INTERIORIZAÇÃO DA AIDS EM MUNICÍPIO DE MÉDIO PORTE DO RIO GRANDE DO SUL (2008-2012): ASPECTOS IMPORTANTES PARA POLÍTICAS DE SAÚDE

A epidemia mundial da AIDS, apesar de concentrada principalmente em grandes centros, tem se disseminado para municípios de médio e pequeno porte. Desse modo, analisaram-se critérios relativos à epidemia entre o município de Santa Maria, o Estado do Rio Grande do Sul e o Brasil, entre 2008 e 2012, bem como as regiões administrativas municipais de maior taxa de detecção da doença em 2010, com o objetivo de comparar o perfil da doença no município com o perfil nacional. Foram utilizadas informações provenientes dos bancos de dados do Sistema Nacional de Agravos Notificáveis e Instituto Brasileiro de Geografia e Estatística , constituindo-se em um estudo descritivo, quantitativo. O perfil encontrado foi semelhante ao nacional, predominando a transmissão por relação sexual, com a doença acometendo principalmente indivíduos adulto-jovens, da raça branca e com baixa escolaridade. Desta forma evidencia-se a necessidade de políticas públicas de saúde com foco especial nesta população. DESCRITORES: Síndrome da Imunodeficiência Adquirida; Epidemiologia; Promoção da Saúde

Evolução da percepção de fala em pacientes com ossificação coclear e implante coclear com eletrodo curto

Purpose. To report the speech perception of users of cochlear implants (CI) with short array, indicated as rehabilitation in patients with severe to profound deafness, especially when there is cochlear ossification. In these cases, with reduced intracochlear patency, total insertion becomes more difficult, requiring the use of this type of electrode (15 mm). Few studies have been published to evaluate auditory performance in these patients, presenting controversial audiological results. Methods. A retrospective analysis of medical records of patients who underwent surgery for cochlear implantation with short electrode, between 2009 and 2020, at the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC-USP) was carried out. Results. There was performance evolution in the speech perception tests in the data analysis. Meningitis and congenital hearing loss were the main indications for CI in the sample. Conclusion. CI with a short lead is an alternative in the management of patients with a history of cochlear ossification and severe or profound sensorineural hearing loss. Significance. To demonstrate the evolution of speech perception tests with short array cochlear implant in patients with or without ossified cochlea and its characteristics for application in clinical practice.Objetivo. Relatar a percepção de fala dos usuários de implante coclear com eletrodo curto, indicado como reabilitação em pacientes com surdez severa a profunda, especialmente quando houver ossificação coclear. Nesses casos, com redução da luz intracoclear, a inserção total se torna mais difícil, com a necessidade do uso desse tipo de eletrodo (15 mm). Poucos estudos foram publicados para avaliar o desempenho auditivo nesses pacientes, apresentando resultados audiológicos, até o momento, controversos. Metodologia. Procedeu-se análise retrospectiva de prontuários de pacientes submetidos à cirurgia para implante coclear com eletrodo curto, entre 2009 e 2020, no Hospital de Reabilitação de Anomalias Craniofaciais da USP. Resultados. Houve evolução de desempenho nos testes de percepção de fala na análise dos dados. Meningite e perda auditiva congênita foram as principais etiologias de indicação de IC na amostra. Conclusão. O IC com eletrodo curto é uma alternativa no manejo de pacientes com história de ossificação coclear e perda auditiva neurossensorial severa ou profunda

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research