How much do the Patients with Acute Myocardial Infarction Know about Chest Pain, Thrombolytic Therapy, and Other Factors Affecting the Treatment Time in the Emergency Room?

Abstract Background: Treatment time in the emergency room for acute myocardial infarction is very important and can be life-saving if one understands the importance of a patient's chest pain. Objetice: The aim of this study is to evaluate how much patients entering the emergency room due to acute myocardial infection (AMI) know about chest pain and thrombolytic therapy. Materials and Methods: One hundred fifty patients (126 males,14 females) from three different institutes with complaints of chest pain were randomly chosen to participate in this study. The mean age of the patients was 55.4 ± 11.2 years (71+33). Patients were asked to fill out a questionnaire consisting of 70 questions within the first seven days. All differences in categorical variables were computed using the χ2-test and Fisher Exact test. A two-tailed hypothesis was used in all statistical evaluations, and p<0.05 was considered significant. Results: It was observed that 17% of the patients came to the hospital within the first 30 minutes; 18.3% of them came to the hospital between 30 minutes and 1 hour; 27.5% of them came to the hospital between 1 hour and 3 hours; and 21.4% of them came to the hospital more than 6 hours after symptoms began. It was also observed that 68% of the patients were not aware of the AMI, and 96% of them had no prior knowledge of antithrombolytic therapy. Conclusion: Because the majority of the patients did not have enough information about AMI, a training program should be implemented to ensure that people to come to the hospital earlier. (Int J Cardiovasc Sci. 2021; [online].ahead print, PP.0-0)

Door-to-balloon Time in Cardiovascular Emergency Care in a Hospital of Northern Brazil

Abstract Background The use of an adequate door-to-balloon time (≤ 90 minutes) is crucial in improving the quality of care provided to patients with ST-segment elevation myocardial infarction (STEMI). Objective To determine the door-to-balloon time in the management of STEMI patients in a cardiovascular emergency department in a hospital of northern Brazil. Methods This was a cross-sectional study based on review of medical records. A total of 109 patients with STEMI admitted to the emergency department of a referral cardiology hospital in Pará State, Brazil, between May 2017 and December 2017. Correlations of the door-to-balloon time with length of hospital stay and mortality rate were assessed, as well as whether the time components of the door-to-balloon time affected the delay in performing primary percutaneous coronary intervention. Quantitative variables were analyzed by Spearman correlation and the G test was used for categorical variables. A p<0.05 was set as statistically significant. Results Median door-to-balloon time was 104 minutes. No significant correlation was found between door-to-balloon time and length of hospital stay or deaths, but significant correlations were found between door-to-balloon time and door-to-ECG time (p<0.001) and ECG-to-activation (of an interventional cardiologist) time (p<0.001). Conclusion The door-to-balloon time was longer the recommended and was not correlated with the length of hospital stay or in-hospital mortality. Door-to-ECG time and ECG-to-activation time contributed to the delay in performing the primary percutaneous coronary intervention. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

Oportunidade de vinculação de pessoas vivendo com HIV em um serviço especializado de saúde, Belo Horizonte (MG) / Timely care linkage of people living with HIV in a reference health service, Belo Horizonte, Minas Gerais

RESUMO: Introdução: A vinculação é um passo fundamental para o cuidado contínuo da infecção pelo vírus da imunodeficiência humana (HIV/aids), sendo essencial para proporcionar o acesso à terapia antirretroviral, bem como ao cuidado integral. Metodologia: Estudo transversal, com pessoas vivendo com HIV (PVHIV), idade ≥ 18 anos, vinculadas entre janeiro e dezembro de 2015, em um serviço de referência para assistência ambulatorial e hospitalar especializada em HIV/aids em Belo Horizonte (MG). O tempo de vinculação foi definido como o tempo do diagnóstico até a vinculação ao serviço. Considerou-se vinculação oportuna quando esse tempo foi menor ou igual a 90 dias. Os dados foram coletados por meio de prontuários clínicos. Realizou-se análise de regressão logística com intervalo de confiança de 95% (IC95%). Resultados: Entre os 208 pacientes, a maioria era do sexo masculino (77,8%) com idade média de 39 anos. Cerca de 45% apresentaram condições definidoras de aids na vinculação. O tempo de vinculação apresentou média de 138 ± 397 dias, e a vinculação oportuna ocorreu para 76,9% dos pacientes. As variáveis associadas com a vinculação oportuna foram: ter idade ≥ 48 anos (odds ratio - OR = 8,50; IC95% 1,53 - 47,28), estar trabalhando (OR = 3,69; IC95% 1,33 - 10,25) no momento da vinculação e apresentar contagem de linfócitos T CD4 (LT CD4+) ≤ 200 células/mm3 no momento do diagnóstico de HIV (OR = 4,84; IC95% 1,54 - 15,18). Observou-se proporção importante de vinculação oportuna entre as PVHA, porém com diagnóstico tardio. Conclusão: Intervenções devem ser direcionadas para pessoas mais jovens e com maior contagem de LT CD4+, visando uma melhor prestação de cuidados contínuos em HIV.

ABSTRACT: Introduction: Linkage is a critical step in the ongoing care of human immunodeficiency virus (HIV/aids) infection and is essential for providing access to antiretroviral therapy, as well as comprehensive care. Methodology: Cross-sectional study on people living with HIV (PLHIV), aged ≥ 18 years old, linked between January and December 2015, in a referral service for outpatient and hospital care specialized in HIV/AIDS in Belo Horizonte, Minas Gerais. Linkage time was defined as the time from diagnosis to service linkage. Timely care linkage was considered when this time was ≤ 90 days. Data were collected through clinical records. A logistic regression analysis with a confidence interval of 95% (95%CI) was performed. Results: Among 208 patients, most of them were males (77.8%) with a mean age of 39 years. About 45% presented AIDS-defining conditions at the moment of linkage. Linkage time presented a mean of 138 ± 397 days. And timely linkage occurred for 76.9% of the patients. The variables associated with timely care linkage were: age ≥ 48 years (odds ratio - OR = 8.50; 95%CI 1.53 - 47.28), currently working (OR = 3.69; 95%CI 1.33 - 10.25) at the time of linkage, and present CD4+ T lymphocyte count (CD4+ T) ≤ 200 cells/mm3 at the time of HIV diagnosis (OR = 4.84; 95%CI 1.54 - 15.18). There was an important proportion of timely care linkage among PLHIV, but with late diagnosis. Conclusion: Interventions should be targeted at younger people with higher CD4+ T lymphocyte counts, in order to better provide continuous HIV care.

Associação de variáveis sociodemográficas e clínicas com os tempos para início do tratamento do câncer de próstata / Association of sociodemographic and clinical variables with time to start prostate cancer treatment

Resumo Disparidades na atenção ao câncer de próstata têm sido reveladas e associadas a fatores sociodemográficos e clínicos, os quais determinam os tempos para diagnóstico e início do tratamento. O objetivo deste artigo é avaliar a associação de variáveis sociodemográficas e clínicas com os tempos para o início do tratamento do câncer de próstata. Estudo de coorte longitudinal prospectivo utilizando dados secundários, cuja população é de homens com câncer de próstata atendidos nos períodos de 2010-2011 e 2013-2014 no Hospital Santa Rita de Cássia, Vitória, Espírito Santo, Brasil. A população do estudo foi de 1.388 homens, do total, os com idade inferior a 70 anos (OR = 1,85; IC = 1,49-2,31), não brancos (OR = 1,30; IC = 1,00-1,70), com menos de oito anos de estudo (OR = 1,52; IC = 1,06-2,17) e encaminhados pelos serviços do Sistema Único de Saúde (OR = 2,52; IC = 1,84-3,46) apresentaram maior risco de atraso no tratamento. Da mesma forma, quanto menor o escore de Gleason (OR = 1,78; IC = 1,37-2,32) e os níveis de Antígeno Prostático Específico (OR = 2,71; IC = 2,07-3,54) maior a probabilidade de atraso para iniciar o tratamento. Portanto, as características sociodemográficas e clínicas exerceram uma forte influência no acesso ao tratamento do câncer de próstata.

Abstract Introduction: Disparities in prostate cancer care have been evidenced and associated with sociodemographic and clinical factors, which establish the time for diagnosis and initiation of treatment. Objective: To evaluate the association of sociodemographic and clinical variables with the onset of prostate cancer treatment. Methods: This is a prospective longitudinal cohort study with secondary data with a population of men with prostate cancer attended in the periods 2010-2011 and 2013-2014 at the Santa Rita de Cássia Hospital in Vitória, Espírito Santo, Brazil. Results: The study population consisted of 1,388 men. Of the total, those younger than 70 years (OR = 1.85; CI = 1.49-2.31), nonwhite (OR = 1.30; CI = 1.00-1.70), less than 8 years of schooling (OR = 1.52; CI = 1.06-2.17) and referred by the Unified Health System services (OR = 2.52; CI = 1.84-3.46) were more likely to have a delayed treatment. Similarly, the lower the Gleason score (OR = 1.78; CI = 1.37-2.32) and Prostate-Specific Antigens levels (OR = 2.71; CI = 2.07-3.54), the greater the likelihood of delay for the onset of treatment. Conclusion: Therefore, sociodemographic and clinical characteristics exerted a strong influence on the access to prostate cancer treatment.

Carcinoma adrenal em crianças: estudo longitudinal em minas gerais, brasil / Adrenal carcinoma in children: longitudinal study in minas gerais, brazil

RESUMO Objetivo: Analisar as características clínicas, laboratoriais e histopatológicas e o percurso até o estabelecimento do diagnóstico e do tratamento de pacientes com carcinoma de suprarrenal (CSR). Métodos: Estudo retrospectivo com 13 pacientes tratados no serviço de oncologia pediátrica do Hospital das Clínicas da Universidade Federal de Minas Gerais (HC-UFMG) entre 2004 e 2015. Resultados: A idade ao diagnóstico variou de 1,0 a 14,8 anos (mediana: 2,0 anos). As manifestações de hipercortisolismo foram identificadas em todos os casos, e as de virilização, em todas as meninas. Todos os pacientes preencheram os critérios de Weiss para diagnóstico histopatológico de CSR. A imuno-histoquímica foi realizada em 61,5% dos casos. A maioria dos pacientes apresentou doença em estádio I (76,9%). Todos foram submetidos à ressecção tumoral total. Dois pacientes (estádios III e IV) receberam quimioterapia associada ao mitotano. O único óbito observado foi do paciente com doença em estádio IV. A probabilidade de sobrevida global para todo o grupo aos 5,0 anos foi de 92,3±7,4%. A mediana de tempo entre o início dos sintomas e o diagnóstico foi de 9,5 meses, e de 6,0 meses entre a primeira consulta e o início do tratamento. Conclusões: A baixa idade ao diagnóstico, o predomínio de casos com doença localizada e a ressecção tumoral completa - com apenas um caso de ruptura de cápsula tumoral - são possivelmente a explicação para a evolução favorável da população estudada. O longo percurso entre o início dos sintomas e o diagnóstico sugere a importância da capacitação dos pediatras para o reconhecimento precoce dos sinais e dos sintomas do CSR.

ABSTRACT Objective: To analyze clinical, laboratory and histopathological features and the path to diagnosis establishment and treatment of patients with adrenal carcinoma (AC). Methods: Retrospective study with 13 patients assisted at the pediatric oncology service of Hospital das Clínicas, Universidade Federal de Minas Gerais, Brazil, between 2004 and 2015. Results: Age at diagnosis ranged from 1.0 to 14.8 years (median: 2.0 years). Manifestations of hypercortisolism were identified in all cases and virilization in all girls. All patients met the Weiss criteria to AC histopathological diagnosis. Immunohistochemistry was performed in 61.5% of the cases. Most patients had stage I disease (76.9%). All subjects were submitted to total tumor resection. Two patients (stages III and IV disease) received chemotherapy associated to mitotane. The only death case was that of a patient with stage IV disease. The probability of overall survival for the entire group up to 5.0 years was 92.3±7.4%. The median time between the onset of symptoms and diagnosis was 9.5 months, and 6.0 months between first visit and start of treatment. Conclusions: Low age at diagnosis, predominance of cases with localized disease and complete tumor resection - with only one case of tumor capsule rupture - can possibly explain the favorable evolution of the studied population. The long period between onset of symptoms and diagnosis highlights the importance of training pediatricians for early recognition of AC signs and symptoms.

Response time in the emergency services. Systematic review

Abstract The growth of the urban population raises concern about municipal public managers in the sense of providing emergency medical services (EMS) that are aligned with the needs of prehospital emergency medical care demanded by the population. The literature review aims at presenting the response time of emergency medical services in several parts of the world and discussing some factors that interfere in the result of this indicator such as GDP (Gross Domestic Product) percentage spent on health and life expectancy of countries. The study will also show that in some of the consulted articles, authors suggest to EMS recommendations for decreasing the response time using simulations, heuristics and metaheuristics. Response time is a basic indicator of emergency medical services, in such a way that researchers use the descriptive statistics to evaluate this parameter. Europe and the USA outstand in the publication of studies that present this information. Some articles use stochastic and mathematical methods to suggest models that simulate scenarios of response time reduction and suggest such proposals to the local EMS. Countries in which the response time was identified have a high index of human development and life expectancy between 74.7 and 83.7 years.

Impact of the delay to start treatment in patients with lung cancer treated in a densely populated area of Brazil

OBJECTIVES: The aim of this study is to evaluate the access of patients with lung cancer in a densely populated area of São Paulo to the Brazilian Public Health System, focusing on the time spent from symptom onset or initial diagnosis until the beginning of treatment. METHODS: We retrospectively reviewed 509 patients with malignant lung neoplasms who were admitted to a single reference oncology center of the public health system between July 2008 and December 2014. Patients were considered eligible for this study if they were older than 18 years and had not undergone any previous oncology treatment when they were admitted to the institution. The following data were collected from all patients: age, gender, smoking status, tumor staging, time from the when the first symptoms were experienced by the patient to when the patient was diagnosed with cancer, time from the first appointment to cancer diagnosis, and time from when the patient was diagnosed with cancer to the initiation of treatment. RESULTS: The median time from symptom onset to diagnosis was three months. From the first appointment to diagnosis, the median time interval was one month; however, 79% of patients were diagnosed in up to two months. The median time from diagnosis to the start of treatment was one month, but most patients (82.5%) started treatment in up to two months. CONCLUSION: In our highly populated region with preferential access to the public health system, patients are required to wait a relatively long time to effectively begin treatment for lung cancer. This type of study is important to alert medical societies and government health agencies.

Riesgo dinámico en pacientes con cáncer diferenciado de tiroides no ablacionados / Dynamic risk assessment in patients with differentiated thyroid cancer without remnant ablation

En la actualidad, el enfoque terapéutico y el seguimiento de los pacientes con carcinoma diferenciado de tiroides (CDT) es individualizado de acuerdo con el riesgo de recurrencia de la enfermedad, con una menor tendencia a ablacionar a pacientes de bajo riesgo de recurrencia. Por otro lado, la evaluación de las respuestas al tratamiento se validó en pacientes tratados con tiroidectomía total (TT) y ablación con radioyodo (RAI), pero son escasos los estudios en pacientes no ablacionados. Los objetivos de este estudio fueron describir las características de una población de pacientes con CDT no ablacionados y validar las respuestas al tratamiento durante el seguimiento. Se incluyó a 88 pacientes con un seguimiento mínimo de 12 meses. El 87,6% eran mujeres y la edad promedio en el momento del diagnóstico fue de 47,5 años. Basados en el Consenso Intersocietario Argentino, el 97,7% de la cohorte fue clasificada como de bajo riesgo y el 2,3% como de riesgo intermedio de recurrencia. Los pacientes presentaron una respuesta inicial excelente en el 73% de los casos, con un estado sin evidencia de enfermedad al final del seguimiento en el 85,5%. Una minoría de los pacientes (1%) presentó una respuesta inicial estructural incompleta, la cual fue similar al final del seguimiento (1%). Por otro lado, el 26% de los pacientes presentó una respuesta inicial indeterminada, aunque solo el 13,5% permaneció con esta respuesta al final del seguimiento. Nuestros datos validan las respuestas al tratamiento en pacientes con CDT que recibieron TT no ablacionados como una herramienta efectiva para la estratificación del riesgo dinámico. Los pacientes apropiadamente seleccionados tratados sin RAI tienen un excelente pronóstico, con una baja frecuencia de respuesta estructural incompleta en el seguimiento, inclusive menor que la de los pacientes de bajo riesgo ablacionados.

The therapeutic approach and the follow-up of patients with differentiated thyroid cancer (DTC) is currently individualised according to the risk of recurrence, with a lower tendency to perform remnant ablation (RA) in patients with low risk of recurrence. While response to therapy assessment has been validated for DTC patients treated by total thyroidectomy (TT) and RA, it has not been widely confirmed in patients treated with TT without RA. The aims of this study were to describe the characteristics of the population of patients treated with TT without RA, and to validate the response to therapy. The study included 88 patients followed-up for at least 12 months after surgery. In the entire cohort, 87.9% were female and the mean age was 47.5 years old. Based on the Argentine Intersociety Consensus, 97.7% and 2.3% were classified as low risk and intermediate risk of recurrence, respectively. Patients had an initial excellent response to treatment in 73% of cases, with a disease-free status at the end of follow-up of 85.5%. A minority of patients (1%) presented with an initial structural incomplete response, which was similar at the end of follow-up (1%). On the other hand, 26% of the patients had an initial indeterminate response, although only 13.5% remained with this response at the end of follow-up. These results validate the responses to treatment in DTC patients treated with TT without RA as an effective tool for the dynamic risk stratification. Patients appropriately selected who did not receive RA have an excellent outcome, with a low frequency of structural incomplete response, even lower than that observed in low risk ablated patients.

Access to surgical assistance: challenges and perspectives / Acesso à assistência cirúrgica: desafios e perspectivas / Acceso a la asistencia quirúrgica: retos y perspectivas

Objective to characterize the access to surgical assistance in Brazil. Method documentary study, with a quantitative approach, developed from information of the Caixa Preta da Saúde [Health Black Box] database, of the Brazilian Medical Association. Results in the one-year period 3773 cases related to health care in Brazil were recorded. There were 458 (12.3%) records on surgical assistance. Of these, most, 339 (74.1%), involved the lack of access in all regions of Brazil. The main access constraint was the prolonged waiting time for surgery. Other constraints were the excessive waiting for medical appointment with experts, doing examinations and cancellation of surgeries. Conclusion the access to surgical assistance, by users of the Brazilian health system, is not widely guaranteed, reinforcing the need for integrated governmental actions, organization of the health care network, management of health care and human resources to overcome the challenges imposed to achieve the Universal Access to Health and Universal Health Coverage.

Objetivo caracterizar o acesso à assistência cirúrgica no Brasil. Método estudo documental, com abordagem quantitativa, desenvolvido a partir de informações do banco de dados A Caixa Preta da Saúde, da Associação Médica Brasileira. Resultados no período de um ano constatou-se 3773 registros relacionados à assistência à saúde no Brasil. Houve 458 (12,3%) registros sobre assistência cirúrgica. Destes, a maioria, 339 (74,1%), envolveu a falta de acesso, em todas as regiões do Brasil. O principal limitante de acesso foi o prolongado tempo de espera para cirurgia. Outros limitantes foram a excessiva espera para consulta com especialistas, realização de exames e cancelamento de cirurgias. Conclusão o acesso à assistência cirúrgica, pelos usuários do sistema de saúde brasileiro, não está amplamente garantido, reforçando a necessidade de ações governamentais integradas, organização da rede de atenção à saúde, gestão dos serviços de saúde e recursos humanos para superação dos desafios impostos ao alcance do Acesso Universal à Saúde e Cobertura Universal de Saúde.

Objetivo caracterizar el acceso a la asistencia quirúrgica en Brasil. Método estudio documental, con enfoque cuantitativo, desarrollado a partir de informaciones del banco de datos la Caja Negra de la Salud (Caixa Preta da Saúde, en portugués), de la Asociación Médica Brasileña. Resultados en el período de un año se constataron 3773 registros relacionados a la asistencia a la salud en Brasil. Hubo 458 (12,3%) registros sobre asistencia quirúrgica. De estos, la mayoría, 339 (74,1%), implicó la falta de acceso a la asistencia quirúrgica, en todas las regiones de Brasil. El principal factor limitante de acceso fue el largo tiempo de espera quirúrgica. Otros limitantes fueron la excesiva espera por una cita con especialistas, por la realización de exámenes y la cancelación de cirugías. Conclusión el acceso a la asistencia quirúrgica por los usuarios del sistema de salud brasileño no está ampliamente garantizado, lo que refuerza la necesidad de acciones gubernamentales integradas, organización de la red de atención a la salud, gestión de los servicios de salud y recursos humanos para superar los retos planteados al alcance del Acceso Universal a la Salud y a la Cobertura Universal de Salud.

Health care seeking behavior and patient delay in tuberculosis diagnosis / Comportamento de busca por cuidados em saúde e atraso do paciente no diagnóstico da tuberculose / Comportamiento de búsqueda de atención de salud y retraso del paciente en el diagnóstico de la tuberculosis

Delays in diagnosis of TB cases are major impeding factors in the control of TB. The objectives of this study were to describe the health care seeking behavior of TB patients, assessing patient delay and the number of health care facilities visited before the start of TB treatment. A cross-sectional study was carried out with adult patients with pulmonary TB presenting to two TB facilities to start treatment. We found a median patient delay of 20 days. The factors associated negatively with patient delay in multivariate analysis were weight loss, and have sought treatment because of the first symptom. We also demonstrated that 44.8% of patients incorrectly reported the mode of transmission of TB. In addition, the local of first attendance was an emergency room of public hospitals in 37.3% of patients. We demonstrated that the median patient delay in TB diagnosis in two TB services in a region with a high prevalence of TB was 20 days, and the protective factors associated with this delay in multivariate analysis were weight loss, and have sought treatment because of the first symptom.

Atrasos no diagnóstico de casos de tuberculose são os principais fatores que impedem o controle da doença. Os objetivos deste estudo foram descrever a trajetória de pacientes com tuberculose, avaliando a demora do paciente e o número de unidades de saúde visitadas antes do início do tratamento. Estudo transversal foi conduzido com pacientes com idade ≥ 18 anos e com diagnóstico de tuberculose pulmonar, que responderam a um questionário. A média de idade dos pacientes foi de 40,4 ± 16,1. Foi encontrada uma mediana de 20 dias no atraso dos pacientes. Também foi verificado que 44,8% relataram incorretamente o modo de transmissão da tuberculose. Além disso, o local do primeiro atendimento para 37,3% dos pacientes foi uma emergência de hospital público. Encontrou-se uma mediana de 20 dias no atraso dos pacientes até o diagnóstico da tuberculose; os fatores protetores associados a este atraso na análise multivariada foram perda de peso e ter procurado tratamento por causa do primeiro sintoma.

Los retrasos en el diagnóstico de la tuberculosis son los principales factores que impiden el control de la tuberculosis. Entre los objetivos de este estudio se encuentra la descripción de la trayectoria de los pacientes con tuberculosis, evaluando el retraso en el diagnóstico del paciente y el número de establecimientos de salud visitados antes de iniciar el tratamiento para la tuberculosis. Se realizó un estudio transversal con pacientes ≥ 18 años de edad y con diagnóstico de tuberculosis pulmonar que respondieron a un cuestionario. La edad media de los pacientes fue de 40,4 ± 16,1. Se encontró un media de 20 días en el retraso del diagnóstico a los pacientes. También se halló que un 44,8 % informó incorrectamente del modo de transmisión de la tuberculosis. Por otra parte, el primer punto de asistencia para un 37,3 % de los pacientes fue el servicio de urgencias en un hospital público. Se halló un promedio de 20 días en el retraso del diagnóstico de la tuberculosis a los pacientes, los factores protectores asociados con el retraso en el análisis multivariado fueron la pérdida de peso y conseguir el tratamiento debido cuando se presenta el primer síntoma.

There Is No Reason to Delay Helicobacter pylori Eradication after Treatment for Upper Gastrointestinal Bleeding

No abstract available.

Helicobacter pylori Eradication within 120 Days Is Associated with Decreased Complicated Recurrent Peptic Ulcers in Peptic Ulcer Bleeding Patients

BACKGROUND/AIMS: The connection between Helicobacter pylori and complicated peptic ulcer disease in peptic ulcer bleeding (PUB) patients taking nonsteroidal anti-inflammatory drugs has not been established. In this study, we sought to determine whether delayed H. pylori eradication therapy in PUB patients increases complicated recurrent peptic ulcers. METHODS: We identified inpatient PUB patients using the Taiwan National Health Insurance Research Database. We categorized patients into early (time lag < or =120 days after peptic ulcer diagnosis) and late H. pylori eradication therapy groups. The Cox proportional hazards model was used. The primary outcome was rehospitalization for patients with complicated recurrent peptic ulcers. RESULTS: Our data indicated that the late H. pylori eradication therapy group had a higher rate of complicated recurrent peptic ulcers (hazard ratio [HR], 1.52; p=0.006), with time lags of more than 120 days. However, our results indicated a similar risk of complicated recurrent peptic ulcers (HR, 1.20; p=0.275) in time lags of more than 1 year and (HR, 1.10; p=0.621) more than 2 years. CONCLUSIONS: H. pylori eradication within 120 days was associated with decreased complicated recurrent peptic ulcers in patients with PUB. We recommend that H. pylori eradication should be conducted within 120 days in patients with PUB.

Predictors of hip fracture mortality at a general hospital in South Brazil: an unacceptable surgical delay

OBJECTIVE: Hip fractures have been associated with increased mortality in the elderly. Several risk factors such as the time between the insult and the surgical repair have been associated with hip fracture mortality. Nevertheless, the risk of delayed surgical repair remains controversial. Few studies have examined this issue in Brazil. The aim of this study was to study the risk factors for death one year after hip fracture and in-hospital stay at a tertiary hospital in South Brazil. METHODS: A prospective cohort study was carried out from April 2005 to April 2011 at a tertiary university hospital at Santa Maria, Brazil. Subjects admitted for hip fracture who were 65 years of age or older were followed for one year. Information about fracture type, age, gender, clinical comorbidities, time to surgery, discharge, and American Society of Anesthesiologists score were recorded. Death was evaluated during the hospital stay and at one year. RESULTS: Four hundred and eighteen subjects were included in the final analysis. Of these, 4.3% died in-hospital and 15.3% were dead at one year. Time to surgery, American Society of Anesthesiologists score, Ischemic Heart Disease, and in-hospital stay were associated with death at one year in the univariate analysis. The American Society of Anesthesiologists score and time to surgery were one-year mortality predictors in the final regression model. In-hospital death was associated with American Society of Anesthesiologists score and age. CONCLUSION: Time to surgery is worryingly high at the South Brazil tertiary public health center studied here. Surgical delay is a risk factor that has the potential to be modified to improve mortality. .

Time-to-treatment of diffuse large B-cell lymphoma in São Paulo

OBJECTIVE: Diffuse large B-cell lymphoma is the most common type of non-Hodgkin lymphoma, accounting for nearly 50% of the cases in the Hematology Department of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo and Instituto do Câncer do Estado de São Paulo. The treatment outcome is influenced by age, abnormal lactate dehydrogenase levels, extranodal infiltration, the disease stage and the patient's performance status. In this study, we sought to report the time-to-treatment of diffuse large B-cell lymphoma in São Paulo's public health system network and its impact on patient outcomes. METHODS: We prospectively followed a cohort of 42 consecutive patients with de novo diffuse large B-cell lymphoma between 2008 and 2012. RESULTS: Our patients had more advanced disease than that reported in the literature (61.9% vs. 46%). In São Paulo's public health system network, it took an average of 7.4 months for a diagnosis to be made and an additional 1.4 months to obtain an appointment with a specialist. Once at our Hematology Department, it took less than 20 days for staging, confirmation of the diagnosis and treatment initiation. An interval from signs or symptoms to treatment of more than 6 months was associated with inferior progression-free survival in 3 years (p = 0.049). CONCLUSION: A delay in the diagnosis of diffuse large B-cell lymphoma is a public health problem and may be associated with worse progression-free survival. .

Interval from Prostate Biopsy to Radical Prostatectomy Does Not Affect Immediate Operative Outcomes for Open or Minimally Invasive Approach

Traditionally, urologists recommend an interval of at least 4 weeks after prostate biopsy before radical prostatectomy. The aim of our study was to evaluate whether the interval from prostate biopsy to radical prostatectomy affects immediate operative outcomes, with a focus on differences in surgical approach. The study population of 1,848 radical prostatectomy patients was divided into two groups according to the surgical approach: open or minimally invasive. Open group included perineal and retropubic approach, and minimally invasive group included laparoscopic and robotic approach. The cut-off of the biopsy-to-surgery interval was 4 weeks. Positive surgical margin status, operative time and estimated blood loss were evaluated as endpoint parameters. In the open group, there were significant differences in operative time and estimated blood loss between the or =4-week interval subgroups, but there was no difference in positive margin rate. In the minimally invasive group, there were no differences in the three outcome parameters between the two subgroups. Multivariate analysis revealed that the biopsy-to-surgery interval was not a significant factor affecting immediate operative outcomes in both open and minimally invasive groups, with the exception of the interval > or =4 weeks as a significant factor decreasing operative time in the minimally invasive group. In conclusion, performing open or minimally invasive radical prostatectomy within 4 weeks of prostate biopsy is feasible for both approaches, and is even beneficial for minimally invasive radical prostatectomy to reduce operative time.

Severe sepsis in the emergency department: an observational cohort study from the university hospital of the West Indies / Sepsis severa en la sala de emergencias: un estudio observacional de cohorte en el hospital universitario de West Indies

OBJECTIVE: To describe the incidence, treatment and outcomes of patients with severe sepsis and septic shock in a setting where early goal directed therapy (EGDT) is not routinely performed. METHOD: An observational study of all adult patients admitted from the emergency department (ED) of the University Hospital of the West Indies (UHWI) with a diagnosis of severe sepsis and septic shock from July 5, 2007 to September 1, 2008 was conducted. Baseline parameters, treatment patterns and inhospital outcomes were evaluated. RESULTS: A total of 58 011 patients were seen and 762 (1.3%) had sepsis, 117 (15.4%) of whom were classified as severe sepsis or septic shock. Mean (SD) age was 59.2 (23.3) years and 49% were female. Medical history included hypertension (29%), diabetes mellitus (26%), stroke (8%), heart failure (6%) and HIV (6%). The most common sources of sepsis were pneumonia (67%) and urinary tract infection (46%). Median, interquartile range (IQR) time from triage to antibiotic administration was 126 (88, 220) minutes and antibiotics were given to 65.7% within three hours. Overall, organisms were sensitive to empirical antibiotics in 69%. Median (IQR) lactate was 5.3 (4.5, 7.5) mmol/L. Most patients (95%) were admitted to the ward; 1% went to the intensive care unit (ICU) and 2% died in the ED. Mean (SD) length of hospital stay was 9.5 (10.3) days. Inhospital mortality was 25% and survival correlated inversely with age (r pb = 0.25; p = 0.006). CONCLUSION: Despite a lack of EGDT, sepsis treatment patterns were consistent with "bestpractice" and mortality was lower than international comparators.

OBJETIVO: Describir la incidencia, el tratamiento y los resultados para pacientes con sepsis severa y shock séptico en un entorno donde la terapia dirigida por metas tempranas (TDMT) no se realiza de modo rutinario. MÉTODO: Se realizó un estudio observacional de todos los pacientes adultos con diagnóstico de sepsis severa y shock séptico, ingresados en la Sala de Emergencias del Hospital Universitario de West Indies (HUWI) desde el 5 de julio de 2007 al 1ero. de septiembre de 2008. Se evaluaron los parámetros iniciales de referencia, los patrones de tratamiento, y la evolución intrahospitalaria. RESULTADOS: Un total de 58 011 pacientes fueron vistos, 762 (1.3%) de ellos con sepsis. De estos casos con sepsis, 117 (15.4%) fueron clasificados como sepsis severa o shock séptico. La edad media (SD) fue 59.2 (23.3) años y 49% eran mujeres. Historia clínica incluía hipertensión (29%), diabetes (26%), accidente cerebrovascular (8%), insuficiencia cardíaca (6%) y VIH (6%). Las fuentes más comunes de la sepsis fueron neumonía (67%) e infección del tracto urinario (46%). La mediana del tiempo (IQR) transcurrido desde la selección (triaje) hasta la administración de antibióticos fue 126 (88, 220) minutos, y los antibióticos fueron entregados al 65.7% dentro de las tres horas. En general, los organismos fueron sensibles a los antibióticos empíricos en 69%. La mediana del lactato (IQR) fue 5.3 (4.5, 7.5) mmol/L. La mayoría de los pacientes (95%) fueron ingresados a la sala; 1% se destinó a la unidad de cuidados intensivos (UCI), y el 2% murió en la Sala de Emergencias. El promedio (SD) de la estancia hospitalaria fue de 9.5 (10.3) días. La mortalidad intrahospitalaria fue de 25%, y la supervivencia se halló en correlación inversa con la edad (rpb = .25; p = 0.006). CONCLUSIÓN: A pesar de la falta de TDMT, los patrones del tratamiento de sepsis fueron consistentes con las "mejores prácticas", y la mortalidad fue menor comparada con los datos de comparación a nivel internacional.

Tempo de chegada do paciente com infarto agudo do miocárdio em unidade de emergência / Time of arrival of patients with acute myocardial infarction to the emergency department

OBJETIVO: Caracterizar o perfil das pessoas com infarto agudo do miocárdio (IAM) atendidas em um serviço de emergência e verificar o tempo de chegada (delta T). Identificar como o paciente foi transportado e correlacionar o delta T com o tratamento e prognóstico do mesmo. MÉTODOS: Pesquisa transversal, incluindo 52 pacientes admitidos na Unidade de Emergência de um Hospital de Ensino com diagnóstico de IAM, no período de julho a dezembro de 2010. A coleta de dados foi realizada por meio do prontuário e entrevista. RESULTADOS: A maioria dos pacientes era do gênero masculino, com idade média de 62,35 ± 14,66 anos, casada, poucos anos de estudo, histórico familiar de doença cardíaca, hipertensão arterial, dislipidemia e sedentarismo. Os sintomas apresentados foram dor no tórax, região epigástrica ou desconforto torácico associado à dispneia e/ou sudorese súbita. A maioria dos pacientes foi transportada por ambulância e submetida a cateterismo cardíaco, seguido de angioplastia. O delta T encontrado foi 9h54min ± 18h9min. A letalidade global do estudo foi de 3,85%. CONCLUSÃO: O reconhecimento dos sinais e sintomas do IAM pelo paciente foi fator determinante para a procura de atendimento especializado e aqueles com menor delta T apresentaram melhor prognóstico.

OBJECTIVES: To characterize the profile of patients with acute myocardial infarction (AMI) treated at the emergency department and to verify the time of arrival of each patient (ΔT). Identify how the patient was transported and to correlate Delta-T (ΔT) with the treatment and the prognosis of each patient. METHODS: Cross-sectional survey involving 52 patients with AMI admitted to the Emergency Department of a Teaching Hospital took part in the study from July to December 2010. Data collection was performed using medical records and interviews. RESULTS: The majority of the patients were male with a mean age of 62.35 ± 14.66 years. The participants were married, with low education levels, family history of heart diseases, arterial hypertension, dyslipidemia, and a sedentary lifestyle. The symptoms presented were pains in the chest, epigastric region, or a chest discomfort associated to dyspnea and/or sudden sweating. The majority of the patients were transported by ambulance. They were submitted to cardiac catheterization followed by angioplasty. Delta-T found was 9h45min ± 18h9min. In this study, the overall lethality was 3.85%. CONCLUSIONS: The perception of signs and symptoms of AMI by the patient was a decisive factor when seeking out specialized treatment. Those with the lowest Delta-T presented better prognosis.