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1.
Rev. enferm. UERJ ; 28: e51034, jan.-dez. 2020.
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1118073

ABSTRACT

Objetivo: verificar se a redução da taxa de hemoglobina no pós-operatório de revascularização do miocárdio interfere na função renal dos pacientes. Método: estudo observacional e prospectivo, desenvolvido entre fevereiro e junho de 2016, com 51 pacientes que realizaram cirurgia de revascularização do miocárdio em um hospital especializado em cardiologia do Distrito Federal. Os dados foram coletados por meio de um instrumento estruturado. O teste exato de Fisher, Qui-quadrado e Kruskal Wallis foram empregados para análise estatística. Considerou-se significativo resultados com p≤0,05. Projeto de pesquisa aprovado pelo Comitê de Ética, protocolo 44999215.9.0000.0026. Resultados: entre os pacientes, 45 (78,9%) evoluíram com lesão renal aguda após revascularização do miocárdio. Idade mais elevada (64±9 anos, p=0,05), tempo de circulação extracorpórea (p=0,05), índice de massa corporal (p=0,02), uso de antibióticos (p=0,03) e redução da taxa de hemoglobina (p=0,04), contribuíram para lesão renal aguda. Conclusão: a redução da taxa de hemoglobina foi associada estatisticamente à lesão renal aguda após revascularização do miocárdio.


Objective: to determine whether decreased hemoglobin rate after myocardial revascularization surgery interferes with patients' renal function. Method: this prospective, observational study was conducted between February and June 2016 with 51 patients who underwent myocardial revascularization surgery at a specialist cardiology hospital specializing in the Federal District. Data were collected using a structured instrument. The Fisher's exact, Chi-square and Kruskal-Wallis tests were used for statistical analysis. Results were considered significant at p ≤ 0.05. The research project was approved by the research ethics committee (Protocol 44999215.9.0000.0026). Results: it was observed that 45 patients (78.9%) developed acute kidney injury after myocardial revascularization. Oldest age (64 ± 9 years, p = 0.05), cardiopulmonary bypass time (p = 0.05), body mass index (p = 0.02), use of antibiotics (p = 0.03), and decreased hemoglobin rate (p = 0.04) contributed to acute kidney injury. Conclusion: decreased hemoglobin rate was statistically associated with acute kidney injury following myocardial revascularization.


Objetivo: verificar si la reduciendo la tasa de hemoglobina en el postoperatorio de revascularización miocárdica interfiere con la función renal de los pacientes. Método: estudio observacional prospectivo realizado entre febrero y junio de 2016 con 51 pacientes que se sometieron a una cirugía de revascularización miocárdica en un hospital especializado en cardiología en el Distrito Federal. Los datos fueron recolectados utilizando un instrumento estructurado. La prueba exacta de Fisher, Chicuadrado y Kruskal-Wallis se utilizaron para el análisis estadístico. Los resultados se consideraron significativos con p≤0.05. Proyecto de investigación aprobado por el Comité de Ética, protocolo 44999215.9.0000.0026. Resultados: se observó que 45 (78,9%) pacientes desarrollaron lesión renal aguda después de la revascularización miocárdica. Edad avanzada (64 ± 9 años, p = 0.05), tiempo de circulación corporal extra (p = 0.05), índice de masa corporal (p = 0.02), uso de antibióticos (p = 0.03) y tasa de hemoglobina reducida (p = 0.04), contribuyó a lesión renal aguda. Conclusión: reduciendo la tasa de hemoglobina contribuyó a lesión renal aguda después de la revascularización miocárdica.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Hemoglobins , Acute Kidney Injury , Myocardial Revascularization , Postoperative Care , Brazil , Prospective Studies , Creatinine/blood , Observational Study , Nursing Care
2.
Rev. enferm. UERJ ; 28: e42285, jan.-dez. 2020.
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1120154

ABSTRACT

Objetivo: comparar o custo entre coberturas com filme transparente versus gaze estéril e fita adesiva microporosa em curativos de acesso venoso central. Método: estudo estatístico, prospectivo, observacional, com abordagem quantitativa à luz da avaliação econômica de saúde. Foram avaliadas 109 coberturas com filme e 168 com gaze, durante 27 dias. Na análise utilizouse o Software Tree Age para se calcular a probabilidade de cada decisão. Resultado: a média de uso das coberturas por dia foi de 2,22 inserções cobertas com filme e 3,43 com gaze. Houve necessidade de troca extra em 38 (23%) das coberturas com gaze e em 16 (15%) das coberturas com filme transparente. Observou-se custo final médio para gaze (R$389,44) 3,7 vezes maior que o filme transparente (R$104,95) durante o período estudado. Conclusão: cobertura com filme transparente tem menor custo quando comparado com cobertura com gaze estéril.


Objective: to compare the cost of transparent film and sterile gauze fixed by microporous adhesive tape in central venous access dressings. Method: quantitative, prospective, observational, statistical study in the light of health economics. A total of 109 film and 168 gauze covers were evaluated for 27 days. Tree Age software was used to calculate the probability of each decision. Results: coverings used per day averaged 2.22 with transparent film-covered inserts and 3.43 with gauze. Additional changes were necessary in 38 (23%) coverings with gauze and 16 (15%) with transparent film. During the study period, the average final cost of gauze (R$ 389.44) was 3.7 times higher than transparent film (R$104.95). Conclusion: transparent film dressing is less expensive than sterile gauze covering.


Objetivo: comparar el costo de la película transparente y la gasa estéril fijada con cinta adhesiva microporosa en apósitos de acceso venoso central. Método: estudio cuantitativo, prospectivo, observacional, estadístico a la luz de la economía de la salud. Se evaluaron un total de 109 películas y 168 cubiertas de gasa durante 27 días. Se utilizó el software Tree Age para calcular la probabilidad de cada decisión. Resultados: los recubrimientos utilizados por día promediaron 2,22 con inserciones transparentes recubiertas con película y 3,43 con gasas. Fueron necesarios cambios adicionales en 38 (23%) revestimientos con gasa y 16 (15%) con película transparente. Durante el período de estudio, el costo final promedio de la gasa (R $ 389,44) fue 3,7 veces superior al de la película transparente (R $ 104,95). Conclusión: el apósito de película transparente es menos costoso que el recubrimiento de gasa estéril.


Subject(s)
Humans , Health Evaluation/economics , Central Venous Catheters , Occlusive Dressings/economics , Brazil , Decision Trees , Prospective Studies , Costs and Cost Analysis , Observational Study , Occlusive Dressings/statistics & numerical data
3.
Arch. argent. pediatr ; 118(6): 386-392, dic 2020. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1146049

ABSTRACT

Introducción. El virus sincicial respiratorio (VSR) es el principal agente causal de la infección respiratoria aguda baja (IRAB) en pediatría. Los niños prematuros tienen mayor riesgo de complicaciones asociadas con esta infección. Los objetivos fueron describir y comparar las características clínicas y epidemiológicas asociadas a IRAB por VSR en niños/as nacidos pretérmino y a término, y establecer predictores de letalidad en los prematuros.Métodos. Estudio prospectivo, transversal, de pacientes ingresados por IRAB, en el período 2000-2018. El diagnóstico virológico se realizó mediante inmunofluorescencia indirecta o reacción en cadena de la polimerasa con transcriptasa inversa de aspirados nasofaríngeos. Se registraron las características clínico-epidemiológicas. Se desarrolló un modelo de regresión logística múltiple para establecer los predictores de letalidad en prematuros.Resultados. Se incluyeron 16 018 casos de IRAB; 13 545 (el 84,6 %) fueron estudiados; 6047 (el 45 %) positivos; VSR predominó en el 81,1 % (4907); mostró un patrón epidémico estacional; el 14 % (686) fueron prematuros.Los prematuros mostraron mayor frecuencia de comorbilidades, antecedentes respiratorios perinatales, cardiopatía congénita, desnutrición, enfermedad respiratoria crónica, displasia broncopulmonar, hospitalización previa por IRAB y enfermedad neurológica crónica (p < 0,001); requirieron más cuidados intensivos, mayor tiempo de internación y mayor tasa de letalidad (p < 0,01). La cardiopatía congénita fue predictor independiente de letalidad por VSR en prematuros [OR 3,67 (1,25-10,8), p = 0,01].Conclusión. VSR mostró un patrón epidémico, afectó a prematuros con ciertas comorbilidades con mayor morbimortalidad que los de término. La letalidad por VSR en prematuros se asoció con la cardiopatía congénita.


Introduction. Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory tract infection (ALRTI) in pediatrics. Preterm infants are at a higher risk for complications. We aimed to describe and compare the clinical and epidemiological characteristics associated with ALRTI due to RSV in preterm and term infants and to establish the predictors of fatality among preterm infants.Methods. Prospective, cross-sectional study of patients admitted due to ALRTI in the 2000-2018 period. Viral diagnosis was done by indirect immunofluorescence or reverse transcription polymerase chain reaction in nasopharyngeal aspirates. Clinical and epidemiological characteristics were recorded. A multiple logistic regression model established the predictors of fatality among preterm infants.Results. A total of 16 018 ALRTI cases were included; 13 545 (84.6 %) were tested; 6047 (45 %) were positive; RSV was prevalent in 81.1 % (4907), with a seasonal epidemic pattern; 14 % (686) were preterm infants.Comorbidities, perinatal respiratory history, congenital heart disease, malnutrition, chronic respiratory disease, bronchopulmonary dysplasia, prior hospitalization due to ALRTI, and chronic neurological disease (p < 0.001) were more common among preterm infants; they required more intensive care and a longer length of stay, and had a higher fatality rate (p < 0.01). Congenital heart disease was an independent predictor of fatality due to RSV among preterm infants (OR: 3.67 [1.25-10.8], p = 0.01).Conclusion. RSV showed an epidemic pattern and affected more preterm infants with certain comorbidities, with a higher morbidity and mortality, compared to term infants. RSV fatality among preterm infants was associated with congenital heart disease.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Respiratory Syncytial Viruses , Respiratory Tract Infections , Infant, Premature , Epidemiologic Studies , Cross-Sectional Studies , Prospective Studies , Risk Factors , Fluorescent Antibody Technique, Indirect
4.
Rev. cuba. pediatr ; 92(4): e1085, oct.-dic. 2020. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1144522

ABSTRACT

Introducción: El síndrome de cascanueces es una anomalía vascular poco buscada y diagnosticada, por su baja incidencia y por la dificultad de sospecharla ante manifestaciones clínicas frecuentes. Objetivo: Examinar las características clínicas e imagenológicas de los pacientes diagnosticados con el síndrome de cascanueces. Método: Estudio descriptivo retrospectivo y prospectivo en pacientes atendidos en el Hospital Pediátrico Universitario William Soler entre enero de 2013 - diciembre de 2017. Cuando se sospechó el síndrome se realizó ultrasonido buscando la dilatación de la vena renal izquierda y el ángulo de salida de la arteria mesentérica superior. En 7 de los pacientes se realizó angio-TAC. Se revisaron variables epidemiológicas, clínicas, de laboratorio e imagenológicas. Presentación de los casos: Del total de 9 pacientes en que se diagnosticó la anomalía vascular, 6 (66,7 por ciento) pertenecen al sexo masculino. La edad media al diagnóstico fue 11,4 años (rango: 7-15). Se diagnosticó cascanueces anterior en 7 (77,7 por ciento), posterior en 1 (11,1 por ciento) y síndrome de Wilkie con fenómeno cascanueces asociado en 1 (11,1 por ciento). En el 100 por ciento de los casos hubo dolor abdominal o lumbar, asociado a hematuria en 4, orinas espumosas en 4 y varicocele izquierdo en 2 de los 6 varones (33,3 por ciento). Conclusiones: El síndrome de cascanueces debe buscarse en los pacientes que presentan dolor abdominal, lumbar o en flanco izquierdo en forma recurrente, episodios de hematuria recurrente o proteinuria ortostática. En el varón con varicocele izquierdo debe descartarse esta posibilidad. El fenómeno cascanueces, puede diagnosticarse cuando se investiga al paciente por causa no relacionada(AU)


Introduction: Nutcracker syndrome (NCS) is a vascular anomaly which is rarely searched and diagnosed due to its low incidence and because of the difficulty to suspect on it among other frequent clinical manifestations. Objective: To examine clinical and imaging characteristics of patients diagnosed with NCS. Methods: Descriptive, retrospective and prospective study in patients admitted in William Soler University Pediatric Hospital in the period from January, 2013 to December, 2017. When it was suspected the presence of the syndrome, it was made an ultrasound looking for dilation of the left renal vein and the output angle of the superior mesenteric artery. In 7 patients it was made an angio-TAC. The epidemiologic, clinical, laboratory and imaging variables were reviewed. Presentation of cases: From the total of 9 patients diagnosed with a vascular anomaly; 6 (66,7 percent) were males. The mean age was 11,4 years (range 7-15 years). It was diagnosed front NCS in 7 patients (77.7 percent), back NCS in 1 patient (11.1 percent) and Wilkie syndrome with associated NCS in 1 patient (11.1 percent). 100 percent of the cases presented abdominal or lumbar pain related to hematuria (4 patients), foaming urine (4 patients) and left varicocele in 2 of the male patients (33.3 percent). Conclusions: Nutcracker syndrome should be searched in patients presenting frequent abdominal, lumbar or left side pain, recurrent hematuria or orthostatic proteinuria episodes. In males with left varicocele should be discounted this possibility. Nutcracker phenomenon can be also diagnosed when the patient is being investigated due to not related causes(AU)


Subject(s)
Prospective Studies , Renal Nutcracker Syndrome/epidemiology , Renal Nutcracker Syndrome/diagnostic imaging
5.
Rev. cuba. pediatr ; 92(4): e1083, oct.-dic. 2020. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1144517

ABSTRACT

Introducción: La malformación aneurismática en la vena de Galeno es infrecuente, pero tiene alta mortalidad en neonatos. Objetivo: Examinar la relevancia clínica del diagnóstico ecográfico de la malformación aneurismática en la vena de Galeno Métodos: Investigación observacional, prospectiva y transversal realizado en el Cardiocentro William Soler. (noviembre 1999-diciembre 2016) La muestra la conformaron 18 neonatos con diagnóstico de malformación aneurismática en la vena de Galeno variedad coroidea mediante ecografía doppler. Se configuraron dos grupos de referencia: 1) 70 niños supuestamente sanos. 2) 73 niños con malformación de la vena Galeno de diferente naturaleza que la variante coroidea estudiada. El procesamiento de la información incluyó elementos de estadística inferencial y herramientas de la medicina basada en la evidencia. Resultados: La presencia de fallo cardíaco neonatal, signos electrocardiográficos de isquemia miocárdica y detección de soplo continuo transcraneal, fueron significativamente diferentes en el grupo de estudio en relación con el grupo de referencia (p= 0,000001), con predominio en el número de pacientes del grupo estudio en todas las variables. Los resultados anteriores conjugados con diversos hallazgos ecográficos: la dilatación anómala de la vena, exceso de vasculatura aferente, reducción de los índices circulatorios encefálicos e incremento en los diámetros vasculares supraaórticos, identificaron de forma precisa la malformación aneurismática en la vena de Galeno. La evaluación del riesgo relativo reafirmó la documentación de los hallazgos expuestos. Conclusiones: La ecografía doppler, por su relevancia clínica y vínculo con otros elementos diagnósticos, es mandatoria en la detección de la malformación aneurismática en la vena de Galeno(AU)


Introduction: Vein of Galen aneurysmal malformation is not frequent but it has high mortality rates in newborns. Objective: To assess the clinical relevance of ultrasound diagnosis of Vein of Galen aneurysmal malformation. Methods: Observational, prospective and cross-sectional research conducted in William Soler Cardiocentro (November 1999- December 2016). The sample was formed by 18 newborns with diagnosis of Vein of Galen aneurysmal malformation (choroidal variety) through doppler echocardiography. Two reference groups were formed: 1) 70 supposedly healthy children; 2) 73 children with Vein of Galen malformation with a nature different to the studied choroidal variety. Processing of the information included elements of inferential statistics and tools from medicine based in evidences. Results: The presence of neonatal heart failure, electrocardiographic signs of myocardial ischemia and detection of transcranial continuous murmur were significantly different in the study group in relation with the reference group (p= 0,000001), with predominance in the number of patients of the study group in all the variables. The previous results combined with different ultrasound findings as the anomalous dilation of the vein, the excess of afferent vasculature, the reduction of encephalic circulation indexes and the increase of the supraaortic vascular diameters identified in a precise way the vein of Galen aneurysmal malformation. The assessment of the relative risk reaffirmed the information on the exposed findings. Conclusions: Doppler echography, due to its clinical importance and its links with other diagnostic elements, is mandatory in the detection of the vein of Galen aneurysmal malformation(AU)


Subject(s)
Ultrasonography, Doppler/methods , Vein of Galen Malformations/mortality , Vein of Galen Malformations/diagnostic imaging , Cross-Sectional Studies , Prospective Studies , Risk Assessment
6.
Rev. cuba. pediatr ; 92(4): e977, oct.-dic. 2020. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1144516

ABSTRACT

Introducción: Las malformaciones congénitas del riñón y del tracto urinario representan entre 20 y 30 por ciento de todas las malformaciones reconocidas en humanos. Objetivo: Identificar los antecedentes patológicos familiares y las enfermedades durante el embarazo asociados a la aparición de defectos congénitos renales. Métodos: Estudio descriptivo prospectivo transversal realizado en 672 niños nacidos entre julio de 2014 y junio de 2015 en Santa Clara, con ultrasonido prenatal normal. A todos los niños durante la consulta médica se les hizo examen físico detallado y previo consentimiento informado del familiar acompañante, se aplicó a estos una encuesta y se registraron variables epidemiológicas, antecedentes familiares de enfermedades renales, morbilidad de la madre durante el embarazo y se realizó un ultrasonido renal para identificar las alteraciones sonográficas sugerentes de algún tipo de anomalías del desarrollo renal. Resultados: En 40 (5,95 por ciento) pacientes se detectó alteración sonográfica. El 27,50 por ciento eran hijos de madres que presentaron alguna enfermedad durante el embarazo. La glucemia elevada afectó 10 por ciento de las madres de los niños con anomalías del desarrollo renal, seguida del bajo peso materno (7,5 por ciento). El hecho de presentar antecedente patológico familiar de enfermedad renal aportó un riesgo de 1,88 y en las de tipo obstructivo el riesgo fue de 5,08. Conclusiones: Las alteraciones sonográficas sugestivas de malformación congénita renal son más frecuentes en los lactantes cuyas madres presentaron concentraciones elevadas de glucosa y bajo peso durante el embarazo. Los niños con antecedentes familiares de malformación renal tienen mayor riesgo de presentar una anomalía del desarrollo renal(AU)


Introduction: Kidney and urinary tract´s malformations represent among 20 and 30 percent of all malformations known in humans. Objective: To identify during pregnancy family pathological history and diseases associated to the onset of renal congenital malformations. Methods: Prospective, descriptive, cross-sectional study carried out to 672 children with normal prenatal ultrasound whom were born from July, 2014 to June 2015 in Santa Clara province. All children during the medical consultation had a detailed physical examination and previous informed concent; it was applied also a survey and the epidemiologic variables, family history of renal diseases, morbility of the mother during pregnancy were recorded, and it was made a renal ultrasound to identify sonographic alterations suggesting any kind of anomaly in the renal development. Results: In 40 patients (5,95 percent), it was detected any sonographic alteration. 27,50 percent were children of mothers that presented any disease during pregnancy. High glycemia affected the 10 percent of mothers of children with anomalies in the renal development, followed by low maternal weight (7,5 percent). The fact of presenting a family pathological history of renal disease implied a risk of 1,88 percent and the risk was of 5,08 percent in the obstructive kind of diseases. Conlusions: Sonographic alterations suggesting renal congenital malformations are more frequent in newborns whose mothers had high concentrations of glycemia and low weight during pregnancy. Children with family history of renal malformations have higher risk of presenting an anomaly of the renal development(AU)


Subject(s)
Humans , Male , Female , Infant , Congenital Abnormalities/diagnosis , Renal Insufficiency, Chronic/etiology , Kidney/abnormalities , Urinary Tract/abnormalities , Epidemiology, Descriptive , Cross-Sectional Studies , Prospective Studies
7.
Arq. bras. cardiol ; 115(5): 821-827, nov. 2020. tab
Article in Portuguese | LILACS, SES-SP | ID: biblio-1142272

ABSTRACT

Resumo Fundamento O tratamento com sacubitril-valsartana teve seu benefício prognóstico confirmado no ensaio PARADIGM-HF. No entanto, dados sobre alterações no teste de esforço cardiopulmonar (TECP) com o uso de sacubitril-valsartana são escassos. Objetivo O objetivo deste estudo foi comparar os parâmetros do TECP antes e depois do tratamento com sacubitril-valsartana. Métodos Avaliação prospectiva de pacientes com insuficiência cardíaca (IC) crônica e fração de ejeção do ventrículo esquerdo ≤40%, mesmo sob terapia padrão otimizada, que iniciaram tratamento com sacubitril-valsartana, sem expectativa de tratamentos adicionais para a IC. Os dados do TECP foram coletados na semana anterior e 6 meses depois do tratamento com sacubitril-valsartana. Diferenças estatísticas com valor p <0,05 foram consideradas significativas. Resultados De 42 pacientes, 35 (83,3%) completaram o seguimento de 6 meses, uma vez que 2 (4,8%) morreram e 5 (11,9%) interromperam o tratamento devido a eventos adversos. A média de idade foi de 58,6±11,1 anos. A classe NYHA (classificação da New York Heart Association) melhorou em 26 (74,3%) pacientes. O consumo máximo de oxigênio (VO2max) (14,4 vs. 18,3 ml/kg/min, p<0,001), a inclinação VE/VCO2 (36,7 vs. 31,1, p<0,001) e a duração do exercício (487,8 vs. 640,3 s, p<0,001) também melhoraram com o uso de sacubitril-valsartana. O benefício foi mantido mesmo com a dose de 24/26 mg (13,5 vs. 19,2 ml/kg/min, p=0,018) de sacubitril-valsartana, desde que esta tenha sido a maior dose tolerada. Conclusões O tratamento com sacubitril-valsartana está associado a uma melhora acentuada do VO2max, da inclinação VE/VCO2 e da duração do exercício no TECP. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)


Abstract Background Sacubitril/valsartan had its prognosis benefit confirmed in the PARADIGM-HF trial. However, data on cardiopulmonary exercise testing (CPET) changes with sacubitril-valsartan therapy are scarce. Objective This study aimed to compare CPET parameters before and after sacubitril-valsartan therapy. Methods Prospective evaluation of chronic heart failure (HF) patients with left ventricular ejection fraction ≤40% despite optimized standard of care therapy, who started sacubitril-valsartan therapy, expecting no additional HF treatment. CPET data were gathered in the week before and 6 months after sacubitril-valsartan therapy. Statistical differences with a p-value <0.05 were considered significant. Results Out of 42 patients, 35 (83.3%) completed the 6-month follow-up, since 2 (4.8%) patients died and 5 (11.9%) discontinued treatment for adverse events. Mean age was 58.6±11.1 years. New York Heart Association class improved in 26 (74.3%) patients. Maximal oxygen uptake (VO2max) (14.4 vs. 18.3 ml/kg/min, p<0.001), VE/VCO2slope (36.7 vs. 31.1, p<0.001), and exercise duration (487.8 vs. 640.3 sec, p<0.001) also improved with sacubitril-valsartan. Benefit was maintained even with the 24/26 mg dose (13.5 vs. 19.2 ml/kg/min, p=0.018) of sacubitril-valsartan, as long as this was the highest tolerated dose. Conclusions Sacubitril-valsartan therapy is associated with marked CPET improvement in VO2max, VE/VCO2slope, and exercise duration. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)


Subject(s)
Humans , Middle Aged , Aged , Ventricular Function, Left , Heart Failure/drug therapy , Oxygen , Stroke Volume , Tetrazoles , Prospective Studies , Treatment Outcome , Drug Combinations , Angiotensin Receptor Antagonists , Aminobutyrates
8.
Arq. bras. cardiol ; 115(5): 916-924, nov. 2020. tab, graf
Article in Portuguese | LILACS, SES-SP | ID: biblio-1142262

ABSTRACT

Resumo Fundamento: O infarto agudo do miocárdio com supradesnivelamento do segmento ST (STEMI) é uma das principais apresentações clínicas da cardiopatia isquêmica. Dados de base populacional são relevantes para entendimento contemporâneo da epidemiologia da doença. Objetivo: Descrever incidência, manejo terapêutico, desfechos clínicos hospitalares e eventos cardiovasculares do primeiro ano de seguimento dos indivíduos hospitalizados por STEMI. Métodos: Estudo de coorte prospectiva de base populacional com registro consecutivo das hospitalizações por STEMI em uma cidade do Sul do Brasil entre 2011 e 2014. Foram incluídos indivíduos com STEMI que apresentaram sintomas de isquemia miocárdica aguda nas últimas 72 horas. Os valores de p < 0,05 foram considerados significativos. Resultados: A incidência anual de hospitalizações por STEMI foi de 108 casos por 100.000 habitantes. A incidência ajustada foi maior entre os mais velhos (risco relativo 64,9; IC95% 26,9 - 156,9; p para tendência linear < 0,001) e entre os homens (risco relativo 2,8; IC95% 2,3 - 3,3; p < 0,001). Ocorreram 530 hospitalizações durante o período avaliado e a taxa de reperfusão foi de 80,9%. A mortalidade hospitalar e a taxa de eventos cardiovasculares em 1 ano foram, respectivamente, 8,9% e 6,1%. Os mais velhos apresentaram maior mortalidade hospitalar (risco relativo 3,72; IC95% 1,57 - 8,82; p para tendência linear = 0,002) e mais eventos cardiovasculares em 1 ano (hazard ratio 2,35; IC95% 1,12 - 4,95; p = 0,03). Conclusão: Este registro demonstra abordagem terapêutica e mortalidade hospitalar semelhante às observadas em países desenvolvidos. Entretanto, a taxa de hospitalizações foi maior comparada com esses países.


Abstract Background: ST-segment elevation myocardial infarction (STEMI) is one of the main clinical manifestations of ischemic heart disease. Population-based data are relevant to better understand the current epidemiology of this condition. Objective: To describe the incidence, therapeutic management, hospital clinical outcomes and cardiovascular events in the first year of follow-up of individuals hospitalized for STEMI. Methods: Population-based prospective cohort study with consecutive registries of hospitalization for STEMI in a city in southern Brazil from 2011 to 2014. It included patients with STEMI who presented acute myocardial ischemia symptoms in the last 72 hours. A p-value < 0.05 was considered significant. Results: The annual incidence of STEMI hospitalizations was 108 cases per 100,000 inhabitants. Adjusted incidence was higher among older individuals (relative risk 64.9; 95% CI 26.9-156.9; p for linear trend < 0.001) and among men (relative risk 2.8; 95% CI 2.3-3.3; p < 0.001). There were 530 hospitalizations in the period under evaluation and the reperfusion rate reached 80.9%. Hospital mortality and the one-year follow-up cardiovascular event rate were, respectively, 8.9% and 6.1%. The oldest patients had higher hospital mortality (relative risk 3.72; 95% CI 1.57-8.82; p for linear trend = 0.002) and more one-year follow-up cardiovascular events (hazard ratio 2.35; 95% CI 1.12-4.95; p = 0.03). Conclusion: This study shows that both the therapeutic approach and hospital mortality are similar to the ones found in developed countries. However, the hospitalization rate was higher in these countries.


Subject(s)
Humans , Male , ST Elevation Myocardial Infarction/therapy , ST Elevation Myocardial Infarction/epidemiology , Myocardial Infarction/therapy , Myocardial Infarction/epidemiology , Brazil/epidemiology , Registries , Prospective Studies , Risk Factors , Treatment Outcome , Hospital Mortality , Hospitalization
9.
Femina ; 48(11): 680-684, 20201130. ilus, tab
Article in Portuguese | LILACS | ID: biblio-1140184

ABSTRACT

Objetivos: Avaliar o conforto no uso do coletor menstrual durante o exercício físico. Métodos: Foi realizado um estudo prospectivo com uma coorte de 49 jogadoras de handebol universitário. As participantes foram convidadas a usar o coletor menstrual descartável Softcup® durante três ciclos menstruais. O desfecho primário foi a satisfação geral no uso do coletor. Os desfechos secundários incluíram: facilidade de inserção e remoção do dispositivo, dor, desconforto nas relações sexuais, vazamento de sangue e/ou perda durante o exercício físico. Resultados: A idade média das participantes foi de 22 ± 2 anos. O grau de satisfação geral durante o esporte foi alto (82%). A inserção e a remoção do dispositivo menstrual foram consideradas fáceis pela maioria das usuárias e o grau de satisfação aumentou nos ciclos subsequentes. A queixa de vazamento do fluxo menstrual durante o esporte ocorreu em 63,3% das atletas no primeiro ciclo e caiu para 42,9% no último ciclo (p > 0,05). Houve perda do dispositivo durante o exercício em 36,7% das atletas no primeiro ciclo, 30,6% no segundo e 26,5% no terceiro ciclo (p > 0,05). Das atletas que tiveram relações sexuais com o uso do coletor menstrual, 90,9% não apresentaram desconforto. Conclusão: O conforto no uso do coletor menstrual durante o exercício físico foi elevado. Vazamento menstrual e perda do dispositivo tendem a diminuir com ciclos subsequentes.(AU)


Objective: To evaluate the safety and comfort of menstrual cup during physical exercise. Methods: A prospective cohort study was setting analysing a total of 49 female handball players with a mean age of 22 ± 2 years. The participants were invited to use Softcup® disposable menstrual during three menstrual cycles. The main outcome measures was overall satisfaction. Secondary outcomes included ease of insertion and removal of the device, pain, discomfort in sexual intercourse, blood leakage and/ or loss of the menstrual cup during sport. Results: The degree of overall satisfaction during sport was high (82%). The insertion and removal of the menstrual cup was considered easy by most users, and the degree of satisfaction increased in subsequent cycles. The complaint of menstrual flow leakage during sport occurred in 63.3% of the athletes in the first cycle and fell to 42.9% in the last cycle (p > 0.05).(AU)


Subject(s)
Humans , Female , Adolescent , Adult , Middle Aged , Menstrual Hygiene Products , Patient Comfort , Motor Activity , Sports , Prospective Studies , Patient Satisfaction
10.
Rev. inf. cient ; 99(5): 442-451, tab
Article in Spanish | LILACS | ID: biblio-1139206

ABSTRACT

RESUMEN * Introducción: Se promueve la utilización de la musicoterapia para el manejo de determinados problemas de salud. Objetivo: Precisar el efecto de la musicoterapia sobre la sedación de pacientes con ventilación mecánica invasiva en la Unidad de Cuidados Intensivos del Hospital General Docente "Dr. Agostinho Neto" de Guantánamo en 2018. Método: Durante enero-diciembre de 2018, se realizó un preexperimento con la aplicación de musicoterapia. Participaron 40 pacientes durante el proceso de destete de la ventilación mecánica invasiva. Aleatoriamente, se asignaron a un grupo estudio (n=20) que se les ofreció musicoterapia y a un grupo control (n=20) que no se les ofreció esta terapéutica. Se estudiaron las modificaciones de la frecuencia cardiaca, frecuencia respiratoria, presión arterial media, dosis de sedantes y el nivel de agitación, criterios de profesionales y pacientes respecto a esta técnica. Los datos se resumieron mediante frecuencias absolutas, porcentajes, media y la desviación típica y las diferencias se evaluaron con la técnica t de Students. Resultados: La musicoterapia mejoró la presión arterial media, frecuencia cardiaca y respiratoria, disminuyó las dosis utilizadas de sedantes y mejoró la agitación en el grupo estudio (p<0,05). Los profesionales y pacientes ofrecieron criterios favorables respecto a sus bondades para el control de la agitación (p<0,05). Conclusiones: La musicoterapia es una terapia no farmacológica útil para el control de la agitación del paciente durante el proceso de destete de la ventilación mecánica invasiva.


ABSTRACT * Introduction: Music therapy is promoted as a tool to handle certain health issues. Objective: To specify the effect of music therapy in sedated patients with invasive mechanical ventilation in the intensive care unit at the General Teaching Hospital ¨Dr. Agostinho Neto¨ in Guantanamo during the year 2018. Method: From January to December, 2018, a pre-experimental application of music therapy was undertaken. 40 patients were part of the experiment, during the process of weaning from invasive mechanical ventilation. Patients were randomly selected to the studied group (n=20) or to a control group (n=20), the first being treated with music therapy while the last was not. Modifications in heart rate, respiratory rate, mean arterial pressure, sedative dose and levels of psychomotor agitation were taken into account; also listening to professionals´ and patients´ opinions on the treatment. The information gathered was sorted in absolute frequencies, percentages, mean and standard deviation, and the differences were evaluated with Student´s t-distribution. Results: Music therapy improved heart and respiratory rate, mean arterial pressure and helped to decrease the use of sedative doses; besides, it improved the agitation in the group studied (p<0.05). Patients and professionals both gave favorable opinions about the treatment and its ability to control the agitation (p<0.05). Conclusions: Music therapy constitutes a non-pharmacological form of therapy that proves effective to control agitation in patients during the process of weaning from invasive mechanical ventilation.


Subject(s)
Humans , Anxiety/therapy , Respiration, Artificial , Music Therapy/methods , Epidemiology, Descriptive , Epidemiology, Experimental , Cross-Sectional Studies , Prospective Studies
11.
Rev. cir. (Impr.) ; 72(5): 389-394, oct. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1138729

ABSTRACT

Resumen Introducción: En pacientes constipados crónicos por obstrucción de salida, la contracción paradojal del puborrectal (CPP) o "anismo" es frecuente. El tratamiento con Biofeedback y rehabilitación pelviperineal presenta resultados exitosos entre el 40-90%. Objetivo: Evaluar el resultado del tratamiento con Biofeedback y rehabilitación pelviperineal en pacientes con CPP a corto plazo. Materiales y Método: Serie de casos. Datos obtenidos prospectivamente de la Unidad de Piso Pelviano. Se incluyó pacientes entre 2008 y 2015 que cumplían criterios de constipación crónica secundaria a CPP, confirmado por manometría anorrectal y/o defeco-resonancia. Se analizaron datos demográficos, frecuencia de evacuaciones, uso de laxantes, enemas, pujo, Score de Altomare y Score de constipación de Wexner pre y post-tratamiento. Resultados: 43 pacientes, de los cuales 39 son mujeres. Edad media de 40 años (rango: 14-84). Duración de síntomas fue ≥ 5 años en el 72,5%. Mediana de sesiones de Biofeedback de 8 (6-10). El 62,8% presenta ≤ 2 evacuaciones semanales y disminuye a un 29,3% post-tratamiento (p < 0,001). El 76,2% requiere laxantes orales y el 42,9% enemas, disminuyendo a 35,1% (p < 0,001) y 5,4% (p < 0,001) respectivamente post-tratamiento. Sensación de evacuación incompleta/fragmentada en todos los intentos mejoró de 67,4% a 14,6% (p < 0,001) y el pujo excesivo en más de la mitad de intentos mejoró de 76,1% a 10,8% (p < 0,001). Score de Wexner para constipación y Altomare mejoró de 18 a 7 (p < 0,001) y de 16 a 5 (p < 0,001) respectivamente. Conclusión: El biofeedback y la rehabilitación pelviperineal son efectivas en el tratamiento de la CPP.


Introduction: In patients with chronic constipation by obstructive defecation syndrome Paradoxical Puborectalis Contraction or "anismus" is important. Successful results for Biofeedback treatment and Pelviperineal Rehabilitation it described between 40-90%. Aim: To evaluate the outcome of biofeedback and pelviperineal rehabilitation in patients with CPP in the short-term. Materials and Method: Case series. Data was obtained from the prospective database of Pelvic Floor Unit of Universidad Católica de Chile. Patients with anismus were included between 2008 and 2015. Diagnostic criteria were chronic constipation patients by anismus with anorectal manometry and/or defecoresonancy that confirms this disorder and discards other causes of obstruted defecation síndrome. Demographic variables, frequency of bowel movements, use of laxatives, enemas, pushing, Altomare Score and Wexner constipation Score were analyzed pre and post-treatment. Results: Series of 43 patients, 39 of whom where women. Median age: 40 years (range: 14-84). Duration of symptoms ≥ 5 years in 72.5%. Median of Biofeedback sessions: 8 (range 6-10). Pre-treatment, 62.8% had ≤ 2 evacuations weekly and 29.3% post-treatment (p < 0.001). Oral laxatives were required in 76.2% and 42.9% enemas, decreasing to 35.1% (p < 0.001) and 5.4% (p < 0.001) post-treatment respectively. Feeling of incomplete/evacuation fragmented all the time improved from 67.4% to 14.6% (p < 0.001) and excessive pushing in more than half of time improved from 76.1% to 10.8% (p < 0.001). Wexner Score for and Altomare Score improved from 18 to 7 (p < 0.001) and 16 to 5 (p < 0.001) respectively. Conclusion: Adult with chronic constipation by anismus can be treated effectively with Biofeedback and Pelviperineal Rehabilitation.


Subject(s)
Humans , Biofeedback, Psychology/methods , Constipation/therapy , Defecation , Prospective Studies , Pelvic Floor/physiopathology , Constipation/physiopathology
12.
Rev. cir. (Impr.) ; 72(5): 395-404, oct. 2020. tab, graf, ilus
Article in Spanish | LILACS | ID: biblio-1138730

ABSTRACT

Resumen Objetivo: Identificar los factores determinantes de la mejoría de la calidad de vida en pacientes sometidos a cirugía de contorno corporal. Materiales y Método: Se estudió una cohorte prospectiva de 113 pacientes sometidos a cirugía de contorno corporal. Se estudiaron características sociodemográficas, mediciones antropométricas, variables relativas a la cirugía y se aplicó el instrumento Body-Qol®. Para el análisis estadístico se utilizó estadística descriptiva, modelos de ecuaciones de estimación generalizada y modelos de regresión lineal y logística. Resultados: Se encontró mejoría en la calidad de vida de forma global (p < 0,0001) y por dominios. Los pacientes con pérdida masiva de peso tuvieron peores puntajes pre y postoperatorio, sin embargo, un delta de mejoría comparable con los pacientes estéticos. Dentro de los factores determinantes, existió una relación positiva entre la edad y la mejoría en la calidad de vida de forma global. El índice de masa corporal (IMC) se encontró asociado negativamente con la mejoría del puntaje global. Dentro de los factores de la cirugía, los pacientes sometidos a lipoabdominoplastía tuvieron una mayor mejoría con respecto a otras técnicas. Además, el patrón de resección ampliado y en flor de Lis se asoció a menor mejoría en el puntaje global. Conclusión: La cirugía de contorno corporal mejora la calidad de vida de forma significativa. Los principales factores determinantes de esta mejoría fueron la edad, el IMC, el antecedente de pérdida masiva de peso y el patrón de resección.


Aim: To identify the factors that have an impact on the quality of life of patients with body contouring surgery. Materials and Method: A prospective cohort of 113 patients was studied. Sociodemographic characteristics, antropometric measures and variables related to the surgery were analized. The Body-Qol® instrument was aplied. Descriptive statistic, generalized estimated equation models and lineal and logistic regresions were used for the statistical analysis. Results: Improvement in the quality of life was found globally (p < 0,0001) and in every domain of the scale. The patients with massive weight loss had worse scores pre- and post-operatively than the esthetic patients. A positive association between age and improvement on quality of life was found. Body mass index (BMI) was negatively associated with improvement of the score. The patients that had a lipoabdominoplasty had a major improvement in comparison with other techniques. Also, the extended resection pattern and Fleur de Lis pattern were associated with lesser improvement in the global score. Conclusion: Body contouring surgery improves quality of life significantly. The principal factors that have an impact on quality of life were age, BMI, massive weight loss and resection pattern.


Subject(s)
Humans , Male , Female , Quality of Life , Reconstructive Surgical Procedures , Body Contouring , Weight Loss , Body Mass Index , Epidemiology, Descriptive , Prospective Studies
13.
Rev. bras. oftalmol ; 79(5): 325-329, set.-out. 2020. tab, graf
Article in English | LILACS | ID: biblio-1137994

ABSTRACT

Abstract Objective: Compared to standard spectacle lenses, do +0.40 EyeZenTM lenses reduce symptoms of asthenopia induced by computer? Methods: A prospective clinical study was carried out with 39 volunteers who spent more than 4 hours a day using a computer (age, 27.31±4.24; male: female =13:26). Asthenopia and visual comfort were assessed using a questionnaires. All participants completed the asthenopia questionnaire with updated regular lenses (baseline). After 4 weeks of +0.40 Eyezen™ lenses wearing all subjects answered the asthenopia questionnaire and a second questionnaire to establish their level of satisfaction with these lenses. Statistical analysis was performed usind the Shapiro-Wilk test and Wilcoxon test, and p-values less than 0.05 were considered statistically significant. Results: Compared to standard spectacle lenses (baseline), +0.40 EyeZenTM lenses wearing reduced the total asthenopia score from17.44 ± 5.51 to 13.18 ± 10.22 (p < 0.001). Regarding the perception of the visual comfort levels with these lenses in the management of digital devices, more than 90% of subjects said they were entirely or delighted with their visual comfort.. Conclusions: Digital asthenopia induced by computer was significantly reduced by +0.40 EyeZen lenses wearing.


Resumo Objetivo: Comparadas com lentes oftálmicas regulares, as lentes de visão simples com +0,40D de poder adicicional de perto reduzem os sintomas de astenopia induzida por computador? Métodos: Foi realizado um estudo clínico prospectivo com 39 voluntários que passavam mais de 4h diárias utilizando computador (idade: 27,31±4,24 anos; masculino:feminino = 26:13). A astenopia e a percepção do conforto visual foram avaliadas com questionários. Todos os participantes respoderam ao questionário de astenopia com lentes regulares atualizadas (baseline). Após 4 semanas de uso das lentes +0.40 Eyezen™ os participantes responderam aos questionários de astenopia e de conforto visual. A análise estatística foi feita com os testes de Shapiro-Wilk e Wilcoxon. Valores de p<0,05 foram considerados estatísticamente significantes. Resultados: Comparadas com lentes oftálmicas regulares (baseline), o uso das lentes de visão simples com +0,40D de poder adicional de perto reduziu o escore total de astenopia de 17,44 ± 5,51 para 13,18± 10,22 (p< 0,001). Mais de 90% dos participantes se declaram completamente ou muito satisfeitos com o conforto visual percebido no uso de dispositivos digitais. Conclusão: A astenopia induzida por computadores foi significativamente reduzida pelo uso das lentes +0,40 Eyezen™ combinadas Crizal® Sapphire™.


Subject(s)
Humans , Male , Female , Adult , Computers , Asthenopia , Lenses , Occupational Diseases , Occupational Medicine , Prospective Studies
14.
Rev. ADM ; 77(5): 247-251, sept.-oct. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1146814

ABSTRACT

Introducción: Se ha documentado que, para tener mejores resultados en el control del biofilm oral, es necesario el uso de controles químicos, antes o después del cepillado dental. Entre éstos, encontramos los enjuagues de aceites esenciales. Objetivo: Determinar la actividad del enjuague con aceites esenciales antes o después del cepillado, en el control del biofilm dental. Material y métodos: El estudio se realizó con 27 voluntarios. Los participantes fueron seleccionados y agrupados. El grupo 1 fue el control, que empleó su técnica de cepillado habitual y dos grupos experimentales que, además del cepillado con dentífrico, usaron un enjuague de aceites esenciales durante ocho días, ya sea antes (grupo 2) o después del cepillado dental (grupo 3). La cuantificación del número de superficies teñidas en los tres grupos, tanto el estado inicial como posterior al uso de los enjuagues, se hizo con el índice de O'Leary y un revelador de placa tritonal, el cual permitió la observación del biofilm de forma clínica, así como su grado de patogenicidad. Resultados y conclusión: El análisis estadístico estableció que no existe diferencia significativa entre no usar y usar el enjuague con aceites esenciales antes o después del cepillado (AU)


Introduction: It has been documented that, to have better results in the control of oral biofilm, it is necessary to use chemical control, before or after tooth brushing. Among these, we find the essential oil rinses. Objective: To determine the activity of the rinse with essential oils before or after brushing, in the control of the dental biofilm. Material and methods: The study was conducted with 27 volunteers. The participants were selected and grouped. Group 1 was the control, which used its usual brushing technique and two experimental groups that, in addition to brushing with toothpaste, used a mouthwash of essential oils, for eight days, either before (group 2) or after tooth brushing (group number 3). For the quantification of the number of stained surfaces in the three groups, to record both the initial and subsequent state of the use of the rinses, it was done with the O'Leary index and a tritonal developer, which allowed the observation of the biofilm of clinical form, as well as its degree of pathogenicity. Results and conclusion: The statistical analysis established that there is no significant difference between not using and using the rinse with essential oils before or after brushing (AU)


Subject(s)
Humans , Male , Female , Adolescent , Adult , Oils, Volatile , Biofilms , Mouthwashes/therapeutic use , Toothbrushing , Oral Hygiene Index , Statistical Analysis , Prospective Studies , Analysis of Variance , Longitudinal Studies , Dental Plaque , Mexico
15.
Rev. bras. ortop ; 55(5): 620-624, Sept.-Oct. 2020. tab
Article in English | LILACS | ID: biblio-1144222

ABSTRACT

Abstract Objective To verify the applicability and agreement of the Ottawa ankle rules applied by medical students and orthopedic residents in a tertiary trauma service thus validating the Ottawa protocol for use on Brazilian soil. Prospective This was a prospective study, conducted in a tertiary hospital, including all patients with acute torsial trauma of the tibiotarsal joint. The patients underwent ankle and/or foot radiographs, and the questionnaire with the Ottawa ankle rules was applied by academics and, subsequently, by residents. The radiographs were evaluated by on-call orthopedists and specialist in foot and ankle, and the expert opinion was considered the gold standard for analysis. Results Two hundred and sixty-three patients were evaluated, and, after application of the established inclusion criteria, 226 cases remained for evaluation. The sensitivity to detect lesions and negative predictive value (NPV) was 100%. The most sensitive test with higher NPV for both academics and residents was palpation of the lateral malleolus. The study presented potential for a reduction of 30% in the total number of tests requested. Conclusion The data showed applicability and agreement between academics and residents, which allows for the validation of the Ottawa protocol in emergency care in Brazil.


Resumo Objetivo Verificar a aplicabilidade e a concordância das regras do tornozelo de Ottawa aplicadas por estudantes de medicina e residentes de ortopedia em um serviço de trauma terciário, validando assim as regras de Ottawa para utilização em solo brasileiro. Método Estudo prospectivo, realizado em um hospital terciário, incluindo todos os pacientes com trauma torcional agudo da articulação tibiotársica. Os pacientes realizaram radiografias de tornozelo e/ou pé, tendo sido aplicado o questionário com as regras do tornozelo de Ottawa por acadêmicos e, na sequência, por residentes. As radiografias foram avaliadas por ortopedistas plantonistas e especialista em pé e tornozelo, sendo a opinião do especialista considerada padrão-ouro da análise. Resultados Foram avaliados 263 pacientes e, após aplicados os critérios de inclusão estabelecidos, restaram para a avaliação 226 casos. A sensibilidade para detectar lesões e o valor preditivo negativo (VPN) foi de 100%. O teste mais sensível e com maior VPN para ambos, acadêmicos e residentes, foi a palpação do maléolo lateral. O estudo apresentou potencial de redução de 30% no total de exames solicitados. Conclusão Os dados demostraram aplicabilidade e concordância entre acadêmicos e residentes, o que permite a validação do protocolo de Ottawa nos atendimentos de urgência e emergência no Brasil.


Subject(s)
Humans , Male , Female , Wounds and Injuries , Prospective Studies , Surveys and Questionnaires , Ankle Injuries , Emergency Medical Services , Tertiary Care Centers , Fractures, Avulsion , Foot , Orthopedic Surgeons , Ankle
16.
Rev. bras. ortop ; 55(5): 570-578, Sept.-Oct. 2020. tab, graf
Article in English | LILACS | ID: biblio-1144217

ABSTRACT

Abstract Objective To demonstrate the clinical outcomes and complication rates of the surgical release with a single posterior approach in the treatment of post-traumatic elbow stiffness. Methods A prospective study with patients submitted to surgery between May 2013 and June 2018 in a single center. The access to the elbow was made through the posterior approach. The patients were followed up by an occupational therapy team, and were submitted to a standardized rehabilitation protocol, with static progressive orthoses and dynamic orthoses. The primary outcome was the range of flexion-extension of the elbow after 6 months. Results A total of 26 patients completed the minimum follow-up of 6-months. The mean range of flexion-extension of the elbow at the end of 6 months was of 98.3 ± 22.0°, with an amplitude gain of 40.0 ± 14.0° in relation to the pre-operative period (p< 0.001). The average flexion-extension gain at the end of 6 months was of 51.7% ± 17.1% (p< 0.001). The mean pronosupination at the end of 6 months was of 129.0 ± 42.7° (p< 0.001). Half of the cases had moderate and severe stiffness in the pre-operative period, compared with 7.7% at 6 months post-operatively (p< 0.001). The mean score for the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand (DASH) instruments was 74.4 ± 16.8 points and 31.7 ± 21.9 points respectively (p< 0.001 for both). The visual analogue scale (VAS) score presented no statistically significant difference compared to the pre-operative period (p= 0.096). Complications were observed in 6 (23%) patients, and no new surgical procedures were necessary. Conclusions The surgical release of the elbow associated with a rehabilitation protocol is a safe technique, with satisfactory results and low rate of complications.


Resumo Objetivo Demonstrar os resultados clínicos e a taxa de complicações da liberação cirúrgica por via única posterior no tratamento da rigidez pós-traumática de cotovelo. Métodos Estudo prospectivo, com pacientes submetidos a cirurgia entre maio de 2013 e junho de 2018 em um único centro. Foi realizado acesso ao cotovelo por via posterior. O seguimento dos pacientes foi feito por uma equipe de terapia ocupacional, e eles foram submetidos a um protocolo de reabilitação padronizado, com órteses estáticas progressivas e dinâmicas. O desfecho primário foi a amplitude de flexoextensão do cotovelo após 6 meses. Resultados Um total de 26 pacientes completaram o seguimento mínimo de 6 meses. A média de flexoextensão do cotovelo, ao final de 6 meses, foi de 98,3° ± 22,0°, com um ganho de amplitude de 40,0° ± 14,0° em relação ao pré-operatório (p< 0,001). A média de ganho relativo de flexoextensão, ao final de 6 meses, foi de 51,7% ± 17,1% (p< 0,001). A média de pronossupinação, ao final de 6 meses, foi de 129,0° ± 42,7° (p< 0,001). Metade dos casos apresentava rigidez moderada e grave no pré-operatório, contra 7,7% aos 6 meses de pós-operatório (p< 0,001). A pontuação nos instrumentos Mayo Elbow Performance Score (MEPS) e Disabilities of the Arm, Shoulder and Hand (DASH) apresentou melhora estatisticamente significativa em relação ao pré-operatório, atingindo 74,4 ± 16,8 pontos e 31,7 ± 21,9 pontos, respectivamente. A escala visual analógica (EVA) não apresentou diferença estatisticamente significativa em relação ao pré-operatório (p= 0,096). Complicações foram observadas em 6 (23%) pacientes, não sendo necessária nova abordagem cirúrgica em nenhum paciente. Conclusões A liberação cirúrgica do cotovelo associada a protocolo de reabilitação é técnica segura, com resultados satisfatórios e baixa taxa de complicações.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Rehabilitation , Splints , Prospective Studies , Contracture , Amplitude , Elbow Joint , Joint Capsule Release
17.
Rev. cuba. cir ; 59(3): e925, jul.-set. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1144431

ABSTRACT

RESUMEN Introducción: La histerectomía constituye la segunda causa más frecuente de cirugía mayor en la mujer. Tres tipos de histerectomías son usadas en la actualidad: la histerectomía vaginal, la histerectomía abdominal y la histerectomía mínimamente invasiva. Esta última variedad se comenzó a realizar en Matanzas a finales de la pasada década. Objetivo: Evaluar las características clínicas epidemiológicas de las pacientes histerectomizadas por cirugía video laparoscópica. Métodos: Se realizó un estudio descriptivo y prospectivo. El universo lo conformaron todas las pacientes en las que se implementó esta técnica quirúrgica y se tomó como muestra al propio universo, 96 pacientes. Resultados: Predominó la edad comprendida entre 40 y 49 años con 44 pacientes; la raza negra con 51 pacientes; diagnóstico de miomatosis uterina con 87 casos; tiempo quirúrgico de 61-90 min con 57 pacientes y estadía hospitalaria de hasta 24 h en 93 de las pacientes. Se presentaron 3 complicaciones en total y el número de casos convertidos fue 0. Conclusiones: La histerectomía videolaparoscópica es implementada de forma segura y eficaz. Se realizó predominantemente en mujeres mayores de 40 años, con diagnóstico de miomatosis uterina. El tiempo quirúrgico promedio es mayor que el reportado en la literatura. La estadía hospitalaria es de 24 horas como promedio y se reincorporaron a sus actividades habituales rápidamente(AU)


ABSTRACT Introduction: Hysterectomy is the second most frequent type of major surgery among women. Three types of hysterectomy are currently used: vaginal hysterectomy, abdominal hysterectomy, and minimally invasive hysterectomy. This last variety began to be performed in Matanzas at the end of the last decade. Objective: To evaluate the clinical-epidemiological characteristics of patients hysterectomized. Methods: A descriptive and prospective study was carried out. The population was made up of all the patients operated on by this surgical technique. The whole population itself was taken as a sample (96 patients). Results: There was predominance of the age group 40-49 years (44 patients), the black race (51 patients), diagnosis of uterine myomatosis (87 cases), surgical time of 61-90 min (57 patients), and hospital stay of up to 24 hours (93 patients). There were three complications and the number of converted cases was 0. Conclusions: Videolaparoscopic hysterectomy is implemented safely and effectively. It was performed predominantly in women over 40 years of age and diagnosed with uterine myomatosis. Average surgical time is greater than that reported in the scientific literature. Hospital stay is 24 hours as an average. The patients returned to their usual activities quickly(AU)


Subject(s)
Humans , Female , Middle Aged , Laparoscopy/methods , Video-Assisted Surgery/methods , Hysterectomy/methods , Epidemiology, Descriptive , Prospective Studies
18.
Rev. cuba. med ; 59(3): e1371, tab, graf
Article in Spanish | LILACS | ID: biblio-1139057

ABSTRACT

Introducción: Las complicaciones cardiovasculares constituyen la primera causa de morbilidad y mortalidad en el receptor de trasplante renal. Objetivo: Caracterizar la repercusión de la fístula arteriovenosa sobre variables hemodinámicas del corazón derecho en trasplante renal. Métodos: Estudio prospectivo, longitudinal. Se incluyeron 52 pacientes, evaluados clínica y ecocardiográficamente. Se compararon cinco variables hemodinámicas en el corazón derecho, previos y seis meses posteriores al cierre de la fístula arteriovenosa. Resultados: La edad promedio 46,02 años, 29 masculinos (55,8 por ciento). El diámetro de la aurícula derecha en las fístulas cerradas en la muñeca izquierda 8805; 6 años disminuyó (p=0,044), al igual que en el ventrículo derecho <6 años a nivel del pliegue del codo izquierdo (p=0,004). La presión sistólica de la arteria pulmonar descendió tras el cierre en el codo izquierdo lt;6 años (p=0,002), en las 8805;6 (p=0,05) y en el derecho (p=0,006). La presión media de la arteria pulmonar se redujo en las cerradas en pliegue del codo izquierdo <6 años (p=0,001) y 8805;6 años (p=0,017) al igual que en el derecho (p=0,009). La fracción de eyección del ventrículo derecho se incrementó al cierre en muñeca izquierda ;6 años (p=0,046) y en el codo derecho 8805;6 años (p=0,027). Conclusiones: La permanencia de la fístula arteriovenosa en el receptor de trasplante renal contribuye a la perpetuación y progresión de la disfunción cardiovascular preexistente(AU)


Introduction: Cardiovascular complications are the leading cause of morbidity and mortality in kidney transplant recipients. Objective: To describe the consequence of arteriovenous fistula on hemodynamic variables of the right heart in kidney transplantation. Methods: We conducted a prospective, longitudinal study. Fifty two patients were included, and they were clinically and echocardiographically assessed. Five hemodynamic variables were compared in the right heart, prior to the closure of the arteriovenous fistula and six months after. Results: The average age was 46.02 years, 29 were male (55.8 percent). The diameter decreased in the right atrium in closed fistulas in the left wrist #8805; 6 years (p = 0.044). The same occurred in the right ventricle <6 years at the level of the left elbow crease (p = 0.004). The systolic pressure of the pulmonary artery decreased after closure in the left elbow <6 years (p = 0.002), in ≥6 (p = 0.05) and in the right (p = 0.006). The mean pressure of the pulmonary artery was reduced in those closed in the crease of the left elbow <6 years (p = 0.001) and ≥6 years (p = 0.017) as well as in the right (p = 0.009). The right ventricular ejection fraction increased at closure in the left wrist <6 years (p = 0.046) and in the right elbow ≥6 years (p = 0.027). Conclusions: The permanence of arteriovenous fistula in the kidney transplant recipient contributes to the perpetuation and progression of the pre-existing cardiovascular dysfunction(AU)


Subject(s)
Humans , Male , Female , Arteriovenous Fistula/complications , Kidney Transplantation/adverse effects , Hemodynamics/physiology , Prospective Studies , Longitudinal Studies
19.
Rev. cuba. oftalmol ; 33(3): e898, tab
Article in Spanish | LILACS, CUMED | ID: biblio-1139088

ABSTRACT

RESUMEN Objetivos: Identificar los factores epidemiológicos, sistémicos y oculares de las oclusiones venosas retinianas. Métodos: Se realizó un estudio observacional descriptivo, transversal y prospectivo de los casos nuevos de oclusiones venosas retinianas que acudieron al Cuerpo de Guardia del Instituto Cubano de Oftalmología "Ramón Pando Ferrer", durante el período de marzo del año 2017 a marzo de 2018. Se estudiaron las variables epidemiológicas, los antecedentes patológicos sistémicos y los oculares. Los resultados se expresaron en frecuencias absolutas y relativas (variables cualitativas) y se calculó la media y la desviación estándar en las cuantitativas. Resultados: En el período se estudiaron 50 ojos de 50 pacientes diagnosticados con oclusión venosa retiniana. La edad promedio fue de 66 años (9,5 desviación estándar). Prevaleció la raza blanca (44 por ciento), sin predilección por sexo. Fueron más frecuentes la oclusión de la vena central de la retina (60 por ciento) y las formas no isquémicas de daño vascular (78 por ciento), así como la hipertensión arterial (78 por ciento), la obesidad (36 por ciento) y la diabetes mellitus (34 por ciento) como factores de riesgo sistémicos asociados, y el glaucoma crónico (24 por ciento) como factor ocular. Conclusiones: Las oclusiones venosas retinianas se presentan en edades avanzadas y asociadas a factores de riesgo sistémicos y oculares(AU)


ABSTRACT Objectives: Identify the epidemiological, systemic and ocular factors associated to retinal vein occlusion. Methods: A descriptive cross-sectional observational prospective study was conducted of the new cases of retinal vein occlusion presenting at the Emergency Service of Ramón Pando Ferrer Cuban Institute of Ophthalmology from March 2017 to March 2018. Analysis was performed of epidemiological variables and systemic and ocular pathological antecedents. Results were expressed as absolute and relative frequencies (qualitative variables), whereas quantitative variables underwent mean and standard deviation estimation. Results: Fifty eyes of 50 patients diagnosed with retinal vein occlusion were studied in the period. Mean age was 66 years (9.5 standard deviation). White skin color prevailed (44 percent) with no sex predominance. The most common disorders were central vein retinal occlusion (60 percent) and non-ischemic forms of vascular damage (78 percent), as well as arterial hypertension (78 percent), obesity (36 percent) and diabetes mellitus (34 percent) as associated systemic risk factors, and chronic glaucoma (24 percent) as an ocular factor. Conclusions: Retinal vein occlusion presents at advanced ages and is associated to systemic and ocular risk factors(AU)


Subject(s)
Humans , Male , Female , Middle Aged , Retinal Vein Occlusion/diagnosis , Epidemiologic Factors , Prospective Studies , Risk Factors , Epidemiology, Descriptive , Cross-Sectional Studies , Observational Studies as Topic
20.
Rev. cuba. oftalmol ; 33(3): e901, tab
Article in Spanish | LILACS, CUMED | ID: biblio-1139086

ABSTRACT

RESUMEN Objetivo: Determinar los resultados visuales de la cirugía de catarata en pacientes diabéticos tipo 2 con y sin alteraciones en el fondo de ojo, posterior a la facoemulcificación. Métodos: Se realizó un estudio descriptivo, longitudinal y prospectivo en 116 pacientes (232 ojos) diabéticos tipo 2 con catarata senil bilateral, en el Instituto Cubano Oftalmología "Ramón Pando Ferrer", de septiembre del año 2015 a septiembre de 2017. Se analizaron las variables sexo, edad, índice de masa corporal, tiempo de evolución de la diabetes tipo 2, tratamiento actual y agudeza visual sin corrección y mejor corregida. Se calcularon los valores absolutos, relativos, la media y la desviación estándar. Resultados: Predominaron el sexo femenino, con 70 años o más, y los pacientes entre los 5 a 9 años del debut de la diabetes. Más del 80 por ciento de los pacientes presentaban sobrepeso y obesidad, en la mayoría de los pacientes diabéticos tipo 2 operados de catarata mejoró la agudeza visual sin corrección y la mejor agudeza visual corregida a pesar del daño en el fondo de ojo. Conclusiones: La diabetes mellitus tipo 2 no es un factor determinante en la recuperación de la visión en pacientes operados de catarata(AU)


ABSTRACT Senile cataract surgery in type 2 diabetic patients, with or without funduscopy alterations, is a controversial issue. Objective: Determine the visual results of cataract surgery in type 2 diabetic patients with and without funduscopy alterations after phacoemulsification. Methods: A prospective longitudinal descriptive study was conducted of 116 type 2 diabetic patients (232 eyes) with bilateral senile cataract at Ramón Pando Ferrer Cuban Institute of Ophthalmology from September 2015 to September 2017. The variables analyzed were sex, age, body mass index, time of evolution of type 2 diabetes, current treatment and visual acuity without correction and best corrected. Estimation was performed of absolute and relative values and mean and standard deviation. Results: There was a predominance of the female sex, the 70 years and over age group, and patients with 5-9 years of diabetes evolution. More than 80 percent of the patients were overweight or obese. Most of the type 2 diabetic patients undergoing cataract surgery showed improvement in their visual acuity without correction and their best corrected visual acuity despite the damage revealed by the funduscopy. Conclusions: Type 2 diabetes mellitus is not a determining factor in sight recovery by patients undergoing cataract surgery(AU)


Subject(s)
Humans , Male , Female , Aged , Cataract Extraction/methods , Visual Acuity/physiology , Phacoemulsification/methods , Diabetes Mellitus, Type 2/etiology , Fundus Oculi , Epidemiology, Descriptive , Prospective Studies , Longitudinal Studies
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