The Effect of Perioperative Fluid Management and Operative Modifications on Mortality and Morbidity in Patients Undergoing Pulmonary Endarterectomy.

INTRODUCTION: Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe disease treated with pulmonary endarterectomy. Our study aims to reveal the differences in liquid modalities and operation modifications, which can affect the patients' mortality and morbidity. METHODS: One hundred twenty-five patients who were diagnosed with CTEPH and underwent pulmonary thromboendarterectomy (PTE) at our center between February 2011 and September 2013 were included in this retrospective study with prospective observation. They were in New York Heart Association functional class II, III, or IV, and mean pulmonary artery pressure was > 40 mmHg. There were two groups, the crystalloid (Group 1) and colloid (Group 2) liquid groups, depending on the treatment fluids. P-value < 0.05 was considered statistically significant. RESULTS: Although the two different fluid types did not show a significant difference in mortality between groups, fluid balance sheets significantly affected the intragroup mortality rate. Negative fluid balance significantly decreased mortality in Group 1 (P<0.01). There was no difference in mortality in positive or negative fluid balance in Group 2 (P>0.05). Mean duration of stay in the intensive care unit (ICU) for Group 1 was 6.2 days and for Group 2 was 5.4 days (P>0.05). Readmission rate to the ICU for respiratory or non-respiratory reasons was 8.3% (n=4) in Group 1 and 11.7% (n=9) in Group 2 (P>0.05). CONCLUSION: Changes in fluid management have an etiological significance on possible complications in patient follow-up. We believe that as new approaches are reported, the number of comorbid events will decrease.

The Effect of Perioperative Fluid Management and Operative Modifications on Mortality and Morbidity in Patients Undergoing Pulmonary Endarterectomy

ABSTRACT Introduction: Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe disease treated with pulmonary endarterectomy. Our study aims to reveal the differences in liquid modalities and operation modifications, which can affect the patients' mortality and morbidity. Methods: One hundred twenty-five patients who were diagnosed with CTEPH and underwent pulmonary thromboendarterectomy (PTE) at our center between February 2011 and September 2013 were included in this retrospective study with prospective observation. They were in New York Heart Association functional class II, III, or IV, and mean pulmonary artery pressure was > 40 mmHg. There were two groups, the crystalloid (Group 1) and colloid (Group 2) liquid groups, depending on the treatment fluids. P-value < 0.05 was considered statistically significant. Results: Although the two different fluid types did not show a significant difference in mortality between groups, fluid balance sheets significantly affected the intragroup mortality rate. Negative fluid balance significantly decreased mortality in Group 1 (P<0.01). There was no difference in mortality in positive or negative fluid balance in Group 2 (P>0.05). Mean duration of stay in the intensive care unit (ICU) for Group 1 was 6.2 days and for Group 2 was 5.4 days (P>0.05). Readmission rate to the ICU for respiratory or non-respiratory reasons was 8.3% (n=4) in Group 1 and 11.7% (n=9) in Group 2 (P>0.05). Conclusion: Changes in fluid management have an etiological significance on possible complications in patient follow-up. We believe that as new approaches are reported, the number of comorbid events will decrease.

Ferimentos não fatais por arma de fogo entre policiais militares do Rio de Janeiro: a saúde como campo de emergência contra a naturalização da violência / Non-fatal gunshot wounds among military police in Rio de Janeiro: health as a field of emergency against the naturalization of violence

Resumo Esse artigo aborda a ocorrência de agravos à saúde decorrentes de ferimentos por arma de fogo (FAF) que atingiram policiais militares da ativa na Região Metropolitana do Rio de Janeiro (RJ). Pesquisa documental, por meio de análise de prontuários médicos de policiais militares atendidos no Hospital Central da Polícia Militar (HCPM) em decorrência de FAF, no período de junho de 2015 a dezembro de 2017 segundo variáveis relativas ao perfil profissional, às características do evento e da lesão, à distribuição espacial dos FAF e às unidades de saúde envolvidas no atendimento. No período investigado, 475 policiais militares sofreram ferimentos por armas de fogo: 98,3% do sexo masculino, 77,3% encontravam-se em serviço, 97,9% eram praças. Quanto à localização anatômica dos ferimentos, as regiões mais acometidas foram: membros inferiores (41,1%) e superiores (33,1%), região da cabeça-pescoço-face (23,5%) e tórax-abdome (17,3%). As áreas na Região Metropolitana do Rio de Janeiro onde foram encontradas as maiores ocorrências de morbidade por arma de fogo foram as áreas de planejamento 3 e 1 e a Baixada Fluminense. Constatou-se correlação entre as taxas de morbidade policial por armas de fogo dos municípios da região metropolitana e densidade demográfica (p = 0,024).

Abstract This article discusses health problems due to firearm injuries suffered on duty military police officers in the metropolitan region of Rio de Janeiro (RJ). Medical records analysis was con ducted referring to military police officers who were treated at the Military Police's Central Hos pital (MPCH) due to gunshot wounds from June 2015 to December 2017 according to professional profile, the characteristics of the event and the le sion, the spatial distribution of the incidents in volving gunshot wounds, and the healthcare units involved in their care. Firearms injured four hun dred seventy-five military police officers: 98.3% were male, 77.3% were in service, 97.9% were soldier personnel. As to the anatomical location of the wounds, the most affected regions were: lower (41.1%) and superior (33.1%) limbs, the head neck-face region (23.5%), and thorax-abdomen (3%). The areas in the metropolitan area of Rio de Janeiro with the highest occurrence of firearm morbidity are program areas 3 and 1 and the Baixada Fluminense. There is a correlation between police morbidity rates due to firearm injuries in the municipalities of the metropolitan region and demographic density (p = 0.024).

Coronary Endarterectomy: a Case Control Study and Evaluation of Early Patency Rate of Endarterectomized Arteries.

OBJECTIVE: To compare two groups of patients - the coronary endarterectomy group, with patients undergoing coronary artery bypass grafting (CABG) with coronary endarterectomy (CE), and the control group, with patients undergoing CABG without CE. We analyzed the rate of major outcomes (perioperative acute myocardial infarction [AMI], stroke, and mortality) and minor outcomes (time of cardiopulmonary bypass [CPB], time of aortic clamp, and postoperative length of hospital stay). We also determined the rates of early graft patency in patients undergoing CE. METHODS: We reviewed a database of patients submitted to CABG, with or without associated CE, between January 2011 and June 2017. Twenty-five patients submitted to CE were compared with 201 patients submitted only to conventional surgery; the two groups presented similar preoperative characteristics and all the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II variables did not presented statistically significant difference. We considered statistically significant values of P< 0.05. RESULTS: There was no statistically significant difference in relation to time of post-surgical hospitalization (P=0.8139), incidence of perioperative AMI (P=0.2976), stroke (P=0,2976), and mortality rate (P=1.0000), but endarterectomy was associated with longer aortic clamping time (P=0.0004) and CPB time (P=0.0030). The rate of patency evaluated in patients submitted to endarterectomy (78,95%) was compatible with that described in the literature. CONCLUSION: In this sample, coronary endarterectomy was associated with the rate of early graft patency similar to that of the literature, with morbidity and mortality rates similar to those of conventional surgery.

Coronary endarterectomy: a case control study and evaluation of early patency rate of endarterectomized arteries

Abstract Objective: To compare two groups of patients - the coronary endarterectomy group, with patients undergoing coronary artery bypass grafting (CABG) with coronary endarterectomy (CE), and the control group, with patients undergoing CABG without CE. We analyzed the rate of major outcomes (perioperative acute myocardial infarction [AMI], stroke, and mortality) and minor outcomes (time of cardiopulmonary bypass [CPB], time of aortic clamp, and postoperative length of hospital stay). We also determined the rates of early graft patency in patients undergoing CE. Methods: We reviewed a database of patients submitted to CABG, with or without associated CE, between January 2011 and June 2017. Twenty-five patients submitted to CE were compared with 201 patients submitted only to conventional surgery; the two groups presented similar preoperative characteristics and all the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II variables did not presented statistically significant difference. We considered statistically significant values of P< 0.05. Results: There was no statistically significant difference in relation to time of post-surgical hospitalization (P=0.8139), incidence of perioperative AMI (P=0.2976), stroke (P=0,2976), and mortality rate (P=1.0000), but endarterectomy was associated with longer aortic clamping time (P=0.0004) and CPB time (P=0.0030). The rate of patency evaluated in patients submitted to endarterectomy (78,95%) was compatible with that described in the literature. Conclusion: In this sample, coronary endarterectomy was associated with the rate of early graft patency similar to that of the literature, with morbidity and mortality rates similar to those of conventional surgery.

"Overtime Hours Effect" on emergency surgery of acute type A aortic dissection

Abstract Objective: Treatment of acute diseases of the aorta is still associated with high mortality and morbidity. It is believed that interventions for these diseases on overtime hours (night shifts or weekend shifts) may increase mortality. In this study, we investigated the effect of performing acute type A aortic dissection surgery on overtime hours in terms of postoperative outcomes. Methods: 206 patients who underwent emergency surgery for acute type A aortic dissection were retrospectively evaluated. Two groups were constituted: patients operated on daytime working hours (n=61), and patients operated on overtime hours (n=145), respectively. Results: Chronic obstructive pulmonary disease and repeat surgery were higher in group 1. There was no statistically significant difference between the two groups in terms of operative and postoperative results. Mortality rates and postoperative neurological complications in group 1 were 9.8% and 13.1%, respectively. In group 2, these rates were 13.8% and 12.4%, respectively (P=0.485 - P=0.890). Multivariate analysis identified that cross-clamp time, amount of postoperative drainage, preoperative loss of consciousness and postoperative neurological complications are the independent predictors of mortality. Conclusions: As the surgical experience of the clinics improves, treatment of acute type A aortic dissections can be successfully performed both overtime and daytime working hours.

"Overtime Hours Effect" on Emergency Surgery of Acute Type A Aortic Dissection.

OBJECTIVE: Treatment of acute diseases of the aorta is still associated with high mortality and morbidity. It is believed that interventions for these diseases on overtime hours (night shifts or weekend shifts) may increase mortality. In this study, we investigated the effect of performing acute type A aortic dissection surgery on overtime hours in terms of postoperative outcomes. METHODS: 206 patients who underwent emergency surgery for acute type A aortic dissection were retrospectively evaluated. Two groups were constituted: patients operated on daytime working hours (n=61), and patients operated on overtime hours (n=145), respectively. RESULTS: Chronic obstructive pulmonary disease and repeat surgery were higher in group 1. There was no statistically significant difference between the two groups in terms of operative and postoperative results. Mortality rates and postoperative neurological complications in group 1 were 9.8% and 13.1%, respectively. In group 2, these rates were 13.8% and 12.4%, respectively (P=0.485 - P=0.890). Multivariate analysis identified that cross-clamp time, amount of postoperative drainage, preoperative loss of consciousness and postoperative neurological complications are the independent predictors of mortality. CONCLUSIONS: As the surgical experience of the clinics improves, treatment of acute type A aortic dissections can be successfully performed both overtime and daytime working hours.

A regurgitação como fator de risco para erosão dental em pacientes gastroplastizados / Regurgitation is a risk factor for dental erosion in bariatric patients

Este estudo teve como objetivo comparar pacientes submetidos a cirurgia bariátrica com e sem tratamento bucal. A metodologia utilizada foi de questionários com dados gerais do paciente (anamnese e exame clínico), questionário de autopercepção da saúde bucal dos pacientes (OHIP-14), questionário de hábitos alimentares, testes salivares, índice para erosão dentária (BEWE) e índices periodontais. O resultado mostrou que os grupos tratados pelo cirurgião-dentista apresentaram ganhos como: em autopercepção da saúde bucal (questionário OHIP-14), em melhora dos problemas periodontais e confirmaram uma diminuição de pH e aumento de frequência de vômitos em pacientes pós cirúrgicos. Assim, baseados nos achados desta pesquisa, conclui-se que a Doença do Refluxo Gástrico Esofágico (DRGE), é um fator de risco, também, nos bariátricos. Foi realizado estudo experimental, controlado, não randomizado, com um acompanhamento de até seis meses de pacientes submetidos à cirurgia bariátrica. O estudo foi composto por pacientes que estavam em tratamento no Centro Multidisciplinar de Tratamento da Obesidade (CMTO) Barra da Tijuca, Rio de Janeiro e Centro de Nova Iguaçu. Participaram da pesquisa 101 pacientes divididos em quatro Grupos. Grupo 1 com 40 pacientes obesos pré-cirúrgicos, Grupo 2, 29 (perda de 11) reavaliados póscirurgicamente seis meses depois. Grupo 3 com 20 pacientes, que se distingue do 1 e 2, por passarem por tratamento odontológico profilático e o mesmo grupo tratado, foi avaliado e chamado de grupo 4, com 17 pacientes (perda de 3) reavaliados, seis meses após. A análise de Dados, para realização dos testes, foi utilizado o teste K-S, os dados não são normalmente distribuídos (p < 0,05%). Foi então utilizada a distribuição t de Student para determinação dos intervalos de confiança para a média, o teste de Mann-whitney (significância p > 0,05) mostrou diferença significativa entre os grupos Gr3 e Gr4 no teste salivar. O programa analítico foi o Statistical Package for the Social Sciences (SPSS) versão 16.0 for Windows (NESC/UFRJ). Foram considerados significativos valores numéricos de P 0,05

This study aimed to compare patients who underwent bariatric surgery with and without oral treatment. The methodology used was questionnaires with general data of the patient (anamnesis and clinical examination), questionnaire of self-perception of patient's oral health (OHIP-14), eating habits questionnaire, salivary tests index for dental erosion (BEWE) and periodontal indexes. The results showed that the groups treated by a dentist showed gains as self-perception of oral health (OHIP-14 questionnaire), in improvement of the periodontal problems and confirmed a decrease in pH and an increase in vomiting frequency in post surgical patients. Thus, based on this research findings, it could be concluded that the inclusion of a dentist in the treatment team of patients undergoing bariatric surgery should be encouraged. Morbid obesity has become a public health problem, from the change in dietary habits of the 21st Century. An experimental controlled and non-randomized study, with a follow-up to six months in patients undergoing bariatric surgery was performed. The study consisted of patients who were being treated at the Multidisciplinary Center for Treatment of Obesity (CMTO). The participants were 101 patients divided into four groups. Group 1 with 40 pre-surgical obese patients; Group 2, 29 Patients (loss of 11) post-surgically re-evaluated after 6 months. Group 3 with 20 patients, which distinguishes the 1 and 2 by passing through oral treatment. Group 4 with 17 patients (loss of 3) evaluated six months after.

Silicosis among agate workers at Shakarpur: An analysis of clinic-based data.

BACKGROUND: There is a high prevalence of silicosis and other morbid conditions leading to early death among agate workers at Khambhat of Gujarat. AIMS: The present study describes the prevalence of X-ray positive silicosis in a sample of a high-risk group visiting a clinic at Shakarpur of Khambhat. SETTINGS AND DESIGN: A cross-sectional study among 123 clinically suspected cases was conducted over 6 months. MATERIALS AND METHODS: A chest physician and a radiologist independently evaluated the Chest X-rays of 123 clinically suspected patients of silicosis. Silicosis was confirmed if either of them rated the X-ray as positive. STATISTICAL ANALYSIS: Descriptive statistics and logistic regression were done using SPSS software version 14. RESULTS: Out of 123 cases, 85 (69.1%) were confirmed as silicosis. There was no significant difference in the prevalence between males (70.3%) and females (69.4%). Workers with more than 10 years of exposure to silica had an odd ratio of 4.8, 95% CI (1.76, 13.60) compared to those with less than 10 years of exposure. A logistic regression analysis showed that for every extra year of exposure, the odds of getting silicosis increased by about 12%. CONCLUSIONS: This study highlights the catastrophic effects of exposures to silica in agate worker, which calls for urgent protective measures for this population.

Comportamiento del embarazo múltiple y sus principales indicadores perinatales / Behavior of multiple pregnancies and its main perinatal indicators

Fundamento: La coexistencia de dos o más fetos en la cavidad uterina conceptúa el término de embarazo múltiple. Al desarrollo simultáneo de dos se le denomina gemelaridad. Objetivo: Determinar el comportamiento del embarazo múltiple en nuestra provincia y sus principales indicadores perinatales. Método: Se realizó un estudio observacional descriptivo desde enero a diciembre de 2006 en el Hospital Ginecobstétrico Docente Provincial «Ana Betancourt de Mora¼. El universo estuvo constituido por 66 mujeres portadoras de gestaciones múltiples; los datos fueron recogidos del libro de morbilidad de las salas de gestante, de las historias clínicas y agrupados en un formulario y procesados mediante estadística descriptiva y distribución de frecuencia. Resultados: Predominaron las embarazadas con edades entre 20-34 años, de piel blanca, las enfermedades asociadas más frecuentes fueron la infección vaginal y la anemia. La presentación cefálicocefálico fue la más frecuente, primaron los partos distócicos. Como morbilidad materna predominó la anemia y en neonatos la prematuridad; hubo 13 muertes fetales. No se registraron muertes maternas ni neonatales. Conclusiones: El índice de morbilidad materna fue bajo, la anemia fue la que más se presentó y en cuanto a la morbi mortalidad perinatal se destacó el bajo peso en sus dos componentes (pretérmino y crecimiento intrauterino retardado).

Background: The coexistence of two or more fetuses in the uterine cavity defines the multiple pregnancies term. To the simultaneous development of two is called gemellarity. Objective: To determine the behavior of multiple pregnancies in our province and its main perinatal indicators. Method: A descriptive observational study from January to December 2006 was conducted at "Ana Betancourt de Mora" Provincial Educational Gynecobstetric Hospital. The universe was constituted by 66 women carriers of multiple gestations; data were collected from the morbidity book of expectant mother wards, of the medical histories and grouped in a form and processed by means of descriptive statistics and distribution of frequency. Results: Pregnant women with white race and ages among 20-34 years predominated; the most frequent associated diseases were the vaginal infection and the anemia. The cephalic-cephalic presentation was the most frequent one, the dystocic labors predominated. As maternal morbidity the anemia predominated and in newborns the prematurity; there was 13 fetal deaths and no maternal neither neonatal deaths were registered. Conclusions: The maternal morbidity rate was low, the anemia was the one most presented and regarding to morbi- perinatal mortality the low weight was pointed out in its two components (preterm and intrauterine growth retarded).

Morbilidad y valimiento del paciente geriátrico en una comunidad / Morbility and valuation of the geriatric patient in a community

Se realizó un estudio descriptivo y transversal sobre la morbilidad y el valimiento del paciente geriátrico en una comunidad con un universo de 122 pacientes, durante un año (enero de 1998- enero de 1999). Fueron atendidos en los consultorios 3,4 y 5 pertenecientes al Reparto Lenin del Policlínico Comunitario Docente Carlos J. Finlay de la Ciudad de Camagüey. Se utilizó para ello una encuesta médica que se convirtió en el registro primario de la investigación. El 51,6% de los pacientes resultaron ser del sexo masculino y el 73,7% del grupo dispensarial III. Los fumadores y la ingestión de bebidas alcohólicas una vez por semana fueron los hábitos tóxicos más frecuentes hallados. La hipertensión arterial fue la enfermedad crónica más encontrada y las discapacidades osteomioarticulares seguidas de las cardiovasculares las mayormente presentadas en el grupo de estudio. La independencia en sus actividades habituales en cuanto al grado de valimiento fue predominante en los pacientes estudiados.

A descriptive, cross-sectional study about morbility and valuation of the geriatric patient in a community with a study universe of122 patients during one-year period (January 1998 to January 1999) who were assisted in the health clinics 3,4 and 5 belongin to Carlos J. Finlay Communitary Teaching Hospital in Lenin locality of Camagüey City. A medical survey was used for this, which was primary register of the research. The 51,6% of patients were masculine and the 73,7% from the diSpensary group III. Somking habit and alcoholism once a week were the toxic habits more frequently found arterial. Hypertension was the chronic disease more frequent together with asteomyarticular discapacitus followed by cardiovascular disorders in the group. Independence as to valuation level prevailed among the studied patients.