Chronic thromboembolic pulmonary hypertension: the impact of advances in perioperative techniques in patient outcomes / Hipertensão pulmonar tromboembólica crônica: o impacto dos avanços nas técnicas perioperatórias nos resultados dos pacientes

ABSTRACT Objectives Pulmonary endarterectomy (PEA) is the gold standard treatment for chronic thromboembolic pulmonary hypertension (CTEPH). This study aimed at reporting outcomes of CTEPH patients undergoing PEA within 10 years, focusing on advances in anesthetic and surgical techniques. Methods We evaluated 102 patients who underwent PEA between January 2007 and May 2016 at the Instituto do Coração do Hospital das Clínicas da Universidade de São Paulo. Changes in techniques included longer cardiopulmonary bypass, heating, and cooling times and mean time of deep hypothermic circulatory arrest and shortened reperfusion time. Patients were stratified according to temporal changes in anesthetic and surgical techniques: group 1 (January 2007-December 2012), group 2 (January 2013-March 2015), and group 3 (April 2015-May 2016). Clinical outcomes were any occurrence of complications during hospitalization. Results Groups 1, 2, and 3 included 38, 35, and 29 patients, respectively. Overall, 62.8% were women (mean age, 49.1 years), and 65.7% were in New York Heart Association functional class III-IV. Postoperative complications were less frequent in group 3 than in groups 1 and 2: surgical complications (10.3% vs. 34.2% vs. 31.4%, p=0.035), bleeding (10.3% vs. 31.5% vs. 25.7%, p=0.047), and stroke (0 vs. 13.2% vs. 0, p=0.01). Between 3 and 6 months post-discharge, 85% were in NYHA class I-II. Conclusion Improvements in anesthetic and surgical procedures were associated with better outcomes in CTEPH patients undergoing PEA during the 10-year period.

RESUMO Objetivo A endarterectomia pulmonar (EAP) é o tratamento padrão ouro para hipertensão pulmonar tromboembólica crônica (HPTEC). O objetivo deste estudo foi relatar a evolução de pacientes com HPTEC submetidos a EAP em 10 anos, com foco nos avanços nas técnicas anestésicas e cirúrgicas. Métodos Foram avaliados 102 pacientes submetidos à EAP entre janeiro de 2007 e maio de 2016 no Instituto do Coração do Hospital das Clínicas da Universidade de São Paulo. Mudanças nas técnicas incluíram circulação extracorpórea, tempos de aquecimento e resfriamento mais longos e tempo médio de hipotermia profunda com parada circulatória e tempo de reperfusão reduzido. Os pacientes foram estratificados de acordo com as mudanças temporais nas técnicas anestésicas e cirúrgicas: grupo 1 (janeiro de 2007 a dezembro de 2012), grupo 2 (janeiro de 2013 a março de 2015) e grupo 3 (abril de 2015 a maio de 2016). Os desfechos clínicos foram qualquer ocorrência de complicações durante a hospitalização. Resultados Os grupos 1, 2 e 3 incluíram 38, 35 e 29 pacientes, respectivamente. No geral, 62,8% eram mulheres (idade média, 49,1 anos) e 65,7% estavam em classe funcional III-IV da New York Heart Association. As complicações pós-operatórias foram menos frequentes no grupo 3 do que nos grupos 1 e 2: complicações cirúrgicas (10,3% vs. 34,2% vs. 31,4%, p=0,035), sangramento (10,3% vs. 31,5% vs. 25,7%, p=0,047) e acidente vascular cerebral (0 vs. 13,2% vs. 0, p=0,01). Entre 3 e 6 meses após a alta, 85% estavam na classe I-II da NYHA. Conclusão Melhorias nos procedimentos anestésicos e cirúrgicos foram associadas a melhores resultados em pacientes com HPTEC submetidos a EAP durante o período de 10 anos.

Differences in children and adolescents with SARS-CoV-2 infection: a cohort study in a Brazilian tertiary referral hospital

OBJECTIVES: To compare demographic/clinical/laboratory/treatments and outcomes among children and adolescents with laboratory-confirmed coronavirus disease 2019 (COVID-19). METHODS: This was a cross-sectional study that included patients diagnosed with pediatric COVID-19 (aged <18 years) between April 11, 2020 and April 22, 2021. During this period, 102/5,951 (1.7%) of all admissions occurred in neonates, children, and adolescents. Furthermore, 3,962 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection samples were processed in patients aged <18 years, and laboratory-confirmed COVID-19 occurred in 155 (4%) inpatients and outpatients. Six/155 pediatric patients were excluded from the study. Therefore, the final group included 149 children and adolescents (n=97 inpatients and 52 outpatients) with positive SARS-CoV-2 results. RESULTS: The frequencies of sore throat, anosmia, dysgeusia, headache, myalgia, nausea, lymphopenia, pre-existing chronic conditions, immunosuppressive conditions, and autoimmune diseases were significantly reduced in children and adolescents (p<0.05). Likewise, the frequencies of enoxaparin use (p=0.037), current immunosuppressant use (p=0.008), vasoactive agents (p=0.045), arterial hypotension (p<0.001), and shock (p=0.024) were significantly lower in children than in adolescents. Logistic regression analysis showed that adolescents with laboratory-confirmed COVID-19 had increased odds ratios (ORs) for sore throat (OR 13.054; 95% confidence interval [CI] 2.750-61.977; p=0.001), nausea (OR 8.875; 95% CI 1.660-47.446; p=0.011), and lymphopenia (OR 3.575; 95% CI 1.355-9.430; p=0.010), but also had less hospitalizations (OR 0.355; 95% CI 0.138-0.916; p=0.032). The additional logistic regression analysis on patients with preexisting chronic conditions (n=108) showed that death as an outcome was significantly associated with pediatric severe acute respiratory syndrome (SARS) (OR 22.300; 95% CI 2.341-212.421; p=0.007) and multisystem inflammatory syndrome in children (MIS-C) (OR 11.261; 95% CI 1.189-106. 581; p=0.035). CONCLUSIONS: Half of the laboratory-confirmed COVID-19 cases occurred in adolescents. Individuals belonging to this age group had an acute systemic involvement of SARS-CoV-2 infection. Pediatric SARS and MIS-C were the most important factors associated with the mortality rate in pediatric chronic conditions with COVID-19.

Pre-validation study of the brazilian version of the disruptions in surgery index (disi) as a safety tool in cardiothoracic surgery

Abstract Introduction: Most risk stratification scores used in surgery do not include external and non-technical factors as predictors of morbidity and mortality. Objective: The present study aimed to translate and adapt transculturally the Brazilian version of the Disruptions in Surgery Index (DiSI) questionnaire, which was developed to capture the self-perception of each member of the surgical team regarding the disruptions that may contribute to error and obstruction of safe surgical flow. Methods: A universalist approach was adopted to evaluate the conceptual equivalence of items and semantics, which included the following stages: (1) translation of the questionnaire into Portuguese; (2) back translation into English; (3) panel of experts to draft the preliminary version; and (4) pre-test for evaluation of verbal comprehension by the target population of 43 professionals working in cardiothoracic surgery. Results: The questionnaire was translated into Portuguese and its final version with 29 items obtained 89.6% approval from the panel of experts. The target population evaluated all items as easy to understand. The mean overall clarity and verbal comprehension observed in the pre-test reached 4.48 ± 0.16 out of the maximum value of 5 on the psychometric Likert scale. Conclusion: Based on the methodology used, the experts' analysis and the results of the pre-test, it is concluded that the essential stages of translation and cross-cultural adaptation of DiSI to the Portuguese language were satisfactorily fulfilled in this study.

Morbidade e sua interferência na capacidade funcional de idosos / Morbilidad y su interferencia en la capacidad funcional de personas de la tercera edad / Morbidity and interference in seniors' functional ability

OBJETIVO: Identificar a interferência de morbidades na capacidade funcional de idosos atendidos em serviço ambulatorial de um hospital escola, em Ribeirão Preto-SP, no período de 02/01/2001 a 30/12/2002. MÉTODOS: Utilizou-se como instrumento de avaliação, o "Older Americans Resources and Services" e um questionário elaborado pelos autores deste estudo. RESULTADOS: Os dados dos 195 idosos avaliados foram analisados de forma descritiva, sendo a maioria mulheres (70,3 por cento). A idade variou de 61 a 97 anos, com média de 76 anos. As doenças mais freqüentes foram hipertensão arterial (HAS) (72,3 por cento), dislipidemia e artrose (24,1 por cento cada), artrite (23 por cento), diabetes (21,5 por cento). As que interferiram em sete ou mais atividades da vida diária (AVDs) foram: AVC (82,6 por cento), catarata (45,4 por cento), osteoporose (35,0 por cento) e HAS (31,8 por cento); as que interferiram em três ou mais atividades instrumentais da vida diária (AIVDs), foram: Acidente Vascular Cerebral (AVC)(83,4 por cento), catarata (61,9 por cento); cardiopatias (55,0 por cento) e doença de Chagas (47,4 por cento). CONCLUSÃO: As morbidades interferem na capacidade funcional dos idosos para as AVDs e AIVDs.

OBJECTIVE: Identifying the interference of morbidity of the functional ability of seniors receiving care in an outpatient clinic of a school hospital, in Ribeirão Preto SP, from January 1, 2001 to December 30, 2002. METHODS: The instrument of assessment used in this study was "Older Americans Resources and Services" and a questionnaire elaborated by the study authors. RESULTS: Data from 195 seniors assessed were analyzed descriptively, with most of tem being female (70.3 percent). Age varied from 61 to 97 years, with 76 years being the average. The most frequent diseases were hypertension (HYP) (72.3 percent), dyslipidemia and atrhrosis (24.1 percent each), arthritis (23 percent) and diabetes (21.5 percent). Those interfering in seven or more daily life activities (DLA) were: Stroke (82.6 percent), cataract (45.5 percent), osteoporosis (35.0 percent) and HYP (31.8 percent); those interfering in three or more instrumental daily life activities (IDLA) were: stroke (83.4 percent), cataract (61.9 percent), heart disease (55.0 percent) and Chagas' disease (47.4 percent). CONCLUSION: Morbidities interfere in the seniors' functional ability to perform DLA and IDLA.

OBJETIVO: Identificar la interferencia de morbilidades en la capacidad funcional de personas de la tercera edad atendidos en consultorios externos de un hospital docente, en Ribeirão Preto-SP, en el período comprendido entre el 02/01/2001 al 30/12/2002. MÉTODOS: Se utilizó como instrumento de evaluación el "Older Americans Resources and Services" y un cuestionario elaborado por los autores de este estudio. RESULTADOS: Los datos de las 195 personas de la tercera edad evaluados fueron analizados de forma descriptiva, siendo la mayoría mujeres (70,3 por ciento). La edad varió de 61 a 97 años, con un promedio de 76 años. Las enfermedades más frecuentes fueron hipertensión arterial (HA) (72,3 por ciento), dislipidemia y artrosis (24,1 por ciento cada), artritis (23 por ciento), diabetes (21,5 por ciento). Las que interfirieron en siete o más actividades de la vida diaria (AVDs) fueron: ACV (82,6 por ciento), catarata (45,4 por ciento), osteoporosis (35,0 por ciento) e HA (31,8 por ciento); las que interfirieron en tres o más actividades instrumentales de la vida diaria (AIVDs), fueron: Accidente Cerebro Vascular (ACV)(83,4 por ciento), catarata (61,9 por ciento); cardiopatías (55,0 por ciento) y enfermedad de Chagas (47,4 por ciento). CONCLUSIÓN: Las morbilidades interfieren en la capacidad funcional de las personas de la tercera edad para las AVDs y AIVDs.