End-Organ Damage in Hypertension: An Insight on a Differentiated Outpatient Consultation.

OBJECTIVE: The objective of this study was to determine the prevalence of end-organ damage in hypertensive patients attending an outpatient consultation. MATERIALS AND METHODS: Patients were selected from an outpatient consultation at a tertiary hospital care center. All patients who consulted between July 2022 and March 2023 were included. Data on demographic characteristics, blood pressure records, hypertension etiology, medication use, and the presence of target organ damage were collected. RESULTS: A total of 73 patients were included in the study, with 34 patients being male (46.6%) and 39 patients being female (53.4%). The mean age of the patients was 49.8 years. Among the cases of hypertension, 14 (19.2%) were classified as secondary arterial hypertension (AH). The most common cause of secondary AH was obstructive sleep apnea (OSA) (42.9%). Approximately 23.2% of patients had documented end-organ damage potentially related to hypertension, with kidney disease being the most frequent (n = 10, 13.7%). The most commonly prescribed pharmacological classes were angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists (n = 46, 63%). CONCLUSION: Despite numerous studies and trials on arterial hypertension, it remains a significant contributor to morbidity and mortality, necessitating the continued awareness of its long-term implications.

Stress Cardiomyopathy as a Complication of SARS-CoV-2 Infection.

The worldwide spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in early 2020 led to the coronavirus disease 2019 (COVID-19) pandemic. Acute lung diseases, such as COVID-19 pneumonia, can trigger stress cardiomyopathy, raising concerns about potential cardiovascular complications related to these diseases. The current case involved a 72-year-old man with SARS-CoV-2 infection who was experiencing dyspnea, desaturation, and oppressive retrosternal chest pain. On his admission to the hospital, an electrocardiogram demonstrated sinus tachycardia, negative T waves in leads V4-V6, and slight ST-segment elevation in the same precordial leads. The patient also had an increased troponin I value and worsening of his baseline respiratory failure, which required starting noninvasive ventilation. The echocardiogram showed moderately depressed left ventricular systolic function and apical ballooning. The echocardiographic changes resolved during hospitalization without directed therapeutic intervention. We diagnosed Takotsubo syndrome associated with SARS-CoV-2 infection; however, the pathophysiological disruption remains to be clarified.

An Echocardiographic Insight Into Post-COVID-19 Symptoms.

INTRODUCTION AND OBJECTIVES: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection has frequent acute cardiovascular manifestations, but long-term sequelae are yet to be described. Our main objective is to describe the echocardiographic findings of patients with a previous SARS-CoV-2 infection. METHODS: A single-center prospective study was conducted. Patients who tested positive for SARS-CoV-2 were selected and submitted to a transthoracic echocardiogram six months after infection. A complete echocardiographic assessment was performed, including tissue Doppler, E/E' ratio, and ventricular longitudinal strain. Patients were divided into two subgroups according to their need for admission to the ICU. RESULTS: A total of 88 patients were enrolled. The mean values and respective standard deviations of the echocardiographic parameters were as follows: left ventricular ejection fraction 60.8 ± 5.9%; left ventricular longitudinal strain 17.9 ± 3.6%; tricuspid annular plane systolic excursion 22.1 ± 3.6 mm; a longitudinal strain of the free wall of the right ventricle 19.0 ± 6.0%. We found no statistically significant differences between subgroups. CONCLUSIONS: At the six-month follow-up, we found no significant impact of past SARS-CoV-2 infection on the heart using echocardiography parameters.

Transesophageal Echocardiogram: Still a Powerful Tool in the 21st Century for the Diagnosis of Aortic Dissection.

A 63-year-old woman with a history of previous anaphylactic reaction to iodate contrast presented with sudden back pain during exertion associated with elevated D-dimer levels. Transthoracic echocardiogram was unremarkable. She was unable to perform a computerized tomography for further evaluation of the aorta due to her allergic background. Transesophageal echocardiogram disclosed a type B aortic dissection. This case report recalls the importance of transesophageal echocardiography in the algorithm for diagnosing aortic dissection in scenarios where CT is not possible.

A Case of a Large Malignant Pericardial Effusion on Computed Tomography Without Electrocardiographic Gating.

A 67-year-old female was admitted due to dyspnea. A computed tomography (CT) disclosed a suspicious pulmonary mass and a pericardial effusion. A transthoracic echocardiogram confirmed a large-volume circumferential pericardial effusion. A pericardiocentesis was performed, and the cytological and histochemical studies later confirmed the diagnosis of pulmonary adenocarcinoma. This case report highlights the casualty of having found a cardiac tamponade through a CT not synchronized with an electrocardiogram.

Löfgren Syndrome: Clinical Presentation, Clinical Course, and Literature Review.

Löfgren syndrome is an acute presentation of sarcoidosis that comprises fever, bilateral and symmetric hilar lymphadenopathies, polyarthritis, and erythema. We present the case of a 34-year-old male patient who presented with ankle monoarthritis without a history of a traumatic event. Contralateral ankle arthritis associated with erythema nodosum and fever developed one week later. Laboratory tests showed anemia, thrombocytosis, and elevated inflammatory parameters. A chest CT revealed symmetrical mediastinal and hilar adenopathies. A transbronchial biopsy was compatible with granulomatous lymphadenitis, and the diagnosis of Löfgren syndrome was confirmed. Our case report and literature review emphasize the wide web of mimicry of acute sarcoidosis. Secondary forms of acute sarcoidosis are likely to benefit from additional and more complex immunomodulatory therapies. Close monitoring and follow-up should be conducted because it is possible that these patients experience higher rates of recurrence or relapse.

Secondary Hyperparathyroidism Presenting as a Brown Tumor: A Case Report and Review of the Literature.

Severe secondary hyperparathyroidism in advanced stages of chronic kidney disease (CKD) is associated with CKD-related mineral and bone disease (CKD-MBD). A 70-year-old woman was admitted at the Hospital for generalized bone pain and peripheral edema. Initial laboratory tests revealed normocytic anemia and severe renal dysfunction, and further tests evidenced severe secondary hyperparathyroidism. Full-body computerized tomography showed an osteolytic lesion in the right iliac wing. The iliac bone lesion was biopsied and histological examination was consistent with the diagnosis of a brown tumor of hyperparathyroidism. Brown tumors are a rare variant of osteitis fibrosa cystica that results from sustained high levels of parathyroid hormone in CKD. This case sheds light on rare complications that are experienced today in CKD. The clinical and biochemical setting, as well as the clinical suspicion, are essential to the diagnosis.

Trends in Breastfeeding and Associated Factors in a Primary Healthcare Service in the South of Brazil: 2004 to 2015.

The aim was to monitor the frequency of Breastfeeding (BF) and Exclusive Breastfeeding (EBF) in a Primary Healthcare Service, between the years of 2004 to 2015. This is a historical series is composed of eight cross-sectional surveys that were carried out during the annual vaccination campaigns. A total of 6027 children were evaluated, with a mean age of 6.2 months. There was a significant increase in the rates of BF (7.2%) and EBF (9.5%) in children less than four months old. In infants from four to five months old, a substantial decline was observed in the EBF rate between 2010 and 2015 (6.3%). The frequency of BF had a 10.1% increase in infants from six to nine months old and remained stable in children from 10 to 11 months of age. Among children less than six months old, monitoring by the health service had a positive impact on the frequency of BF (p < 0.001) and EBF (p < 0.001). The better BF and EBF rates seen in this study in infants followed up by the primary healthcare centers reinforce the evidence on the importance of expanding and qualifying primary healthcare as support for mother and child healthcare.

Apical hypertrophic cardiomyopathy, are low-risk patients really at low risk? A case report.

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is a genetically determined myocardial disease that constitutes the main cause of sudden cardiac death (SCD) in young athletes. Apical HCM (ApHCM) represents a complex subset of patients, whose risk of SCD seems not negligible. Most applied scores likely underestimate the risk of heart events in this subset of patients. CASE SUMMARY: We report the case of a 55-year-old man who was admitted in the emergency department after an episode of aborted sudden death due to ventricular fibrillation. The electrocardiogram made at admission was noted for atrial fibrillation and a new-onset left bundle branch block. Emergency coronary angiography was normal. The electrocardiogram was repeated and showed symmetrical and profound inversion of T waves in the lateral leads. Transthoracic echocardiogram and cardiac magnetic resonance revealed left ventricular apical hypertrophy suggestive of apical variant of HCM. A cardiac defibrillator was implanted for secondary prevention of SCD. After 6 months of follow-up no further rhythmic events were noted. DISCUSSION: Although low, the risk of SCD of ApHCM patients is not negligible. This case illustrates the need for searching of new predictors of rhythmic risk in patients with ApHCM.

Atendimento sequencial multiprofissional de crianças e adolescentes com asma em um serviço de atenção primária à saúde / Multiprofessional sequential care of asthmatic children and adolescents in a primary health care service

O objetivo do presente trabalho foi avaliar o impacto de um modelo sequencial de atendimento a crianças e adolescentes com asma em uma unidade de atenção primária à saúde. Foram acompanhados, no ano de 2012, 89 usu- ários, entre 4 meses e 15 anos de idade, com diagnóstico de asma. Esses usuários foram agendados para consultas sequenciais de atendimentos de 15 minutos com profissionais de diferentes categorias e foram vistos em intervalos de 3-4 meses, priorizando-se aqueles com história de internações e consultas extras frequentes. Os objetivos específicos e métodos de cada atendimento foram pactuados e definidos previamente. A avaliação da estratégia foi realizada por meio de um estudo retrospectivo analí- tico longitudinal, com base nos registros de prontuários e do Sistema de Informação em Saúde (SIS) do GHC. Foram analisados questionários aplicados na primeira e última consulta médica. As informações foram digitadas em um banco de dados em excel e avaliadas a partir de testes estatísticos de McNemar e Wilcoxon, por meio do Programa SPSS. Entre os 89 usuários atendidos, 80 (90%) aderiram ao modelo de atenção e 44 (49%) obtiveram melhor nível de controle da asma (p =0,001). Apenas 4 (5%) foram acompanhados também por pneumologista. As famílias dos usuários (19 vs 80) passaram a utilizar um plano de ação escrito para tratamento dos sintomas e mais usuários fizeram uso de corticoide inalatório (14 vs 61), evidenciando melhores resultados (p=0,001 para ambos). A redução de idas à emergência (127 vs 39) e de interna- ções por asma (14 vs 1) após intervenção também foi significativa (p=<0,001 para ambos). Os 89 usuários foram atendidos pelo dentista, sendo que 64% necessitavam de revisão odontológica e 40% receberam algum tipo de tratamento odontológico. Os resultados sugerem boa adesão ao modelo de atendimento sequencial, maior qualificação da atenção, melhor controle da asma e redução de idas à emergência e de hospitalizações.

This work aimed at assessing the impact of a sequential care model for asthmatic children and adolescents in a primary health care unit. Eighty-nine users between 4 months and 15 years of age, diagnosed with asthma, were followed throughout 2012. These users were scheduled in 15-minute sequential appointments with professionals in different categories and were seen at 3-4-month intervals; the ones with a history of hospitalization and constant extra-appointments were prioritized. The specific objectives and methods of each appointment were previously agreed upon and defined. The evaluation of the strategy was performed by a longitudinal analytic retrospective study based on the records from medical charts and from the Health Information System (SIS) of Grupo Hospitalar Conceiçao (GHC). Surveys applied during the first and last medical appointments were assessed. Data were typed into an Excel spreadsheet databank and assessed by McNemar and Wilcoxon?s tests using SPSS Software. Among the 89 users attended, 80 (90%) adhered to the care model and 44 (49%) showed better levels of asthma control (p=0.001). Only 4 (5%) were also monitored by a pulmonologist. The users' families (19 vs. 80) began using a written plan of action to treat symptoms and more users made use of inhaled corticosteroids (14 vs. 61), thus showing better results (p=0.001 for both). The reduction in emergency visits (127 vs. 39) and hospitalizations due to asthma (14 vs. 1) after the intervention was also significant (p=<0,001 for both). The 89 users were attended by a dentist, where 64% required additional dental exams and 40% received some sort of oral treatment. The results suggest good adherence to the sequential care model, higher quality in health care, better asthma control, and a decrease in emergency visits and hospitalization.

[Health situation assessment by primary care workers based on geographic information systems]. / Avaliação da situação de saúde por profissionais da atenção primária em saúde com base no georreferencimento dos sistemas de informação.

Primary healthcare has made little use of information systems to assess the population's health situation due to the difficulty in understanding the reports. Generic definitions of actions are common, based on empirical observations. The current study aimed to evaluate whether the introduction of georeferenced indicators can serve to better identify individuals' health situation, which would help planning actions by health teams. Healthcare workers from eight teams answered a questionnaire at three different moments: the first, before reading the information system's reports; the second after reading; and the third after using georeferencing. The results showed a significant difference in the classification of the health situation using georeferencing when compared to the previous moments (p < 0.05). Georeferencing facilitated analysis of the health situation, fostering better monitoring of work processes. Finally, use of the data points to rationalization of actions and possible upgrading of healthcare. The study suggests the use of georeferencing in the work agenda to become an effective tool for orienting actions.

Avaliação da situação de saúde por profissionais da atenção primária em saúde com base no georreferencimento dos sistemas de informação / Health situation assessment by primary care workers based on geographic information systems / Evaluación de la situación de los profesionales de la salud para la atención primaria de salud, basándose en la georreferenciación de los sistemas de información

A atenção primária em saúde (APS) pouco tem se valido dos sistemas de informação para avaliar a situação de saúde da população devido à dificuldade de compreensão dos relatórios. É usual a definição genérica das ações a partir de constatações empíricas. O objetivo desse trabalho é avaliar se a introdução de indicadores georreferenciados pode ser uma tecnologia para melhorar a identificação da situação de saúde das pessoas, o que ajudaria no planejamento das ações das equipes. Para tanto, foi aplicado um questionário nos profissionais de oito equipes em três momentos: o primeiro, antes da leitura dos relatórios do sistema de informação, o segundo após a leitura e o terceiro usando os georreferenciados. Os resultados mostraram diferença significativa na classificação da situação de saúde quando da utilização do georreferenciamento comparado aos momentos anteriores (p < 0,05). O georreferenciamento facilitou a análise da situação de saúde, propiciando melhor monitoramento dos processos de trabalho. Por fim, a utilização aponta para uma racionalização das ações e possível qualificação da atenção à saúde. Sugere-se o uso do georreferenciamento na agenda de trabalho para que se tornem uma ferramenta efetiva e norteadora das ações.

Primary healthcare has made little use of information systems to assess the population's health situation due to the difficulty in understanding the reports. Generic definitions of actions are common, based on empirical observations. The current study aimed to evaluate whether the introduction of georeferenced indicators can serve to better identify individuals' health situation, which would help planning actions by health teams. Healthcare workers from eight teams answered a questionnaire at three different moments: the first, before reading the information system's reports; the second after reading; and the third after using georeferencing. The results showed a significant difference in the classification of the health situation using georeferencing when compared to the previous moments (p < 0.05). Georeferencing facilitated analysis of the health situation, fostering better monitoring of work processes. Finally, use of the data points to rationalization of actions and possible upgrading of healthcare. The study suggests the use of georeferencing in the work agenda to become an effective tool for orienting actions.

En la atención primaria de salud poco han valido la pena los sistemas de información para evaluar el estado de salud de la población, debido a la dificultad de entender los informes; al tratarse de definiciones genéricas para las acciones habituales de los resultados empíricos. El objetivo de este estudio es evaluar si los indicadores de información georreferenciada pueden ser una tecnología que mejore la identificación de la situación de salud para las personas que ayuden en la planificación de acciones. Para ello, se aplicó un cuestionario por parte de ocho equipos profesionales en tres etapas: la primera, antes de la lectura de los informes del sistema de información, la segunda y la tercera lectura, después de usar información georreferenciada. Los resultados mostraron diferencias significativas en la clasificación del estado de salud al utilizar georreferenciación en comparación con períodos anteriores (p < 0,05). La geocodificación facilitó el análisis de la situación de salud, proporcionando un mejor monitoreo de los procesos de trabajo. Por último, se utilizaron puntos para la racionalización de las acciones y la posible calificación de la atención sanitaria. Sugerimos el uso de georreferenciación regularmente para que se convierta en una herramienta eficaz en las acciones de orientación.

Hospitalizações entre crianças e adolescentes no território de abrangência de um serviço de Atenção Primária à saúde / Hospitalizations among children and adolescents within the scope of a Primary Care Service

A hospitalização, além de sofrimento familiar importante, é um evento de custo elevado para o sistema de saúde; além disso, ela pode ser, muitas vezes, prevenida no nível ambulatorial. Oobjetivo deste estudo foi identificar o percentual de hospitalizações por condições sensíveis à atenção ambulatorial (CSAA) que se referem àquelas em que a atenção efetiva e a tempo podem evitar internação. Foram estudadas 3.329 hospitalizações em menores de 19 anos, ocorridas nos anos de 2001 a 2004, em quatro hospitais do SUS, principais referências para uma população de áreas adscritas de um serviço de Atenção Primária em Saúde (APS). Análises univariadas e multivariadas foram empregadas para verificar associação entre variáveis independentes e a ocorrência de hospitalizações por CSAA. Identificou-se uma taxa anual de hospitalização de 2,9%. As doenças do aparelho respiratório são o grupo de causa mais freqüente (36%), seguido do grupo das perinatais (14%), infecciosas e parasitárias (10%), do aparelho digestivo (9%) e das causas externas (6%). As reinternações corresponderam a 16% do total de internações. A taxa de hospitalização por CSAA foi de 35,6%, variando de 25% a 43% entre as Unidades de APS. As variáveis relacionadas à maior ocorrência de hospitalizações por este motivo foram: idade de um a quatro anos (p<0,01), ter ido direto para o hospital porque a Unidade estava fechada (p=0,04) ou pela gravidade do caso (p=0,03). O estudo indica a necessidade de incrementar ações de vigilância às hospitalizações por CSAA, que ocorrem com maior freqüência nos meses de inverno, às crianças de um a nove anos, por apresentarem-se mais vulneráveis à hospitalização por essas condições, e às reinternações, não reduzidas nos últimos quatro anos.

The hospitalization of a child, in addition to bringing about major family distress, is a costly event for the health system. Besides, it can often be avoided on an outpatient care basis. The aim of this study was to identify the percentage of hospitalizations for Ambulatory Care Sensitive (ACS) conditions, i.e. those for which effective and timely care can avoid hospital admission. We investigated 3.329 hospitalizations of patients under 19 years of age, occurred between 2001 and 2004 in four hospitals of the Brazilian Health System (SUS), the main references for a population of areas astricted to a primary care service (PCS). The hospitalizations in this population were identified using the hospital information system of the GHC (Grupo Hospitalar Conceição). Univariate and multivariate analysis were employed to verify associations between independent variables and the occurrence of admissions for ACS conditions. A hospitalization rate of 2.9% was found for the studied age group. Respiratory system disorders were the leading cause of admission (36%), followed by perinatal diseases (14%), infectious and parasitic diseases (10%), disorders of the digestive system (9%), and external causes (6%). Readmission accounted for 16% of the total admissions. The hospitalization rate for ACS conditions was 35.6%, ranging from 25% to 43% across the Health Care Centers of the PCS. The variables associated with higher occurrence of hospitalizations for this reason were: age between 1 and 4 years (p<0.01); having gone straight to the hospital because the Unit was closed (p=0.04); and having gone straight to the hospital due to the severity of the case (p=0.03). The study points to the need for a better monitoring of hospitalizations for ACS conditions - occurring more frequently in the winter months and involving children from 1 to 9 years of age for being more vulnerable to respiratory diseases - and of the number of readmissions, which did not decrease over the last four years.

Em busca de melhores resultados em saúde: a experiência do Serviço de Saúde Comunitária, Porto Alegre, RS, Brasil

Este texto relata a experiência do Serviço de Saúde Comunitária do Grupo Conceição em um projeto com os objetivos de alcançar melhores resultados dos indicadores de saúde e diminuir as iniqüidades nos territórios de responsabilidade de doze equipes de Saúde, em área de periferia urbana com uma população de aproximadamente 120 mil habitantes.(AU)

Introdução à Estatística Espacial para a Saúde Pública

O livro pretende ir além dos mapas coropléticos (temáticos), mostrando ao leitor os primeiros passos dos pressupostos estatísticos nas abordagens espaciais. As técnicas estatísticas apresentadas ampliam as análises de modo a permitir a realização de inferências e de testes de hipóteses geradas pelos profissionais de saúde pública para responder questões sobre a distribuição de eventos no seu dia-a-dia. O livro pertence a série: Textos básicos em saúde e Capacitação e atualização em geoprocessamento em saúde (v. 3).

Estimativa da prevalência de HIV em gestantes por análise espacial, Porto Alegre, RS / Estimate of HIV prevalence in pregnant women by means of spatial analysis in Southern Brazil / Estimate of HIV prevalence in pregnant women by means of spatial analysis in Southern Brazil

Por meio de técnicas de análise espacial foram estimados os diferenciais intra-urbanos da prevalência de HIV entre gestantes no município de Porto Alegre, Rio Grande do Sul. As estimativas foram obtidas por meio da suavização espacial dos pontos referentes às residências de nascidos vivos e gestantes HIV positivas para o ano de 2003. Foi identificada a sobreposição de áreas de alta prevalência com favelas da cidade, o que ratifica o processo de pauperização da Aids e aponta locais onde estratégias de atenção primária e educação devem ser reforçadas.

Spatial analysis techniques were used to estimate the interurban differential HIV prevalence among pregnant women in the city of Porto Alegre, Southern Brazil. The estimates were produced through the spatial smoothing of residence pinpoints with live newborns and HIV infected pregnant women for the year of 2003. The overlay of high prevalence areas in city slums was identified. This finding confirms the intensification of AIDS epidemic among poor urban populations, and indicates areas where basic care and educational strategies should be reinforced.

[Estimate of HIV prevalence in pregnant women by means of spatial analysis in Southern Brazil]. / Estimativa da prevalência de HIV em gestantes por análise espacial, Porto Alegre, RS.

Spatial analysis techniques were used to estimate the interurban differential HIV prevalence among pregnant women in the city of Porto Alegre, Southern Brazil. The estimates were produced through the spatial smoothing of residence pinpoints with live newborns and HIV infected pregnant women for the year of 2003. The overlay of high prevalence areas in city slums was identified. This finding confirms the intensification of AIDS epidemic among poor urban populations, and indicates areas where basic care and educational strategies should be reinforced.

As práticas de vigilância em Porto Alegre: a história da Coordenadoria Geral de Vigilância da Saúde / Surveillance producedures in Porto Alegre: history of th Health Surveillance General Coordination

Pretende-se descrever a experiência da Coordenadoria Geral de Vigilância da Saúde (CGVS), da Secretaria Municipal de saúde, com a municipalização das ações de vigilância epidemiológica, sanitária e ambiental em Porto Alegre, e com a construção do modelo de atenção da Vigilância da Saúde para toda a população do município. A partir da assinatura do Convênio de Municipalização das Ações de Vigilância (1994), tem-se enfatizado as atividades de promoção, proteção e educação em saúde, buscando construir um trabalho de co-responsabilidade com outras instituições governamentais , não governamentais e principalmente com a população de Porto Alegre.