Santa Casa De Research Articles

An economic study of neuro-oncological patients in a large developing country: a cost analysis.

Neuro-oncological patients require specialized medical care. However, the data on the costs incurred for such specialized care in developing countries are currently lacking. These data are relevant for international cooperation. The present study aimed to estimate the direct cost of specialized care for an adult neuro-oncological patient with meningioma or glioma during hospitalization in the largest philanthropic hospital in Latin America. The present observational economic analysis describes the direct cost of care of neuro-oncological patients in Santa Casa de São Paulo, Brazil. Only adult patients with a common primary brain tumor were included. Due to differences in the system records, the period analyzed for cost estimation was between December 2016 and December 2019. A group of patients with meningiomas and gliomas was analyzed. The estimated mean cost of neurosurgical hospitalization was US$4,166. The cost of the operating room and intensive care unit represented the largest proportion of the total cost. A total of 17.5% of patients had some type of infection, and 66.67% of these occurred in nonelective procedures. The mortality rate was 12.7% and 92.3% of all deaths occurred in emergency procedures. Emergency surgeries were associated with an increased rate of infections and mortality. The findings of the present study could be used by policymakers for resource allocation and to perform economic analyses to establish the value of neurosurgery in achieving global health goals.

Prevalence of postpartum depression in patients with migraine

Introduction Migraine is a disease of the central nervous system characterized by moderate or severe headache. Migraine is considered the third most prevalent disease and the seventh specific cause of incapacity in the world. The prevalence of migraine in women increase after menarche compared with the prevalence of migraine in men. According to previous population-based studies, during reproductive years, a woman who has the diagnosis of menstrual migraine experiences the same symptoms throughout pregnancy and postpartum. Childbirth is a major event in a woman’s life. However, some mothers might present symptoms of postnatal depression. Postpartum depression is a mental disorder that reflects on the maternal role. Thus, it has negative consequences for them and their children. Postpartum depression is associated with increased risk for cognitive BB impairment, emotional difficulties and behavioral problems. Clinically, headache influences the mental and physical health of pregnant and postpartum women. Studies reported that anxiety and depression disorders are two to ten times more common in migraineurs than in the general population. Therefore, it can be a risk for postpartum depression development. Objective To verify postpartum depression in migraine and non-migraine parturients. Methods Data was collected from a sample of 155 women, older than 18 years old, in the obstetric center of Santa Casa de Misericórdia de Barbacena, between October 2021 and August 2022, in the first 24 hours after labor by the members of the research. Clinic and concomitant disorders were collected from the patient's record. Parturients who did not agree to participate in the study and those with cognitive impairment were excluded. All the patients signed an informed consent form to participate in the study. All the patients answered the Edinburgh Postnatal Depression Scale (EPDS) and the ID-Migraine... (To see the complet abstract, please, check out the PDF.)

Prevalence of postpartum depression in patients with migraine

Introduction Migraine is a frequent and chronic condition that affects 3 times more women than men. Overall, it shows that migraine is influenced by variables such as fluctuating hormones levels throughout life with migraine. Women can also experience symptoms of postpartum depression (PPD) which can cause issues for new moms in terms of behavior, emotion and cognition. Clinical investigations have shown that headaches affects pregnants and parturients. Objective To verify PPD in migraine and non-migrainous parturients. Methods Data was collected from a sample of 155 women over 18 years old in the obstetric center of Santa Casa de Misericórdia de Barbacena, from October 2021 to August 2022, in the first 24 hours after labor. Parturients who did not agree to participate and those with cognitive impairment were excluded. All patients signed an informed consent form and answered the Edinburgh Postnatal Depression Scale (EPDS) and the ID-MigraineTM, in addition to clinic data and concomitant disorders from the patient's record. Results 25 of the 155 postpartum women achieved the criteria for migraine and 130 for non-migraine. Of the patients with postpartum depression associated with migraine, 4 were classified as migraine and 8 as non-migrainous. Among patients who had headaches during pregnancy, 11 had PPD compared to those who did not have headaches during pregnancy: 1. The OR=8.9 (CI 1.12-70) and RR=7.9 (CI 1.05-60) were higher compared to those who did not have PPD. The analysis did not find a relation between migraine and PPD. However, a relation was found between headaches during pregnancy and the presence of PPD (p<0.05). Conclusion Patients who experienced headaches while pregnant are more likely to have postpartum depression. However, migraine-diagnosed puerperal women do not present considerable concerns for the development of depression.

423.4: Raising the Potential of Transplantation With a KPD Collaborative Program

Purpose: Up to 30% of potential living donor/recipient pairs cannot proceed to live donor kidney transplantation (LDKT) for immunological reasons (ABO incompatibility or positive crossmatch). Kidney Paired Donation (KPD) programs have been conducted in various countries for over 20 years as an alternative for these patients. Our goal was to estimate the potential of paired transplantation when increasing the pool of pairs by collaboration between 2 centers in Brazil. Methods: We conducted simulated match-runs involving 2 centers: Santa Casa de Misericórdia de Juiz de Fora (SC) and Hospital das Clínicas da Universidade de São Paulo (HC). At SC, all the contraindicated donor-recipient pairs because of a positive crossmatch between January 2013 - February 2022 and whose recipients are still on the waitlist were included (N= 28 recipients and 39 donors). At HC, the pool is composed of pairs enrolled in a KPD study protocol that already performed its first paired transplant in March 2020 (N= 25 recipients and 28 donors). We used the StanfordKPD platform to optimize transplant numbers favoring high PRA recipients matches. Four acceptable ranges of DSAs MFI were established (<500, <1500, <3000 and <5000), three types of programs (accepting only 2-way exchanges; 2-and-3-way exchanges and N-way exchanges) and we also evaluated the possibility of collaboration between centers. Results: The demographic data of both pools are shown in Table 1. The results of various KPD match-runs are shown in Table 2. As was expected, the number of transplants increases when allowing longer chains, higher MFI thresholds and collaboration between the centers. Despite the high median PRA in the pool, the StanfordKPD platform was able to find a match for up to 64% of the recipients when allowing MFI <5000. This is especially possible when we combine KPD with desensitization.Conclusions: A KPD program can enable kidney transplant for hard-to-match patients, that tend to accumulate on the waitlist. The probability of finding a match rises with the increase of the pool of pairs and the flexibilization of the acceptance criteria.

Intraobserver and Interobserver Reliability of the Lenke Classification Among Spine Surgeons

Objective: The objective of this study was to analyze the intraobserver and interobserver reliability of the Lenke classification among spine surgeons from the city of Salvador, Bahia. Methods: Preoperative imaging (front, profile and lateral inclinations) examinations of 20 patients at the Outpatient Clinic of the of Santa Izabel Hospital Orthopedic Department, Salvador, Bahia, who had been diagnosed with adolescent idiopathic scoliosis, were selected to be evaluated by 15 spine surgeons two times at an interval of 30 days, for analysis of the intraobserver and interobserver reliability of the Lenke classification. The project was first submitted for ethical analysis to the Institutional Review Board of the Santa Izabel Hospital - Santa Casa de Misericórdia da Bahia / Prof. Dr. Celso Figueirôa and approved with voucher number 002650/2019. All the participants signed the Informed Consent Form (ICF). Results: Analyzing the concordance using the Kappa index, interobserver reproducibilities of 0.755, 0.525 and 0.840 were obtained for the type of curve and the lumbar and sagittal modifiers, respectively, while the intraobserver reliabilities for the same parameters were 0.921, 0.370 and 0.929. Conclusion: For the study population, the reliability of Lenke’s classification was moderate to almost perfect. Level of evidence III; Interobserver and intraobserver reliability.

Effects of Cimicifuga racemosa (L.) Nutt on sexual function in women receiving tamoxifen for breast cancer

To assess the effects of Cimicifuga racemosa (L.) Nutt on climacteric symptoms and sexual function in women receiving tamoxifen after breast cancer treatment. A prospective study of women treated at the Mastology Outpatient Clinic of the Department of Obstetrics and Gynecology of the Santa Casa de Sao Paulo School of Medical Science of the hospital was conducted between 2018 and 2021. Patients diagnosed with breast cancer that underwent surgical, radiotherapy and chemotherapy treatment more than one year prior, receiving tamoxifen, exhibited climacteric symptoms and were sexually active were selected. Total of 34 women were recruited and during outpatient visits completed sociodemographic questionnaire, Blatt-Kupperman Index (KI) and Female Sexual Function Index (FSFI). The group showed improvements in climacteric symptoms (p<.001) and sexual function (p=.011) after the 6-month follow-up. Cimicifuga racemosa (L.) Nutt promoted improvements in climacteric symptoms and sexual function in women surgically treated for breast cancer. Clinical Trials.gov ID: NCT02467686. Impact Statement What is already known on this subject? The medications used for the treatment of breast cancer can lead to important complaints of vasomotor manifestations with a negative impact on the success of their treatment, and cases have been described until their interruption. Cimicifuga racemosa (L.) Nutt. is described in several works as a therapy to alleviate these symptoms. Numerous works in the literature present climatic symptoms and sexual function with a selective approach to the themes. What do the results of this study add? Our study evaluated a group of women who were treated for breast cancer after menopause taking into account the following aspects: climacteric symptoms and sexual function. When we reviewed the literature, we did not find, so far, work similar to ours. What are the implications of these findings for clinical practice and/or further research? In clinical practice, assessing vasomotor symptoms and sexual response of breast cancer patients can contribute towards improving the lives of this patient group. Prescribing Cimicifuga racemosa (L.) Nutt in cases with climacteric complaints and poor sexual response can relieve distress and promote better health and life status for these women. Although the present investigation has generated important data on female breast cancer survivors, there are limitations regarding the number of participants. We recommend further clinical research with expansion of the sample studied and the results presented.

Alteração da complacência intracraniana em paciente com doença renal crônica e diabetes mellitus T1: um relato de caso

Objective: The aim of this study was to relate the clinical profile with data on blood pressure (BP), intracranial pressure (ICP) and laboratory tests of a patient with Diabetes mellitus (DM) type 1 and chronic kidney disease (CKD) stage 5. Methodology: The research was carried out at the renal replacement therapy outpatient clinic of the Santa Casa de Misericórdia hospital, in Ponta Grossa-PR, previously approved by the ethics committee, under opinion nº 4,039,453. ICP monitoring and BP measurement were performed twice, on follow-up consultation days, in February and September 2020. In addition to the aforementioned parameters, a questionnaire on the patient's habits and demographic data was applied, and a consultation was carried out with the patient medical record for the collection of laboratory test data. Results: From February to September, the volunteer presented with persistent Systemic Arterial Hypertension (SAH) and hyperglycemia, and worsening of laboratory parameters. In February, the ICP morphology showed a significant change, suggesting intracranial hypertension, and the patient had a great impairment of visual acuity. In September, despite the worsening of the health condition, there was a significant improvement in vision and, also, an improvement in the ICP parameters, approaching normality. Between consultations, the diuretic administered by the patient was replaced. Conclusion: it is suggested that the visual impairment is due to intracranial hypertension and the improvement of both is related to the replacement of hydrochlorothiazide by furosemide, which occurred between consultations.

Potentially inappropriate medication use in hospitalized elderly patients.

SUMMARYOBJECTIVE:This study aimed to assess the prevalence of potentially inappropriate medication prescription in hospitalized elderly patients according to the 2019 American Geriatrics Society Beers Criteria.METHODS:This study is a prospective analysis of electronic medical records of elderly patients admitted to the Department of Medicine, Hospital Central da Irmandade da Santa Casa de Misericórdia de São Paulo, between 1 September 2020 and 30 April 2021.RESULTS:A total of 142 patients (85 women and 57 men) with a mean age of 74.5±7.3 years (65–99 years) were assessed. Of these, 108 (76.1%) were elderly (age ≥65 years and <80 years) and 34 (23.9%) long-lived (age ≥80 years). The average length of stay found in the sample was 25.3±28.7 days (between 2 and 235 days), and 102 out of the 140 patients assessed remained in the hospital for up to 29 days. Sixteen drugs considered potentially inappropriate medication were found in the patients’ prescriptions, with at least one potentially inappropriate medication having been prescribed to 141 (99.3%) patients. Elderly patients had a mean of 2.57±0.94 potentially inappropriate medication prescribed versus 2.56±0.89 among long-lived patients. The most prescribed potentially inappropriate medication were as follows: regular human insulin as required (85.2%), and omeprazole (73.9%) and metoclopramide as required (61.3%).CONCLUSION:The study sample showed significant percentages of potentially inappropriate medication prescriptions for the elderly admitted to the hospital.

Teaching and practice in Homeopathy via pharmacobotany and pathophysiology

Background: Semiology, Clinical Pathophysiology, Phytotherapy and Homeopathy were taught through active methodology by the Moodle platform (HL) also using apps for monitoring injuries through SAPB site, building rationality for the external topic use of homeopathic and herbal medicines. At the 7th Infirmary of General Hospital Santa Casa de Misericordia in Rio de Janeiro, the clinical medical team of the Benoit Mure Nucleus of Assistance Teaching and Research, made a medicinal plant garden with the agricultural/environmental educator, and community ethnical leaders. Undergraduate students from UNIFASE/FMP Academic League of Physiology and Pathophysiology planted Calendula Officinalis seedlings, destined to research in pharmacobotany and to be in touch with pharmacotechnical prepares. Aims: To follow-up the study since from seedling of Calendula Officinalis till to prepare of HUD. Methodology: To prepare medicinal garden: plant seedlings of Calendula offin accordance with good agricultural techniques. At first: Three seeds in ten pots, made in triplicate (N = 90), to obtain explants of quality analyzed whose evaluation was about plant development (explants percentual: weight, size, viability, morphology). To visit pharmacy-school to learn how to prepare matrix extracts and High Ultra-Diluted Solutions (HUD) of Calendula off 6DH. Results and Discussion: The stages of teaching semiology and practice in pharmacobotany, besides cultive plant have been completed. Viability was impaired because of lack of irrigation during 4 months (50%). Weight, size were minor than usual but with no statistical significance (p&gt;0.05). Morphology was maintained. Unfortunately, the visit to pharmacy-school couldn’t be performed at this period. Conclusion: Through hybrid learning and face-to-face activities completely realized, students had qualitative perception of the relevance about morphology and quality of plant development, chemistry plant production, aiming for resolutive actions based upon pathophysiology of chronic diseases. Because of pandemic, it was described just a preliminary experience. After returning to normal activities the experiment will be repeated.

The impact of COVID-19 in children and adolescents with obesity in Brazil.

The primary goal of the study was to evaluate weight gain in children and adolescents with obesity during the COVID-19 pandemic period, and compare it with the period before the pandemic. The sample comprised 68 children with obesity aged between 7 and 18 years, 30 (44.1%) boys and 38 (55.9%) girls, who were attended at the pediatric endocrinology clinic of the Irmandade da Santa Casa de Misericórdia de São Paulo, SP, Brazil. Weight gain in the sample in the pre-lockdown period (December 2, 2018 to March 11, 2020) was compared with that in the lockdown period (March 11, 2020 to February 21, 2021). Approximately one year before the start of the pandemic period, the mean (SD) chronological age was 10.1 years old (± 2.4), and an average weight gain of 4.4 kg (± 4.8) was observed during the pre-lockdown period described. One year after the start of the pandemic, mean (SD) chronological age was 11.8 years old (± 2.4), and an average weight gain of 8.5 kg (± 7.6) was observed in the lockdown period described. When we compared the weight gain in the two periods, it was higher in the pandemic period, both in girls and boys (p = 0.013 and 0.035, respectively). The results of the study show that the period of social isolation adopted to mitigate the COVID-19 pandemic was associated with increased weight gain in the studied population, probably due to a reduction in physical activities and an increase in energy consumption.

Predictive values of the Pediatric Penetrating Ocular Trauma Score and the Toddler/Infant Ocular Trauma Score in Brazilian children with open globe injury.

ObjectiveThis study compared the prognostic value of the Pediatric Penetrating Ocular Trauma Score (POTS) with the Toddler/Infant Ocular Trauma Score (TOTS) in a cohort of Brazilian children with open-globe injuries.MethodsThis retrospective, observational case series included consecutive children with open-globe injuries seen at the Santa Casa de Sao Paulo Eye Emergency Service. The medical records of all patients were reviewed for data analysis, including the circumstance and time of injury, type of penetrating injury, initial and final visual acuity (VA), time of surgery, and associated eye diseases. The test characteristics of POTS and TOTS for VA were calculated and compared by the McNemar test.ResultsThirty patients were included. The mean age was 3.9 ± 1.6 years; 20 were male patients and 10 were female patients. Most wounds were limited to the anterior segment (93.3%). The sensitivity for the POTS was higher than that of the TOTS (100%; 95% confidence interval [CI], 75.3–100 vs. 61.5%; 95% CI, 31.6–86.1; P = 0.014). The specificity was not significantly different (14.3%; 95% CI, 0.4–57.8 vs. 0%; 95% CI, 0–41.0; P = 0.563). The accuracy for the POTS was higher than the TOTS (70.0%; 95% CI, 45.7–88.1 vs. 40.0%; 95% CI, 19.1–63.9; P = 0.001).ConclusionIn this cohort of Brazilian children with open-globe injuries, the POTS had better accuracy than did the TOTS in predicting VA after treatment.

Health profile of the patients with pre-eclampsia in a referral hospital in the Amazon region.

To describe the epidemiological and clinical profile of the patients with preeclampsia in a hospital in the Amazon region. Observational descriptive cross-sectional study, performed at Fundação Santa Casa de Misericórdia do Pará, a maternity hospital in Pará, Brazil. The pregnant patients admitted between July 1st and December 31st 2018 due to pre-eclampsia had their medical records researched to describe their epidemiological profile, medical history, obstetric profile and clinical manifestations of pre-eclampsia. Patients with incomplete data were not included in the missing variable's rate. 3450 pregnant patients were admitted, and 381 of them due to pre-eclampsia, revealing a 11.04% prevalence. Both arithmetic mean and median of maternal age were approximately 27 years. 94.25% of the participants were parda. Regarding medical history, 50.27% had chronic hypertension, and 37.23% had urinary tract infection during pregnancy. The obstetric profile revealed that 42.26% were primigravid, and 30% of the multigravid participants had already manifested pregnancy hypertension. 78.1% of the participants attended less than 6 prenatal consultations, and 10.03% used chemical substances during pregnancy. Twin pregnancy had a 3.14% prevalence. Beyond hypertension and proteinuria, scotoma was the most frequent (28.57%) clinical manifestation. 2.36% of the patients developed seizures, mostly (55.55%) before 37 weeks of pregnancy. The profile of the participants was mean age 27 years, parda race, with chronic hypertension, single fetus, multigravid without previous pregnancy hypertension, with less than 6 prenatal consultations, no use of chemical substances and without any manifestations of pre-eclampsia beyond hypertension and proteinuria.

A case report on the septic arthritis in a newborn: therapeutic approaches and major considerations

Introduction: The prevalence of septic arthritis (SA) is higher in underdeveloped countries than in developed countries, and the number of hospitalizations of children for this cause is decreasing and the most prevalent age group is between 0 and 4 years of age. Clinical history and detailed physical examination are essential to make an accurate diagnosis, but the neonatal period has certain limitations. Objective: To report a case of septic arthritis that occurred in a newborn admitted to the Neonatal Intensive Care Unit (ICU) due to its serious condition, morbidity, and unusual evolution of the pathology in the pediatric population, scarcity of epidemiological data on the subject, still aiming address aspects of the treatment of the disease. Case report: Male patient, born on 09/11/2020 at Santa Casa de Tupã, Sao Paulo, with a gestational age of 36 weeks and 6 days, through cesarean delivery and without complications, obtaining APGAR 9 and 10, and maintained in a room with the mother. The morning after birth, the newborn (NB) began to groan and have mild respiratory distress. The patient evolved with worsening of the breathing pattern and oxygen was concentrated at 6L/min in Hood's Halo, presenting hyperthermia, hyperemia, and edema in the right elbow. Laboratory tests showed an increase in C-Reactive Protein and worsened hematimetric indices of the blood count, and antibiotic therapy was then started with oxacillin 50 mg/kg/dose and amikacin 15 mg/kg/day. The ultrasound of the right elbow showed skin thickening, absence of collections, and no changes in vasculature, being suggestive of cellulite. A new ultrasound of the right elbow showed bulging, intra-articular collection, and discreet collection with extra-articular communication in the medial region, being suggestive of septic arthritis. Blood culture collection resulted in the growth of gram-positive cocci (Staphylococcus aureus) in a pair of samples. The patient received intravenous treatment with Vancomycin for 14 days with clinical and laboratory improvement of the infection and was discharged with the use of oral Clindamycin for another 14 days and physical therapy follow-up for rehabilitation of movement of the affected limb. Final considerations: Due to the unusual evolution of SA in the neonatal period, and the scarcity of literature on the pathology in this age group, the importance of further studies on the subject, and greater surveillance for neonatal diagnosis, in addition to early treatment to reduce of complications.

Low T3 syndrome as a prognostic factor in patients in the intensive care unit: an observational cohort study

ObjectiveTo assess euthyroid sick syndrome as a prognostic factor in patients in the intensive care unit; to detect factors that may affect mortality; and to develop an equation to calculate death probability.MethodsThis was a longitudinal, observational, nonconcurrent cohort study developed in the intensive care unit of Fundação Santa Casa de Misericórdia do Pará. One hundred adults with no prior documented endocrinopathy were submitted to a 20mL blood sample collection for the measurement of thyroid stimulating hormone, free tetraiodothyronine, free triiodothyronine and reverse triiodothyronine.ResultsMost patients were female, aged 20 to 29 years. Most patients who died were older (median age of 48 years), and euthyroid sick syndrome was present in 97.5% of them. Euthyroid sick syndrome was related to death, comorbidities, age and length of stay in the intensive care unit (median of 7.5 days).There was an association between lower thyroid stimulating hormone and death. Patients with free triiodothyronine levels below 2.9pg/mL were more likely to die; reverse triiodothyronine rates were above 0.2ng/mL in those who died. Free triiodothyronine had greater sensitivity and accuracy, and reverse triiodothyronine had greater specificity to predict mortality. Based on the results and cutoff points, a multiple logistic regression formula was developed to calculate the probability of death.ConclusionThe main limitation of this study is the fact that it was conducted in a reference hospital for maternal and child care; therefore, there was a greater number of female patients and, consequently, a sampling bias existed. However, opportune measurement of free and reverse triiodothyronine levels in critical patients and application of the proposed equation are suggested.

Violence against women

Violence against women is any form of discrimination, aggression or coercion, caused by the simple fact that the victim is a woman and causes physical, psychological, sexual, or moral damage, whether in the public or private sphere. It is a manifestation of historically unequal power relations between genders, which were gradually built and which continue today, showing the importance of knowledge of the actions of the Unified Health System (SUS) that coordinate and guide the conduct of health professionals, especially from the doctor. The present study aims to investigate medical conduct in the care of women victims of violence, SUS actions, and programs, specifically carried out at the Santa Casa de Misericórdia do Pará Foundation. This is a quantitative study and the instrument used was a questionnaire, prepared by the authors. Thirty-three physicians answered the questionnaire, where 97% have already assisted women in situations of violence, 97% know the protocols for the care of women victims of violence, and 67% judge public health actions to support these victims as ineffective. The data allow us to conclude that SUS actions have the potential to have a direct impact in the context of violence against women, if the necessary support is provided to make complaints, in addition to long-term protection and prevention protocols.

Análise da influência da endometriose na qualidade de vida

Abstract Introduction: Endometriosis is a disorder that can significantly affect quality of life (QOL) and interfere in biological, psychological, social, marital and family aspects. Objective: To analyze the influence of endometriosis on the QOL of women diagnosed with the disease. Methods: The study was carried out from March to April 2018, with 10 volunteers from the Santa Casa de Misericórdia do Pará Foundation, with a clinical diagnosis of endometriosis. The Portuguese version of the endometriosis health profile questionnaire (EHP-30) was applied in order to assess QOL in women with this pathology. Results: The sociodemographic results revealed a predominance of women aged between 29 and 55 years, most of whom were married (6) and high school graduates (5). Seven of the ten volunteers had previous pregnancies. Of the aspects evaluated in the EHP-30, 79% of the items associated with pelvic pain in the core questionnaire were present in the participants. In other questionnaires, sexual life (82%) was the most affected index, followed by professional life (70%) and infertility (58.82%). Conclusion: The aspects of QOL most impacted by pelvic pain associated with endometriosis in the women evaluated were sexuality and professional life, leading to biopsychosocial trauma.

Low T3 syndrome as a prognostic factor in patients in the intensive care unit: an observational cohort study.

To assess euthyroid sick syndrome as a prognostic factor in patients in the intensive care unit; to detect factors that may affect mortality; and to develop an equation to calculate death probability. This was a longitudinal, observational, nonconcurrent cohort study developed in the intensive care unit of Fundação Santa Casa de Misericórdia do Pará. One hundred adults with no prior documented endocrinopathy were submitted to a 20mL blood sample collection for the measurement of thyroid stimulating hormone, free tetraiodothyronine, free triiodothyronine and reverse triiodothyronine. Most patients were female, aged 20 to 29 years. Most patients who died were older (median age of 48 years), and euthyroid sick syndrome was present in 97.5% of them. Euthyroid sick syndrome was related to death, comorbidities, age and length of stay in the intensive care unit (median of 7.5 days).There was an association between lower thyroid stimulating hormone and death. Patients with free triiodothyronine levels below 2.9pg/mL were more likely to die; reverse triiodothyronine rates were above 0.2ng/mL in those who died. Free triiodothyronine had greater sensitivity and accuracy, and reverse triiodothyronine had greater specificity to predict mortality. Based on the results and cutoff points, a multiple logistic regression formula was developed to calculate the probability of death. The main limitation of this study is the fact that it was conducted in a reference hospital for maternal and child care; therefore, there was a greater number of female patients and, consequently, a sampling bias existed. However, opportune measurement of free and reverse triiodothyronine levels in critical patients and application of the proposed equation are suggested.

Funcionários da saúde com relatos de dor de cabeça em hospital de médio porte no interior de São Paulo e automedicação com analgésicos

The aim was to detect the level of headache prevalence and awareness of the nursing team regarding self-medication for headache, 50 nursing professionals answered the questionnaire applied at Santa Casa de Misericórdia de Avaré, the data obtained were analyzed by the Epi-Info® software. Self-medication with analgesics is something very common among health professionals. Nursing has a pharmacological knowledge base and for this reason has greater self-confidence to self-medicate. It was evidenced that 100% of people are aware of self-medication and are fully aware of its risks, although this knowledge does not prevent 78.9% of people who participated in the research from self-medicating with analgesics, the ease of access to drugs makes it easier for the individual to self-medicate to feel pain relief, which may be camouflaging a more serious disease, causing chronic dependence or collateral damage in their body by the use of analgesics with certain types of active principles. A relative percentage sought medical attention for headache although this did not prevent them from self-medicating with other non-prescription drugs.

Mannheim's peritonitis index in the prediction of postoperative outcome of peritonitis.

evaluate the effectiveness of MPI to predict mortality in patients with peritonitis in Santa Casa de Misericordia de Vitoria Hospital (HSCMV). a longitudinal observational cohort retrospectively study, with a sample of 75 patients diagnosed with peritonitis between January 2010 to December 2 of 2015, in HSCMV and with all the necessary criteria for the calculation of IPM. we found a profile of the patients, 33 female and 42 male, mean age 42 years, 11 deaths and 14.67% mortality percentage. Comparing the MPI variables into two groups (survivors and deceased) was found that older than 50 years, presence of malignancy and patients with organ dysfunction have statistical significance for mortality, with p<0.05. The MPI ranged between 4-41 points, with average of 21.2 points. However, among the dead, the score ranged from 23 to 41, with a mean of 32.8. Therefore, the cutoff point of 27 points was established by evaluating the best value of Kappa concordance index, and through it were calculated: 90.90% sensitivity and specificity of 78.13% by the ROC curve. based on these results, it was established that the MPI was effective in estimating the risk of death when the index reaches values = 27 points. Categorizing patients into different risk groups helps in determining a better prognosis and defining operative risk, thus contributing to the choice of the surgical procedure nature.

Dengue infection in kidney transplant recipients: clinical course and its impact on renal function.

Introduction:Kidney transplant recipients (KTR) are at increased risk for dengue virus (DENV) infection. The aim of this study was to outline the clinical presentation and laboratory profile of DENV infection in KTR and its impact on renal function.Methods:This was a retrospective study of KTR diagnosed with DENV infection. Adult patients who visited Santa Casa de Belo Horizonte Nephrology Center between April and September 2019 were included. Patients who did not sign the Informed Consent were excluded. Data were collected from the database and medical records. The study was approved by the local Institutional Ethics Committee and the Informed Consent was obtained.Results:Nineteen KTR were evaluated. The main signs and symptoms were myalgia, headache/retro-orbital pain, fever, and gastrointestinal symptoms. Two patients had acute cholecystitis without calculus, three experienced pleural and/or pericardial effusion, and one developed acute myocarditis. All patients were under immunosuppression with prednisone, tacrolimus, and mycophenolate, and most were not receiving induction therapy. Temporary suspension/reduction of immunosuppression was required in 58% of patients and leukopenia was the most common reason. Thrombocytopenia was common and 58% of patients developed acute kidney injury. All patients recovered renal function.Conclusions:DENV infection in KTR patients seems to follow a similar course as in the general population. Although there was no control group, we suspect that immunosuppression, preexisting kidney disease or type of donor was not a determining factor in most patients. Transient renal dysfunction was common but reversible. No patient experienced death or graft loss.