ANÁLISE DO USO DO SLEEVE GÁSTRICO NO TRATAMENTO DA OBESIDADE MÓRBIDA

The present study aims to analyze the effectiveness and safety of Sleeve Gastrectomy as a surgical technique for treating morbid obesity, comparing its outcomes with other bariatric methods and evaluating its impact on patients' quality of life. This research utilized a comprehensive literature review, encompassing studies published between 2000 and 2024 in English, Portuguese, and Spanish. Databases such as PubMed, Google Scholar, SciELO, as well as specialized scientific journals and academic repositories were consulted. The results indicate that Sleeve Gastrectomy is an effective technique for weight loss, showing outcomes comparable to other bariatric surgeries such as Roux-en-Y Gastric Bypass. Literature analysis revealed that Sleeve Gastrectomy provides significant short-term and long-term weight loss with lower incidence of postoperative complications compared to other techniques. Furthermore, patients' quality of life improved considerably after surgery, covering physical, psychological, and social aspects. It is concluded that Sleeve Gastrectomy is a viable and safe surgical option for treating morbid obesity, offering significant advantages in terms of weight loss and patient quality of life. However, further long-term studies are needed to fully compare this technique with other bariatric treatment modalities and assess the maintenance of weight loss and improvement of associated comorbidities.O presente estudo visa analisar a eficácia e a segurança do Sleeve Gástrico como técnica cirúrgica no tratamento da obesidade mórbida, comparando seus resultados com outros métodos bariátricos e avaliando seu impacto na qualidade de vida dos pacientes. Esta pesquisa utilizou uma revisão da literatura abrangente, incluindo estudos publicados entre 2000 e 2024 em inglês, português e espanhol. Foram consultadas bases de dados como PubMed, Google Acadêmico, SciELO, além de revistas científicas especializadas e repositórios acadêmicos. Os resultados indicam que o Sleeve Gástrico é uma técnica eficaz para a perda de peso, apresentando resultados comparáveis a outras cirurgias bariátricas como o Bypass Gástrico em Y de Roux. A análise da literatura revelou que o Sleeve Gástrico proporciona uma perda de peso significativa a curto e longo prazo, com menor incidência de complicações pós-operatórias em comparação com outras técnicas. Além disso, a qualidade de vida dos pacientes melhorou consideravelmente após a cirurgia, abrangendo aspectos físicos, psicológicos e sociais. Conclui-se que o Sleeve Gástrico é uma opção cirúrgica viável e segura para o tratamento da obesidade mórbida, oferecendo vantagens significativas em termos de perda de peso e qualidade de vida dos pacientes. No entanto, é necessário mais estudo de longo prazo para comparar plenamente esta técnica com outras modalidades de tratamento bariátrico e avaliar a manutenção da perda de peso e a melhoria das comorbidades associadas

Dengue: aspectos epidemiológicos no município de Salgueiro do Sertão Pernambucano, Brasil / Dengue: epidemiological aspects in the municipality of Salgueiro do Sertão Pernambucano, Brazil

A dengue é atualmente a arbovirose mais prevalente no Brasil, configurando-se como um agravo na saúde pública nas últimas décadas. O presente trabalho tem como objetivo analisar estatisticamente dados cadastrados em planilhas eletrônicas do SINAN. Foi realizado um estudo de série histórica observacional do tipo transversal dos casos notificados de dengue no município de Salgueiro- PE, Brasil, entre os anos de 2007 a 2012. O Sinan online notificou para o intervalo de tempo em estudo, 1818 casos de dengue, desses 62,65% eram do sexo feminino e 37,35% do sexo masculino. Os dados demonstram que houve uma quantidade significativa de casos para região, porém a questão da subnotificação é notável, além disso, cabe aos órgãos de saúde pública do município, melhorar a qualidade de prevenção desse agravo

Acidentes ofídicos: perfil epidemiológico na mesorregião do sertão Pernambucano, Brasil / Snaky accidents: epidemiological profile in the meso-region of Pernambuco, Brazil

Os acidentes ofídicos representam sério problema de saúde pública, pela freqüência e morbi-mortalidade, o Brasil tem cerca de 20.000 casos por ano, o coeficiente médio, foi de 13,8 casos/100 mil habitantes. O objetivo do estudo foi analisar os casos notificados de acidentes ofidicos  ocorridos na região do Sertão do Pajeú, Pernambuco, Brasil, entre os anos de 2007 a 2016. ). Os dados foram tabulados em um banco de dados com auxílio do recurso Tabelas e Gráficos do Excel 2010. No período investigado o número de casos de acidentes ofídicos foram  1.375 casos, o município que teve a maior prevalência foi Serra Talhada. Percebe-se que o perfil desse estudo corrobora com perfil do Brasil, onde se tem destaque para sexo masculino

Doença de chagas: tendência epidemiológica por regiões do Brasil / Chagas disease: epidemiological trend by regions of Brazil

A doença de Chagas é uma condição crônica negligenciada com elevada carga de morbimortalidade, no período de 2000 a 2013 foram notificados 1.570 casos de doença de Chagas aguda . Trata-se de um estudo transversal de caráter descritivo, teve como população os casos de notificados doença de chagas aguda dos últimos anos disponíveis do DATASUS,foram dos anos 2013 a 2014 no Brasil. Os dados obtidos foram coletados do DATASUS nas informações de saúde (TABNET). O total de 191 de notificações de doença de chagas aguda no anos de 2014 no Brasil. Os dados epidemiológicos demonstram a necessidade de se aumentar à vigilância na região Norte e incorporar indicadores ambientais para a detecção precoce e prevenção de agravos à saúde da população em relação a doença de chagas

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

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