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ABSTRACT Objective To describe and compare the clinical characteristics and outcomes of patients admitted to intensive care units during the first and second waves of the COVID-19 pandemic. Methods In this retrospective single-center cohort study, data were retrieved from the Epimed Monitor System; all adult patients admitted to the intensive care unit between March 4, 2020, and October 1, 2021, were included in the study. We compared the clinical characteristics and outcomes of patients admitted to the intensive care unit of a quaternary private hospital in São Paulo, Brazil, during the first (May 1, 2020, to August 31, 2020) and second (March 1, 2021, to June 30, 2021) waves of the COVID-19 pandemic. Results In total, 1,427 patients with COVID-19 were admitted to the intensive care unit during the first (421 patients) and second (1,006 patients) waves. Compared with the first wave group [median (IQR)], the second wave group was younger [57 (46-70) versus 67 (52-80) years; p<0.001], had a lower SAPS 3 Score [45 (42-52) versus 49 (43-57); p<0.001], lower SOFA Score on intensive care unit admission [3 (1-6) versus 4 (2-6); p=0.018], lower Charlson Comorbidity Index [0 (0-1) versus 1 (0-2); p<0.001], and were less frequently frail (10.4% versus 18.1%; p<0.001). The second wave group used more noninvasive ventilation (81.3% versus 53.4%; p<0.001) and high-flow nasal cannula (63.2% versus 23.0%; p<0.001) during their intensive care unit stay. The intensive care unit (11.3% versus 10.5%; p=0.696) and in-hospital mortality (12.3% versus 12.1%; p=0.998) rates did not differ between both waves. Conclusion In the first and second waves, patients with severe COVID-19 exhibited similar mortality rates and need for invasive organ support, despite the second wave group being younger and less severely ill at the time of intensive care unit admission.

https://doi.org/10.31744/einstein_journal/2023ao0233

Perianal fistulizing Crohn's disease is associated with a higher prevalence of HPV in the anorectal fistula tract. A comparative study
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Boarini, Lucas Rodrigues

; Sobrado, Carlos Walter

; Mota, Giana Rabello

; Villa, Luisa Lina

; Albuquerque, Idblan Carvalho de

; Queiroz, Natalia Sousa Freitas

; Facanali, Carolina Bortolozzo Graciolli

; Nadal, Sidney Roberto

; Cecconello, Ivan

Clinics

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2023, Volume 78 elocation 100219

Abstract: En | Text: En | PDF: En

Abstract Background & Aims Perianal fistulizing Crohn's disease is the main risk factor for anal cancer in patients with inflammatory bowel disease. Whether this occurs due to a higher frequency of human papillomavirus remains unclear. The authors aimed to evaluate the prevalence of HPV and high-risk HPV in patients with perianal Crohn's disease, compared with a control group. Methods The authors conducted a two-center cross-sectional study in which perianal fistulizing Crohn's disease patients were matched for age and sex with patients with anorectal fistula without Crohn's disease. Biopsy specimens were obtained from fistulous tracts during examination under anesthesia for both groups. The samples were sent for HPV detection and genotyping using the INNO-LiPA test. Results A total of 108 subjects (54 in each group) were recruited. The perianal fistulizing Crohn's disease group showed a statistically higher frequency of HPV in the fistulous tract than the control group (33.3% vs. 16.7%; p = 0.046). Separate analyses on high-risk types demonstrated that there was a numerically higher frequency of HPV in the perianal fistulizing Crohn's disease group. In multiple logistic regression, patients with perianal fistulizing Crohn's disease were found to have a chance of HPV 3.29 times higher than patients without Crohn's disease (OR = 3.29; 95% CI 1.20‒9.01), regardless of other variables. The types most frequently identified in the perianal fistulizing Crohn's disease group were HPV 11 (12.96%) and HPV 16 (9.26%). Conclusion Perianal fistulizing Crohn's disease is associated with a higher prevalence of HPV than in patients with anorectal fistula without Crohn's disease.

https://doi.org/10.1016/j.clinsp.2023.100219

Carbon, nitrogen, and physical fractions of organic matter in recovered pastures of the Maranhense Amazon
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Rego, Carlos Augusto Rocha de Moraes

; Oliveira, Paulo Sérgio Rabello de

; Rosset, Jean Sérgio

; Muniz, Luciano Cavalcante

; Mattei, Eloisa

; Reis, Victor Roberto Ribeiro

; Costa, Bruna Penha

; Nunes Neto, Wallace Ribeiro

Acta Scientiarum. Agronomy

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2023, Volume 45 elocation e60794

Abstract: En | Text: En | PDF: En

ABSTRACT. In Maranhão State, Brazil, soils are naturally acidic, nutrient-deficient, and prone to cohesion and erosion. Removing the natural cover to establish pastures causes physical, chemical, and biological changes in the soil. Therefore, this study aimed to evaluate the contents and stocks of carbon (C), nitrogen (N), and particle-size fractions of soil organic matter (SOM) in pastures with different years of recovery, and compare them with a secondary forest in the Legal Amazon. Four treatments were evaluated: secondary forest, perennial pasture, and perennial pastures recovered for five years and eight years, both of the latter through corn + brachiaria intercropping. The contents and stocks of total organic carbon, total nitrogen, C, and N from the soil organic matter particle-size fractions, as well as the carbon management indexes (CMI) of the 0.00-0.10, 0.10-0.20, 0.20-0.30, and 0.30-0.40 m layers were evaluated. The perennial pasture environment presented the highest total soil C and N contents; however, when observing the granulometric fractions and CMI, these increases were qualitative in relation to the secondary forest. Pasture recovery over eight years contributed to an improvement of soil quality similar to secondary forest, indicating that an increase in SOM quality, quantity, and recovery time related to increased pasture capacity to accumulate C and N in the soil.

https://doi.org/10.4025/actasciagron.v45i1.60794

Uma metodologia reflexiva para desocidentalizar o subcampo da Comunicação Organizacional LatinoAmericana
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Vásquez, Consuelo

; Burgueño, Roberto

; Lima, Gabriela Rabello de

; Queiroz, Marcela Marques de

Intercom: Revista Brasileira de Ciências da Comunicação

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2022, Volume 45 elocation e2022110

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

Resumo O presente artigo visa desenvolver uma metodologia reflexiva para investigar a produção de conhecimento do subcampo de pesquisa de Comunicação Organizacional, levando em conta as realidades contextuais, institucionais e culturais da região latino-americana. Para isso, respondendo aos recentes chamados de desocidentalização da Comunicação, adotamos neste artigo uma abordagem de trabalho “de baixo para cima”, que favorece as realidades vivenciadas pelos pesquisadores latino-americanos e estudiosos em Comunicação Organizacional. A metodologia proposta proporciona um modelo investigativo que possa servir como um exemplo para desocidentalizar a produção de conhecimento em campos correlacionados.

Abstract This paper aims to develop a reflexive methodology to explore the production of knowledge of the subfield of Organizational Communication research, considering the contextual, institutional, and cultural realities of the Latin American region. For this purpose, responding to the recent calls to de-westernized Communication, this paper adopted a “bottom-up” approach, which favors the realities experienced by Latin American Organizational Communication researchers and scholars. The proposed methodology provides a model that can serve as an example to de-westernize knowledge production in related fields.

Resumen Este artículo busca desarrollar una metodología reflexiva para explorar la producción de conocimiento del subcampo de la investigación en Comunicación Organizacional, teniendo en cuenta las realidades contextuales, institucionales y culturales de la región latinoamericana. Con este fin, respondiendo a los recientes llamados a desoccidentalizar la Comunicación, este artículo adoptó un enfoque de trabajo “de abajo hacia arriba”, que favorece las realidades vividas por los investigadores y académicos latinoamericanos de la Comunicación Organizacional. La metodología propuesta proporciona un modelo de investigación que puede servir de ejemplo para desoccidentalizar la producción de conocimiento en campos afines.

https://doi.org/10.1590/1809-58442022110pt

The influence of the ACTN3 R577X polymorphism in the responsiveness to post-activation jump performance enhancement in untrained young men
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Mantovani, Guilherme Beneduzzi

; Barreto, Renan Vieira

; Souza, Victor Alvino de

; Bueno Júnior, Carlos Roberto

; Assumpção, Claudio de Oliveira

; Greco, Camila Coelho

; Denadai, Benedito Sérgio

; de Lima, Leonardo Coelho Rabello

Revista Brasileira de Cineantropometria & Desempenho Humano

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2021, Volume 23 elocation e77035

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

RESUMO Tivemos como objetivo investigar a influência do polimorfismo do gene ACTN3 na responsividade à potencialização do desempenho de salto com contra movimento (CMJ) pós-ativação (PAPE). Dezesseis homens destreinados foram divididos em dois grupos: homozigotos para os alelos X (XX, n = 9) ou R (RR, n = 7). A altura de CMJ, a potência média e a força vertical aplicada durante o salto pelos participantes foram determinadas duas vezes (CMJ1 e CMJ2) em duas condições: controle (CON) e potencializado (PAPE). Na condição CON, os CMJ foram realizados antes e depois de um período de 15 minutos de repouso. Na condição PAPE, os CMJ foram realizados 15 minutos antes e 4 minutos após a realização de cinco agachamentos com carga de cinco repetições máximas (5RM). As diferentes condições foram realizadas em dias separados e em ordem randomizada. ANOVAs fatoriais de três caminhos foram utilizadas para comparar diferenças entre condições, tempos e grupos. O tamanho do efeito foi calculado pelo d de Cohen. Os tamanhos do efeito para alterações na altura de CMJ para os grupos CON e PAPE foram 0.04 e 0.08, respectivamente. Não houve diferenças significantes entre os grupos XX e RR na altura de salto em condição basal (1.07 ± 2.54 cm e -0.82 ± 2.56 cm, respectivamente). Não houve diferenças significativas na responsividade à PAPE entre os grupos (XX = -0.20 ± 1.6 cm e RR = -0.81 ± 2.7 cm). O polimorfismo do gene ACTN3 parece não ser influenciar isoladamente a responsividade à PAPE.

ABSTRACT We aimed to investigate the influence of alpha-actinin-3 (ACTN3) R577X polymorphism on responsiveness to post-activation performance enhancement (PAPE) of countermovement jumps (CMJ) in untrained subjects. Sixteen untrained men were allocated into two groups according to their ACTN3 gene alleles: homozygous for the X allele (XX, n = 9) or homozygous for the R allele (RR, n = 7). CMJ height, mean power output and vertical force were determined twice (CMJ1 and CMJ2) in two conditions: control (CON) and potentiated (PAPE). In the CON condition, CMJ were performed before and after a 15-min rest. In the PAPE condition, CMJ were performed 15 min before and 4 min following five squats with a 5-repetition maximum (5RM) load. Different conditions were applied on separate days in a randomized order. Statistical analysis involved three-way ANOVAs to compare the differences between conditions (CON and PAPE), time (CMJ1 and CMJ2), and groups (XX and RR). Significance level considered was p < 0.05. Effect sizes were calculated as Cohen’s d. The effect sizes for changes in CMJ height for CON and following pre-activation for PAPE were 0.04 and 0.08, respectively. No significant differences were found for CMJ height between XX and RR at baseline (1.07 ± 2.54 cm e -0.82 ± 2.56 cm, respectively). No differences were found (p>0.05) in responsiveness to PAPE between the groups (XX = -0.20 ± 1.6 cm and RR = -0.81 ± 2.7 cm). We conclude that ACTN3 gene polymorphisms does not influence responsiveness to PAPE.

https://doi.org/10.1590/1980-0037.2021v23e77035 68 downloads

Clinical characteristics and outcomes of COVID-19 patients admitted to the intensive care unit during the first year of the pandemic in Brazil: a single center retrospective cohort study
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Corrêa, Thiago Domingos

; Midega, Thais Dias

; Timenetsky, Karina Tavares

; Cordioli, Ricardo Luiz

; Barbas, Carmen Silvia Valente

; Silva Júnior, Moacyr

; Bravim, Bruno de Arruda

; Silva, Bruno Caldin

; Matos, Gustavo Faissol Janot de

; Nawa, Ricardo Kenji

; Carvalho, Fabrício Rodrigues Torres de

; Queiroz, Verônica Neves Fialho

; Rabello Filho, Roberto

; Piza, Felipe Maia de Toledo

; Pereira, Adriano José

; Pesavento, Marcele Liliane

; Eid, Raquel Afonso Caserta

; Santos, Bento Fortunato Cardoso dos

; Pardini, Andreia

; Teich, Vanessa Damázio

; Laselva, Claudia Regina

; Cendoroglo Neto, Miguel

; Klajner, Sidney

; Ferraz, Leonardo José Rolim

einstein (São Paulo)

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2021, Volume 19 elocation eAO6739

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

RESUMO Objetivo: Descrever características clínicas, uso de recursos e desfechos e identificar preditores de mortalidade intra-hospitalar de pacientes com COVID-19 admitidos na unidade de terapia intensiva. Métodos: Estudo de coorte retrospectivo, em centro único, realizado em um hospital privado localizado em São Paulo (SP). Pacientes adultos (≥18 anos) admitidos consecutivamente na unidade de terapia intensiva, entre 4 de março de 2020 a 28 de fevereiro de 2021, foram incluídos neste estudo. Os pacientes foram classificados como sobreviventes e não sobreviventes, de acordo com a alta hospitalar. Resultados: Durante o período do estudo, 1.296 pacientes [mediana (intervalo interquartil) de idade: 66 (53-77) anos] com COVID-19 foram admitidos na unidade de terapia intensiva. Destes, 170 (13,6%) pacientes morreram no hospital (não sobreviventes), e 1.078 (86,4%) receberam alta hospitalar (sobreviventes). Comparados aos sobreviventes, os não sobreviventes eram mais idosos [80 (70-88) versus 63 (50-74) anos; p<0,001], apresentavam pontuação mais alta no sistema prognóstico Simpliﬁed Acute Physiology Score 3 [59 (54-66) versus 47 (42-53); pontos p<0,001] e tinham mais comorbidades. Durante a internação na unidade de terapia intensiva, 56,6% dos pacientes usaram ventilação não invasiva, 32,9% usaram ventilação mecânica invasiva, 31,3% usaram cateter nasal de alto fluxo, 11,7% foram submetidos à terapia renal substitutiva, e 1,5% usou oxigenação por membrana extracorpórea. Os preditores independentes de mortalidade intra-hospitalar foram idade, Sequential Organ Failure Assessment, Índice de Comorbidade de Charlson, necessidade de ventilação mecânica, uso de cateter nasal de alto fluxo, uso de terapia renal substitutiva e suporte por oxigenação por membrana extracorpórea. Conclusão: Pacientes com quadros graves da COVID-19 admitidos na unidade de terapia intensiva apresentaram considerável mortalidade e morbidade, com alta demanda de terapia de suporte e internação prolongada em unidade de terapia intensiva e hospitalar.

ABSTRACT Objective: To describe clinical characteristics, resource use, outcomes, and to identify predictors of in-hospital mortality of patients with COVID-19 admitted to the intensive care unit. Methods: Retrospective single-center cohort study conducted at a private hospital in São Paulo (SP), Brazil. All consecutive adult (≥18 years) patients admitted to the intensive care unit, between March 4, 2020 and February 28, 2021 were included in this study. Patients were categorized between survivors and non-survivors according to hospital discharge. Results: During the study period, 1,296 patients [median (interquartile range) age: 66 (53-77) years] with COVID-19 were admitted to the intensive care unit. Out of those, 170 (13.6%) died at hospital (non-survivors) and 1,078 (86.4%) were discharged (survivors). Compared to survivors, non-survivors were older [80 (70-88) versus 63 (50-74) years; p<0.001], had a higher Simpliﬁed Acute Physiology Score 3 [59 (54-66) versus 47 (42-53) points; p<0.001], and presented comorbidities more frequently. During the intensive care unit stay, 56.6% of patients received noninvasive ventilation, 32.9% received mechanical ventilation, 31.3% used high flow nasal cannula, 11.7% received renal replacement therapy, and 1.5% used extracorporeal membrane oxygenation. Independent predictors of in-hospital mortality included age, Sequential Organ Failure Assessment score, Charlson Comorbidity Index, need for mechanical ventilation, high flow nasal cannula, renal replacement therapy, and extracorporeal membrane oxygenation support. Conclusion: Patients with severe COVID-19 admitted to the intensive care unit exhibited a considerable morbidity and mortality, demanding substantial organ support, and prolonged intensive care unit and hospital stay.

https://doi.org/10.31744/einstein_journal/2021ao6739

Intensive support recommendations for critically-ill patients with suspected or confirmed COVID-19 infection
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Corrêa, Thiago Domingos

; Matos, Gustavo Faissol Janot de

; Bravim, Bruno de Arruda

; Cordioli, Ricardo Luiz

; Garrido, Alejandra del Pilar Gallardo

; Assuncao, Murillo Santucci Cesar de

; Barbas, Carmen Silvia Valente

; Timenetsky, Karina Tavares

; Rodrigues, Roseny dos Reis

; Guimarães, Hélio Penna

; Rabello Filho, Roberto

; Lomar, Frederico Polito

; Scarin, Farah Christina de La Cruz

; Batista, Carla Luciana

; Pereira, Adriano José

; Guerra, João Carlos de Campos

; Carneiro, Bárbara Vieira

; Nawa, Ricardo Kenji

; Brandão, Rodrigo Martins

; Pesaro, Antônio Eduardo Pereira

; Silva Júnior, Moacyr

; Carvalho, Fabricio Rodrigues Torres de

; Silva, Cilene Saghabi de Medeiros

; Almeida, Ana Claudia Ferraz de

; Franken, Marcelo

; Pesavento, Marcele Liliane

; Eid, Raquel Afonso Caserta

; Ferraz, Leonardo José Rolim

einstein (São Paulo)

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2020, Volume 18 elocation eAE5793

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

RESUMO Em dezembro de 2019, uma série de pacientes com pneumonia grave foi identificada em Wuhan, província de Hubei, na China. Esses pacientes evoluíram para síndrome respiratória aguda grave e síndrome do desconforto respiratório agudo. Posteriormente, a COVID-19 foi atribuída a um novo betacoronavírus, o coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2). Cerca de 20% dos pacientes com diagnóstico de COVID-19 desenvolvem formas graves da doença, incluindo insuficiência respiratória aguda hipoxêmica, síndrome respiratória aguda grave, síndrome do desconforto respiratório agudo e insuficiência renal aguda e requerem admissão em unidade de terapia intensiva. Não há nenhum ensaio clínico randomizado controlado que avalie potenciais tratamentos para pacientes com infecção confirmada pela COVID-19 no momento da publicação destas recomendações de tratamento. Dessa forma, essas recomendações são baseadas predominantemente na opinião de especialistas (grau de recomendação de nível C).

ABSTRACT In December 2019, a series of patients with severe pneumonia were identified in Wuhan, Hubei province, China, who progressed to severe acute respiratory syndrome and acute respiratory distress syndrome. Subsequently, COVID-19 was attributed to a new betacoronavirus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Approximately 20% of patients diagnosed as COVID-19 develop severe forms of the disease, including acute hypoxemic respiratory failure, severe acute respiratory syndrome, acute respiratory distress syndrome and acute renal failure and require intensive care. There is no randomized controlled clinical trial addressing potential therapies for patients with confirmed COVID-19 infection at the time of publishing these treatment recommendations. Therefore, these recommendations are based predominantly on the opinion of experts (level C of recommendation).

https://doi.org/10.31744/einstein_journal/2020ae5793 23244 downloads

Use of telemedicine to combat the COVID-19 pandemic in Brazil
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Carvalho, Carlos Roberto Ribeiro

; Scudeller, Paula Gobi

; Rabello, Guilherme

; Gutierrez, Marco Antonio

; Jatene, Fabio Biscegli

Clinics

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2020, Volume 75 elocation e2217

Abstract: En | Text: En | PDF: En

https://doi.org/10.6061/clinics/2020/e2217 1082 downloads

Comment to: Intensive support recommendations for critically-ill patients with suspected or confirmed COVID-19 infection
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Corrêa, Thiago Domingos

; Matos, Gustavo Faissol Janot de

; Bravim, Bruno de Arruda

; Cordioli, Ricardo Luiz

; Garrido, Alejandra del Pilar Gallardo

; Assuncao, Murillo Santucci Cesar de

; Barbas, Carmen Silvia Valente

; Timenetsky, Karina Tavares

; Rodrigues, Roseny dos Reis

; Guimarães, Hélio Penna

; Rabello Filho, Roberto

; Lomar, Frederico Polito

; Scarin, Farah Christina de La Cruz

; Batista, Carla Luciana

; Pereira, Adriano José

; Guerra, João Carlos de Campos

; Carneiro, Bárbara Vieira

; Nawa, Ricardo Kenji

; Brandão, Rodrigo Martins

; Pesaro, Antônio Eduardo Pereira

; Silva Júnior, Moacyr

; Carvalho, Fabricio Rodrigues Torres de

; Silva, Cilene Saghabi de Medeiros

; Almeida, Ana Claudia Ferraz de

; Franken, Marcelo

; Pesavento, Marcele Liliane

; Eid, Raquel Afonso Caserta

; Ferraz, Leonardo José Rolim

einstein (São Paulo)

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2020, Volume 18 elocation eCE5931

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

https://doi.org/10.31744/einstein_journal/2020ce5931 214 downloads

10.

Ultrasound-guided costoclavicular block as an alternative for upper limb anesthesia in obese patients
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Silva, Grazielle Rodrigues

; Borges, Danielle Gonçalves

; Lopes, Iuri Ferreira

; Ruzi, Roberto Araújo

; Costa, Paulo Ricardo Rabello de Macedo

; Mandim, Beatriz Lemos da Silva

Revista Brasileira de Anestesiologia

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oct 2019, Volume 69 N. 5 Pages 510 - 513

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

Resumo Justificativa e objetivos: O bloqueio de plexo braquial via costoclavicular é uma anestesia feita por via infraclavicular, já descrita na literatura como uma via segura e efetiva para anestesia de membro superior distal ao cotovelo. O relato a seguir trata de um paciente em que as técnicas tradicionais para bloqueio de plexo apresentavam dificuldade de visibilização à ultrassonografia, já a via costoclavicular foi de fácil visibilização para execução do bloqueio anestésico. Relato de caso: Paciente com obesidade grau 3 a ser submetido a correção de fratura e luxação de cotovelo esquerdo apresentava anatomia da região supraclavicular distorcida à avaliação ultrassonográfica e região axilar com lesões de pele, que impossibilitavam o bloqueio nessas regiões. Optou-se por fazer o bloqueio de plexo via infraclavicular no espaço costoclavicular, região onde as estruturas do plexo braquial estão mais superficiais e unidas, amparadas por uma estrutura muscular, laterais a todas as estruturas vasculares adjacentes e com a visibilização plena da pleura. O bloqueio anestésico foi efetivo para a realização do procedimento sob punção única em pele e sem intercorrências. Conclusão: O bloqueio de plexo braquial via costoclavicular é uma boa opção para anestesia de membro superior distal ao cotovelo, é uma opção segura e efetiva para pacientes obesos ou que tenham outras limitações à aplicação de outras técnicas de bloqueio de membro superior.

Abstract Background and objectives: Costoclavicular brachial plexus block is an anesthesia performed through the infraclavicular route described in the literature as a safe and effective route for upper limb anesthesia distal to the elbow. The following report describes the case of a patient whose traditional plexus blocking techniques presented ultrasound visualization difficulty, but the costoclavicular approach was easy to visualize for anesthetic blockade. Case report: A grade 3 obese patient scheduled for repair of left elbow fracture and dislocation. Ultrasound examination revealed a distorted anatomy of the supraclavicular region and the axillary region with skin lesions, which made it impossible to perform the blockade in these regions. It was decided to perform an infraclavicular plexus block at the costoclavicular space, where the brachial plexus structures are more superficial and closer together, supported by a muscular structure, lateral to all adjacent vascular structures and with full view of the pleura. The anesthetic block was effective to perform the procedure with a single injection and uneventfully. Conclusion: Costoclavicular brachial plexus block is a good alternative for upper limb anesthesia distal to the elbow, being a safe and effective option for patients who are obese or have other limitations to the use of other upper limb blocking techniques.

https://doi.org/10.1016/j.bjane.2019.09.003 1095 downloads

11.

Oxigenação por membrana extracorpórea: revisão da literatura
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Chaves, Renato Carneiro de Freitas

; Rabello Filho, Roberto

; Timenetsky, Karina Tavares

; Moreira, Fabio Tanzillo

; Vilanova, Luiz Carlos da Silva

; Bravim, Bruno de Arruda

; Serpa Neto, Ary

; Corrêa, Thiago Domingos

Revista Brasileira de Terapia Intensiva

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sep 2019, Volume 31 N. 3 Pages 410 - 424

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

RESUMO A oxigenação por membrana extracorpórea é uma modalidade de suporte de vida extracorpóreo que possibilita suporte temporário à falência da função pulmonar e/ou cardíaca, refratária ao tratamento clínico convencional. Desde as primeiras descrições da oxigenação por membrana extracorpórea, melhorias significativas ocorreram no dispositivo, no manejo do paciente e, consequentemente, nos desfechos dos pacientes em oxigenação por membrana extracorpórea. Diversos estudos importantes sobre a utilização de oxigenação por membrana extracorpórea em pacientes com síndrome do desconforto respiratório agudo refratária ao suporte clínico convencional, em parada cardíaca intra-hospitalar e choque cardiogênico refratário foram publicados nos últimos anos. Dessa forma, o objetivo desta revisão é apresentar conceitos teóricos e práticos sobre a utilização da oxigenação por membrana extracorpórea em situações de falência pulmonar e/ou cardíaca refratária ao manejo clínico convencional em pacientes críticos.

ABSTRACT Extracorporeal membrane oxygenation is a modality of extracorporeal life support that allows for temporary support in pulmonary and/or cardiac failure refractory to conventional therapy. Since the first descriptions of extracorporeal membrane oxygenation, significant improvements have occurred in the device and the management of patients and, consequently, in the outcomes of critically ill patients during extracorporeal membrane oxygenation. Many important studies about the use of extracorporeal membrane oxygenation in patients with acute respiratory distress syndrome refractory to conventional clinical support, under in-hospital cardiac arrest and with cardiogenic refractory shock have been published in recent years. The objective of this literature review is to present the theoretical and practical aspects of extracorporeal membrane oxygenation support for respiratory and/or cardiac functions in critically ill patients.

https://doi.org/10.5935/0103-507x.20190063 57456 downloads

12.

Avaliação de um aplicativo para smartphone para aprimoramento da certificação médica da causa da morte
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Ishitani, Lenice Harumi

; Cunha, Carolina Cândida da

; Ladeira, Roberto Marini

; Corrêa, Paulo Roberto Lopes

; Santos, Mayara Rocha dos

; Rego, Maria Albertina Santiago

; Rabello Neto, Dácio de Lyra

; Taniguchi, Mauro

; Lehrer, Cristiano

; Paixão, Lucia Maria Miana Mattos

; Frederes, Ashley

; Souza, Maria de Fatima Marinho de

; França, Elisabeth Barboza

Revista Brasileira de Epidemiologia

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2019, Volume 22 Suppl. 3 elocation e190014.supl.3

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

RESUMO Introdução: O aplicativo para smartphone AtestaDO foi desenvolvido para auxiliar o médico na certificação da causa de morte. Neste estudo se propõe avaliar a aceitabilidade desse aplicativo. Métodos: Médicos foram convidados para participar de reuniões sobre certificação correta da causa da morte e avaliar o aplicativo em três etapas dessas reuniões, realizadas em Natal e em dois grandes hospitais de Belo Horizonte. Resultados: Em Natal, 82% dos 38 médicos participantes tinham mais de 20 anos de graduação, e em Belo Horizonte, mais de 67% dos 58 médicos tinham menos de 5 anos de graduação. As seções “Interface do aplicativo”, “Como atestar as causas de morte”, “Prática com exercícios” e “Outras informações para o médico” foram bem avaliadas por mais de 50% dos médicos de Belo Horizonte. Em Natal, todas as seções foram bem avaliadas por pelo menos 80% dos médicos. Mais de 70% dos participantes de Natal e da segunda etapa de Belo Horizonte usariam o aplicativo para preencher a causa de morte. A probabilidade de usar o AtestaDO para dar aulas sobre preenchimento da Declaração de Óbito foi de 83% para médicos de Natal, mas inferior a 60% em Belo Horizonte. Nas três etapas, a maioria dos médicos recomendaria o uso do aplicativo para outros colegas. Conclusão: A avaliação do aplicativo AtestaDO mostrou boa aceitabilidade. Espera-se que o uso dessa ferramenta permita alcançar melhorias na certificação médica da causa do óbito.

ABSTRACT Introduction: A smartphone application named AtestaDO was developed to support physicians with medical certification of the cause of death. The objective of this study is to evaluate the acceptability of the app. Methods: Physicians were invited to attend meetings on the proper certification of cause of death, and to evaluate the application in a national workshop in Natal (first stage) and in two large hospitals in Belo Horizonte (second and third stages). Results: In Natal, 82% of 38 physicians had more than 20 years of experience and in Belo Horizonte, more than 67% of 58 physicians had less than 5 years of experience. The sections “Application interface”, “How to certify the causes of death”, “Practice with exercises” and “Other information for physicians” were positively evaluated by more than 50% of physicians in Belo Horizonte. In Natal, all sections were positively evaluated by at least 80% of participants. More than 70% of the participants in both Natal and the second stage of Belo Horizonte indicated they would possibly use AtestaDO to guide filling of a death certificate. The probability of using AtestaDO to teach classes on filling death certificates was 83.3% for Natal’s physicians but less than 60% in Belo Horizonte. In the three stages, most physicians would recommend using the application to other colleagues. Conclusion: The evaluation of AtestaDO showed good acceptability. We expect that the use of this tool enables improvements in medical certification of causes of death.

https://doi.org/10.1590/1980-549720190014.supl.3

13.

Avaliação de um aplicativo para smartphone para aprimoramento da certificação médica da causa da morte
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Ishitani, Lenice Harumi

; Cunha, Carolina Cândida da

; Ladeira, Roberto Marini

; Corrêa, Paulo Roberto Lopes

; Santos, Mayara Rocha dos

; Rego, Maria Albertina Santiago

; Rabello Neto, Dácio de Lyra

; Taniguchi, Mauro

; Lehrer, Cristiano

; Paixão, Lucia Maria Miana Mattos

; Frederes, Ashley

; Souza, Maria de Fatima Marinho de

; França, Elisabeth Barboza

Revista Brasileira de Epidemiologia

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2019, Volume 22 Suppl. 3 elocation e190014.supl.3

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

https://doi.org/10.1590/1980-549720190014.supl.3 1061 downloads

14.

Near-infrared spectroscopy parameters in patients undergoing continuous venovenous hemodiafiltration
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Chaves, Renato Carneiro de Freitas

; Tafner, Philipe Franco do Amaral

; Chen, Felipe Ko

; Meneghini, Letícia Bagatini

; Corrêa, Thiago Domingos

; Rabello Filho, Roberto

; Cendoroglo Neto, Miguel

; Santos, Oscar Fernando Pavão dos

; Serpa Neto, Ary

einstein (São Paulo)

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2019, Volume 17 N. 1 elocation eAO4439

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

RESUMO Objetivo Avaliar o impacto da hemodiafiltração venovenosa contínua na microcirculação de pacientes com lesão renal aguda. Métodos Estudo piloto, prospectivo e observacional conduzido em uma unidade de terapia intensiva clínico-cirúrgica aberta, com 40 leitos, localizada em um hospital terciário, privado, na cidade de São Paulo (SP), Brasil. A microcirculação foi avaliada empregando-se a espectroscopia no infravermelho próximo, por meio de uma sonda de 15mm posicionada sobre a eminência tenar. O teste de oclusão vascular foi realizado no antebraço a ser submetido à espectroscopia no infravermelho próximo, inflando-se o manguito de um esfigmomanômetro a um valor 30mmHg acima da pressão arterial sistólica. O desfecho primário foi a avaliação dos parâmetros derivados por espectroscopia no infravermelho próximo imediatamente antes, 1, 4 e 24 horas após o início da hemodiafiltração venovenosa contínua. Resultados Foram incluídos nove pacientes neste estudo piloto ao longo de 2 meses. A saturação de oxigênio tecidual mínima mensurada durante o teste de oclusão vascular foi o único parâmetro derivado por espectroscopia no infravermelho próximo que diferiu ao longo do tempo, com queda em relação aos valores iniciais nas primeiras 24 horas após o início da hemodiafiltração venovenosa contínua. Conclusão A influência da disfunção microcirculatória sobre os desfechos clínicos de pacientes submetidos à hemodiafiltração venovenosa contínua precisa ser melhor investigada.

ABSTRACT Objective To investigate the impacts of continuous venovenous hemodiafiltration on the microcirculation in patients with acute kidney injury. Methods A prospective observational pilot study conducted in a 40-bed, open clinical-surgical intensive care unit of a private tertiary care hospital located in the city of São Paulo (SP), Brazil. Microcirculation was assessed using near-infrared spectroscopy by means of a 15mm probe placed over the thenar eminence. Vascular occlusion test was performed on the forearm to be submitted to near-infrared spectroscopy by inflation of a sphygmomanometer cuff to 30mmHg higher than the systolic arterial pressure. The primary endpoint was the assessment of near-infrared spectroscopy-derived parameters immediately before, 1, 4 and 24 hours after the initiation of continuous venovenous hemodiafiltration. Results Nine patients were included in this pilot study over a period of 2 months. Minimum tissue oxygen saturation measured during the vascular occlusion test was the only near-infrared spectroscopy-derived parameter to differed over the time (decrease compared to baseline values up to 24 hours after initiation of continuous venovenous hemodiafiltration). Conclusion The impacts of microcirculatory dysfunction on clinical outcomes of patients undergoing to continuous venovenous hemodiafiltration need to be further investigated.

https://doi.org/10.31744/einstein_journal/2019ao4439 763 downloads

15.

Primeiro datathon brasileiro em terapia intensiva
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Serpa Neto, Ary

; Kugener, Guillaume

; Bulgarelli, Lucas

; Rabello Filho, Roberto

; Hoz, Miguel Ángel Armengol de la

; Johnson, Alistair EW

; Paik, Kenneth E

; Torres, Felipe

; Xie, Chen

; Amaro Júnior, Edson

; Ferraz, Leonardo José Rolim

; Celi, Leo Anthony

; Deliberato, Rodrigo Octavio

Revista Brasileira de Terapia Intensiva

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mar 2018, Volume 30 N. 1 Pages 6 - 8

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

https://doi.org/10.5935/0103-507x.20180006 1135 downloads

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