Renal vein thrombosis in the course of non-operative treatment of kidney trauma: A rare case report.

INTRODUCTION: Venous thromboembolism is widely recognized as a life-threatening complication in trauma, yet renal vein thrombosis (RVT) following trauma is particularly rare. PRESENTATION OF CASE: We report a case of a 67-year-old man who was brought to the emergency department after falling down a 14-step staircase at home which presented right kidney trauma (parenchyma laceration with a perirenal hematoma) on computed tomography, and hematuria. Considering the patient's hemodynamic stability, a non-operative treatment was initiated, and the patient was referred to the intensive care unit for close observation. On post-trauma day 3, a repeated CT revealed right renal vein thrombosis. After evaluation, it was decided to maintain prophylactic anticoagulation doses of enoxaparin (40 mg/day) due to the elevated risk of bleeding in high-grade renal trauma and planned an inferior vena cava (IVC) filter placement. In the following days, the hematuria resolved spontaneously and an IVC filter was placed. The patient progressed with no complaints, spontaneous diuresis, improvement in laboratory parameters, and cardiovascular stability, which led to his discharge on day 12 with rivaroxaban 10 mg/day. The patient was successfully treated with a non-operative approach, and the RVT disappeared after 35 days. DISCUSSION: Post-traumatic renal vein thrombosis is a rare occurrence, and due to the infrequent nature of these events, specific management guidelines are not fully established, particularly when thrombosis is confirmed in an acutely injured patient. CONCLUSION: Conservative therapy seems to play a meaningful role in trauma-related renal vein thrombosis treatment.

Feasibility of multimedia animations as preoperative guides for urgent abdominal surgeries in a public hospital in Brazil.

Health literacy, culture and language play vital roles in patients' understanding of health issues. Obstacles are more evident in low- and middle-income countries (LMICs), where inadequate patient education levels are higher and hospital resources are lower. This is a prospective pilot study assessing the feasibility of digital preoperative animations as guides for surgical patients. Patients admitted to a public hospital in Brazil for acute cholecystitis or appendicitis were included. Feasibility was represented by acceptability rate and ease of integration with department protocols. Thirty-four patients were included, and 26 patients concluded the intervention (76.5% acceptability rate). Demographic factors seemed to affect the results, indicated by higher acceptability from those with lower education levels, from younger patients and from women. Few studies have evaluated the use of multimedia resources for surgical patients, and no studies assessed the use of animations as digital patient education resources in an LMIC. This study demonstrated that the use of animations for patient education in LMICs is feasible. A step-based approach is proposed to aid the implementation of patient education digital interventions. The use of digital multimedia animations as preoperative guides in LMICs is feasible. It may help improve patient education and promote clinical benefits.

The role of digital patient education in maternal health: A systematic review.

OBJECTIVE: To assess the recent trends, acceptability, and effectiveness of digital maternal patient education through summarizing the literature. METHODS: Articles published in 2010-2020 on patient education, digital tools, and maternal health were searched on PubMed. Abstract and full texts were reviewed to identify eligible studies and extract key information. RESULTS: Digital patient education studies covered various topics throughout pregnancy, with the greatest number of studies targeting the prenatal period. Among the 55 studies, 38 (69%) reported significant patient outcomes, with the main benefits of increased knowledge (83.3%), emotional benefits (73.7%), and behavioral changes (60.6%). The number of studies per year increased steadily over the past decade, with frequently utilized formats of texts with images (40%), SMS (30.9%), and videos (25.5%). Video produced the highest rate of positive patient outcomes; however, no statistical significance was found. CONCLUSION: Our study presented evidence supporting the high effectiveness and prevalence of digital tools in maternal patient education, and analyzed the content, platforms, and formats utilized by digital tools of the past decade. PRACTICE IMPLICATIONS: Digital tools are effective and feasible in conducting maternal patient education. No specific patient education format is found to be superior in improving patient's health outcomes.

Development of a Digital Patient Education Tool for Patients With Cancer During the COVID-19 Pandemic.

BACKGROUND: Due to the COVID-19 pandemic, a large portion of oncology consultations have been conducted remotely. The maladaptation or compromise of care could negatively impact oncology patients and their disease management. OBJECTIVE: We aimed to describe the development and implementation process of a web-based, animated patient education tool that supports oncology patients remotely in the context of fewer in-person interactions with health care providers. METHODS: The platform created presents multilingual oncology care instructions. Animations concerning cancer care and mental health during the COVID-19 pandemic as well as immunotherapy and chemotherapy guides were the major areas of focus and represented 6 final produced video guides. RESULTS: The videos were watched 1244 times in a period of 6 months. The most watched animation was the COVID-19 & Oncology guide (viewed 565 times), followed by the video concerning general treatment orientations (viewed 249 times) and the video titled "Chemotherapy" (viewed 205 times). Although viewers were equally distributed among the age groups, most were aged 25 to 34 years (342/1244, 27.5%) and were females (745/1244, 59.9%). CONCLUSIONS: The implementation of a patient education platform can be designed to prepare patients and their caregivers for their treatment and thus improve outcomes and satisfaction by using a methodical and collaborative approach. Multimedia tools allow a portion of a patient's care to occur in a home setting, thereby freeing them from the need for hospital resources.

Potentially modifiable factors associated with non-adherence to phosphate binder use in patients on hemodialysis.

BACKGROUND: Despite the evidence that phosphate binder (PB) is associated with improved outcomes many hemodialysis patients do not adhere to prescribed PB regimen. Therefore, barriers to PB adherence should be identified and eliminated. The purpose of this study was to evaluate PB adherence among hemodialysis patients and to explore potentially modifiable factors associated with low PB adherence. METHODS: A cross-sectional study (502 patients) was performed in four dialysis units in Salvador, Brazil, using data from the second phase of the Prospective Study of the Prognosis of Chronic Hemodialysis Patients (PROHEMO). Patients were categorized as adherent or non-adherent to PB based on their responses to a semi-structured questionnaire. RESULTS: Non-adherence to PB was observed for 65.7% of the patients. After adjustments for numerous covariates, cerebrovascular disease (odds ratio (OR), 3.30; 95% confidence interval (CI), 1.03-10.61), higher PTH (OR per each 300 pg/mL, 1.14; 95% CI, 1.01-1.28), lack of comprehension of the appropriate time to use PB (OR, 7.09; 95% CI, 2.10-23.95) and stopping PB use after feeling better (OR, 4.54; 95% CI, 1.45-14.25) or feeling worse (OR, 11.04; 95% CI, 1.79- 68.03) were significantly associated with PB non-adherence. By contrast, the adjusted odds of PB non-adherence were lower for patients with more years on dialysis (OR by each 2 years, 0.87; 95% CI, 0.80-0.95), with serum phosphorus above 5.5 mg/dL (OR, 0.53; 95% CI 0.34-0.82), who referred that were encouraged by the dialysis staff to be independent (OR, 0.52; 95% CI 0.30-0.90), and reported that the nephrologist explained how PB should be used (OR, 0.20; 95% CI 0.05-0.73). CONCLUSION: The results of the present study are encouraging by showing evidence that improvement in the care provided by the dialysis staff and the attending nephrologist may play an important role in reducing the high prevalence of non-adherence to PB in maintenance hemodialysis patients. A new questionnaire is presented and may help to evaluate systematically the patients regarding PB adherence in hemodialysis setting.

Taxa de mortalidade por suicídio e indicadores socioeconômicos nas Capitais brasileiras / Rate of mortality by suicide and socialeconomic indicators in brazilian capitals

O estudo em questão considera o suicídio um problema de saúde pública, um acontecimento complexo desencadeado pela influência de fatores estressores sobre o indivíduo. O objetivo deste artigo é avaliar o componente social nas mortes por suicídio, pela análise de indicadores socioeconômicos. Trata-se de um estudo do tipo ecológico exploratório que busca a associação entre dez indicadores socioeconômicos e a taxa de suicídio em todas as capitais do país. Os dados utilizados foram obtidos no DATASUS e no Atlas de Desenvolvimento Humano no Brasil do IBGE, referentes ao ano 2000. Os resultados apontam que a taxa de mortalidade por suicídio variou de 0,77 100 mil habitantes em Salvador BA a 14,04 100 mil habitantes em Boa Vista AC. O sexo masculino apresenta risco relativo 3,7 vezes maior de cometer suicídio do que o feminino. A faixa etária de 15 a 29 anos apresentou menor risco relativo de cometer suicídio, enquanto o maior risco relativo foi encontrado na população com idade igual ou superior a 60 anos. Ambos os indicadores de desigualdade social Índice de Gini e Índice L de Theil apresentaram correlação negativa com a taxa de mortalidade por suicídio, com significância estatística rs igual menos 0,479, p igual 0,011 e rs igual 0,403, p igual 0,037, respectivamente. Concluiu se que há associação entre os indicadores de desigualdade social e as taxas de suicídio. Nenhum outro indicador socioeconômico apresentou correlação, o que leva a acreditar que a origem e o amadurecimento do pensamento suicida parecem sofrer influência preponderante de fatores biopsicológicos.

This study considers suicide a public health issue, a complex event triggered by stress factors pressing on the individual. The objective of this study is to evaluate the social component in the deaths by suicide, by analyzing socioeconomic indicators. This is an exploratory and ecological study that seeks to establish the relation between ten socioeconomic indicators and the suicide rate in all the capitals of the country. The data was obtained from the DATASUS and the Atlas de Desenvolvimento Humano no Brasil Alas of Human Development in Brazil, loosely translated by IBGE, referring to the year 2000. The results show that the suicide varied from 0.77 100 thousand habitants in Salvador Bahia to 14.04 100 thousand habitants in Boa Vista AC. The male gender presented a 3.7 times higher relative risk of committing suicide than the female one. The age group from 15 to 29 years presented lower relative risk of committing suicide whereas the highest relative risk was found in the population with ages equal or above 60 years. Both indicators of social inequality gini index and l theil Index, presented negative correlation with the mortality rate by suicide, with statistical significance rs equals 0,479, p equals 0,011 and rsequals 0,403, p equals 0,037, respectively. In conclusion, there is no relation between social inequality indicators and the suicide rate. No other socioeconomic indicator presented any correlation, which leads us to believe that the origin and maturation of the suicidal thoughts suffer prevailing influence of biopsychological factors.