Epidemiological data of patients diagnosed with COVID-19 in the municipality of Gurupi, Tocantins

According to the World Health Organization (WHO), COVID-19 is a viral disease transmitted from person to person, which has the fastest spread in the world. OBJECTIVE: This project aimed to analyze epidemiological aspects of COVID-19 in the municipality of Gurupi/TO. METHODOLOGY: The research was conducted by consulting the epidemiological bulletin of COVID-19 made available daily by VISAE, from March 16, 2020, to May 15, 2021, where we identified the evolution of positive cases, deaths, and gender identification of this population, and analysis of literature review on the subject. RESULTS: Of the 10,336 positive cases, 5,570 (53.89%) of the cases are female, 194 (7.13%) evolved to deaths, of these 70 (36.08%) were female and 124 (63.92%) were male. FINAL CONSIDERATIONS: From the results, it is visible the reduction in the numbers of positive cases for COVID-19 from April 2021, which can be taken into consideration the measures adopted through the Municipal Decrees, and in part to the beginning of the immunization process. Thus, the continuity of prophylaxis measures is essential for the control of the high chain of transmission in the municipality

Measuring adherence to inhaled control medication in patients with asthma: Comparison among an asthma app, patient self‐report and physician assessment

Background Previous studies have demonstrated the feasibility of using an asthma app to support medication management and adherence but failed to compare with other measures currently used in clinical practice. However, in a clinical setting, any additional adherence measurement must be evaluated in the context of both the patient and physician perspectives so that it can also help improve the process of shared decision making. Thus, we aimed to compare different measures of adherence to asthma control inhalers in clinical practice, namely through an app, patient self-report and physician assessment. Methods This study is a secondary analysis of three prospective multicentre observational studies with patients (≥13 years old) with persistent asthma recruited from 61 primary and secondary care centres in Portugal. Patients were invited to use the InspirerMundi app and register their inhaled medication. Adherence was measured by the app as the number of doses taken divided by the number of doses scheduled each day and two time points were considered for analysis: 1-week and 1-month. At baseline, patients and physicians independently assessed adherence to asthma control inhalers during the previous week using a Visual Analogue Scale (VAS 0–100). Results A total of 193 patients (72% female; median [P25–P75] age 28 [19–41] years old) were included in the analysis. Adherence measured by the app was lower (1 week: 31 [0–71]%; 1 month: 18 [0–48]%) than patient self-report (80 [60–95]) and physician assessment (82 [51–94]) (p 0.05). There was a moderate correlation between patient self-report and physician assessment (ρ = 0.596, p < 0.001). Conclusions Adherence measured by the app was lower than that reported by the patient or the physician. This was expected as objective measurements are commonly lower than subjective evaluations, which tend to overestimate adherence. Nevertheless, the low adherence measured by the app may also be influenced by the use of the app itself and this needs to be considered in future studies.info:eu-repo/semantics/publishedVersio

Doppler transcraniano para avaliação hemodinâmica dos vasos cerebrais na comparação entre AVC hemorrágico e lacunar

O acidente vascular cerebral é uma patologia bastante prevalente na população ocidental, sendo os principais grupos isquémico e hemorrágico. O isquémico divide-se em várias categorias, uma delas o enfarte lacunar. O hemorrágico inclui o profundo (também chamado de hipertensivo) e o lobar. O enfarte lacunar surge em pequenos vasos afetados por um processo de microangiopatia secundária principalmente à hipertensão arterial de longo prazo, ocorrendo habitualmente nos gânglios da base, tálamo, ponte e cerebelo, os mesmos locais onde a hemorragia intracerebral hipertensiva ocorre. Esta microangiopatia causa endurecimento e espessamento arterial com alterações hemodinâmicas que se repercutem a montante nas artérias donde derivam. Estudos recentes mostraram que parâmetros de fluxo cerebral, obtidos por doppler transcraniano, como o índice de pulsatilidade ou o de resistividade podem ser usados como marcadores de resistência vascular das artérias cerebrais distais para avaliação preventiva do acidente vascular cerebral isquémico. Surgiu assim a questão de se a mesma abordagem poderia também ser efetiva na hemorragia intracerebral. Este estudo é retrospetivo, com consulta de registos clínicos de pacientes internados no Centro Hospitalar Cova da Beira estando aprovado pela Comissão de Ética do mesmo. O objetivo é comparar entre os grupos com hemorragia intracerebral, enfarte lacunar e grupo de controlo, parâmetros de fluxo sanguíneo cerebral medidos na artéria cerebral média por doppler transcraniano. Alguns desses parâmetros são obtidos diretamente (velocidades sistólica e diastólica) enquanto outros são calculados (velocidade média, índice de pulsatilidade e índice de resistividade). Pretende-se tentar corroborar a base fisiopatológica semelhante desses dois tipos de acidente vascular cerebral e tentar compreender se o doppler transcraniano pode ser preditivo para um evento de hemorragia intracerebral. Foram também recolhidos dados epidemiológicos e analisado o grau de leucoaraiose cerebral presente em cada paciente. Os resultados indicam que as velocidades sistólica, diastólica e média não mostraram diferenças significativas entre qualquer grupo. Os índices de pulsatilidade e de resistividade não revelaram diferenças entre os grupos de enfarte lacunar e hemorragia intracerebral, mas ambos os grupos têm os valores desses índices elevados quando comparados com o grupo de controlo. Isto é sugestivo de uma base fisiopatológica semelhante entre o enfare lacunar e a hemorragia intracerebral pois ambos têm aumento dos marcadores de resistência vascular cerebral e abre-se a possibilidade para que futuros estudos prospetivos possam avaliar se o aumento dos índices de pulsatilidade e resistividade poderão efetivamente ser considerados um fator de risco preditivo para a ocorrência de hemorragia intracerebral secundária à hipertensão crónica.Stroke is a very common disease in the western population and the two main categories are ischemic and hemorrhagic. Ischemic is divided into several categories, one of them is lacunar infarct. Hemorrhagic stroke includes deep (also called hypertensive) and lobar. The lacunar infarcts occurs in small vessels affected by a process called microangiopathy, mainly secondary to long-term hypertension, usually occurring in the basal ganglia, thalamus, pons and cerebellum, the same places where usually hypertensive intracerebral hemorrhage occurs. This microangiopathy causes hardening and thickening of the wall of that blood vessels resulting into hemodynamic changes that can be detected upstream in the main arteries from which derived. Recent studies have shown that certain cerebral blood flow parameters obtained by transcranial doppler, as pulsatility or resistivity indexes can be used as markers of vascular resistance of the distal cerebral arteries and used in preventive evaluation of ischemic stroke. Having this in mind arose the question if the same approach could also be effective to intracerebral hemorrhage. This study is retrospective with consultation of clinical records of hospitalized patients in the Cova da Beira Hospital, being approved by its Ethics Committee. The objective is to compare cerebral blood flow parameters measured in the middle cerebral artery by transcranial doppler between the groups with intracerebral hemorrhage, lacunar infarct and control group. Some of these parameters are obtained directly (systolic and diastolic velocities) while others are calculated (mean velocity, pulsatility index and resistivity index). With this we want try to corroborate the similar pathophysiological basis of these two types of stroke and try to understand if the transcranial doppler may be predictive of an intracerebral bleeding event. Epidemiological data were also collected and was analyzed the degree of brain leukoaraiosis present in each patient. The results indicate that systolic, diastolic and mean velocities have no significant differences between any groups. The pulsatility and resistivity indexes revealed no differences between the groups of intracerebral hemorrhage and lacunar infarct, but both groups have the values of these indexes elevated when compared with the control group. This is suggestive of a similar pathophysiological basis between lacunar infarct and intracerebral hemorrhage as both have increased cerebrovascular resistance markers and opens up the possibility for future prospective studies to evaluate if increased pulsatility and resistivity indexes can effectively be considered a predictive risk factor for the occurrence of intracerebral hemorrhage secondary to chronic hypertension

The incidence of chronic pain following Cesarean section and associated risk factors: A cohort of women followed up for three months.

BackgroundChronic post-surgical pain (CPSP) is one of the post-surgical complications of a Cesarean section. Despite the high rates of Cesarean section worldwide, the incidence of CPSP and the risk factors for this condition remain relatively unknown. The objective of this study was to calculate the incidence of CPSP in women submitted to Cesarean section and to analyze the associated risk factors.Materials and methodsA prospective cohort of 621 women undergoing Cesarean section was recruited preoperatively. Potential presurgical (sociodemographic, clinical and lifestyle-related characteristics) and post-surgical risk factors (the presence and intensity of pain) risk factors were analyzed. Pain was measured at 24 hours and 7, 30, 60 and 90 days after surgery. Following discharge from hospital, data were collected by telephone. The outcome measure was self-reported pain three months after a Cesarean section. The risk factors for chronic pain were analyzed using the log-binomial regression model (a generalized linear model).ResultsA total of 462 women were successfully contacted 90 days following surgery. The incidence of CPSP was 25.5% (95%CI: 21.8-29.7). Risk factors included presurgical anxiety (adjusted relative risk [RR] 1.03; 95%CI: 1.01-1.05), smoking (adjusted RR 2.22; 95%CI: 1.27-3.88) and severe pain in the early postoperative period (adjusted RR 2.79; 95%CI: 1.29-6.00).ConclusionOne in four women submitted to Cesarean section may develop CPSP; however, the risk factors identified here are modifiable and preventable. Preventive strategies directed towards controlling anxiety, reducing smoking during pregnancy and managing pain soon after hospital discharge are recommended