle Aged , Treatment Failure