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What else in times of COVID-19? The role of minimally invasive autopsy for the differential diagnosis of acute respiratory failure in a case of kala-azar COVID19 COVID 19 COVID-19 kalaazar kala azar COVID1 1 COVID-1 COVID-
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Geber Júnior, João Carlos

; Monteiro, Renata Aparecida de Almeida

; Rocha, João Wilson Pedro da

; Duarte, Edson Luiz Társia

; Nicodemo, Elizabete

; Munhoz, Olavo

; Paiva, Edison Ferreira de

; Mauad, Thais

; Silva, Luiz Fernando Ferraz da

; Saldiva, Paulo Hilario Nascimento

; Dolhnikoff, Marisa

; Duarte-Neto, Amaro Nunes

Revista do Instituto de Medicina Tropical de São Paulo

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2023, Volume 65 elocation e36

Abstract: En | Text: En | PDF: En

ABSTRACT Visceral leishmaniasis (VL) is a chronic vector-borne zoonotic disease caused by trypanosomatids, considered endemic in 98 countries, mainly associated with poverty. About 50,000–90,000 cases of VL occur annually worldwide, and Brazil has the second largest number of cases in the world. The clinical picture of VL is fever, hepatosplenomegaly, and pancytopenia, progressing to death in 90% of cases due to secondary infections and multi-organ failure, if left untreated. We describe the case of a 25-year-old female who lived in the metropolitan area of Sao Paulo, who had recently taken touristic trips to several rural areas in Southeastern Brazil and was diagnosed post-mortem. During the hospitalization in a hospital reference for the treatment of COVID-19, the patient developed acute respiratory failure, with chest radiographic changes, and died due to refractory shock. The ultrasound-guided minimally invasive autopsy diagnosed VL (macrophages containing amastigote forms of Leishmania in the spleen, liver and bone marrow), as well as pneumonia and bloodstream infection by gram-negative bacilli. (VL vectorborne vector borne trypanosomatids 9 countries poverty 5000090000 50 000 90 50,000–90,00 worldwide world fever hepatosplenomegaly pancytopenia multiorgan multi organ failure untreated 25yearold yearold 25 year old Paulo postmortem. postmortem post mortem. mortem post-mortem COVID19, COVID19 COVID 19, 19 COVID-19 changes shock ultrasoundguided ultrasound guided macrophages spleen marrow, marrow , marrow) gramnegative gram negative bacilli 500009000 5 00 50,000–90,0 2 COVID1 1 COVID-1 50000900 0 50,000–90, COVID- 5000090 50,000–90 500009 50,000–9 50000 50,000– 5000 50,000 500 50,00 50,0 50,

https://doi.org/10.1590/s1678-9946202365036

O Uso de um Ventilador Mecânico Portátil na Ressuscitação Cardiopulmonar é Viável, Melhora os Parâmetros Respiratórios e Previne a Redução da Complacência Pulmonar Dinâmica Viável
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Palácio, Manoel Ângelo Gomes

; Paiva, Edison Ferreira de

; Oliveira, Gustavo Bernardes de Figueiredo

; Azevedo, Luciano César Pontes de

; Pedron, Bruno Gregnanin

; Santos, Elizabete Silva dos

; Timerman, Ari

Arquivos Brasileiros de Cardiologia

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2023, Volume 120 N. 7 elocation e20220564

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Fundamentos Para ventilação prática e protetora durante a ressuscitação cardiopulmonar (RCP), desenvolveu-se um ventilador mecânico (VLP2000E) de 150 gramas que limita o pico de pressão inspiratória (PPI) durante ventilação e compressões torácicas simultâneas. Objetivos Avaliar a viabilidade da ventilação com VLP2000E durante RCP e comparar os parâmetros monitorados versus ventilação com bolsa-válvula. Métodos Estudo experimental randomizado com 10 porcos intubados por grupo. Após sete minutos de fibrilação ventricular, iniciaram-se ciclos de RCP de 2 minutos. Todos os animais foram ventilados com VLP2000E após o retorno da circulação espontânea (RCE). Resultados Os grupos bolsa-válvula e VLP2000E apresentaram taxa de RCE (60% vs. 50%, respectivamente) e saturação arterial de oxigênio similares na maioria dos ciclos de RCP, volume corrente basal diferente [0,764 (0,068) vs. 0,591 (0,123) L, p = 0,0309, respectivamente] e, em 14 ciclos, diferentes PPI [52 (9) vs. 39 (5) cm H2O, respectivamente], volume corrente [0,635 (0,172) vs. 0,306 (0,129) L], ETCO2 [14 (8) vs. 27 (9) mm Hg], e pico de fluxo inspiratório [0,878 (0,234) vs. 0,533 (0,105) L/s], todos p < 0,0001. A complacência pulmonar dinâmica (≥ 0,025 L/cm H2O) diminuiu após o RCE no grupo bolsa-válvula, mas se manteve no grupo VLP2000E [ 0,019 (0,006) vs. 0,024 (0,008) L/cm H2O, p = 0,0003]. Conclusões Ventilação com VLP2000E durante RCP é viável e equivalente a ventilação com bolsa-válvula quanto à taxa de RCE e saturação arterial de oxigênio. Esse ventilador produz melhores parâmetros respiratórios, com pressão das vias aéreas e volume corrente menores. Ventilação com VLP2000E também previne a redução significante da complacência pulmonar dinâmica observada após ventilação com bolsa-válvula. Seria interessante realizar mais estudos pré-clínicos para confirmar esses resultados. , (RCP) desenvolveuse desenvolveu VLPE VLP E (VLP2000E 15 (PPI simultâneas bolsaválvula. bolsaválvula bolsa válvula. válvula 1 ventricular iniciaramse iniciaram RCE. . (RCE) 60% 60 (60 vs 50 50% respectivamente 0,764 0764 0 764 [0,76 0,068 0068 068 (0,068 0591 591 0,59 0,123 0123 123 (0,123 L 00309 0309 0,0309 52 [5 9 (9 3 5 (5 H2O HO H O respectivamente, 0,635 0635 635 [0,63 0,172 0172 172 (0,172 0306 306 0,30 0,129 0129 129 (0,129 L] ETCO [1 8 (8 Hg, Hg Hg] 0,878 0878 878 [0,87 0,234 0234 234 (0,234 0533 533 0,53 0,105 0105 105 (0,105 L/s, Ls L/s s L/s] 00001 0001 0,0001 ≥ ( 0025 025 0,02 Lcm bolsaválvula, válvula, 0019 019 0,01 0,006 0006 006 (0,006 0024 024 0,008 0008 008 (0,008 0,0003. 00003 0,0003 0003 0,0003] respiratórios menores préclínicos pré clínicos resultados (RCP (RCE 6 (6 0,76 076 76 [0,7 0,06 06 (0,06 059 59 0,5 0,12 012 12 (0,12 0030 030 0,030 0,63 063 63 [0,6 0,17 017 17 (0,17 30 0,3 0,87 087 87 [0,8 0,23 023 23 (0,23 053 53 0,10 010 (0,10 0000 000 0,000 002 02 0,0 001 01 0,00 00 (0,00 0,7 07 7 [0, (0,0 05 0, 0,1 (0,1 003 03 0,03 0,6 0,8 08 0,2 (0,2 [0 (0, (0

Abstract Background For practical and protective ventilation during cardiopulmonary resuscitation (CPR), a 150-grams mechanical ventilator (VLP2000E) that limits peak inspiratory pressure (PIP) during simultaneous ventilation with chest compressions was developed. Objectives To evaluate the feasibility of VLP2000E ventilation during CPR and to compare monitored parameters versus bag-valve ventilation. Methods A randomized experimental study with 10 intubated pigs per group. After seven minutes of ventricular fibrillation, 2-minute CPR cycles were delivered. All animals were placed on VLP2000E after achieving return of spontaneous circulation (ROSC). Results Bag-valve and VLP2000E groups had similar ROSC rate (60% vs. 50%, respectively) and arterial oxygen saturation in most CPR cycles, different baseline tidal volume [0.764 (0.068) vs. 0.591 (0.123) L, p = 0.0309, respectively] and, in 14 cycles, different PIP [52 (9) vs. 39 (5) cm H2O, respectively], tidal volume [0.635 (0.172) vs. 0.306 (0.129) L], ETCO2[14 (8) vs. 27 (9) mm Hg], and peak inspiratory flow [0.878 (0.234) vs. 0.533 (0.105) L/s], all p < 0.0001. Dynamic lung compliance (≥ 0.025 L/cm H2O) decreased after ROSC in bag-valve group but was maintained in VLP2000E group [0.019 (0.006) vs. 0.024 (0.008) L/cm H2O, p = 0.0003]. Conclusions VLP2000E ventilation during CPR is feasible and equivalent to bag-valve ventilation in ROSC rate and arterial oxygen saturation. It produces better respiratory parameters, with lower airway pressure and tidal volume. VLP2000E ventilation also prevents the significant decrease of dynamic lung compliance observed after bag-valve ventilation. Further preclinical studies confirming these findings would be interesting. CPR, , (CPR) 150grams grams 150 VLPE VLP E (VLP2000E (PIP developed bagvalve bag valve 1 fibrillation 2minute minute 2 delivered ROSC. . (ROSC) Bagvalve Bag 60% 60 (60 vs 50 50% respectively 0.764 0764 0 764 [0.76 0.068 0068 068 (0.068 0591 591 0.59 0.123 0123 123 (0.123 L 00309 0309 0.0309 52 [5 9 (9 3 5 (5 H2O HO H O respectively, 0.635 0635 635 [0.63 0.172 0172 172 (0.172 0306 306 0.30 0.129 0129 129 (0.129 L] ETCO214 ETCO ETCO2 ETCO2[1 8 (8 Hg, Hg Hg] 0.878 0878 878 [0.87 0.234 0234 234 (0.234 0533 533 0.53 0.105 0105 105 (0.105 L/s, Ls L/s s L/s] 00001 0001 0.0001 ≥ ( 0025 025 0.02 Lcm 0.019 0019 019 [0.01 0.006 0006 006 (0.006 0024 024 0.008 0008 008 (0.008 0.0003. 00003 0.0003 0003 0.0003] interesting (CPR 15 (ROSC 6 (6 0.76 076 76 [0.7 0.06 06 (0.06 059 59 0.5 0.12 012 12 (0.12 0030 030 0.030 [ 0.63 063 63 [0.6 0.17 017 17 (0.17 30 0.3 ETCO21 ETCO2[ 0.87 087 87 [0.8 0.23 023 23 (0.23 053 53 0.10 010 (0.10 0000 000 0.000 002 02 0.0 0.01 001 01 [0.0 0.00 00 (0.00 0.7 07 7 [0. (0.0 05 0. 0.1 (0.1 003 03 0.03 0.6 0.8 08 0.2 (0.2 [0 (0. (0

https://doi.org/10.36660/abc.20220564

InsulinAPP application protocol for the inpatient management of type 2 diabetes on a hospitalist-managed ward: a retrospective study
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Toyoshima, Marcos Tadashi Kakitani

; Brandes, Pedro Henrique Ribeiro

; Lauterbach, Gerhard da Paz

; Moraes, Jéssica Ribeiro Andrade

; Paiva, Edison Ferreira de

; Umpierrez, Guillermo E.

; Nery, Marcia

; Kondo, Rodrigo Hidd

Archives of Endocrinology and Metabolism

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aug 2022, Volume 66 N. 4 Pages 498 - 505

Abstract: En | Text: En | PDF: En

ABSTRACT Objective: We assessed metrics related to inpatient glycemic control using InsulinAPP, an application available for free in Brazil, on the hospitalist-managed ward of our hospital. Subjects and methods: We performed a retrospective study of patients with type 2 diabetes (T2D) admitted from November 2018 to October 2019. InsulinAPP recommends NPH and regular insulins three times a day, in bolus-correction or basal-bolus schemes. Parameters that included BG within range of 70-180 mg/dL, insulin treatment regimen and frequency of hypoglycemia were evaluated. Results: A total of 147 T2D individuals (23% medicine and 77% surgery) were included (mean age 62.3 ± 12.7 years, HbA1c: 8.3 ± 3.0%). The initial insulin regimen was 50% bolus-correction, 47% basal-bolus and 3% with sliding scale insulin. During hospitalization, 71% patients required a bolus-basal regimen. In the first 10 days of the protocol, 71% BG measurements were between 70-180 mg/dL and 26% patients experienced one or more episodes of hypoglycemia < 70 mg/dL, and 5% with BG < 54 mg/dL. Conclusion: The results of this retrospective study indicate the InsulinAPP application using human insulin formulations was effective and safe for the management of hyperglycemia on a hospitalist-managed ward, with more than 70% BG measurements within the therapeutic range and a low rate of hypoglycemia.

https://doi.org/10.20945/2359-3997000000496

Cardiac Arrest Due to Hypocalcemia
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Salvadori, Fernanda Aburesi

; Moreira, Eduardo Martelli

; Dias, Murilo Bacchini

; Duarte-Neto, Amaro Nunes

; Paiva, Edison Ferreira de

International Journal of Cardiovascular Sciences

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nov 2021, Volume 34 N. 5 Pages 154 - 157

Abstract: En | Text: En | PDF: En

https://doi.org/10.36660/ijcs.20200034 75 downloads

Papel do Instrutor de Pediatric Advanced Life Support na Aplicação das Melhores Práticas em Ressuscitação Pediátrica
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Gaspary, Lisiane Valdez

; Paiva, Edison Ferreira de

Revista Brasileira de Educação Médica

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2020, Volume 44 N. 4 elocation e171

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo: Introdução: A parada cardiorrespiratória é um evento emergencial que requer tanto a identificação precoce de sinais de deterioração clínica quanto ações rápidas e eficazes para a sua reversão. Muitos médicos e enfermeiros que atendem crianças procuram se capacitar no atendimento desses eventos, realizando o curso Pediatric Advanced Life Support (PALS), tornando-se posteriormente instrutores. O objetivo desta pesquisa foi conhecer a percepção do instrutor de PALS sobre seu papel na articulação entre o cenário simulado e o real da ressuscitação pediátrica. Método: Trata-se de uma abordagem qualitativa em que se utilizou a entrevista semiestruturada como técnica de pesquisa. Foram realizadas 12 entrevistas com instrutores do PALS vinculados a variados centros de treinamento em São Paulo. Os dados qualitativos das entrevistas seguiram o método de análise proposto por Minayo, e o marco teórico adotou os conceitos de campo e habitus de Pierre Bourdieu. Resultados: A análise das entrevistas mostrou que os médicos e enfermeiros se sentem reconhecidos e seguros, conduzem melhor a equipe, realizam intervenção construtiva, sugerem mais treinamentos em ressuscitação pediátrica e implantam melhorias nos serviços após se tornarem instrutores do PALS. O habitus incorporado no campo simulado foi reproduzido pelos instrutores no campo da assistência, exceto na aplicação do debriefing. Conclusão: O papel dos instrutores foi de multiplicação das boas práticas, envolvendo as equipes e favorecendo a realização de atendimentos sistematizados e baseados em evidências, com resultados positivos no dia a dia das instituições hospitalares.

Abstract: Introduction: Cardiopulmonary arrest is an emergency event that requires both early identification of signs of clinical deterioration and rapid and effective actions for its reversal. Many physicians and nurses who provide care for children seek to training in this area of care by completing the Pediatric Advanced Life Support (PALS) course, and subsequently becoming an instructor. The aim of this research was to understand the PALS instructors’ views on their role in connecting simulated scenarios to real life pediatric resuscitation situations. Method: The article has a qualitative approach and semi-structured interviews were used as the research technique. Twelve interviews were conducted with PALS instructors linked to various training centers in São Paulo. For qualitative analysis of the interviews the method proposed by Minayo was used, and Pierre Bourdieu’s field and habitus theoretical framework was also adopted. Results: Analysis of the interviews showed that after becoming PALS instructors, physicians and nurses feel recognized and self-confident, are better team leaders, make constructive interventions, suggest more training in pediatric emergencies and implement improvements in their services. The built-in habitus in the simulated field was reproduced by the instructors in the field of assistance, except in the debriefing application. Conclusion: The role of the instructors was to multiply best practices, involving the teams and favoring the execution of systematized and evidence-based care, with positive results in the day-to-day of hospital institutions.

https://doi.org/10.1590/1981-5271v44.4-20200031 392 downloads

Atualização da Diretriz de Ressuscitação Cardiopulmonar e Cuidados Cardiovasculares de Emergência da Sociedade Brasileira de Cardiologia - 2019
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Bernoche, Claudia

; Timerman, Sergio

; Polastri, Thatiane Facholi

; Giannetti, Natali Schiavo

; Siqueira, Adailson Wagner da Silva

; Piscopo, Agnaldo

; Soeiro, Alexandre de Matos

; Reis, Amélia Gorete Afonso da Costa

; Tanaka, Ana Cristina Sayuri

; Thomaz, Ana Maria

; Quilici, Ana Paula

; Catarino, Andrei Hilário

; Ribeiro, Anna Christina de Lima

; Barreto, Antonio Carlos Pereira

; Azevedo Filho, Antonio Fernando Barros de

; Pazin Filho, Antonio

; Timerman, Ari

; Scarpa, Bruna Romanelli

; Timerman, Bruno

; Tavares, Caio de Assis Moura

; Martins, Cantidio Soares Lemos

; Serrano Junior, Carlos Vicente

; Malaque, Ceila Maria Sant’Ana

; Pisani, Cristiano Faria

; Batista, Daniel Valente

; Leandro, Daniela Luana Fernandes

; Szpilman, David

; Gonçalves, Diego Manoel

; Paiva, Edison Ferreira de

; Osawa, Eduardo Atsushi

; Lima, Eduardo Gomes

; Adam, Eduardo Leal

; Peixoto, Elaine

; Evaristo, Eli Faria

; Azeka, Estela

; Silva, Fabio Bruno da

; Wen, Fan Hui

; Ferreira, Fatima Gil

; Lima, Felipe Gallego

; Fernandes, Felipe Lourenço

; Ganem, Fernando

; Galas, Filomena Regina Barbosa Gomes

; Tarasoutchi, Flavio

; Souza, Germano Emilio Conceição

; Feitosa Filho, Gilson Soares

; Foronda, Gustavo

; Guimarães, Helio Penna

; Abud, Isabela Cristina Kirnew

; Leite, Ivanhoé Stuart Lima

; Linhares Filho, Jaime Paula Pessoa

; Moraes Junior, João Batista de Moura Xavier

; Falcão, João Luiz Alencar de Araripe

; Ramires, Jose Antônio Franchini

; Cavalini, José Fernando

; Saraiva, José Francisco Kerr

; Abrão, Karen Cristine

; Pinto, Lecio Figueira

; Bianchi, Leonardo Luís Torres

; Lopes, Leonardo Nícolau Geisler Daud

; Piegas, Leopoldo Soares

; Kopel, Liliane

; Godoy, Lucas Colombo

; Tobase, Lucia

; Hajjar, Ludhmila Abrahão

; Dallan, Luís Augusto Palma

; Caneo, Luiz Fernando

; Cardoso, Luiz Francisco

; Canesin, Manoel Fernandes

; Park, Marcelo

; Rabelo, Marcia Maria Noya

; Malachias, Marcus Vinícius Bolívar

; Gonçalves, Maria Aparecida Batistão

; Almeida, Maria Fernanda Branco de

; Souza, Maria Francilene Silva

; Favarato, Maria Helena Sampaio

; Carrion, Maria Julia Machline

; Gonzalez, Maria Margarita

; Bortolotto, Maria Rita de Figueiredo Lemos

; Macatrão-Costa, Milena Frota

; Shimoda, Mônica Satsuki

; Oliveira-Junior, Mucio Tavares de

; Ikari, Nana Miura

; Dutra, Oscar Pereira

; Berwanger, Otávio

; Pinheiro, Patricia Ana Paiva Corrêa

; Reis, Patrícia Feitosa Frota dos

; Cellia, Pedro Henrique Moraes

; Santos Filho, Raul Dias dos

; Gianotto-Oliveira, Renan

; Kalil Filho, Roberto

; Guinsburg, Ruth

; Managini, Sandrigo

; Lage, Silvia Helena Gelas

; Yeu, So Pei

; Franchi, Sonia Meiken

; Shimoda-Sakano, Tania

; Accorsi, Tarso Duenhas

; Leal, Tatiana de Carvalho Andreucci

; Guimarães, Vanessa

; Sallai, Vanessa Santos

; Ávila, Walkiria Samuel

; Sako, Yara Kimiko

Arquivos Brasileiros de Cardiologia

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sep 2019, Volume 113 N. 3 Pages 449 - 663

Abstract: Pt | Text: Pt | PDF: Pt

https://doi.org/10.5935/abc.20190203 54793 downloads

CARACTERIZAÇÃO DO ATENDIMENTO DO SERVIÇO DE ATENDIMENTO MÓVEL DE URGÊNCIA (SAMU) ÀS EMERGÊNCIAS CLÍNICAS
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Hora, Rauan Sousa da

; Paiva, Edison Ferreira de

; Sampaio, Elieusa e Silva

; Oliveira, Josias Alves de

; Souza, Virgínia Ramos dos Santos

; Brandão, Paloma de Castro

Reme: Revista Mineira de Enfermagem

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2019, Volume 23 elocation e-1256

Abstract: En Es Pt | Text: En Es Pt | PDF: En | PDF: Es | PDF: Pt

ABSTRACT Objectives: to characterize the clinical care provided by SAMU of Salvador. Methodology: this is a descriptive, exploratory and cross-sectional study whose sample consisted of 465 records of clinical care performed by the SAMU, in the city of Salvador, Bahia. Data was obtained through a data collection instrument and descriptive analysis was performed with the SPSS software, in which relative and absolute freq uencies were processed. Results: the patients attended were characterized by being men (49.9%) with a mean age of 54 years old [Standard Deviation (SD)=21)]. Neurological (36.1%), cardiac (14.4%) and respiratory (12.9%) injuries were prevalent. Basic support units were the most triggered (63.7%) and their main outcome was on-site care and removal to a reference hospital (21.7%); however, resources such as oxygen therapy and venipuncture were not used in most calls. The mean time between the opening of the occurrence and the output was 22 minutes (SD=20). The mean response time was 39 minutes (SD=25) and the total mean duration of occurrence was two hours (SD=1:23). Conclusion: SAMU clinical consultations occur predominantly with men and neurological disorders. Disagreement was identified between the patients' need and the dispatching of resources, according to the team's evaluation. The times involved in pre-hospital care are high.

RESUMEN Objetivo: caracterizar la atención clínica brindada por el SAMU de Salvador. Metodologia: estudio descriptivo, exploratorio y transversal cuya muestra consistió en 465 registros de atención clínica realizadas por el SAMU, en la ciudad de Salvador, Bahía. Los datos se obtuvieron mediante un instrumento de recogida datos y un análisis descriptivo realizado con el software SPSS, en el que se procesaron las frecuencias relativas y absolutas. Resultados: los usuarios atendidos se caracterizaron como varones (49,9%) con edad media de 54 anos [desviación estándar (DP) = 21)]. Prevalecieron los problemas neurológicos (36.1%), cardíacos (14.4%) y respiratorios (12.9%). Las unidades de apoyo básicas fueron las más necesitadas (63,7%) y su resultado principal fue la atención in situ y el traslado a un hospital de referencia (21,7%); sin embargo, en la mayoría de los casos, no se utilizaron recursos como la oxigenoterapia y la punción venosa. El tiempo promedio entre la apertura del incidente y la salida de la base fue de 22 minutos (DP = 20). El promedio del tiempo de respuesta fue de 39 minutos (DP = 25) y la duración total promedio del incidente fue de dos horas (DP = 1:23). Conclusión: las casos clínicos atendidos por el SAMU ocurren básicamente entre hombres y por problemas neurológicos. Se identificó un desacuerdo entre la necesidad de los pacientes y el envío de recursos, de acuerdo con la evaluación del equipo. Los tiempos de atención prehospitalaria son elevados.

RESUMO Objetivo: caracterizar os atendimentos clínicos realizados pelo SAMU de Salvador. Metodologia: trata-se de estudo descritivo, exploratório e transversal cuja amostra foi composta de 465 fichas de atendimentos clínicos realizados pelo SAMU, na cidade de Salvador na Bahia. Os dados foram obtidos por meio de instrumento de coleta de dados e a análise descritiva realizada com o software SPSS, no qual foram processadas frequências relativas e absolutas. Resultados: os usuários atendidos se caracterizaram por serem homens (49,9%) com média de idade de 54 anos [desvio-padrão (DP)=21)]. Os agravos neurológicos (36,1%), cardiológicos (14,4%) e respiratórios (12,9%) foram prevalentes. Unidades de suporte básico foram as mais acionadas (63,7%) e tiveram como principal desfecho o atendimento no local e remoção para um hospital de referência (21,7%), no entanto, recursos como oxigenoterapia e punção venosa não foram utilizados na maior parte dos atendimentos. A média de tempo entre a abertura da ocorrência e saída da base foi de 22 minutos (DP= 20). O tempo resposta teve média de 39 minutos (DP= 25) e a duração total média da ocorrência foi de duas horas (DP= 1:23). Conclusão: os atendimentos clínicos realizados pelo SAMU ocorrem prevalentemente com homens e por agravos neurológicos. Identificou-se discordância entre a necessidade dos pacientes e o envio de recursos, mediante a avaliação da equipe. Os tempos implicados no atendimento pré-hospitalar são elevados.

https://doi.org/10.5935/1415-2762.20190104 3 downloads

Kidney injury and other complications related to colonoscopy in inpatients at a tertiary teaching hospital
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Ivanovic, Ligia Fidelis

; Silva, Bruno C.

; Lichtenstein, Arnaldo

; Paiva, Edison Ferreira de

; Bueno-Garcia, Maria Lucia

Clinics

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2018, Volume 73 elocation e456

Abstract: En | Text: En | PDF: En

OBJECTIVES: To describe clinical complications related to colonoscopy in inpatients with multiple diseases. Among the known complications, acute kidney injury was the primary focus. METHODS: This was an observational retrospective study of 97 inpatients. Data relating to age; gender; comorbidities; current medication; blood tests (renal function, blood glucose and LDL cholesterol levels); length of hospital stay; indication, results, and complications of colonoscopies; and time to the development of kidney injury were collected between June 2011 to February 2012. RESULTS: A total of 108 colonoscopies (9 screening and 88 diagnostic) were conducted in 97 patients. Renal injury occurred in 41.2% of the patients. The univariate analysis revealed that kidney injury was related to the use of diuretics, statins, calcium channel blockers, and angiotensin converting enzyme inhibitor; however, the multivariate analysis showed that only the use of diuretics was associated with kidney injury. The occurrence of kidney injury and the time to its development were independent of the previous glomerular filtration rate as calculated with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. CONCLUSIONS: The use of diuretics was the only independent variable associated with the development of kidney injury in inpatients with multiple comorbidities who underwent colonoscopy. The occurrence of kidney injury and the time to its development were independent of previous CKD-EPI-based assessments of renal function. These results highlight the increased risk of colonoscopy in such patients, and its indication should be balanced strictly and perhaps avoided as a screening test.

https://doi.org/10.6061/clinics/2018/e456 864 downloads

Tratamento da parada cardíaca experimental com adrenalina, vasopressina ou placebo
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Palácio, Manoel Ângelo Gomes

; Paiva, Edison Ferreira de

; Azevedo, Luciano Cesar Pontes de

; Timerman, Ari

Arquivos Brasileiros de Cardiologia

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dec 2013, Volume 101 N. 6 Pages 536 - 544

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

FUNDAMENTO: Na ressuscitação cardiopulmonar (RCP) prolongada, o efeito dos vasoconstritores não foi plenamente esclarecido. OBJETIVOS: Avaliar o efeito pressórico da adrenalina e da vasopressina, e observar o retorno da circulação espontânea (RCE). MÉTODOS: Estudo prospectivo, randomizado, cego e placebo-controlado. Após sete minutos em fibrilação ventricular, porcos receberam ciclos de dois minutos de RCP. Tentou-se a desfibrilação (4 J/kg) uma vez aos 9 minutos e após cada ciclo, conforme o ritmo verificado, reiniciando-se a RCP imediatamente. Aos 9 minutos e depois de cada cinco minutos, aplicou-se adrenalina 0,02 mg/kg (n = 12 porcos), ou vasopressina 0,4 U/kg (n = 12), ou solução salina 0,9% 0,2 mL/kg (n = 8). A RCP continuou por 30 minutos ou até o RCE. RESULTADOS: A pressão de perfusão coronária aumentou para aproximadamente 20 mmHg nos três grupos. Com os vasoconstritores, a pressão alcançou 35 mmHg versus 15 mmHg com placebo (p < 0,001). Com vasopressina, manteve-se efeito de 15-20 mmHg após três doses versus zero com adrenalina ou placebo. Observou-se o RCE com frequência diferente (p = 0,031) entre adrenalina (10/12), vasopressina (6/12) e placebo (2/8). O tempo médio até o RCE não diferiu (16 minutos), nem o número de doses recebidas até então (uma ou duas). Entre os vasoconstritores não houve diferença significante, mas, frente ao placebo, apenas a adrenalina aumentou significantemente o RCE (p = 0,019). CONCLUSÃO: O efeito pressórico inicial dos vasoconstritores foi equivalente, e a vasopressina manteve um efeito tardio na ressuscitação prolongada. Apesar disso, comparando-se ao placebo, apenas a adrenalina aumentou significantemente a frequência do retorno da circulação espontânea.

BACKGROUND: The effect of vasoconstrictors in prolonged cardiopulmonary resuscitation (CPR) has not been fully clarified. OBJECTIVES: To evaluate adrenaline and vasopressin pressure effect, and observe the return of spontaneous circulation (ROSC). METHODS: A prospective, randomized, blinded, and placebo-controlled study. After seven minutes of untreated ventricular fibrillation, pigs received two minutes cycles of CPR. Defibrillation was attempted (4 J/kg) once at 9 minutes, and after every cycle if a shockable rhythm was present, after what CPR was immediately resumed. At 9 minutes and every five minutes intervals, 0.02 mg/kg (n = 12 pigs) adrenaline, or 0.4 U/kg (n = 12) vasopressin, or 0.2 mL/kg (n = 8) 0.9% saline solution was administered. CPR continued for 30 minutes or until the ROSC. RESULTS: Coronary perfusion pressure increased to about 20 mmHg in the three groups. Following vasoconstrictors doses, pressure level reached 35 mmHg versus 15 mmHg with placebo (p < 0.001). Vasopressin effect remained at 15-20 mmHg after three doses versus zero with adrenaline or placebo. ROSC rate differed (p = 0.031) among adrenaline (10/12), vasopressin (6/12), and placebo (2/8). Time-to-ROSC did not differ (16 minutes), nor the number of doses previously received (one or two). There was no difference between vasoconstrictors, but against placebo, only adrenaline significantly increased the ROSC rate (p = 0.019). CONCLUSION: The vasoconstrictors initial pressure effect was equivalent and vasopressin maintained a late effect at prolonged resuscitation. Nevertheless, when compared with placebo, only adrenaline significantly increased the ROSC rate.

https://doi.org/10.5935/abc.20130213 4857 downloads

10.

Venous thromboembolism risk assessment in hospitalised patients: A new proposal
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Alckmin, Carolina Alves Vono

; Garcia, Mariana Dionisia

; Bricola, Solange Aparecida Petilo de Carvalho

; Martins, Milton de Arruda

; Lichtenstein, Arnaldo

; Paiva, Edison Ferreira de

Clinics

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nov 2013, Volume 68 N. 11 Pages 1416 - 1420

Abstract: En | Text: En | PDF: En

OBJECTIVE: Cross-sectional studies have been conducted to evaluate the adequacy of prophylaxis for venous thromboembolism. However, these studies often evaluate prophylaxis on the data collection day, without analysing the prophylactic dose or duration and without reference to inappropriate use in patients without risk. A prospective, observational study was performed to assess the adequacy of prophylaxis in a general medicine ward of a university hospital. METHOD: In the analysis, the use of the proper prophylactic dose at the correct time, the use in patients with contraindications, and the misuse in patients without risk of venous thromboembolism were considered. RESULTS: A total of 245 patients were evaluated. Of these patients, 104 (42.4%) were considered to be at risk, and 82.7% either received adequate prophylaxis (i.e., the correct dose at the right time) or did not receive prophylaxis because it was contraindicated. Among the 141 patients who were not at risk, 81 (57.4%) incorrectly received prophylaxis, the majority (61/81) of whom presented with risk factors but did not demonstrate reduced mobility. Among the entire group, only 59.6% of patients were properly treated. CONCLUSIONS: The evaluation of prophylaxis adequacy should consider not only whether the correct dose is administered at the correct time but also whether it is used in patients with contraindications and whether it is inappropriately administered to patients who are not at risk.

https://doi.org/10.6061/clinics/2013(11)06 2776 downloads

11.

Impacto de um programa para profilaxia de tromboembolismo venoso em pacientes clínicos em quatro hospitais de Salvador
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Rocha, Ana Thereza C.

; Paiva, Edison Ferreira de

; Araújo, Danilo Miranda de

; Cardoso, Dulceane Natyara

; Pereira, Aline Cristina da Hora

; Lopes, Antônio Alberto

; Darzé, Eduardo S.

Revista da Associação Médica Brasileira

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2010, Volume 56 N. 2 Pages 197 - 203

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: Implementar um programa hospitalar de profilaxia de TEV através da criação de uma comissão, da realização de palestras e da distribuição de algoritmos baseados na Diretriz Brasileira para Profilaxia de TEV em Pacientes Clínicos e avaliar seu impacto na adequação da utilização de profilaxia em quatro hospitais de Salvador, Bahia. MÉTODOS: Foram realizados dois estudos de corte-transversal, um antes e um depois da implementação do programa, e comparadas as proporções de pacientes em risco de TEV e as mudanças na adequação da profilaxia. RESULTADOS: Foram avaliados 219 pacientes clínicos antes e 292 depois do programa. As taxas daqueles com pelo menos um fator de risco para TEV e daqueles com contra indicação (CI) para heparina foram semelhantes nos dois grupos: 95% vs. 98% (p=0,13) e 42% vs. 34% (p=0,08), respectivamente. Nos dois estudos, 75% vs. 82% (p=0,06) eram candidates para profilaxia, e 44% vs. 55% (p =0,02) eram candidatos sem qualquer CI para heparina. Após o programa, utilizou-se mais profilaxia mecânica, 0,9% vs. 4,5% (p=0,03) e menos profilaxia farmacológica, 55,3% vs. 47,9% (p=0,04), embora tenha havido um aumento significativo na utilização das doses corretas das heparinas, 53% vs. 75% (p<0,001). CONCLUSÃO: A profilaxia de TEV é subutilizada nos hospitais brasileiros. Aulas de educação continuada e distribuição passiva de algoritmos de profilaxia de TEV são insuficientes para melhorar a utilização, mas melhoram a adequação da profilaxia.

There is a discrepancy between guideline recommendations and practice of venous thromboembolism (VTE) prophylaxis in hospitals worldwide. OBJECTIVE: To implement a program using a risk-assessment tool (RAT) for VTE and educational lectures based on the Brazilian Guidelines for VTE Prophylaxis for Medical Patients and to evaluate the impact of these tools on adequacy of VTE prophylaxis in 4 hospitals in Salvador, Bahia. METHODS: We performed two cross-sectional surveys before and after the implementation of the program to compare the proportion of patients at-risk of VTE and the changes in the adequacy of VTE prophylaxis. RESULTS: We compared the data of 219 medical patients before with 292 patients after the program. The rates of patients with at least one risk factor for VTE and with contraindications (CI) for heparins were similar: 95% vs. 98% (p=0.13), and 42% vs. 34% (p=0.08), respectively. In both studies, 75% vs. 82% (p=0.06) were candidates for prophylaxis, and 44% vs. 55% (p =0.02) were candidates for prophylaxis and had no CI for heparin. After the program there was an increase in the use of mechanical prophylaxis 0.9% vs. 4.5% (p=0.03) and a decrease in pharmacological prophylaxis, 55.3% vs. 47.9% (p=0.04). However, there was a significant increase of use of the recommended doses of heparins, 53% vs. 75 (p<0.001). CONCLUSION: There is underutilization of VTE prophylaxis in Brazilian hospitals. Strategies based on passive distribution of RAT and educational lectures were not sufficient to improve the practice of prophylaxis, but improved the adequacy of VTE prophylaxis in hospitalized patients.

4261 downloads

12.

Atualização em tromboembolismo venoso: profilaxia em pacientes clínicos - Parte III
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Rocha, Ana Thereza

; Paiva, Edison Ferreira de

; Bernardo, Wanderley Marques

Revista da Associação Médica Brasileira

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2009, Volume 55 N. 5 Pages 519 - 520

Abstract: Pt | Text: Pt | PDF: Pt

2369 downloads Cited 2 times in SciELO

13.

Atualização em tromboembolismo venoso: profilaxia em pacientes clínicos - parte I
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Rocha, Ana Thereza

; Paiva, Edison Ferreira de

; Bernardo, Wanderley Marques

Revista da Associação Médica Brasileira

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2009, Volume 55 N. 3 Pages 249 - 250

Abstract: Pt | Text: Pt | PDF: Pt

1677 downloads Cited 2 times in SciELO

14.

Atualização em tromboembolismo venoso: profilaxia em pacientes clínicos - Parte II
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Rocha, Ana Thereza

; Paiva, Edison Ferreira de

; Bernardo, Wanderley Marques

Revista da Associação Médica Brasileira

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2009, Volume 55 N. 4 Pages 380 - 381

Abstract: Pt | Text: Pt | PDF: Pt

2200 downloads Cited 2 times in SciELO

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