Perfil das cirurgias oncológicas e reparadoras de mama no norte do Brasil: Análise da última década / Profile of oncological and breast repair surgeries in northern Brazil: Analysis of the last decade

Introdução: O diagnóstico tardio do câncer de mama eleva o número de cirurgias, resultando em alta mortalidade e resultado pouco estético. Assim, é fundamental a instituição de procedimentos de reconstrução mamária. Método: Estudo descritivo, quantitativo e retrospectivo sobre as autorizações de internação hospitalar de pacientes submetidos a procedimentos cirúrgicos de mama em oncologia, no período de 2011 a 2020, cujo dados foram obtidos na plataforma DATASUS. Resultados: 7.529 cirurgias de câncer de mama e 1.949 cirurgias reparadoras foram realizadas na Região Norte. Houve aumento do número de procedimentos ao longo da década. Em todos os estados é possível perceber a diferença no número de municípios de residência, comparado aos municípios de internação. Conclusão: Necessita-se instituir centros de referência oncológica, garantindo tratamento individualizado e a reconstrução mamária.

Introduction: Late breast cancer diagnosis increases the number of surgeries, resulting in high mortality and unsightly results. Therefore, the institution of breast reconstruction procedures is essential. Method: Descriptive, quantitative, and retrospective study on authorizations for hospital admission of patients undergoing breast surgical procedures in oncology from 2011 to 2020, whose data were obtained from the DATASUS platform. Results: 7,529 breast cancer surgeries and 1,949 reconstructive surgeries were performed in the North Region. There was an increase in the number of procedures throughout the decade. In all states, it is possible to notice the difference in the number of municipalities of residence compared to the municipalities of hospitalization. Conclusion: It is necessary to establish oncological reference centers, guaranteeing individualized treatment and breast reconstruction.

Profile of thyroidectomies in Brazil from 2010 to 2020 from a macro-regional perspective

ABSTRACT Objective: To describe the distribution profile of thyroidectomies in Brazil from 2010 to 2020 from a macro-regional perspective. Materials and methods: This is a retrospective, detailed and descriptive study built on secondary data obtained from the Hospital Information System of the Unified Health System (SIH/SUS). We organized the data in tables and grouped them according to the federative unit, macro-region, type of procedure, mortality rate, and year of performance. We performed statistical analysis using the χ2 test to assess the association between the variables, observing a P value of < 0.05 and a confidence interval of 95%. Results: From 2010 to 2020, 160 219 thyroidectomy surgeries were performed, of which 77 812 (48.56%) were total, 38 064 (23.76%) partial and 41 191 (25.70%) oncological.The Southeast was responsible for the largest share of procedures, with 70 745 (44.15%), followed by the Northeast with 43 887 (27.39%). In 2020, the procedure was less performed, with 9226 (5.75%) surgeries. The total mortality rate was 0.16% during the study period. Conclusion: We found that thyroidectomies are carried out mainly in the Southeastern, Northeastern, and Southern regions, and showed a downward trend in 2020, which may be related to the COVID-19 pandemic. In addition, total thyroidectomy is the most performed surgery, and the Northern region had the highest mortality rate.

Women in surgery: do surgical specialties keep up with the feminization of medicine in Brazil? / Mulheres na cirurgia: as especialidades cirúrgicas acompanham a feminização da medicina no Brasil?

ABSTRACT Introduction: historically, surgical medical specialties are mostly male, a scenario which, in recent years, has undergone changes. In this sense, despite the relevance of the growth of female participation in the medical career, little is discussed about the distribution between genders of the main surgical medical specialties in the country. Objective: discuss the process of feminization in surgical specialties in Brazil over the last few years, tracing a distribution profile of these specialties. Methods: this is a retrospective and cross-sectional study with secondary data from the Censuses of Medical Demography in Brazil in the years 2011, 2013, 2015, 2018, 2020 and 2023, including the surgical specialties: Urology, Orthopedics and Traumatology, Thoracic Surgery, Neurosurgery, Digestive System Surgery, Cardiovascular Surgery, Hand Surgery, General Surgery, Head and Neck Surgery, Vascular Surgery, Plastic Surgery, Ophthalmology, Coloproctology, Otorhinolaryngology, Pediatric Surgery, and Gynecology and Obstetrics. Results: males prevails in numbers, among the surgical specialties, however, with a lower growth rate compared to females. Specialties such as urology, orthopedics and traumatology and neurosurgery are mostly male, while gynecology and obstetrics are female. Conclusion: it is evident that female participation in the surgical medical field has increased significantly over the last few years.

RESUMO Introdução: historicamente, as especialidades médicas cirúrgicas são, majoritariamente, masculinas, cenário o qual, nos últimos anos, passa por mudanças. Nesse sentido, apesar da relevância do crescimento da participação feminina na carreira médica, pouco se debate sobre a distribuição entre sexos das principais especialidades médicas cirúrgicas no país. Objetivo: discutir o processo de feminização nas especialidades cirúrgicas no Brasil ao longo dos últimos anos, traçando um perfil de distribuição dessas especialidades. Métodos: Trata-se de um estudo retrospectivo e transversal com dados secundários oriundos dos Censos de Demografia Médica no Brasil dos anos de 2011, 2013, 2015, 2018, 2020 e 2023, incluindo as especialidades cirúrgicas:Urologia, Ortopedia e Traumatologia, Cirurgia Torácica, Neurocirurgia, Cirurgia do Aparelho Digestivo, Cirurgia Cardiovascular, Cirurgia da Mão, Cirurgia Geral, Cirurgia de Cabeça e Pescoço, Cirurgia Vascular, Cirurgia Plástica, Oftalmologia, Coloproctologia, Otorrinolaringologia, Cirurgia Pediátrica e Ginecologia e Obstetrícia. Resultados: O sexo masculino prevalece em números, dentre as especialidades cirúrgicas, porém, com menor taxa de crescimento em comparação ao sexo feminino. Especialidades como a urologia, ortopedia e traumatologia e neurocirurgia são majoritariamente masculinas, enquanto a ginecologia e obstetrícia, feminina. Conclusão: evidencia-se que a participação feminina na área médica cirúrgica aumentou significativamente ao longo dos últimos anos.

Low-cost suture simulator to gain basic surgical skills

ABSTRACT Purpose: To introduce a new low-cost simulation model for training basic surgical skills. Methods: The training model was made from a mixture of 20 g of acetic silicone with 11 g of maize starch. Validation consisted of serial training sessions, evaluating the mean pre- and post-training time and the mean final score according to the global rating scale. Results: A decrease in the time required to perform the sutures was observed, comparing the average post and pre-training time of each training day, with a significant correlation between the order of training and the time for performing the simulation. Conclusions: The presented model proved to be capable of simulating the basic suture training skills. It is easy to make, has low cost, and can be easily reproduced in educational institutions.

Analysis of trends in sepsis mortality in Brazil and by regions from 2010 to 2019 / Análise de tendência de mortalidade por sepse no Brasil e por regiões de 2010 a 2019

ABSTRACT OBJECTIVE To characterize the profile of inpatients and trend of sepsis mortality in the Brazilian Unified Health System (SUS), throughout Brazil, and in its regions separately, from 2010 to 2019. METHODS Observational, analytical and retrospective study of secondary data obtained through consultation to the Sistema de Informação Hospitalar (Hospital Information System). All incoming septicemia notifications from January 1, 2010 to December 31, 2019 were included. The following sociodemographic variables were used: sex, age, race, region and federative unit of residence. For data analysis, we used mortality and hospitalization coefficient, relative risk and Joinpoint regression. RESULTS There were a total of 1,044,227 cases of sepsis in Brazil, yielding a mean prevalence coefficient of 51.3/100 thousand inhabitants. There were 463,000 deaths from sepsis recorded, with a mean prevalence coefficient of 22.8 deaths/100,000 inhabitants. The highest rates occurred among the elderly, of brown race, and there was no significant difference between genders. The Southeast region accounted for the highest rates of hospitalization and deaths. A general trend toward increased mortality was observed in the period studied. CONCLUSION The heterogeneity of Brazil should be considered regarding socioeconomic and demographic characteristics, and differences in health investment and underreporting between regions, in order to understand the disease's epidemiological course. Finally, these findings should be correlated with other studies, in an effort to understand the behavior of the disease, and provide inputs for public and private policies in order to reduce the expressiveness of cases and deaths from sepsis in Brazil.

RESUMO OBJETIVO Caracterizar o perfil dos pacientes internados e a tendência de mortalidade por sepse no Sistema Único de Saúde (SUS), em todo Brasil e em suas regiões separadamente, entre os anos de 2010 e 2019. MÉTODOS Estudo observacional, analítico e retrospectivo de dados secundários obtidos por consulta ao Sistema de Informação Hospitalar. Foram incluídas todas as notificações por septicemia admitidas entre 1 de janeiro de 2010 e 31 de dezembro de 2019. Utilizou-se as variáveis sociodemográficas: sexo, idade, raça, região e unidade federativa de residência. Para a análise dos dados, utilizou-se coeficiente de mortalidade e de internação, risco relativo e regressão por Joinpoints. RESULTADOS Totalizaram-se 1.044.227 casos de sepse no país, perfazendo um coeficiente de prevalência média de 51,3/100 mil habitantes. Foram registrados 463 mil óbitos por sepse, com coeficiente médio de 22,8 óbitos/100 mil habitantes. As maiores taxas ocorreram entre os idosos, de raça parda e não houve uma diferença significativa entre os sexos. A Região Sudeste foi responsável pelo maior índice de internação e óbitos. Observou-se uma tendência geral de aumento da mortalidade no período estudado. CONCLUSÃO Cabe considerar a heterogeneidade do Brasil, no que concerne às características socioeconômicas e demográficas e às diferenças de investimento em saúde e de subnotificações entre as regiões, a fim de entender o traçado epidemiológico da doença. Por fim, é necessário correlacionar esses achados com demais estudos, buscando entendimento do comportamento da doença e embasamento para políticas públicas e privadas, com intuito de diminuir a expressividade de casos e óbitos por sepse no país.

Anatomical description of the extratemporal facial nerve under high-definition system: a microsurgical study in rats

Purpose: To describe the microsurgical anatomical aspects of the extratemporal facial nerve of Wistar rats under a high-definition video system. Methods: Ten male Wistar rats (12­15 weeks old), without veterinary diseases, weighing 220­280 g, were used in this study. All animals in this study were submitted to the same protocol and by the same surgeon. A 10-mm incision was made below the bony prominence of the right or left ear, and extended towards the angle of the mandible. The dissection was performed and the main branches of the facial nerve were dissected. Results: The main trunk of the facial nerve has a length of 0.88 ± 0.10 mm and a length of 3.81 ± 1.03 mm, measured from its emergence from the stylomastoid foramen to its bifurcation. Seven branches originating from the facial nerve were identified: posterior auricular, posterior cervical, cervical, mandibular, buccal, temporal, and zygomatic. Conclusions: The anatomy of the facial nerve is comparable to that of humans, with some variations. The most observed anatomical division was the distribution in posterior auricular, posterior cervical, cervical, mandibular, buccal, temporal, and zygomatic branches. There is no statistical difference between the thickness and distance of the structures compared to the contralateral side.