ABSTRACT The Verbal Autopsy (VA) is a questionnaire about the circumstances surrounding a death. It was widely used in Brazil to assist in postmortem diagnoses and investigate excess mortality during the Coronavirus Disease 2019 (COVID-19) pandemic. This study aimed to determine the accuracy of investigating acute respiratory distress syndrome (ARDS) using VA. This is a cross-sectional study with prospective data collected from January 2020 to August 2021 at the Death Verification Service of Sao Luis city, Brazil. VA was performed for suspected COVID-19 deaths, and one day of the week was randomly chosen to collect samples from patients without suspected COVID-19. Two swabs were collected after death and subjected to reverse transcription-polymerase chain reaction (RT-PCR) for SARS-CoV-2 detection. Of the 250 cases included, the VA questionnaire identified COVID-19-related ARDS in 67.2% (52.98% were positive for COVID-19). The sensitivity of the VA questionnaire was 0.53 (0.45–0.61), the specificity was 0.75 (0.64–0.84), the positive predictive value was 0.81 (0.72–0.88), and the negative predictive value was 0.44 (0.36–0.53). The VA had a lower-than-expected accuracy for detecting COVID-19 deaths; however, because it is an easily accessible and cost-effective tool, it can be combined with more accurate methods to improve its performance. (VA 201 COVID19 COVID 19 (COVID-19 pandemic (ARDS crosssectional cross sectional 202 city COVID-1 deaths COVID19. 19. transcriptionpolymerase transcription polymerase RTPCR RT PCR (RT-PCR SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- detection 25 included COVID19related COVIDrelated related 672 67 67.2 52.98% 5298 52 98 (52.98 . COVID-19) 053 0 53 0.5 0.45–0.61, 045061 0.45–0.61 , 45 61 (0.45–0.61) 075 75 0.7 0.64–0.84, 064084 0.64–0.84 64 84 (0.64–0.84) 081 81 0.8 0.72–0.88, 072088 0.72–0.88 72 88 (0.72–0.88) 044 44 0.4 0.36–0.53. 036053 0.36–0.53 36 (0.36–0.53) lowerthanexpected lower than expected however costeffective cost effective tool performance 20 COVID1 1 (COVID-1 COVID- SARS-CoV 6 67. 52.98 529 5 9 (52.9 05 0. 04506 0.45–0.6 4 (0.45–0.61 07 7 06408 0.64–0.8 8 (0.64–0.84 08 07208 0.72–0.8 (0.72–0.88 04 03605 0.36–0.5 3 (0.36–0.53 (COVID- 52.9 (52. 0450 0.45–0. (0.45–0.6 0640 0.64–0. (0.64–0.8 0720 0.72–0. (0.72–0.8 0360 0.36–0. (0.36–0.5 (COVID 52. (52 045 0.45–0 (0.45–0. 064 0.64–0 (0.64–0. 072 0.72–0 (0.72–0. 036 0.36–0 (0.36–0. (5 0.45– (0.45–0 06 0.64– (0.64–0 0.72– (0.72–0 03 0.36– (0.36–0 ( 0.45 (0.45– 0.64 (0.64– 0.72 (0.72– 0.36 (0.36– (0.45 0.6 (0.64 (0.72 0.3 (0.36 (0.4 (0.6 (0.7 (0.3 (0. (0

Abstract In the pediatric population, complex regional pain syndrome (CRPS) is a challenging condition that leads to chronic psychosocial dysfunction. This case is of a 12-year-old male patient, 50 kg, who, after twisting his right ankle, started to present intense pain. Without adequate diagnosis and treatment, his family sought a pain specialist. During the evaluation, a change in sensitivity and temperature was observed, besides hyperalgesia, allodynia, redness, edema, and motor dysfunction, being diagnosed with CRPS. Ultrasound-guided sciatic blocks were performed on the affected limb, increasing the interval between crises, reducing pain intensity, and promoting a return to daily activities. population CRPS (CRPS dysfunction 12yearold yearold 12 year old patient 5 kg who ankle treatment specialist evaluation observed hyperalgesia allodynia redness edema Ultrasoundguided Ultrasound guided limb crises intensity activities 1

ABSTRACT Introduction: The perception of prejudice against, and stigmatization of, sickle cell disease (SCD) leads the patient to perceive a different treatment, due to the disease stigma and maybe related to a worse quality of life (QoL). Objectives: Describe and evaluate the perception of the prejudice against the disease and its impact on the quality of life of patients with sickle cell disease. Methods: This is a cross-sectional study conducted between March 2019 and February 2020, with patients diagnosed with SCD. Patients were questioned about the perception of prejudice in any kind of situation, choosing between “Yes” or “No”, not differentiating situations related to prejudice. To assess the QoL and impact of the disease, the volunteers answered a version of the SF-36 questionnaire translated and validated into Brazilian Portuguese. Results: In this study, 113 patients with SCD were followed up, 92% were classified as HbSS and the rest, divided between HbSC and HbS-β-0. Regarding the SF-36, the worst scores were in the summary of the physical components (mean 48.19 ± 21.51) and the physical aspect had the lowest mean (30.75 ± €42.65). When questioned if they had already perceived any kind of prejudice, including the SCD, 32.74% answered “Yes”. For this comparison, there was a significant difference in the summary of the physical and mental components, with worse QoL for those who had already suffered prejudice. Conclusion: Patients diagnosed with SCD who reported perception of prejudice had statistically significant worse QoL, revealing the negative impact, that might lead to sadness and social isolation. Introduction (SCD treatment QoL. . (QoL) Objectives Methods crosssectional cross sectional 201 2020 situation Yes “Yes No, No , “No” SF36 SF 36 SF-3 Portuguese Results 11 up 92 rest HbSβ0. HbSβ0 HbSβ HbS β 0. 0 HbS-β-0 SF36, 36, 4819 48 19 48.1 21.51 2151 21 51 30.75 3075 30 75 (30.7 €42.65. 4265 €42.65 42 65 €42.65) 3274 32 74 32.74 Yes. comparison Conclusion isolation (QoL 20 202 “No SF3 3 SF- 1 9 HbS-β- 481 4 48. 21.5 215 2 5 30.7 307 7 (30. 426 €42.6 6 327 32.7 HbS-β 21. 30. (30 €42. 32. (3 €42 ( €4 €

SUMMARY OBJECTIVE: This study aimed to evaluate postoperative pain and quality of life in patients undergoing median sternotomy. METHODS: A cohort study was carried out on a sample of 30 patients who underwent elective cardiac surgery by longitudinal median sternotomy. Patients were interviewed at Intensive Care Unit discharge and hospital discharge, when the Visual Numeric Scale and the Brief Pain Inventory were applied, and 2 weeks after hospital discharge, when the World Health Organization Quality of Life-Bref questionnaire was administered. The normality of the results was analyzed by the Shapiro-Wilk test, and Wilcoxon Rank Sum and McNemar tests were utilized for the analysis of numerical and categorical variables. For correlation between numerical variables, Spearman's linear correlation test was applied. To compare numerical variables, Mann-Whitney U and Kruskal-Wallis tests were applied. Differences between groups were considered significant when the p-value was <0.05. RESULTS: Between Intensive Care Unit and hospital discharge, there was a reduction in median pain intensity assessed by the Visual Numeric Scale from 5.0 to 2.0 (p<0.001), as well as in eight Brief Pain Inventory parameters: worst pain intensity in the last 24 h (p=0.001), analgesic relief (p=0.035), and pain felt right now (p=0.009); and in interference in daily activities (p<0.001), mood (p=0.017), ability to walk (p<0.001), relationship with other people (p=0.005), and sleep (p=0.006). Higher pain intensity at Intensive Care Unit discharge was associated with worse performance in the psychological domain of quality of life at out-of-hospital follow-up. CONCLUSION: Proper management of post-sternotomy pain in the Intensive Care Unit may imply better quality of life at out-of-hospital follow-up. OBJECTIVE sternotomy METHODS 3 applied LifeBref Life Bref administered ShapiroWilk Shapiro Wilk variables Spearmans Spearman s MannWhitney Mann Whitney KruskalWallis Kruskal Wallis pvalue p value 005 0 05 <0.05 RESULTS 50 5 5. 20 2. p<0.001, p0001 p<0.001 , 001 (p<0.001) parameters p=0.001, p=0.001 (p=0.001) p=0.035, p0035 p=0.035 035 (p=0.035) p=0.009 p0009 009 (p=0.009) p=0.017, p0017 p=0.017 017 (p=0.017) p=0.005, p0005 p=0.005 (p=0.005) p=0.006. p0006 p=0.006 . 006 (p=0.006) outofhospital followup. followup follow up. up follow-up CONCLUSION poststernotomy post 00 <0.0 p000 p<0.00 (p<0.001 p=0.00 (p=0.001 p003 p=0.03 03 (p=0.035 (p=0.009 p001 p=0.01 01 (p=0.017 (p=0.005 (p=0.006 <0. p00 p<0.0 (p<0.00 p=0.0 (p=0.00 (p=0.03 (p=0.01 <0 p0 p<0. (p<0.0 p=0. (p=0.0 < p<0 (p<0. p=0 (p=0. p< (p<0 p= (p=0 (p< (p= (p

ABSTRACT Purpose: To demonstrate through a controlled study whether the use of tranexamic acid in bariatric surgeries is effective for bleeding control. Methods: Prospective, comparative, and double-blind study performed with patients from 18 to 65 years old submitted to bariatric surgery. The selected patients received venous tranexamic acid (TXA) during the induction of anesthesia or not (CG). The anesthesia and thromboprophylaxis protocols were similar among the groups. For statistical analysis, the χ2 and analysis of variance tests were performed at a significance level of p < 0.05, using the statistical program SPSS 21.0®. Results: Sixty-one patients were included in the study, 31 in the control group and 30 in the TXA group (GTXA). In the intraoperative period, the bleeding volume was greater in the CG than in the GTXA. In the postoperative period, the tranexamic acid group had a higher value hematocrit, absence of surgical reoperations due to bleeding complications, and shorter hospitalization time than the control group. Conclusions: The use of tranexamic acid was effective in reducing bleeding rates and of hospital stay length, in addition to demonstrating the clinical safety of its use, for not having been associated with any thromboembolic events.

Abstract We report the anesthetic management with combined spinal-epidural in a patient with limb-girdle muscular dystrophy type 2A, submitted to abdominoplasty and liposuction. The patient had onset of symptoms at 8 years old, diagnosed by muscular biopsy, presenting muscle weakness in the scapular and pelvic girdles, with reduced mobility. We performed monitorization with noninvasive blood pressure, oximeter, thermometer, and electrocardiogram. In the postoperative period, she showed no clinical signs of rhabdomyolysis, myotonia, or adverse effects, maintaining hemodynamic stability. The anesthesia technique allowed spontaneous ventilation, monitoring of clinical parameters close to physiological conditions and used smaller doses of medication, reducing related risks.

RESUMO JUSTIFICATIVA E OBJETIVOS: A osteoartrite do joelho é uma doença crônica que tende a afetar pessoas idosas e é caracterizada por dor intensa, rigidez articular e limitação da mobilidade. Em casos mais avançados, a abordagem da osteoartrite do joelho com o tratamento conservador convencional farmacológico e não farmacológico pode não apresentar resultados satisfatórios. Nesse sentido, existem alternativas de intervenção em dor com resultados favoráveis, com maior tempo de analgesia e que auxiliam a reabilitação, como a realização de bloqueios analgésicos em nervos periféricos, como bloqueio dos nervos geniculares e a ablação por radiofrequência. Este estudo teve como objetivo relatar casos de bloqueios dos nervos geniculares guiados por ultrassonografia, com resultados favoráveis em relação à analgesia e retorno da capacidade funcional. RELATO DOS CASOS: Quatro pacientes idosos diagnosticados com osteoartrite de joelho em grau avançado, com limitação da amplitude de movimento e com dor crônica, com intensidade média de 7,75 pela escala visual numérica, foram submetidos ao bloqueio de nervos geniculares guiado por ultrassonografia, apresentando melhora importante da dor após um mês do bloqueio, com intensidade média de 2,25 e reganho da capacidade funcional, não havendo casos de complicações relacionadas aos bloqueios. CONCLUSÃO: O bloqueio dos nervos geniculares guiado por ultrassonografia é uma técnica que promoveu analgesia satisfatória e ganho da capacidade funcional, além de facilitar o processo de reabilitação, podendo ser realizada em caráter ambulatorial.

ABSTRACT BACKGROUND AND OBJECTIVES: Knee osteoarthritis is a chronic disease that tends to affect elderly people and is characterized by severe pain, joint stiffness and limited function. In more advanced cases, the initial approach of knee osteoarthritis performed with traditional conservative pharmacological or non-pharmacological treatment may not present satisfactory results. There are alternatives for pain intervention with favorable results, with longer analgesia and that can help rehabilitation, such as analgesic peripheral nerve blocks, including the genicular nerve block, and radiofrequency ablation. The objective of this study is to report cases of genicular nerve block guided by ultrasonography, with favorable results in relation to analgesia and return of functional capacity. CASE REPORTS: Four elderly patients diagnosed with advanced knee osteoarthritis, with limited range of motion, and with severe chronic pain (mean visual numeric scale - VNS=7.75) were submitted to ultrasound-guided genicular nerve block, presenting significant pain improvement (mean VNS after 1 month of block=2.25) and regain of functional capacity. There were no cases of complications. CONCLUSION: Genicular nerve block guided by ultrasonography is a technique that can be performed as an intervention measure in pain. It presents satisfactory results of analgesia and regain of functional capacity, facilitating the rehabilitation process, and can be adopted in an outpatient clinic context.

RESUMO Racional: A gastrectomia vertical ampliada é uma variação da técnica da gastrectomia vertical, necessitando de estudos a fim de elucidar a segurança em relação ao refluxo gastroesofágico. Objetivo: Analisar comparativamente gastrectomia vertical (GV) e gastrectomia vertical ampliada (GVA) em ratos com obesidade induzida por dieta cafeteria em relação à presença de esofagite de refluxo, perda de peso e alterações macroscópicas relacionadas aos procedimentos. Método: Trinta ratos Wistar foram randomizados em três grupos, e após período de indução de obesidade por meio de dieta cafeteria de 28 dias, foram submetidos a operação simulada (grupo controle GC), gastrectomia vertical (grupo GV) e gastrectomia vertical ampliada (grupo GVA). Os animais foram acompanhados por 28 dias no pós-operatório e, após a eutanásia, foi realizada a pesquisa de esofagite de refluxo através de avaliação histopatológica. Peso e avaliação macroscópica foram as outras variáveis de estudo, sendo o peso aferido semanalmente e a avaliação macroscópica no momento da eutanásia. Resultados: Todos os animais apresentaram algum grau de inflamação e a presença de ao menos um critério de inflamação, porém, não houve diferença estatisticamente significante na análise entre os grupos. Em relação à perda de peso, os animais do GC apresentaram aumento gradativo durante todo experimento evoluindo para super-obesidade ao término do estudo, enquanto os dos grupos GV e GVA tiveram reganho de peso após a primeira semana do pós-operatório, porém, reganho menos acentuado se comparável ao GC, tanto para GV quanto para GVA. Conclusões: Não há diferença em relação à esofagite de refluxo entre GV e GVA, bem como em relação às alterações macroscópicas. Ambas as técnicas têm capacidade de controlar a evolução do peso no pós-operatório em relação ao grupo controle.

ABSTRACT Background: Extended vertical gastrectomy is a variation of the vertical gastrectomy technique requiring studies to elucidate safety in relation to gastroesophageal reflux. Aim: To analyze comparatively vertical gastrectomy (VG) and extended vertical gastrectomy (EVG) in rats with obesity induced by cafeteria diet in relation to the presence of reflux esophagitis, weight loss and macroscopic changes related to the procedures. Methods: Thirty Wistar rats were randomized into three groups, and after the obesity induction period by means of a 28-day cafeteria diet, underwent a simulated surgery (CG), VG and VGA. The animals were followed up for 28 days in the post-operative period, and after euthanasia, the reflux esophagitis evaluation was histopathologically performed. Weight and macroscopy were the other variables; weight was measured weekly and the macroscopic evaluation was performed during euthanasia. Results: All animals presented some degree of inflammation and the presence of at least one inflammation criterion; however, there was no statistically significant difference in the analysis among the groups. In relation to weight loss, the animals in CG showed a gradual increase during the whole experiment, evolving to super-obesity at the end of the study, while the ones with VG and EVG had weight regain after the first post-operative period; however, a less marked regain compared to CG, both for VG and EVG. Conclusion: There is no difference in relation to reflux esophagitis VG and EVG, as well as macroscopic alterations, and both techniques have the ability to control the evolution of weight during postoperative period in relation to CG.