5 research outputs found

    Analysis of the surgical results of the anal operations performed in a secondary level training center

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    Introdução: As doenças anais benignas possuem elevada incidência na população geral. De forma geral, podem ser tratadas de forma conservadora e, em caso de insucesso, submetidas à cirurgia. Algumas doenças, como a fístula anal e o cisto pilonidal, possuem indicação cirúrgica ao diagnóstico. Com o advento da cirurgia ambulatorial, as operações anais passaram a ser realizadas em centros de menor complexidade, entretanto, pouco se sabe dobre os principais desfechos cirúrgicos dos centros de treinamento. O presente estudo visa ampliar o entendimento sobre o impacto do treinamento médico nos resultados das cirurgias anais benignas. Objetivos: Avaliar perfil epidemiológico, tipos de cirurgia e complicações das doenças anais submetidas ao tratamento cirúrgico em um centro de treinamento de nível secundário de Ribeirão Preto. Método: Trata-se de uma análise retrospectiva de um banco de dados prospectivo de pacientes operados no Hospital Estadual de Ribeirão Preto (HERP) entre janeiro de 2010 e junho de 2018. Resultados: Foram analisados 1856 prontuários; os pacientes eram em sua maioria do sexo masculino (n=1137; 61,3%), com idade média de 39,7 anos e índice de massa corporal médio de 26,9 kg/m². A maioria dos pacientes não possuía comorbidades (n=1313; 70,7%). Tabagismo e etilismo foram observados em 612 (33%) e 177 (9,5%) pacientes, respectivamente. A maior parte dos procedimentos ocorreu no primeiro semestre de cada ano (n=1004; 54,1%) e no período da manhã (n=947; 51,0%). A duração média dos procedimentos foi de 21,8 minutos. A distribuição das doenças tratadas foi: doença hemorroidária (n=804; 43,3%), condiloma anal (n=406; 24,6%), fissura anal (n=244; 13,1%), fístula anal (n=224; 12,1%) e doença pilonidal (n=128; 6,9%). Hemorragia anal foi a única complicação precoce observada (n=8, 0,4%). Desses, 7 (87,5%) necessitaram de reoperação imediata. A maior parte dos pacientes recebeu alta no mesmo dia do procedimento (n=1819, 98%). Complicações tardias ocorreram em 140 (7,5%) pacientes, sendo as mais comuns: sangramento anal persistente (n=43, 30,7%), infecção de ferida operatória (n=36, 25,7%) e fissura anal (n=23, 16,3%). Na análise multivariada observou-se que o tratamento cirúrgico da fissura anal foi preditor de menor taxa de complicação tardia (3,7% x 8,4%; p=0,012 [1,2- 4,7]). Na doença hemorroidária, a ressecção de múltiplos mamilos associou-se a maiores taxas de complicações tardias (11,2% x 6,5%; p=0,026). Conclusão: No presente estudo, observou-se uma população relativamente jovem, com poucas comorbidades. Hemorroidas, condilomas e fissuras anais foram os principais diagnósticos. No geral, as doenças apresentavam longo tempo de sintomas. As taxas de complicações observadas foram baixas e a ressecção de múltiplos mamilos hemorroidários foi fator de risco para complicações tardias. A cirurgia para fissura foi preditor independente de menores taxas de complicações tardias.Introduction: Benign anal diseases have a high incidence in the general population. In general, they can be treated conservatively and, in case of failure, submitted to surgery. Some diseases, such as anal fistula and pilonidal cyst, have surgical indication at diagnosis. With the advent of outpatient surgery, the anal operations began to be performed in less complex centers; however, little is known about the main surgical outcomes of training centers. The present study aims to broaden the understanding of the impact of medical training on the results of benign anal surgeries. Objectives: To evaluate epidemiological profile, types of surgery and complications of the anal diseases submitted to surgical treatment in a secondary level training center in Ribeirão Preto. Method: This is a retrospective analysis of a prospective database of patients operated at the State Hospital of Ribeirão Preto (HERP) between January 2010 and June 2018. Results: A total of 1,856 medical records were analyzed; the patients were mostly male (n=1137; 61.3%), with a mean age of 39.7 years and mean body mass index of 26.9 kg/m². Most patients did not have comorbidities (n=1313; 70.7%). Smoking and alcohol consumption were observed in 612 (33%) and 177 (9.5%) patients, respectively. Most procedures occurred in the first semester of each year (n=1004; 54.1%) and in the morning (n=947; 51.0%). The mean duration of the procedures was 21.8 minutes. The distribution of the treated diseases was: hemorrhoidal disease (n=804; 43.3%), anal condyloma (n=406; 24.6%), anal fissure (n=244; 13.1%), anal fistula (n=224; 12.1%) and pilonidal disease (n=128; 6.9%). Anal hemorrhage was the only early complication observed (n=8, 0.4%). Of these, 7 (87.5%) required immediate reoperation. Most patients were discharged on the same day of the procedure (n=1819, 98%). Late complications occurred in 140 (7.5%) patients, the most common being: persistent anal bleeding (n=43, 30.7%), surgical wound infection (n=36, 25.7%) and anal fissure (n=23, 16.3%). In the multivariate analysis, it was observed that surgical treatment of anal fissure was a predictor of lower late complication rate (3.7% x 8.4%; p=0.012 [1.2-4.7]). In hemorrhoidal disease, multiple pile resection was associated with higher rates of late complications (11.2% x 6.5%; p=0.026). Conclusion: In the present study, a relatively young population, with few comorbidities, was treated. Hemorrhoids, condylomas and fissures were the main diagnoses. In general, the diseases had long-term symptoms. The rates of complications observed were low and resection of multiple hemorrhoidal nipples was associated with higher rates of late complications. Anal Sphincterotomy was an independent predictor of lower rates of late complications

    Educational strategies for the prevention of diabetes, hypertension, and obesity

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    Objective: The main goal of this work was to produce a review of educational strategies to prevent diabetes, hypertension, and obesity. Method: PubMed database was consulted using combined descriptors such as [Prevention] Results: A total of 8,908 articles were found, of which 1,539 were selected about diabetes mellitus (DM, n=369), arterial systemic hypertension (ASH, n=200), and obesity (OBES, n=970). The number of free full text articles available was 1,075 (DM = 276, ASH = 118 and OBES = 681). In most of these studies, demographic characteristics such as gender and age were randomized, and the population mainly composed by students, ethnic groups, family members, pregnant, health or education professionals, patients with chronic diseases (DM, ASH, OBES) or other comorbidities. Group dynamics, physical activity practices, nutritional education, questionnaires, interviews, employment of new technologies, people training and workshops were the main intervention strategies used. Conclusion: The most efficient interventions occurred at community level, whenever the intervention was permanent or maintained for long periods, and relied on the continuous education of community health workers that had a constant interference inside the population covered. Many studies focused their actions in children and adolescents, especially on students, because they were more influenced by educational activities of prevention, and the knowledge acquired by them would spread more easily to their family and to society
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