Desigualdades por sexo e por raça e o direito aos transplantes de órgãos no Brasil = Inequalities by gender and race and the right to organ transplantantion in Brazil

- Volume e número errados no rodapé do documento. Onde se lê: v. 12, n. 3, leia-se: v. 13, n. 1

Desigualdades por sexo e por raça e o direito aos transplantes de órgãos no Brasil

O presente texto trata do perfi l dos transplantados e do problema das desigualdades no acesso aos transplantes de órgãos no Sistema Nacional de Transplantes (SNT) do Sistema Único de Saúde (SUS). A equidade nos procedimentos relacionados com transplantes de órgãos no Brasil recebe garantias constitucionais. Um recorte por gênero indica que o Brasil tem população com maioria de mulheres. Sob o ponto de vista étnico, pretos e pardos são a maioria da população. As necessidades de transplantes não diferem muito entre esses diferentes grupos populacionais. A despeito disso, contata-se que a maioria dos transplantes de órgãos, no Brasil, são feitos em homens e em brancos. Existem inúmeras causas para essas desigualdades

ULTRASSONOGRAFIA DOPPLER EM OBSTETRÍCIA DE PEQUENOS ANIMAIS: REVISÃO DE LITERATURA

Considerando os recentes avanços em diagnóstico por imagem para animais de companhia, a ultrassonografia Doppler está se destacando como uma importante e adequada ferramenta não invasiva para a avaliação do fluxo sanguíneo, utilizada para o estudo do ciclo estral em cadelas e gatas, assim como no diagnóstico e acompanhamento da gestação, no estudo da viabilidade fetal e na detecção da malignidade em tecidos mamários nestas espécies. Em machos, os estudos com a técnica Doppler em tecidos prostáticos e testiculares são recentes, com grandes perspectivas para sua aplicabilidade. Dessa forma, esta revisão tem como objetivo descrever o uso da técnica de ultrassonografia Doppler em reprodução e obstetrícia veterinária de pequenos animais, além de trazer um breve histórico a respeito dos diferentes modos de apresentação da tecnologia, que podem ser utilizadas em medicina veterinária de animais de companhia

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Disparidades nas filas para transplantes de órgãos nos estados brasileiros

Avaliamos alguns aspectos dos transplantes de órgãos nas Unidades da Federação brasileira, nos anos de 2004, 2005 e 2006. Estimamos, com base em um modelo de teoria das filas, os tempos de espera para transplantes de coração, córnea, fígado, pulmão, rim, pâncreas, e transplante simultâneo de rim e pâncreas. Os resultados indicam redução na espera por alguns órgãos (córnea, e pâncreas); elevação em outros (fígado, coração, rim/pâncreas); e ligeiras flutuações, sem tendência muito definida, nos transplantes de rim e nos transplantes de pulmão ao longo do período estudado. Os estados das regiões Sul e Sudeste (com a exceção do Rio de Janeiro) e Centro-oeste têm os menores tempos de espera e as maiores taxas de atendimento do país

Avaliação comparativa de sistemas de saúde com a utilização de fronteiras estocásticas: Brasil e OCDE

Avaliamos a eficiência na provisão de serviços de saúde no Brasil, comparado com os países da Organização para Cooperação e Desenvolvimento Econômico (OCDE). Estimamos, em que medida, variáveis como: gasto per capita em saúde; esperança de vida ao nascer; e índice de sobrevivência infantil; servem de representação para um serviço de saúde eficiente, dado o gasto per capita com saúde. Foram geradas fronteiras de eficiência, calculadas em modelos de fronteiras estocásticas (stochastic frontiers ), e os resultados, em termos relativos, não são totalmente desfavoráveis ao Brasil. Nosso país, a despeito dos indicadores de saúde desfavoráveis em relação aos países da amostra tem, em termos de eficiência técnica relativa, o melhor desempenho relativo em todos os anos da análise