Navegando por Palavras-chave "Complications"

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    Aspectos gerais da COVID-19 e suas consequências
    (Universidade Federal de São Paulo, 2021-08-06) Silva, Wagner Zaki Ribeiro da [UNIFESP]; Nappo, Solange Aparecida [UNIFESP]; http://lattes.cnpq.br/4675292090990088 ID
    Introdução: Em dezembro de 2019, foram relatados na cidade de Wuhan, China, vários casos de pneumonia de etiologia desconhecida. A doença denominada COVID­19 tornou­se uma pandemia. O novo vírus foi nomeado SARS­CoV­2. Justificativa: Importante para compreender melhor como o vírus age no organismo e a gravidade da doença. Objetivo: Descrever as consequências da COVID­19, abordando aspectos gerais da infecção por SARS­CoV­2 e seu acometimento sistêmico. Material e métodos: Foi feita uma revisão narrativa da literatura e foram selecionados 50 artigos de interesse, sendo 16 descartados e 34 compuseram este trabalho. As bases de dados utilizadas foram Pubmed, Scielo, Google Scholar e Organização Mundial da Saúde (OMS). Resultados: SARS­CoV­2 é um RNA vírus, envelopado, pertencente ao gênero β-CoV. Através da proteína de pico S (Spike), SARS­CoV­2, anexa­se às células humanas através do receptor da enzima conversora de angiotensina­2 (ECA2). A transmissão do SARS­CoV­2 de pessoa a pessoa ocorre por meio de auto inoculação nas mucosas (nariz, olhos ou boca) e contato com superfícies inanimadas contaminadas. Seus sintomas incluem desde manifestações em estágios mais leves ou de modo mais grave, como febre, fadiga, tosse seca, mialgia, insuficiência respiratória e até mesmo a morte. Pessoas idosas e com comorbidades são consideradas grupo de risco e merecem especial atenção. Discussão: O acometimento de vários órgãos pelo SARS­CoV­2 tem sido associado à ampla distribuição da ECA2 no corpo. No pulmão, pneumonia parece ser a manifestação mais grave da infecção por SARS­CoV­2. No coração, níveis elevados de troponina evidenciam lesão cardíaca. No rim, ECA2 é expressa em várias células e lesão renal aguda é a complicação mais frequente. No fígado, lesão hepática aguda e anormalidades em enzimas hepáticas foram relatadas. O acometimento neurológico é decorrente de múltiplas vias fisiopatológicas. No trato gastrointestinal (TGI), atenção especial é necessária, pois as manifestações podem preceder a apresentação respiratória típica. Conclusão: A presença da ECA2 no organismo é fundamental para o vírus SARS­CoV­2. Além do pulmão, outros órgãos também são afetados pela infecção. Palavras chaves: pandemia, COVID­19, virologia, sintomas, comorbidades, complicações.
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    Avaliação do resultado de implante coclear em perdas auditivas pós-meningite
    (Universidade Federal de São Paulo (UNIFESP), 2017-03-29) Britto, Fernanda Carneiro Corujeira de [UNIFESP]; Cruz, Oswaldo Laercio Mendonça [UNIFESP]; http://lattes.cnpq.br/3152241414526004; http://lattes.cnpq.br/5549090058807804; Universidade Federal de São Paulo (UNIFESP)
    Objetivo: Analisar os resultados audiológicos do implante coclear em pacientes com perda auditiva pós-lingual secundária a meningite bacteriana, bem como compará-los com os resultados nas perdas auditivas por outras etiologias. Métodos: Trata-se de uma estudo retrospectivo, do tipo caso-controle, no qual foram avaliados 22 pacientes com surdez pós-lingual, submetidos à cirurgia de implante coclear, sendo 11 com suspeita diagnóstica de meningite bacteriana (casos) e 11 com outro tipo de etiologia (controles). Os pacientes foram avaliados quanto aos limiares auditivos, com a média tri-tonal, índice de reconhecimento de palavras e de sentenças em conjunto fechado e aberto, no período pré-implante coclear e após a ativação do mesmo (6, 12 e 24 meses). Resultados: Não foi observada diferença com significância estatística nos resultados audiológicos e no s testes de desempenho de fala entre os grupos, após a cirurgia do implante coclear. Conclusão: A surdez pós-meningite, por si só, não parece estar relacionado um pior desempenho com implante coclear.
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    Clinical management of localized bcg adverse events in children
    (Ios Press, 2016) Moreira, Thais das Neves Fraga [UNIFESP]; de Moraes-Pinto, Maria Isabel [UNIFESP]; Costa-Carvalho, Beatriz Tavares [UNIFESP]; Grumach, Anete Sevciovic; Weckx, Lily Yin [UNIFESP]
    BCG adverse events (BCG-AE) are rare conditions with no well-established treatment. This study aims to describe clinical characteristics and outcome of localized BCG-AE. Children with BCG-AEs who were treated at the Reference Center for Special Immunobiologicals of the Federal University of Sao Paulo from 2009 to 2011 were included. Patients were followed monthly until 3 months after healing. One hundred and twenty-seven patients with localized BCG-AE were followed: 67 (52.7%) had suppurative lymphadenitis
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    Complicações da intubação traqueal em pediatria
    (Associação Médica Brasileira, 2009-01-01) Souza, Nélio de; Carvalho, Werther Brunow de [UNIFESP]; Santa Casa de São Paulo; Universidade Federal de São Paulo (UNIFESP); Hospital Santa Catarina; Hospital Infantil Sabará
    OBJECTIVE: To describe the frequency and types of tracheal intubation complications and their main causes. METHODS: Cross sectional study of patients who were submitted to tracheal intubation for more than 24 hours at the Pediatric ICU of Santa Casa de Misericórdia de São Paulo, between May 1998 and December 1999. Exclusion criteria were previous intubations, surgeries or traumas in the cervical region or oropharynx. RESULTS: A study of 147 patients with ages varying from 1 month to 15 years and 3 months was carried out. An inadequate tracheal tube had been used in 31.3% of patients submitted to tracheal intubation and 14.3% needed 5 or more attempts to achieve intubation. Resident physicians had more difficulty with intubation. Most tracheal intubation attempts were related to increased traumas, hypoxia, bradycardia and worsening of the Downes score after extubation. Accidental extubation was observed in 21.8%, related to worsening in the score of Downes and need for reintubation. The resident physicians also caused a higher number of traumas and bradycardia. CONCLUSION: Most complications may be attributed to lack of experience and training of the physician performing the tracheal intubation. We should implement training programs and increase supervision during tracheal intubation to minimize these outcomes.
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    Complicações relacionadas ao uso de cateteres intravenosos periféricos em pacientes adultos internados em um hospital de ensino na Amazônia ocidental brasileira
    (Universidade Federal de São Paulo (UNIFESP), 2014-12-17) Enes, Sandra Maria Sampaio [UNIFESP]; Pedreira, Mavilde da Luz Goncalves [UNIFESP]; http://lattes.cnpq.br/5901248667753975; http://lattes.cnpq.br/1005630791206101; Universidade Federal de São Paulo (UNIFESP)
    A terapia intravenosa é uma das mais importantes intervenções terapêuticas na assistência à saúde. Para sua implementação são empregados diferentes dispositivos, destacando-se cateteres intravenosos periféricos (CIP) que podem acarretar complicações relacionadas ao seu uso. Objetivos: Descrever complicações decorrentes do uso de CIP e os fatores relacionados à sua ocorrência, em pacientes adultos de um hospital de ensino na Amazônia Ocidental Brasileira. Método: Estudo exploratório realizado em uma unidade de clínica médica de um hospital de ensino localizado em Rio Branco, Acre. A amostra foi composta por 122 CIP instalados em 122 pacientes com idade igual ou superior a 18 anos. A coleta dos dados ocorreu de setembro de 2013 a fevereiro de 2014, após aprovação do Comitê de Ética em Pesquisa (nº296912). Investigaram-se variáveis relativas à caracterização demográfica, da terapia intravenosa (TIV) pregressa e atual; da punção venosa periférica; dos motivos da retirada e tempo de permanência do CIP, e complicações associadas. Para a análise estatística foram aplicados os testes do Qui-quadrado e Teste Exato de Fisher, com nível de significância fixado em 5%. Resultados: Quanto as variáveis demográficas verificou-se distribuição exatamente igual da amostra quanto ao gênero (50,0%), com média de idade de 46,1(± 17,6) anos e cor da pele parda (57,3%). Quanto a TIV pregressa, a maior parte dos pacientes não havia tido internações anteriores (83,6%), mas o uso prévio e recente de TIV e CIP foi relatado por 79,5%, com tempo inferior a 72 horas (96,9%), e 52,5% refeririam complicações prévias. Quanto a TIV atual obteve-se tempo médio de uso de 8,81(± 6,89) dias, para infusão contínua e intermitente (61,5%), pelo método de infusão gravitacional e bolus (74,6%) e de soluções e fármacos (82,0%). Usar tratamento com risco, de fármacos com extremo de pH (62,5%) e vesicantes (62,5%) foi presente para a maioria, assim como apresentar doença crônica (71,1%) como condição predisponente à complicação. O tipo de CIP mais utilizado foi o sobre agulha (99,0%), de calibre 20G (39,3%), instalados nas veias do arco dorsal da mão (36,9%), em membro dominante (48,4%), fixados com fita tipo esparadrapo (98,4%), a punção realizada por técnicos de enfermagem (91,8%) e com grau de cuidado com o CIP insatisfatório (Grau 1= 73,0%). O tempo de permanência do CIP foi de 68,4(±46,28) horas e apenas 22,9% foram retirados por alta do tratamento. A complicação foi o principal motivo de retirada (67,2%), destacando-se flebite (31,1%), infiltração (24,6%), hematoma (23,8%) e obstrução (14,8%). Os fatores relacionados a complicações foram: antecedentes de complicações (p=0,002), TIV inferior a sete dias (p=0,015), infusão contínua e intermitente (p=0,007), em bolus e gravitacional (p=0,001), de soluções e fármacos (p<0,001), de mais de dois fármacos (p=0,001) e de fármacos vesicantes e com extremos de pH (p=0,034). Conclusão: Foi identificada alta proporção de complicações, principais motivos de retirada do CIP, destacando-se a flebite. Fatores relacionados ao paciente e a punção venosa periférica não influenciaram complicações, e sim antecedentes de complicações e características da TIV atual.
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    Complications From Surgically Assisted Rapid Maxillary Expansion With HAAS and HYRAX Expanders
    (Lippincott Williams & Wilkins, 2018) Pereira, Max Domingues [UNIFESP]; Koga, Alexandre Fukuzo [UNIFESP]; Prado, Gabriela Pereira Ribeiro [UNIFESP]; Ferreira, Lydia Masako [UNIFESP]
    The current study aimed at comparing the number and type of undesired outcomes during and after the maxillary expansion performed with HYRAX and HAAS expanders. A total of 90 patients (41 males and 49 females, 45.6% and 54.4%, respectively) aged 18 to 59 (mean age of 26.1
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    Educação em diabetes: papel e resultados das colônias de férias
    (Sociedade Brasileira de Endocrinologia e Metabologia, 1998-12-01) Vivolo, Marco Antonio [UNIFESP]; Monteiro, Odete de Oliveira [UNIFESP]; Ferreira, Sandra Roberta Gouvea [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Improving diabetes care is essential to preserve quality of life and longevity. The achievement of this goal depends on the diabetes education. Different health care centers have developed diabetes programmes based on regional characteristics and availability of resources. Our experience with educational summer camp (SC) for type 1 diabetic subjects is presented. The UNIFESP-ADJ SC aims to promote diabetes education at leisure with the participation of a multiprofessional team who has the opportunity to improve knowledge and skills in diabetes management. Seven-hundred-ninety subjects participated in 18 camps. The 9-day camp programme included adequate diet and exercise 3 times a day. Capillary glucose is monitored with appropriate insulin closes adjustments. The same questionnaire is applied at the beginning and end of the camping period in order to evaluate knowledge improvement in diabetes; they are invited to participate in educational daily meetings. Also the multiprofessional team meets every night for cases discussion. Anthropometric measurements, blood pressure, urine an blood samples are obtained. Individual recordings are provided to the respective families and physicians at the end of the camping period. The SCs have allowed diabetic subjects to recognize the possibility of a normal life. Improvement of knowledge in diabetes was confirmed by the comparison of questionnaires scores. They experienced the benefits of an adequate diet associated with exercise for glucose control and understood its importance to prevent long-term complications. Hypoglycemia occured more frequently, but they learned how to identify symptoms and to treat them. Blood pressure, plasma glucose and lipoproteins levels were reduced. The multiprofessional team recognized the role of diabetes education and developed skills to improve effectiveness of diabetes care. The complexity of diabetes treatment required the participation of the patient and its family in order to achieve metabolic control. Short-term benefits of diabetes education are seen by patients and their families. Assuming that metabolic control is necessary to prevent diabetic chronic complications, long-term benefits should be detected by the implementation of educational SCs for diabetic youngsters. The proposed modality of diabetes education in SCs showed to be reliable and effective, contributing to improve health of diabetic people and the quality of diabetes management. We concluded that such proposal should become more widespread.
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    Efeito da espuma de polidocanol no parênquima pulmonar após administração em veia periférica de ratos
    (Universidade Federal de São Paulo (UNIFESP), 2016-04-29) Silva, Melissa Andreia de Moraes [UNIFESP]; Miranda Junior, Fausto [UNIFESP]; http://lattes.cnpq.br/0032704511396445; http://lattes.cnpq.br/6749209338440036; Universidade Federal de São Paulo (UNIFESP)
    Background: Sclerotherapy has been gaining increased acceptance and popularity as an effective therapy for the treatment of varicose veins. This attention has fed growing interest into the safety and potential complications of this procedure. There is no evidence of pulmonary complications from foam sclerotherapy in humans; however, animal studies have shown possible damage. Objective: The aim of this study is to show the changes in rat pulmonary parenchyma after the injection of 1% polidocanol foam into the peripheral vein using histological analysis of the inflammatory and fibrosis processes. Method: Twenty-four Wistar albino rats were divided into the following four groups: 24 h Polidocanol, 7 day Polidocanol, 28 day Polidocanol, and control. After foam was injected into the lateral saphenous vein, the lungs of the rats were removed for histological analysis. Results: Alveolar edema was observed in only the 24 h group (p <0.005). Vessel thickening was observed in the 7 and 28 day groups (p <0.001). Interstitial fibrosis was found in only the 28 day group (p=0.006). There was no evidence of venous or arterial thrombosis in either group. Conclusions: Polidocanol foam injection into rat peripheral veins causes alveolar edema, vessel thickening and interstitial fibrosis.
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    Epidemiology of Behcet Disease
    (Informa Healthcare, 2012-10-01) Khairallah, Moncef; Accorinti, Massimo; Muccioli, Cristina [UNIFESP]; Kahloun, Rim; Kempen, John H.; Fattouma Bourguiba Univ Hosp; Univ Monastir; Univ Roma La Sapienza; Universidade Federal de São Paulo (UNIFESP); Univ Penn
    Behcet disease (BD) is a multisystem inflammatory disorder that is an important cause of morbidity worldwide. BD is most common along the ancient Silk Road route in the Far East and Mediterranean basin. the eye is the most commonly involved organ in BD patients. the prototypical form of involvement is a relapsing remitting panuveitis and retinal vasculitis. Less commonly, BD may present in the form of conjunctivitis, conjunctival ulcers, keratitis, episcleritis, scleritis, and extraocular muscle paralysis. Uveitis in BD carries significant implications for the patient, because it is a chronic recurrent disease characterized by explosive attacks of severe inflammation that may cause significant, cumulative damage to the intraocular structures. This review summarizes the epidemiology of systemic and ocular clinical features of BD with particular focus on risk factors, clinical characteristics, complications, and prognosis of BD-associated uveitis.
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    Escore preditivo de transformação hemorrágica em pacientes com acidente vascular cerebral isquêmico não submetidos a terapias de reperfusão
    (Universidade Federal de São Paulo (UNIFESP), 2020-02-13) Andrade, Joao Brainer Clares De [UNIFESP]; Silva, Gisele Sampaio [UNIFESP]; Universidade Federal de São Paulo
    Background. Hemorrhagic transformation (HT) is a common neurological complication after Ischemic Stroke. The prevalence of HT, in particular among patients not submitted to reperfusion therapies (TH) is still unclear. Typically studied in patients treated with RT, HT can be as important in patients not treated with RT. Furthermore these patients are the majority of ischemic stroke patients in developed countries and up to 98% in low and middle-income countries. Objectives. To develop a predictive score of hemorrhagic transformation (HT) in patients not treated with RT, describing the baseline characteristics of those patients. We also aimed to analyze other outcomes such as clinical complications, neurological recovery, length of hospitalization and in-hospital mortality. Finally, we sought to perform an external validation of our proposed predictive score in patients from other centers. Methods. Patients with a diagnosis of acute ischemic stroke admitted to a Comprehensive Stroke Center in Brazil from 2015 to 2017 were prospectively evaluated and randomly selected to the derivation cohort. We excluded patients who did not have both a head CT scan on admission and a follow-up neuroimaging within 7 days of admission. All other patients who met inclusion criteria were included in the validation cohort. The validation cohort also included patients from six Brazilian centers and one American center. A multivariate logistic regression model was built using variables available at the time of admission to produce a predictive grading score for HT. We assessed the score performance with measurements of calibration and discrimination. Results. In the final analysis, we included 448 patients in the derivation group. The prevalence of HT was 21.3% (N=95/448), from which 43.15% were symptomatic cases of HT. HT was identified within 3.4 (±1.9) days. Significant predictors of HT in the multivariate analysis included male sex, ASPECTS on admission, presence of leukoaraiosis, hyperdense cerebral middle artery sign, hyperglycemia on admission and cardioembolism stroke etiology. The clinical presentation as a lacunar syndrome was a protective factor. The score derived from the logistic regression analysis was male sex (1 point), ASPECTS ≤7 (2 points), presence of leukoaraiosis (1 point), hyperdense cerebral middle artery sign (1 point), glycemia on admission ≥180mg/dL (1 point), cardioembolism (1 point) and lacunar syndrome (-3 points). A Score ≥3 had 78% sensitivity and 75% specificity, and cstatistic 0.82 for all cases of HT and 0.83 for symptomatic cases. In the validation cohort, we included 2,683 patients, and our score had a c-statistics of 0.83. HT was associated with pneumonia; and symptomatic cases with epileptic events. Patients with HT had a lower neurological improvement, a longer length of hospitalization and poor functional outcomes at hospital discharge. Symptomatic cases of HT were associated with higher in-hospital mortality. Conclusions. Our proposed score is a simple, quick and easy-to-perform tool that allows feasible risk stratification of HT in patients not submitted to RT within seven days. The external validation of our score confirms the good accuracy of the tool. A digital tool has been developed, and it is currently available for use.
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    Estado atual do diagnóstico e tratamento da apendicite aguda na criança: avaliação de 300 casos
    (Colégio Brasileiro de Cirurgiões, 2005-12-01) Vital Junior, Pedro Felix [UNIFESP]; Martins, Jose Luiz [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    BACKGROUND: In our clinical practice, we have observed that despite the great technological advances in diagnostic methods acute appendicitis still represents a problem in children, resulting in late diagnosis and treatment, and case of greater severity. Our objective is to assess the current state of diagnosis and treatment of acute appendicitis in children treated in two important referral hospitals of São Paulo (Brazil), over a 30 month's period. METHODS: The variables studied were: age, sex, clinical manifestations, time for the diagnosis to be established, the findings from physical examination and laboratory tests, surgical findings and antibiotic protocols, postoperative complications and hospital lenght of stay. RESULTS: In the present sample, of 300 children, 65% were boys and 35% girls, with an initial diagnosis of appendicitis being made in 63% of the cases. The signs and symptoms most frequently encountered were: abdominal pain in the right iliac fossa (85.3%) and peritoneal irritation in this region (82%). We identified leukocytosis in 83% of the patients and the urine analysis showed leukocyturia in 39.7% of the patients. Around 92.4% of the simple radiological studies of the abdomen produced images that were not specific to acute appendicitis. Ultrasonography studies diagnosed the disease in 80.1% of the cases. Various antibiotic schemes were used, although there was special attention towards Gram-negative and anaerobic bacteria. The main complication was infection of the surgical wound, and there was no mortality. The average hospital length of stay was 5 days. CONCLUSION: In spite of greater knowledge of acute appendicitis and greater refinement of laboratory and radiological techniques, the diagnosis is still delayed and disease constitutes a cause of great morbidity among pediatric age groups.
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    Estudo clínico prospectivo aleatório sobre o uso da máscara laríngea Supreme® em pacientes submetidos a anestesia geral
    (Sociedade Brasileira de Anestesiologia, 2013-12-01) Barreira, Sara Rocha [UNIFESP]; Souza, Camila Machado [UNIFESP]; Fabrizia, Fernanda [UNIFESP]; Azevedo, Ana Bárbara G. [UNIFESP]; Lelis, Talitha G. [UNIFESP]; Lutke, Claudia [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    BACKGROUND AND OBJECTIVES: Supraglottic airway devices are increasingly used as an option to tracheal intubation for elective procedures of varying complexity. The aim of this study was to prospectively evaluate the clinical use of the laryngeal mask airway Supreme® (LMAS) in patients undergoing elective breast surgery and compare it with endotracheal tube (ETT). METHODS: Sixty patients undergoing breast procedures under general anesthesia were randomly divided into two groups according to the device used (LMAS or ETT). Time of insertion, number of insertion attempts, hemodynamic response to insertion, presence of blood on the device used; and incidence of sore throat, dysphagia, nausea and vomiting were assessed postoperatively. RESULTS: There was no difference between groups regarding time of insertion, number of attempts for successful insertion, and presence of blood on the device. Heart rate and blood pressure after insertion were higher in ETT group. Incidence of sore throat and dysphagia was also higher in ETT group after two hours in the postoperative period. There was no difference regarding incidence and severity of complications evaluated after six hours postoperatively. CONCLUSIONS: The use of the LMAS technique to access airway during general anesthesia for elective breast surgery is as safe and effective as tracheal intubation, with the advantage of promoting smaller hemodynamic response during its management and lower incidence of sore throat and dysphagia in the first hours after surgery.
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    Estudo da resposta inflamatória em pacientes com epilepsia e hipertrofia gengival por uso de DAEs após terapia com laser de diodo
    (Universidade Federal de São Paulo (UNIFESP), 2017-01-31) Milena, Sheila Parreira [UNIFESP]; Scerni, Debora Amado [UNIFESP]; http://lattes.cnpq.br/3964840204818021; http://lattes.cnpq.br/6136397596258479; Universidade Federal de São Paulo (UNIFESP)
    Epilepsy affects around 70 million people representing an important public health issue and its treatment implies appropriate seizures control with minimal adverse effects. The treatment is done with the antiepileptic drugs (AEDs), being the most used, carbamazepine (CBZ), phenytoin (PHT) and valproic acid (VPA) causing gingival enlargement (GE). PHT is related to HG around 50% of patients who needs odontology treatment. Objectives: This study evaluated the effectiveness of laser therapy in the treatment of GE by use of AEDs, after conventional periodontal treatment in a group of patients with hard-to-control epilepsy with polytherapy, using clinical indexes to verify reduction of GE after the dental treatment and dosage of inflammatory mediators throughout the salivary treatment. Methods: Fifteen patients were selected between 17 and 60 years old who made continuous use of AEDs for more than twelve months without periodontal treatment for at least six months and who had moderate to severe GE. Eleven patients received, in addition to the conventional treatment, laser therapy in selected parameters and constituted 0.5 Joule and groups 1.0 Joule of energy applied to each session. The other four patients received only basic periodontal treatment and composed the placebo group. To quantify the GE was used the index of Seymour, and the dimensions of the gingival papillae were measured in millimeters on plaster models, before and after the proposed protocol, using a precision caliper. Results: The papillae inferior responded favorably to the clinical protocol, and the 1.0 J presented better results compared to 0.5 J protocol and relation to the placebo group. The index of Seymour showed that there were no statistically significant differences between the groups and even between the observation periods (before and after). It has been found that even patients in the placebo group, who received only basic periodontal therapy with oral hygiene instructions, have improved the clinical conditions, with a decrease of bleeding, edema and inflammatory conditions, indicating that the basic periodontal procedures should be applied in all conditions regardless of laser therapy for the improvement of the clinical conditions. Conclusion: The study leads to conclude the existence of important benefits to patients receiving laser therapy when compared with the placebo group, because the reduction in gingival dimension and rise reducing the inflammatory clinical standards. It was concluded that the dose of 1.0 J is more effective. Despite the conclusions favorable to the adoption of laser therapy in cases of GE studied, in some severe cases surgical intervention was required, in addition to the application of the dose of 1.0 J.
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    Fatores preditivos de complicações relacionadas à terapia de oxigenação por membrana extracorpórea venoarterial em adultos
    (Universidade Federal de São Paulo (UNIFESP), 2018-12-20) Nakasato, Gislaine Rodrigues [UNIFESP]; Lopes, Camila Takao [UNIFESP]; http://lattes.cnpq.br/8617271560426429; São Paulo; Lopes, Juliana de Lima [UNIFESP]; http://lattes.cnpq.br/1478157388713375; Universidade Federal de São Paulo (UNIFESP)
    used as cardiopulmonary support when cardiac dysfunction is refractory to conventional therapeutic measures, mainly in cardiac surgery. It is an expensive, complex technology, which is not riskfree or free of complications. The main complications associated with ECMO therapy have been well defined by previous studies, but their predictors are not known in Brazil. The objective of this study was to identify predictive factors of complications related to VAECMO in adults. Method: a retrospective cohort study, performed in two institutions recognized by the Extracorporeal Life Support Organization as reference ECMO centers in the state of São Paulo. Data were collected from all adult patients ever submitted to VAECMO for any cardiocirculatory indications since both hospitals implemented ECMO treatment (1999 for Hospital A, 2012 for Hospital B) through March 2018 (n=63). The independent variables included demographics, ECMO indications, preECMO clinical characteristics and type of cannulation. The dependent variables included neurologic, renal, vascular, bleeding, infection and devicerelated complications. The association between the independent variables and the outcomes was investigated through simple regression models and those with a pvalue ≤0,05 were submitted to logistic regression analysis. Results: The patients’ median age was 42.5 years, 56.2% male, 51.6% submitted to ECMO due to refractory postcardiotomy cardiogenic shock, 53.2% with central cannulation. The frequency of complications was: 84.4% bleeding, 60.9% renal, 60.9% vascular, 59.4% infections, 32.8% neurologic, 28.1% devicerelated. The predictors of neurologic complications were cardiogenic shock after cardiotomy (OR=0.09, 95% CI=0.000.76, p=0.049) and cardiac or lung transplantation as ECMO indications (OR=0.04, 95%=CI 0.000.42, p=0.018) as compared to cardiac arrest as an indication. Vascular complications were predicted by the use of inotropes/vasopressors before ECMO (OR=7.72 95% CI:1.8339.87, p=0.008). The CKMB level was the predictor of renal complications (OR=0.87 95% CI:0.720.97, p=0.046). The predictors of infectious complications were total bilirubin (OR=0.02 95% CI:0.000.26, p=0.038) and weight (OR=1.24 95% CI:1.981.61, p=0.028). Heart failure functional class III was a predictor of mechanical complications (OR=0.07 95% CI:0.000.66, p=0.034). Conclusion: Predictive factors for neurological, vascular, renal, infectious and mechanical complications were found in all patients ever submitted to ECMOVA in two centers. These results can contribute to increase awareness in patient’s clinical assessment and in the indication of the procedure.
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    High-intensity inspiratory protocol increases heart rate variability in myocardial revascularization patients
    (Hospital Clinicas, Univ Sao Paulo, 2016) Rossi Caruso, Flavia Cristina; Simoes, Rodrigo Polaquini; Reis, Michel Silva; Guizilini, Solange [UNIFESP]; dos Santos Alves, Vera Lucia; Papa, Valeria; Arena, Ross; Borghi-Silva, Audrey
    Objective: To evaluate heart rate variability during an inspiratory muscle endurance protocol at three different load levels [30%, 60% and 80% of maximal inspiratory pressure], in patients who had previously undergone coronary artery bypass grafting. Methods: Nineteen late postoperative myocardial revascularization patients participating in a cardiovascular rehabilitation program were studied. Maximal inspiratory pressure maneuvers were performed. An inspiratory muscle endurance protocol at 30%, 60% and 80% of maximal inspiratory pressure was applied for four minutes each, in random order. Heart rate and RR intervals were recorded and heart rate variability was analyzed by time (RMSSD-the mean of the standard deviations for all R-R intervals, and RMSM-root-mean square differences of successive R-R intervals) and frequency domains indices (high and low frequency) in normalized units. ANOVA for repeated measurements was used to compare heart rate variability indices and Student t-test was used to compare the maximal inspiratory pressure and maximal expiratory pressure values. Results: Heart rate increased during performance of maximal respiratory pressures maneuvers, and the maximal inspiratory pressure and maximal expiratory pressure mean values were significantly lower than predicted values (P<0.05). RMSSD increased significantly at 80% in relation to rest and 30% of maximal inspiratory pressure and RMSM decreased at 30% and 60% of maximal inspiratory pressure in relation to rest (P<0.05). Additionally, there was significant and progressive decrease in low frequency and increase in high frequency at 30%, 60% and 80% of maximal inspiratory pressure in relation to the resting condition. Conclusion: These results suggest that respiratory muscle training at high intensities can promote greater parasympathetic activity and it may confer important benefits during a rehabilitation program in post-coronary artery bypass grafting.
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    Impact of Pancreatic Allograft Function on 1-Year Survival Rates After Simultaneous Pancreatic-Renal Transplant
    (Baskent Univ, 2008-12-01) Rangel, Erika Bevilaqua [UNIFESP]; Melaragno, Cláudio Santiago [UNIFESP]; Gonzalez, Adriano Miziara [UNIFESP]; Linhares, Marcelo Moura [UNIFESP]; Sá, João Roberto de [UNIFESP]; Salzedas, Alcides [UNIFESP]; Pestana, Jose Osmar Medina [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objectives: Simultaneous pancreatic-renal transplant is an effective treatment for insulin-dependent patients with chronic renal failure. We sought to identify the main influences on pancreatic and patient survival rates after simultaneous pancreas-kidney transplants.Patients and Methods: The 1-year patient and pancreas survival rates of 150 patients who had undergone simultaneous pancreas-kidney transplant were analyzed by the Cox proportional hazards regression model and the Kaplan-Meier method. Uni- and multivariate analyses were performed in terms of transplant-, recipient-, and donor-related risk factors.Results: At 1 year, patient and pancreatic allograft survival rates were 82% and 76.7%, respectively. Delayed graft function in the kidney (P = .001, HR 5.41), acute kidney rejection (P = .016, HR 3.36), and intra-abdominal infection (P < .0001, HR 4.15) were the main factors related to 1-year patient survival. Pancreatic allograft survival at 1 year was related to intra-abdominal infection (P < .0001, OR 12.83), vascular thrombosis (P = .002, OR 40.55), acute kidney rejection (P = .027, OR 3.06), donor sodium greater than 155 mEq/L (P = .02, OR 3.27), and dopamine administration exceeding 7.6 mu g/kg/min (P = .046, OR 2.85).Conclusions: Delayed kidney allograft function and intra-abdominal infection had an important effect on both patient and pancreatic allograft survival rates.
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    Implantation of a second glaucoma drainage device
    (Springer, 2017) Francis, Brian A.; Fernandes, Rodrigo A. B. [UNIFESP]; Akil, Handan; Chopra, Vikas; Diniz, Bruno [UNIFESP]; Tan, James; Huang, Alex
    Purpose To evaluate success rates in controlling intraocular pressure (IOP) after implantation of a second glaucoma drainage device (GDD) with a Baerveldt glaucoma implant in patients with refractory glaucoma, with a secondary aim of reducing the need for postoperative glaucoma medications. Material and methods This retrospective, noncomparative, interventional study included patients undergoing a second GDD for uncontrolled glaucoma from a tertiary care glaucoma service. Data were obtained from the medical records for the preoperative period and after the 1st, 15th, and 30th day, 3, 6, and 12 months, and then yearly until the last postoperative visit. Visual acuity, IOP, and number of glaucoma medications (NGM) from the follow-up visits were compared to baseline. Success and failure criteria were analyzed based on IOP level or need of glaucoma medications. Results Forty-nine patients were studied, with a mean follow-up time of 25 +/- 21 months. The mean preoperative IOP was 23.7 +/- 8.2 mmHg, and decreased to 14.8 +/- 4.0 mmHg after 1 year, 14.4 +/- 3.9 mmHg after 2 years, and 16.6 +/- 8.5 mmHg after 3 years. The mean preoperative NGM was 3.4 +/- 1.3, and decreased to 2.0 +/- 1.8 after 1 year, 2.5 +/- 1.6 after 2 years, and 2.8 +/- 2.0 after 3 years. Absolute success was 9% after 1 year for a postoperative IOP between 5 and 18 mmHg, and 76% for a postoperative IOP between 5 and 21 mmHg. The qualified success was 88% at the first and second years and 83% at the third year. Conclusion With up to 3 years of follow-up, a second glaucoma drainage device was successful in reducing IOP to below 21 mmHg, but not as successful below 18 mmHg. The success rate is improved with the use of glaucoma medications with up to 3 years of follow-up.
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    Induction of life-threatening supraventricular tachycardia during central venous catheter placement: an unusual complication
    (Elsevier B.V., 2010-08-01) Silva, Paulo Sergio Lucas da [UNIFESP]; Waisberg, Jaques [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Cardiac arrhythmias during central venous catheter (CVC) insertion are typically transient events with no hemodynamic repercussions. Pediatric reports on this condition are scarce and fail to describe potentially life-threatening complications.Case: A 14-day-old boy was admitted to the pediatric intensive care unit presenting with septic shock. During CVC insertion, the patient developed supraventricular tachycardia (SVT), which was unresponsive to vagal maneuvers or adenosine. Chest roentgenogram control revealed the tip of the catheter positioned in the midportion of the superior vena cava. After 30 minutes, the patient had a heart rate of 215 beats/min (bpm) and signs of hemodynamic compromise. the SVT eventually reverted to a sinus rhythm with synchronized cardioversion. the patient was discharged in good health.Conclusion: Awareness of this potential complication of CVC insertion warrants a high level of concern by pediatric surgeons performing these procedures. Patients with sepsis and/or cardiac dysfunction who present SVT during catheter insertion can represent a therapeutic challenge for surgeons. (C) 2010 Elsevier Inc. All rights reserved.
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    Influence of sedation on morbidity and mortality in the intensive care unit
    (Associação Paulista de Medicina - APM, 2004-02-01) Rodrigues Junior, Geraldo Rolim; Amaral, José Luiz Gomes do [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Estadual Paulista (UNESP)
    CONTEXT: Although 30 to 50% of hospitalized patients in a critical care unit are under sedation, there is sparse data on the impact of sedation on morbidity and case-fatality rates in Brazil. Sedation is associated with higher risks of infection and death rate among patients. However, it is difficult to assess the clinical impact of sedation. OBJECTIVE: To evaluate the impact of sedation on the incidence of nosocomial infection and all-cause deaths at a critical care unit. TYPE OF STUDY: Prospective study. SETTING: Tertiary-care teaching hospital. PARTICIPANTS: After the exclusion of patients hospitalized for less than 24 hours, 307 patients were assigned to two groups, considering their states of sedation. After confirmation of heterogeneity in relation to the Acute Physiology and Chronic Health Evaluation (APACHE II) prognostic system, 97 sedated and 97 non-sedated patients were matched in relation to this severity index. MAIN MEASUREMENTS: Impact of sedation on deep venous thrombosis, incidence of decubital eschars, presence of infection, mortality and length of hospital stay. RESULTS: There was no difference in the incidence of deep venous thrombosis between the sedated and non-sedated groups, while the frequency of decubital eschars was significantly higher among sedated patients (p = 0.03). Infection was detected in 45.4% of patients under sedation and 21.6% of patients not under sedation (p = 0.006). Mortality for patients that did not receive any kind of sedative was 20.6% and, for those that were sedated during hospitalization, the rate was 52.6% (p < 0.0001). The sedated patients had longer hospitalization (11 vs. 4 days) (p < 0.0001). CONCLUSION: We concluded that sedation is associated with higher infection risk and case-fatality rate, and longer hospital stay.
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    Injuries caused by Veress needle insertion for creation of pneumoperitoneum: a systematic literature review
    (Springer, 2009-07-01) Azevedo, Joao Luiz Moreira Coutinho [UNIFESP]; Azevedo, Otavio Cansancao [UNIFESP]; Miyahira, Susana Abe [UNIFESP]; Miguel, Gustavo Peixoto Soares [UNIFESP]; Becker, Otavio Monteiro [UNIFESP]; Hypolito, Octavio Henrique Mendes [UNIFESP]; Machado, Afonso Cesar Cabral Guedes [UNIFESP]; Cardia, Wellington [UNIFESP]; Aguiar-Yamaguchi, Gilmara Silva [UNIFESP]; Godinho, Lola [UNIFESP]; Almeida, Carlos Eduardo Saldanha [UNIFESP]; Moreira, Camila Hobi [UNIFESP]; Freire, Dalmer Faria [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Background the aim of this study was to assess the prevalence, risks, and outcomes of injuries caused by the Veress needle described in the literature.Methods Iatrogenic injuries caused by Veress needle insertion during diagnostic or therapeutic laparoscopies in humans were researched, with no language restriction, in the Medline, Lilacs, Embase, Scielo, and Cochrane Library databases. the following words were combined: Veress'' or insufflation needle'' or pneumoperitoneum needle,'' and complications'' or injuries'' or lesions.'' the bibliographic references of the selected articles were also analyzed. We considered the following: (1) number of injuries described in the literature, (2) relationship between number of injuries and number of patients who underwent Veress needle insertion in the studies that reported Veress needle injury, (3) organs and structures injured (retroperitoneal vessels, digestive tract, and self-limited, minor injuries), and (4) outcome (death, conversion to laparotomy, laparoscopic repair, spontaneous resolution).Results Thirty-eight selected articles included 696,502 laparoscopies, with 1,575 injuries (0.23%), 126 (8%) of which involved blood vessels or hollow viscera (0.018% of all laparoscopies). of the 98 vascular injuries, 8 (8.1%) were injuries to major retroperitoneal vessels. There were 34 other reported retroperitoneal injuries, but the authors were not specific as to which vessel was injured. of the 28 injuries to hollow viscera, 17 were considered major injuries, i.e., 60.7% (0.0024% of the total cases assessed).Conclusion the insertion of the Veress needle in the abdominal midline, at the umbilicus, poses serious risk to the life of patients. Therefore, further studies should be conducted to investigate alternative sites for Veress needle insertion.