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Evidências em política, planejamento e gestão em saúde aplicadas à doença renal crônica: revisão de escopo
No full textDiante do contexto histórico e epidemiológico da doença renal no Brasil, observou-se a necessidade de aprofundar na política, planejamento e gestão em saúde. Para tanto, objetivou-se mapear as iniciativas nacionais nestes campos. Trata-se de uma revisão de escopo, realizada a partir da consulta nas bases de dados Web of Science, MEDLINE, BVS, Scopus e CINAHL, por periódicos científicos e na literatura cinzenta. Selecionamos 47 publicações para extração de dados dos 604 documentos encontrados inicialmente, e organizou-se categorias. O escopo das produções acerca da política, planejamento e gestão em saúde aplicados à doença renal crônica foi se desenvolvendo ao longo dos anos, em meio a portarias, resoluções, documentos oficiais do Ministério da Saúde e artigos científicos diversos, porém incipientes diante da relevância da doença. Aponta-se o baixo interesse de pesquisa nessa área específica, assim como a necessidade de maior abordagem na política em saúde, planejamento e gestão da doença renal no Brasil, para que se tenha base científica acurada nas decisões gestoras. Acredita-se que compreender o contexto, o conceito e as características da doença renal influencie a operacionalização, governança e avaliação de desempenho na sua gestão
Infectious endocarditis due to Bacillus Cereus in a patient with a pacemaker: case report and literature review
Get PDFIntroduction: Infective endocarditis (IE) is an infectious process of the cardiac endothelium, often related to the use of pacemakers and valve prostheses, which may facilitate microorganism” proliferation. Case Report: In this article, we describe the case of an 81-year-old man with infective endocarditis due to Bacillus Cereus related to the use of a pacemaker and perform a brief literature review. Discussion: Bacillus Cereus is a Gram-positive, aerobic, spore-forming, large, and generally motile bacterium that constitutes a rare cause of endocarditis, but few cases like this are described in the literature. Conclusion: Determining the etiology of IE through culture-guided methods plays a pivotal role in selecting appropriate antibiotic treatment. Maintain a high clinical suspicion for IE is paramount, especially when fever arises in patients with cardiac devices after surgical or dental procedures.Introduction: Infective endocarditis (IE) is an infectious process of the cardiac endothelium, often related to the use of pacemakers and valve prostheses, which may facilitate microorganism” proliferation. Case Report: In this article, we describe the case of an 81-year-old man with infective endocarditis due to Bacillus Cereus related to the use of a pacemaker and perform a brief literature review. Discussion: Bacillus Cereus is a Gram-positive, aerobic, spore-forming, large, and generally motile bacterium that constitutes a rare cause of endocarditis, but few cases like this are described in the literature. Conclusion: Determining the etiology of IE through culture-guided methods plays a pivotal role in selecting appropriate antibiotic treatment. Maintain a high clinical suspicion for IE is paramount, especially when fever arises in patients with cardiac devices after surgical or dental procedures
Analysis of the metabolic profile and comorbidities in women with endometriosis before and after surgical treatment
Get PDFAim: this study aimed to evaluate the effects of surgical treatment for endometriosis on the metabolic profile of women diagnosed with deep endometriosis. Methods: we conducted a prospective observational study with a sample of 30 women in the menacme diagnosed with deep endometriosis who underwent videolaparoscopic surgery in a reference center in Brazil between October 2020 and December 2021. A total of 30 women performed clinical and laboratory tests regarding their metabolic profile on two occasions, during preoperative tests and six months after video-laparoscopy. Results: patients had lower average levels of Total Cholesterol (TC), Low-Density Cholesterol (LDL-c), Triglycerides (TGC), and Fasting Glycemia (FG) after the surgical procedure. The average TC level was 8.2% lower after surgery, LDL-c was 12.8% lower, TGC was 10.9% lower, and FG was 7.3% lower. The results showed a statistically significant difference for all these parameters (p < 0.001). Conclusions: video-laparoscopy was associated with a favorable lipid profile compared to the preoperative lipid profile, with a significant improvement in the average levels of LDL-c, HDL-c, TC, TGC, and FG. Long-term follow-up studies are needed to determine whether surgical treatment for endometriosis can improve the metabolic parameters of women with endometriosis and favor a lower predisposition to atherogenesis.Aim: this study aimed to evaluate the effects of surgical treatment for endometriosis on the metabolic profile of women diagnosed with deep endometriosis. Methods: we conducted a prospective observational study with a sample of 30 women in the menacme diagnosed with deep endometriosis who underwent videolaparoscopic surgery in a reference center in Brazil between October 2020 and December 2021. A total of 30 women performed clinical and laboratory tests regarding their metabolic profile on two occasions, during preoperative tests and six months after video-laparoscopy. Results: patients had lower average levels of Total Cholesterol (TC), Low-Density Cholesterol (LDL-c), Triglycerides (TGC), and Fasting Glycemia (FG) after the surgical procedure. The average TC level was 8.2% lower after surgery, LDL-c was 12.8% lower, TGC was 10.9% lower, and FG was 7.3% lower. The results showed a statistically significant difference for all these parameters (p < 0.001). Conclusions: video-laparoscopy was associated with a favorable lipid profile compared to the preoperative lipid profile, with a significant improvement in the average levels of LDL-c, HDL-c, TC, TGC, and FG. Long-term follow-up studies are needed to determine whether surgical treatment for endometriosis can improve the metabolic parameters of women with endometriosis and favor a lower predisposition to atherogenesis
Repercussões na saúde mental de profissionais da saúde de um hospital público do Recife durante a pandemia de COVID-19
Get PDFAim: This article aimed to analyze factors associated with anxiety and depression in health professionals who provide care to patients with COVID-19 in Recife public hospital. Method: cross-sectional study, with the application of an online questionnaire containing sociodemographic and work-related variables and the Depression, Anxiety, and Stress Scale instrument. Descriptive analyses of the independent variables and bivariate analysis were performed using linear regression of the relationship between the dependent and the independent variables. Results: 77 professionals answered the questionnaire. Physiotherapy was the professional category associated with anxiety, and the sector of activity in COVID-19 and exercise time were associated with depression. Conclusion: actions to promote the mental health of these professionals are essential, mainly considering the impacts of the COVID-19 pandemic.Objetivo: analisar fatores associados à ansiedade e depressão em profissionais de saúde que prestam assistência a pacientes com COVID-19 em um hospital público de Recife. Método: estudo transversal, com aplicação de questionário online contendo variáveis sociodemográficas e relacionadas ao trabalho e instrumento escala de depressão, ansiedade e estresse. Realizadas análises descritivas das variáveis independentes e análise bivariada usando regressão linear da relação entre a variável dependente e das variáveis independentes. Resultados: 77 profissionais responderam ao questionário. A fisioterapia foi a categoria profissional associada à ansiedade, e o setor de atuação no COVID- 19 e o tempo de exercício foram associados à depressão. Conclusão: são imprescindíveis as ações de promoção da saúde mental desses profissionais, considerando, principalmente, os impactos da pandemia de COVID-19
Perfil da microbiota e padrões de resistência aos antimicrobianos em uroculturas de pacientes transplantados renais
Get PDFObjective: to analyze the profile of microorganisms present and their resistance to antimicrobials in urocultures of renal transplant patients in 2021-2022. Methods: it is a cross-sectional study with quantitative data analysis from positive urocultures of renal transplant patients accompanied at the General Hospital of Fortaleza between January 2021 and December 2022. An elaborate research instrument containing classification variables was employed, and the data were obtained through records of the urocultures existing in the electronic checkbook system used by the hospital. Results: of the 534 urocultures requested, 36.7% showed a positive result, of which 60.4% were women aged between 20 and 59. Most cases were developed by patients who received outpatient follow-up (56.2%). The isolated microorganisms were predominantly enterobacteria (81.34%), with the prevalence of E.coli (69.30%). Antimicrobial sensitivity profiles varied, with E.coli resistance to antibiotics such as ampicillin, nalidixic acid, norfloxacin, and ciprofloxacin. Conclusion: these findings provide important information about specific clinical methods, preventive methods, and improvements in the quality of life of renal transplant patients.El trasplante renal consiste en uno de los medios para mantener la vida en pacientes con enfermedad renal terminal y se trata del manejo con mayor coste-beneficio, sin embargo es un procedimiento quirúrgico complejo. Los factores asociados al desarrollo de la UTI post-transplante son multifactoriales y se definen según la relación entre los agentes etiológicos y las causas del anfitrión. La presencia de microorganismos están relacionados con mal pronóstico a corto y largo plazo en las unidades de trasplante renal. Ante esto, el objetivo del estudio fue analizar el perfil de microorganismos presentes y sensibilidad de éstos a los antimicrobianos en uroculturas de pacientes trasplantados renales en el período 2021-2022. Se trata de un estudio retrospectivo con análisis cuantitativo de los datos de uroculturas positivas de pacientes trasplantados renales acompañados en el Hospital General de Fortaleza entre enero de 2021 y diciembre de 2022. Se empleó un instrumento de investigación elaborado que contenía variables clasificatorias y los datos se obtuvieron a través de registros de las uroculturas existentes en el sistema de prontuario electrónico utilizado por el hospital. De las 534 uroculturas solicitadas, el 36,7% presentó resultado positivo, siendo el 60,4% mujeres de entre 20 y 59 años. La mayoría de los casos se desarrolló en pacientes que recibieron seguimiento ambulatorio (56,2%). Los microorganismos aislados fueron predominantemente enterobacterias (81,34%), con prevalencia de E. coli (69,30%). Los perfiles de sensibilidad antimicrobiana variaron, con la resistencia de E. coli a antibióticos como ampicilina, ácido nalidíxico, norfloxacino y ciprofloxacin. Estos hallazgos proporcionan información importante sobre métodos clínicos específicos, métodos preventivos y mejoras en la calidad de vida de los trasplantes renales.
Objetivo: analisar o perfil de micro-organismos presentes e resistência destes aos antimicrobianos em uroculturas de pacientes transplantados renais no período de 2021-2022. Métodos: trata-se de um estudo transversal com análise quantitativa dos dados de uroculturas positivas de pacientes transplantados renais, acompanhados no Hospital Geral de Fortaleza entre janeiro de 2021 a dezembro de 2022. Foi empregado um instrumento de pesquisa elaborado, contendo variáveis classificatórias, e os dados foram obtidos por meio de registros das uroculturas existentes no sistema de prontuário eletrônico utilizado pelo hospital. Resultados: das 534 uroculturas solicitadas, 36,7% apresentaram resultado positivo, sendo 60,4% de mulheres com idades entre 20 e 59 anos. A maioria dos casos foram desenvolvidos por pacientes que receberam acompanhamento ambulatorial (56,2%). Os micro-organismos isolados foram, predominantemente, enterobactérias (81,34%), com prevalência de E.coli (69,30%). Os perfis de sensibilidade antimicrobiana variaram, com a resistência da E.coli a antibióticos como ampicilina, ácido nalidíxico, norfloxacino e ciprofloxacino. Conclusões: essas descobertas fornecem informações importantes sobre métodos clínicos específicos, métodos preventivos e melhorias na qualidade de vida dos transplantados renais
Osteoarthritis induced by monosodium iodoacetate model: evolution of inflammatory, nociceptive and histopathological markers
Get PDFObjectives: this study aimed to highlight the evolution of the osteoarthritis (OA) model induced by monosodium iodoacetate (MIA) and its collaboration with the knowledge of the pathophysiology of inflammation, hypernociception and cartilage degeneration. Methods: PubMed and Science Direct were used with the descriptors: knee osteoarthritis or osteoarthritis of ankle) and (rat or osteoarthritis induced by monoiodoacetate) and (animal model of osteoarthritis or joint nociception). Studies containing rats, mice, and monoiodoacetate-induced osteoathritis were included. Exclusion criteria were: Animal models of osteoarthritis induced by destabilization; meniscectomy-induced osteoarthritis; non-invasive animal models of osteoarthritis induced by fracture, compression and tibial overload; animal models of osteoarthritis with large animals and models of osteoarthritis by papain or bacterial collagenase. We summarized studies that used MIA to induce knee or ankle OA in rats or mice and the evolution of the inflammatory markers. Results: a total of 38 original manuscripts met the inclusion criteria and were considered in the study. The model of OA induced by MIA is well-established and explored with several methodologies and has been widely used in different species. MIA induces cell death, progressive loss of chondrocytes and histological changes that mimics human OA. Studies with this model demonstrated inflammation, neurogenic hyperalgesia, release of cytokines and matrix metalloproteinases. More recently, molecular biology data confirm the activation of nuclear transcription factors, which modulates the expression of citokines in apoptotic chondrocytes. Conclusion: the MIA-induced OA has been useful in predicting several characteristics for the elucidation of osteoarthritis pathophysiology.Objectives: this study aimed to highlight the evolution of the osteoarthritis (OA) model induced by monosodium iodoacetate (MIA) and its collaboration with the knowledge of the pathophysiology of inflammation, hypernociception and cartilage degeneration. Methods: PubMed and Science Direct were used with the descriptors: knee osteoarthritis or osteoarthritis of ankle) and (rat or osteoarthritis induced by monoiodoacetate) and (animal model of osteoarthritis or joint nociception). Studies containing rats, mice, and monoiodoacetate-induced osteoathritis were included. Exclusion criteria were: Animal models of osteoarthritis induced by destabilization; meniscectomy-induced osteoarthritis; non-invasive animal models of osteoarthritis induced by fracture, compression and tibial overload; animal models of osteoarthritis with large animals and models of osteoarthritis by papain or bacterial collagenase. We summarized studies that used MIA to induce knee or ankle OA in rats or mice and the evolution of the inflammatory markers. Results: a total of 38 original manuscripts met the inclusion criteria and were considered in the study. The model of OA induced by MIA is well-established and explored with several methodologies and has been widely used in different species. MIA induces cell death, progressive loss of chondrocytes and histological changes that mimics human OA. Studies with this model demonstrated inflammation, neurogenic hyperalgesia, release of cytokines and matrix metalloproteinases. More recently, molecular biology data confirm the activation of nuclear transcription factors, which modulates the expression of citokines in apoptotic chondrocytes. Conclusion: the MIA-induced OA has been useful in predicting several characteristics for the elucidation of osteoarthritis pathophysiology
Tratamento cirúrgico de displasia fibrosa em mandíbula: relato de caso
Get PDFObjective: To describe a case of fibrous dysplasia in the mandible treated with functional osteoplasty. Case Report: A 40-year-old female patient presented at the bucomaxillofacial clinic, complaining of altered tongue positioning due to bone growth in the mandible. Physical examination revealed a firm, enlarged area in the left mandibular region, and radiographs showed a ground-glass appearance consistent with fibrous dysplasia. The treatment chosen was functional osteoplasty followed by preservation. Final Considerations: The approach is guided by the severity of the disease and its potential for deformity and recurrence, with osteoplasty selected to prevent mutilation and functional impairments.Objetivo: descrever um caso de displasia fibrosa em mandíbula tratada com osteoplastia funcional. Relato de caso: paciente de 40 anos, compareceu ao ambulatório de bucomaxilofacial queixando-se de alteração no posicionamento da língua devido à crescimento ósseo em mandíbula. Ao exame físico notou-se aumento de volume de consistência firme em região mandibular a esquerda e que radiograficamente evidenciava alteração em forma de vidro fosco compatível com displasia fibrosa. Como tratamento, optou-se pela osteoplastia funcional seguida de proservação. Considerações finais: a abordagem é norteada pela gravidade da doença e no seu potencial deformador e recidivante, sendo a osteoplastia escolhida para evitar mutilações e prejuízos funcionais
Antropometria, desempenho físico e modelos preditivos para a força de preensão manual relativa de adolescentes escolares
Get PDFPurpose: to propose predictive models for relative handgrip strength (RHS) in school adolescents, in addition to comparing anthropometric measurements and performance tests among adolescents, considering their body mass index (BMI). Methods: data from 100 adolescents between 13 and 16 years were analyzed regarding anthropometric measurements, physical performance through the absolute and relative horizontal impulsion test (AHI; RHI), and handgrip strength. Predictive models were developed considering height, sex, body mass index, and physical performance. Results: eutrophic adolescents had significantly higher RHS, AHI, and RHI when compared to overweight/obese adolescents (P<0.001). Height (β=0.305; P<0.001) and AHI (β=0.222; P=0.045) were positively associated with RHS, while female sex (β=-0.311; P=0.001) and BMI (β=-0.277; P=0.004) decreased this measure. Conclusion: overweight/obese adolescents have greater absolute strength but not relative strength to normal-weight adolescents. Height and AHI are positively associated with RHS, while female gender and BMI decrease this measure. These markers are easy to use to identify physical, functional, and health indicators in adolescents.Introducción: La obesidad es un problema creciente entre los adolescentes, afectando su salud y desarrollo físico y funcional. Así, este estudio tuvo como objetivo proponer modelos predictivos de la fuerza relativa de prensión manual (RPM) en adolescentes escolares, además de comparar medidas antropométricas y pruebas de rendimiento entre adolescentes, considerando su índice de masa corporal (IMC). Métodos: Se analizaron datos de 100 adolescentes entre 13 y 16 años de edad respecto a medidas antropométricas, rendimiento físico mediante el test de impulsión horizontal absoluta y relativa (IHA; IHR) y fuerza de prensión manual. Se desarrollaron modelos predictivos considerando variables como altura, sexo, índice de masa corporal y rendimiento físico. Resultados: Los adolescentes eutróficos tuvieron FPMR, IAH y IHR significativamente más altos en comparación con los adolescentes con sobrepeso/obesidad (P <0,001). La altura (β = 0,305; P < 0,001) y el IAH (β = 0,222; P = 0,045) se asociaron positivamente con la FPMR, mientras que el sexo femenino (β = -0,311; P = 0,001) y el IMC (β = -0,277; P = 0.004) disminuyó esta medida. Conclusión: Los adolescentes con sobrepeso/obesidad tienen mayor fuerza absoluta, pero no fuerza relativa en relación a los adolescentes con peso normal. La altura, el IAH se asocian positivamente con la FPMR, mientras que el sexo femenino y el IMC disminuyen esta medida. Estos marcadores son fáciles de usar como medidas para identificar indicadores físicos, funcionales y de salud en adolescentes.Objetivo: propor modelos preditivos para a força de preensão manual relativa (FPMR) em adolescentes escolares, além de comparar medidas antropométricas e testes de desempenho entre os adolescentes, considerando seu índice de massa corporal (IMC). Métodos: foram analisados dados de 100 adolescentes entre 13 e 16 anos de idade, quanto às medidas antropométricas, desempenho físico por meio do teste de impulsão horizontal absoluta e relativa (IHA; IHR) e força de preensão manual. Modelos preditivos foram desenvolvidos considerando as variáveis como estatura, sexo, índice de massa corporal e desempenho físico. Resultados: os adolescentes eutróficos apresentaram FPMR, IHA e IHR significativamente maiores em relação aos adolescentes com sobrepeso/obesidade (P<0,001). Estatura (β=0,305; P<0,001) e IHA (β=0,222; P=0,045) estavam positivamente associadas à FPMR, enquanto sexo feminino (β=-0,311; P=0,001) e IMC (β=-0,277; P=0,004) diminuíram essa medida. Conclusão: adolescentes com sobrepeso/obesidade apresentam maior força absoluta, mas não relativa em relação a adolescentes eutróficos. Estatura, IHA estão positivamente associadas à FPMR, enquanto o sexo feminino e o IMC diminuem essa medida. Esses marcadores são fáceis de usar como medidas de identificar indicadores físicos, funcionais e de saúde em adolescentes
Perfil sociodemográfico da tuberculose no estado de São Paulo antes e durante a pandemia de COVID-19
Get PDFObjective: to describe the sociodemographic profile of patients in the state of São Paulo with Tuberculosis in relation to the COVID-19 pandemic. Methods: the study was carried out by collecting data in the SUS Hospital Information System (SIH/SUS) linked to DATASUS, according to the State\u27s processing variables in 2019-2022 concerning Tuberculosis diagnoses. Results: between 2019 and 2022, 69,053 cases of TB were reported in the State of São Paulo. The largest number of cases occurred after the height of the COVID-19 pandemic in 2022 (27.12%). As for mortality, there was an increase during the period analyzed, with 2022 being the year with the highest rate. There was a reduction in notifications between 2020 and 2021. Regarding race, the incidence is predominant in black people, followed by indigenous people. In 2020 and 2021, in white people, the incidence was 5.21%, brown people 11.98%, black people 19.54%, yellow people 4.86%, and indigenous people 13.29%. Regarding gender, more than half of the cases were attributed to males (72.1%). Conclusion: it is necessary to return financial investments in primary care with a focus on eradicating Tuberculosis, as it is one of the pathologies impacted by COVID-19.Objetivo: descrever o perfil sociodemográfico dos pacientes do estado de São Paulo com tuberculose em relação à pandemia de COVID-19. Métodos: estudo realizado mediante coleta de dados no Sistema de Informações Hospitalares do SUS (SIH/SUS) vinculado ao DATASUS, segundo as variáveis de processamento do Estado nos anos 2019-2022 em relação aos diagnósticos de tuberculose. Resultados: entre os anos de 2019 e 2022, foram notificados 69.053 casos de TB no Estado de São Paulo. A maior quantidade dos casos ocorreu após o apogeu da pandemia de COVID-19, no ano de 2022 (27,12%). Quanto à mortalidade, houve um aumento durante o período analisado, sendo 2022 o ano que teve a maior taxa. Evidenciou-se uma redução de notificações entre os anos de 2020 e 2021. Quanto à raça, a incidência é predominante nos negros, seguida pelos indígenas. Em 2020 e 2021, em brancos, a incidência foi 5,21%; pardos 11,98%; negros 19,54%; amarelos 4,86% e indígenas 13,29%. Em relação ao sexo, mais da metade dos casos foi atribuída ao sexo masculino (72,1%). Conclusão: faz-se necessário o retorno de investimentos financeiros na atenção primária com foco na erradicação da tuberculose, uma vez que é uma das patologias impactadas pela COVID-19
Facial edema associated to central vein stenosis in a chronic kidney disease patient
Get PDFIntroduction: central vein stenosis (CVS) is a common complication in chronic kidney disease (CKD) patients, leading to vascular complications and higher mortality. Exposure to catheters is an important risk factor, and there is a wide spectrum of clinical presentation, including edema of the upper arm, neck, upper chest, and face, impairment of dialysis efficiency, and reduction of vascular accesses. Case report: a 41-year-old woman with CKD on dialysis and a history of multiple vascular accesses was admitted with a 3-month history of cervical and left hemiface edema. An angiotomography revealed marked stenosis in the proximal segment of the left brachiocephalic vein, and a venography confirmed the diagnosis of CVS, with subocclusive stenosis of the venous trunk and significant collateral veins. An endovascular treatment was performed with balloon angioplasty. She presented considerable improvement in the edema after the procedure. Conclusion: to avoid the development of central vein obstruction, it is important to enhance our knowledge about the main risk factors associated with this pathology. Although it is a treatable condition, recurrence of symptoms may occur, and subsequent vascular interventions may be needed. Therefore, prevention strategies are the most efficient approach.Introduction: central vein stenosis (CVS) is a common complication in chronic kidney disease (CKD) patients, leading to vascular complications and higher mortality. Exposure to catheters is an important risk factor, and there is a wide spectrum of clinical presentation, including edema of the upper arm, neck, upper chest, and face, impairment of dialysis efficiency, and reduction of vascular accesses. Case report: a 41-year-old woman with CKD on dialysis and a history of multiple vascular accesses was admitted with a 3-month history of cervical and left hemiface edema. An angiotomography revealed marked stenosis in the proximal segment of the left brachiocephalic vein, and a venography confirmed the diagnosis of CVS, with subocclusive stenosis of the venous trunk and significant collateral veins. An endovascular treatment was performed with balloon angioplasty. She presented considerable improvement in the edema after the procedure. Conclusion: to avoid the development of central vein obstruction, it is important to enhance our knowledge about the main risk factors associated with this pathology. Although it is a treatable condition, recurrence of symptoms may occur, and subsequent vascular interventions may be needed. Therefore, prevention strategies are the most efficient approach