Análise da suspensão de cirurgias em um hospital de ensino

In the search for better quality indices, the suspensions of surgeries have been examined by and received attention from researchers in the field of health. High cancellation rates reveal an inadequate management that impacts negatively on the health team iself and the patient's life and and that of his or her family.This retrospective descriptive study aim to identify the rate of surgical suspension and the reasons for this procedure in a public teaching hospital.Data were collected from the Surgical Center Archive and Medical Archive Service Statistics. There was a rate of 14.14% surgical cancellations and in 1,402 (63.78%) occasions no records were found that justify the suspension of the surgeries. The results showed the following justifications for the suspensions of the surgery: 194 (8.82%) were non hospitalized patients; 182 (8.30%) for inadequate clinical conditions;, 179 (8.14%) due to administrative problems;, 94 (4.27%) for welfare issues;, 61 (2.77%) for structural issues; 40 (1.82%) for lack of patients and 46 (2.10%) for other reasons.These findings point to the need to adopt measures that will ensure patient safety and quality of service offered.En busca de los índices de mejor calidad, la suspensión de las cirugías han sido examinadas por los servicios y recibido la atención de los investigadores en el campo de la salud. Las altas tasas de cancelación revelan un manejo inadecuado que tienen efectos negativos en el equipo de salud y en la vida del paciente y su familia.Este estúdio retrospectivo y descriptivo tuvo como objetivo identificar el tipo de suspensión quirúrgica y las razones de este procedimiento en un hospital público de enseñanza. Los datos fueron recolectados de los archivos del Archivo de la Unidad Quirúrgica y Servicio de Archivo Médico y Estadístico del referido hospital.Hubo una tasa de anulación quirúrgica de 14.14% y para 1402 (63,78%) cirugías canceladas no había constancia de la justificación de la suspensión. Las razones para la suspensión de las cirugías fueron: 194 (8,82%) por la no hospitalización de los pacientes, 182 (8,30%) por las condiciones clínicas inadecuadas, 179 (8,14%) debido a problemas administrativos, 94 (4,27%) por asuntos de asistencia para el cuidados de la salud, 61 (2,77%) por problemas estructurales, 40 (1,82%) por ausencia del pacientes y 46 (2.10%) por otras razones.Estos resultados señalan a la necesidad de adoptar medidas para garantizar la seguridad del paciente y la calidad del servicio ofrecido.Em busca de melhores índices de qualidade, as suspensões de cirurgias têm sido analisadas pelos serviços e recebido atenção por parte de pesquisadores da área de saúde. Altas taxas de cancelamento revelam uma inadequação de gerenciamento que repercutem negativamente na própria equipe de saúde e na vida do paciente e sua família. O presente estudo, retrospectivo e descritivo, teve como objetivo identificar a taxa de suspensão cirúrgica e as justificativas para este procedimento em um hospital público de ensino. Os dados foram coletados junto ao Arquivo do Centro Cirúrgico e Serviço de Arquivo Médico e Estatístico do referido hospital. Verificou-se uma taxa de suspensão cirúrgica de 14,14% e 1402 (63,78%) cirurgias suspensas não houve registro da justificativa da suspensão. Das suspensões justificadas, 194 (8,82%) foram por não internação do paciente; 182 (8,30%) por condições clínicas do paciente inadequadas; 179 (8,14%) por problemas administrativos; 94 (4,27%) por questões assistenciais; 61 (2,77%) por questões estruturais; 40 (1,82%) por ausência do paciente e 46 (2,10%) por outros motivos. Estes achados apontam para a necessidade da adoção de medidas que garantam segurança ao paciente e qualidade do serviço oferecido

Fluoride Concentration in Public Water Supply in a City in the Amazon Region

Objective: To analyze the fluoride concentration in the public water supply in Manaus, Brazil. Material and Methods: Water samples were collected in 50 mL polyethylene bottles, identified, and labeled. The collection was performed from September 2016 to August 2018. For the selection of collection points, all neighborhoods of the city of Manaus, divided into four health districts (North, South, East, and West), were mapped. From each district, 30 samples were collected, totaling 120 monthly samples. Water samples were analyzed using an ion analyzer, ORION 720-A, and a specific electrode, ORION 96-09. The ion analyzer and electrode were calibrated in standard solutions. The levels were classified in intervals based on technical consensus to guide the health surveillance agencies. Results: Of the 2,874 water samples, 50.3% were within the recommended range, and 49.7% were inadequate, with 31.6% considered above the parameters and 18.1% below. Among the districts, the North had the highest percentages of unsatisfactory samples, resulting in limited action to prevent tooth decay. During the 24 months of analysis, there were large oscillations in the values in all four districts of Manaus. Conclusion: Results reinforce the importance of heterocontrol for the city to guarantee the effectiveness of this public health measure

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK.

BACKGROUND: A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. METHODS: This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. FINDINGS: Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0-75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4-97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8-80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3-4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. INTERPRETATION: ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials. FUNDING: UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, Bill & Melinda Gates Foundation, Lemann Foundation, Rede D'Or, Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK

Background A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. Methods This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. Findings Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0–75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4–97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8–80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3–4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. Interpretation ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials

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

Análisis de la suspensión de cirugía en un hospital docente

In the search for better quality indices, the suspensions of surgeries have been examined by and received attention from researchers in the field of health. High cancellation rates reveal an inadequate management that impacts negatively on the health team iself and the patient's life and and that of his or her family.This retrospective descriptive study aim to identify the rate of surgical suspension and the reasons for this procedure in a public teaching hospital.Data were collected from the Surgical Center Archive and Medical Archive Service Statistics. There was a rate of 14.14% surgical cancellations and in 1,402 (63.78%) occasions no records were found that justify the suspension of the surgeries. The results showed the following justifications for the suspensions of the surgery: 194 (8.82%) were non hospitalized patients; 182 (8.30%) for inadequate clinical conditions;, 179 (8.14%) due to administrative problems;, 94 (4.27%) for welfare issues;, 61 (2.77%) for structural issues; 40 (1.82%) for lack of patients and 46 (2.10%) for other reasons.These findings point to the need to adopt measures that will ensure patient safety and quality of service offered.En busca de los índices de mejor calidad, la suspensión de las cirugías han sido examinadas por los servicios y recibido la atención de los investigadores en el campo de la salud. Las altas tasas de cancelación revelan un manejo inadecuado que tienen efectos negativos en el equipo de salud y en la vida del paciente y su familia.Este estúdio retrospectivo y descriptivo tuvo como objetivo identificar el tipo de suspensión quirúrgica y las razones de este procedimiento en un hospital público de enseñanza. Los datos fueron recolectados de los archivos del Archivo de la Unidad Quirúrgica y Servicio de Archivo Médico y Estadístico del referido hospital.Hubo una tasa de anulación quirúrgica de 14.14% y para 1402 (63,78%) cirugías canceladas no había constancia de la justificación de la suspensión. Las razones para la suspensión de las cirugías fueron: 194 (8,82%) por la no hospitalización de los pacientes, 182 (8,30%) por las condiciones clínicas inadecuadas, 179 (8,14%) debido a problemas administrativos, 94 (4,27%) por asuntos de asistencia para el cuidados de la salud, 61 (2,77%) por problemas estructurales, 40 (1,82%) por ausencia del pacientes y 46 (2.10%) por otras razones.Estos resultados señalan a la necesidad de adoptar medidas para garantizar la seguridad del paciente y la calidad del servicio ofrecido.Em busca de melhores índices de qualidade, as suspensões de cirurgias têm sido analisadas pelos serviços e recebido atenção por parte de pesquisadores da área de saúde. Altas taxas de cancelamento revelam uma inadequação de gerenciamento que repercutem negativamente na própria equipe de saúde e na vida do paciente e sua família. O presente estudo, retrospectivo e descritivo, teve como objetivo identificar a taxa de suspensão cirúrgica e as justificativas para este procedimento em um hospital público de ensino. Os dados foram coletados junto ao Arquivo do Centro Cirúrgico e Serviço de Arquivo Médico e Estatístico do referido hospital. Verificou-se uma taxa de suspensão cirúrgica de 14,14% e 1402 (63,78%) cirurgias suspensas não houve registro da justificativa da suspensão. Das suspensões justificadas, 194 (8,82%) foram por não internação do paciente; 182 (8,30%) por condições clínicas do paciente inadequadas; 179 (8,14%) por problemas administrativos; 94 (4,27%) por questões assistenciais; 61 (2,77%) por questões estruturais; 40 (1,82%) por ausência do paciente e 46 (2,10%) por outros motivos. Estes achados apontam para a necessidade da adoção de medidas que garantam segurança ao paciente e qualidade do serviço oferecido

Fatores que afetam o período de gestação de cabras da raça anglo-nubiana, criadas em regime semi-intensivo

Objetivou-se neste estudo avaliar o período de gestação de um rebanho de caprinos da raça Anglo-nubiana, criados em regime semi-intensivo. A duração média do período de gestação das cabras foi de 148,23 ± 3,943 dias, com um coeficiente de variação de 2,66%. Foram verificados intervalos de 136 a 160 dias para a duração da gestação, com uma maior concentração (60,4%) de partos entre 146 e 150 dias. O período de gestação foi influenciado pela ordem e tipo de parição. Constatou-se a existência de uma relação inversa entre o número de crias e a duração da gestação

Fatores que afetam o período de gestação de cabras da raça anglo-nubiana, criadas em regime semi-intensivo

Objetivou-se neste estudo avaliar o período de gestação de um rebanho de caprinos da raça Anglo-nubiana, criados em regime semi-intensivo. A duração média do período de gestação das cabras foi de 148,23 ± 3,943 dias, com um coeficiente de variação de 2,66%. Foram verificados intervalos de 136 a 160 dias para a duração da gestação, com uma maior concentração (60,4%) de partos entre 146 e 150 dias. O período de gestação foi influenciado pela ordem e tipo de parição. Constatou-se a existência de uma relação inversa entre o número de crias e a duração da gestação

Desempenho de um rebanho caprino Anglo-nubiano, no Município do Rio de Janeiro. II. Fatores que afetam o peso ao nascer e a mortalidade

Objetivou-se neste estudo avaliar o desempenho produtivo de um rebanho de caprinos da raça Anglo-nubiana, criados em regime semi-intensivo. O peso médio ao nascer das crias foi de 3,33 + 0,01 kg. O peso ao nascer foi influenciado significativamente (P<0,01) pela ordem de parição, tipo de nascimento (simples ou múltiplo), sexo da cria e da interação ordem de parição x tipo de nascimento. A taxa de mortalidade de cabritos do nascimento aos 90 dias de idade foi de 9,55%. O peso ao nascer, o tipo de nascimento e a interação idade da cria x tipo de nascimento exerceram influência significativa (P<0,01) sobre a mortalidade de cabritos. Existiu uma associa- ção positiva entre o peso ao nascer e o percentual de sobrevivência, e uma associação negativa entre o índice de prolificidade e a sobrevivência das crias