ABSTRACT
BACKGROUND: Normal pressure hydrocephalus (NPH) treatment consists of using valves for drainage, as it is for hydrocephalus in general. Despite this, complications can occur, putting the patient at risk, and neurological monitoring is crucial. OBSERVATIONS: A 61-year-old male, who had been diagnosed with NPH 3 years prior and was being treated with a ventriculoperitoneal shunt with a programmable valve, presented to the emergency department because of a traumatic brain injury due to a fall from standing height. No previous complications were reported. He had an altered intracranial pressure (ICP) waveform in the emergency room when monitored with the brain4care device, with a P2/P1 ratio of 1.6. Imaging helped to confirm shunt dysfunction. Revision surgery normalized the ratio to 1.0, and the patient was discharged. Upon return after 14 days, an outpatient analysis revealed a ratio of 0.6, indicating improvement. LESSONS: In selected cases of NPH, noninvasive ICP waveform morphology analysis can be effective as a diagnostic aid, as well as in the pre- and postsurgical follow-up, given the possibility of comparing the values of ICP preoperatively and immediately postoperatively and the outpatient P2/P1 ratio, helping to manage these patients.
ABSTRACT
Abstract Introduction Appendicitis is the surgical disease with the highest prevalence in emergency rooms. Its clinical and/or surgical complications are associated with the time course of symptoms, age, comorbidities, and stages of the disease. Objectives To analyze the demographic and clinical data of patients who underwent appendectomy for acute appendicitis in a tertiary referral hospital in the city of São Paulo and compare these data between services provided by the Public and Supplementary Health System. Methodology Retrospective analysis of data from electronic medical records of patients over 14 years old who underwent appendectomy for acute appendicitis at Hospital Santa Marcelina, both in the Public and Supplementary Health Systems from January 2015 to December 2017. Results A total of 536 patients were analyzed, 354 (66%) of whom were male with a general mean age of 29.85 years (14-81 years). The mean time from symptoms to seeking medical care was 53.84 hours. Regarding the phases of acute appendicitis, a greater number of cases of complicated disease was observed in patients operated on in the Public Health System (p < 0.0001), as well as the time course of symptoms (p = 0.0005) and Conclusion There was a predominance of male patients undergoing appendectomy for acute appendicitis, with longer time course of symptoms in those operated on in the Public Health System and a predominance of appendicitis in advanced stages (3 and 4) in this group. However, in this group there was no significant increase in the rate of postoperative infection, and the length of stay was shorter than that of patients operated on in the Supplementary Health System.
ABSTRACT
Resumo Este trabalho avalia, sob a ótica da bioética, o impacto estrutural, institucional e emocional da alocação de recursos escassos durante a pandemia de covid-19, doença que emergiu no final de 2019 e se tornou um dos maiores desafios da sociedade. A análise dos artigos selecionados indica que, mesmo após ampliação de leitos em santas casas e hospitais filantrópicos, a demanda continuou maior que a oferta. Desse modo, é necessário reestruturar o atendimento com medidas de recomendação e protocolos que priorizem profissionais da saúde e melhores prognósticos, com maior tempo de vida pós-tratamento, e excluam qualquer prioridade por classe ou influência social não médica. A adoção dessas medidas e protocolos de atendimento otimiza o tratamento e maximiza os recursos, abrangendo um número maior de doentes e possibilitando a oferta de tratamento com medidas justas, éticas e resolutivas.
Abstract This work evaluates, from the perspective of Bioethics, the structural, institutional and emotional impact of the allocation of scarce resources during the COVID-19 pandemic, a disease that emerged at the end of 2019 and has become one of the greatest challenges of society. The analysis of the selected articles indicates that, even after the expansion of beds in holy houses and philanthropic hospitals, demand remained higher than supply. Thus, it is necessary to restructure care with recommendation measures and protocols that prioritize health professionals and a better prognosis, with longer life after treatment, and exclude any priority by class or non-medical social influence. The adoption of these care measures and protocols optimizes treatment and maximizes resources, covering a greater number of patients and enabling the provision of treatment with fair, ethical and resolute measures.
Resumen Este trabajo evalúa, desde la perspectiva de la Bioética, el impacto estructural, institucional y emocional de la asignación de recursos escasos durante la pandemia de covid-19, una enfermedad que surgió a finales de 2019 y se ha convertido en uno de los mayores retos de la sociedad. El análisis de los artículos seleccionados indica que, incluso después de la expansión de camas en santas casas y hospitales filantrópicos, la demanda se mantuvo por encima de la oferta. Así, es necesario reestructurar el funcionamiento con medidas de recomendación y protocolos que prioricen a los profesionales de la salud y un mejor pronóstico, con una vida más larga después del tratamiento, y excluir cualquier prioridad por clase o influencia social no médica. La adopción de estas medidas y protocolos de atención optimiza el tratamiento y maximiza los recursos, cubriendo un mayor número de pacientes y permitiendo la prestación del tratamiento con medidas justas, éticas y resolutivas.
