Enfrentamento à pandemia: conhecimento acessível à comunidade / Coping with the pandemic: Knowledge accessible to the community

A pandemia pela COVID-19 altera a saúde global e coloca em risco a comunidade e o grupo de pessoas com deficiência visual e surdas. Docentes e alunos da Universidade Federal de Minas Gerais decidiram ofertar curso via e-mail e via página eletrônica para disseminar conhecimento sobre medidas preventivas e combate às fake News. A divulgação ocorreu dentro da comunidade universitária e em grupos comunitários. O objetivo deste estudo foi avaliar duas metodologias (por e-mail e pela página eletrônica) do curso, com avaliação do perfil dos participantes, da adesão e do desempenho. O curso contou com 1.841 inscritos. O grupo de participantes via e-mail apresentou em relação aos demais:  idade superior (p<0,001); maior número de deficientes (p=0,008) e de mulheres (p<0,001); maior escolaridade (p<0,001). Constatou-se associação entre a metodologia do curso e ter ou não recebido o auxílio financeiro emergencial (p=0,001) devido à pandemia e possuir filhos (p<0,001). Ocorreu progressão no conhecimento em ambos os grupos. A persistência até o final do curso foi maior no sexo masculino com correlação positiva (p=0,03; força de associação de 5,1%). Aqueles que não finalizaram o curso apresentaram média de idade superior (37,5 anos) aos que finalizaram (35,6 anos), com p=0,04. Apesar da baixa adesão geral, o curso contribuiu de forma acessível para disseminação do conhecimento científico sobre a COVID-19

Amyotrophic lateral sclerosis and herpes virus: a casual or causal association? Twelve years after

Made available in DSpace on 2019-09-11T20:58:38Z (GMT). No. of bitstreams: 0 Previous issue date: 2010[Ferri-de-Barros, João Eliezer; Moreira, Marina] Universidade de Taubaté, Brazi

Unmet Needs of Surgical Care for Children: A Case Study in the Brazilian Publicly-Financed Health System

Abstract Objective To measure and document the clinical impact of the waiting time for surgical treatment of patients with spinal deformities in a quaternary center in Brazil. Methods In total, 59 patients with spinal deformity waiting for surgery on our hospital's list were evaluated to observe the impact of the waiting time on the progression of the deformity. Patient evaluation was performed using the SRS-22r questionnaire for health-related quality of life (HRQL) and radiographic images to evaluate the deformity of the spine at the time the patients were included in the waiting list and at the most recent appointment. The radiographic parameters selected for comparison were: Cobb angle of the primary and secondary curves, coronal alignment, apical vertebral translation, pelvic obliquity, sagittal vertebral axis, kyphosis (T5-T12), and lordosis (L1-S1). Results Low HRQL scores according to the SRS-22r questionnaire were observed in patients waiting for surgery. The radiographic parameters showed progression of the deformity on the initial evaluation when compared with the most recent follow-up evaluation. Conclusion The patients waiting for surgical treatment of spinal deformities in our center showed relatively low HRQL scores and radiographic progression of the deformity

Teaching basic life support for medical students: Assessment of learning and knowledge retention

BACKGROUND: Education mediated by simulation is a widely used method for teaching basic life support (BLS). The American Heart Association recommends protocols based on scientific evidence to reduce sequelae and mortality. We aimed to assess learning and retention of knowledge of BLS in students of the first semester of the medical course using teaching methods of dialogic expository class (group 1), expository and demonstrative class (group 2), and the two previous methodologies associated with simulated practice (group 3), and after 3 months, memory retention. MATERIALS AND METHODS: This was an experimental, prospective, randomized study. Participants were assessed in terms of performance in theoretical and simulated practical tests, satisfaction with training (Likert scale), and knowledge retention. RESULTS: The practical test results were analyzed by two experienced observers. Students had 20% progression in knowledge and 80% retention of knowledge after 3 months of exposure comparing the theoretical pre- and posttest. The students in group 3 performed better than the others (P = 0.007) in the posttest. With the simulated practice, the knowledge acquired was maintained after 3 months with a mean performance of 90%, but in the test of the infant age group, there was a loss of learning retention by 10%. There was no difference of the results between the two evaluators (P < 0.001). The training was positively assessed by the participants. CONCLUSION: The use of different methodologies promoted knowledge progression, with emphasis on simulated practice. Learning retention was maintained after 3 months. In order to teach BLS to infants, it may be necessary to improve teaching techniques

Esclerose lateral amiotrófica e herpes vírus. Relato de um caso curioso: uma associação casual ou causal? Amyotrophic lateral sclerosis and herpes virus. A curious case report: a cause or casual association?

OBJETIVO: Apresentar o relato de um caso curioso de esclerose lateral amiotrófica (ELA). CASO: Homem de 47 anos que apresentava déficit de força nos membros superiores evoluindo há 4 anos. A eletroneuromiografia era compatível a ELA, forma de Vulpian-Bernardt. O estudo do líquido cefalorraqueano (LCR) mostrava processo inflamatório e positividade das reações para Herpes vírus I e II. O estudo do LCR, do soro sanguíneo e da barreira hemato-encefálica sugeria imunoprodução local para Herpes vírus tipo I. A ressonância nuclear magnética sugeria mielopatia cística ou seringomielia em medula cervical estendendo-se nos espaços C2 a C4. O paciente foi tratado com aciclovir endovenoso por 21 dias. Até dois meses após, o paciente não foi submetido a novos exames subsidiários para controle. DISCUSSÃO: Até o momento atual, a doença ELA não tem tratamento medicamentoso específico. A noção da existência de "síndrome esclerose lateral amiotrófica" associada a etiologias diversas pode contribuir para o tratamento de alguns doentes.<br>OBJECTIVE: To present a curious case of amyotrophic lateral sclerosis (ALS). CASE: A forty-seven year old man claimed of paresis in the arms since four years. The electrical study of the muscles and nerves diagnosis was ALS, type Vulpian-Bernardt. The cerebrospinal fluid study revealed an inflammatory process and the positivity of immulogical reactions for Herpes simplex I. The blood-brain barrier study showed the possibility that immulogical response for Herpes simplex I was produced in the spinal fluid space. A magnetic resonance suggested cystic myelopathy of cervical spinal cord expanding from C2 to C4. The patient received endovenous acyclovir for 21 days. Until two months after the medication we did not submit the patient to other subsidiary examinations. DISCUSSION: Until now there is no specific drug treatment for ALS. The notion that there is a "syndrome of ALS" related with various causes may help to treat some patients

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