Epidemiological Analysis of 5,595 Procedures of Endovascular Correction of Isolated Descending Thoracic Aortic Disease Over 12 Years in the Public Health System in Brazil

OBJECTIVES: In Brazil, descending thoracic aorta disease, including aneurysms and dissections, is managed preferentially by endovascular treatment, owing to its feasibility and good results. In this study, we analyzed endovascular treatment of isolated descending thoracic aortic disease cases in the Brazilian public health system over a 12-year period. METHODS: Public data from procedures performed from 2008 to 2019 were extracted using web scraping techniques to assess procedure type frequency (elective or urgency), mortality, and governmental costs. RESULTS: A total of 5,595 procedures were analyzed, the vast majority of which were urgent procedures (61.82% vs. 38.18%). In-hospital mortality was lower for elective than for urgent surgeries (4.96 vs.10.32% p=0.008). An average of R$16,845.86 and R$20,012.04 was paid per elective and emergency procedure, respectively, with no statistical difference (p=0.095). CONCLUSION: Elective procedures were associated with lower mortality than urgent procedures. There was no statistically significant difference between elective and urgent procedures regarding costs

Symptoms of anxiety and depression in patients with primary hyperhidrosis and its association with the result of clinical treatment with oxybutynin

OBJECTIVES: Studies have identified correlations between the psychological characteristics of individuals with primary hyperhidrosis (HH), the degree of sweating, and the quality of life (QoL). This study aimed to evaluate the prevalence of anxiety and depression symptoms in patients with HH before and after oxybutynin treatment. METHODS: Data were collected from 81 patients. Palmar or axillary HH was the most frequent complaint (84.0%). All patients were evaluated before the medication was prescribed and after five weeks of treatment. The Beck Depression Inventory and Beck Anxiety Inventory were used to evaluate depression and anxiety. RESULTS: Improvement in HH occurred in 58 patients (71.6%), but there was no improvement in 23 patients (28.4%). The QoL before treatment in all patients was either “poor” or “very poor.” Patients who experienced improvement in sweating rates also experienced a greater improvement in QoL than patients who did not experience improvement in sweating at the main site (87.9% vs. 34.7%) (p<0.001). A total of 19.7% of patients showed an improvement in their level of depression, and a total of 46.9% of patients exhibited improvements in their level of anxiety. A significant correlation was observed between sweating and anxiety (p=0.015). CONCLUSION: Patients with HH who experienced improvements in sweating immediately after treatment with oxybutynin exhibited small improvements in their levels of depression and significant improvements in their levels of anxiety and QoL

Trasplante cardíaco en pacientes con enfermedad de Chagas. Experiencia de un único centro

IntroducciónLa enfermedad de Chagas es un problema de salud pública en América Latina con repercusión mundial por la globalización.ObjetivoPresentar la experiencia acumulada después de 25 años de un único centro con trasplante cardíaco en la cardiomiopatía chagásica.Método y casuísticaDe 417 pacientes sometidos a trasplante cardíaco desde marzo de 1985 hasta marzo de 2010, 111 (26,6%) eran portadores de cardiomiopatía chagásica: 77 (69,3%) estaban en clase funcional IV; 34 (30,6%) usaban agentes vasopresores y 17 (15,3%) recibían asistencia circulatoria mecánica.ResultadosLa mortalidad hospitalaria fue 17,1% (19 casos), por infección en 6 (31,5%) casos, disfunción del injerto en 6 (31,5%), rechazo en 4 (21,1%) y muerte súbita en 2 (10,5%) casos, y debido a la falta de coincidencia ABO en 1 (5,3%) caso. la mortalidad tardía fue de 24,3% (26), distribuidos así: 6 (22,2%) por rechazo, 6 (22,2%) por infección, 4 (14,8%) por linfoma; 2 (7,4%) por Kaposi, 2 (7,4%) por pericarditis constrictiva y 1 (7,1%) por reactivación de la enfermedad del sistema nervioso central.ConclusionesEl trasplante cardíaco es el único tratamiento actual eficaz de tratamiento de la enfermedad de Chagas en fase terminal. La reactivación de la enfermedad es un problema real que es fácilmente revertido con la introducción de la terapéutica farmacológica específica, restaurando los padrones histológicos del miocardio sin dejar secuelas. La inmunosupresión, en especial los corticoides, predisponen al desarrollo de neoplasias y a la reactivación de la enfermedad, exigiendo una atención especial su interrupción o reducción precoz.IntroductionChagas’ disease is a public health problem in Latin America and with universal repercussions by globalization.ObjectiveTo show the accumulated experience after 25 years with heart transplantation in Chagas’ disease in a single center.Casuistic and methodFrom 417 patients underwent to heart transplantation since March 1985 to March 2010, 111 (26.6%) patients had Chagas’ disease and formed the current study group: 77 (69.3%) were in functional class IV, 34 (30.6%) in use of vasopressor agents of which 17 (15.3%) were under mechanical circulatory support.ResultsHospital mortality was 17.1% (19 cases) due to the infection in 6 cases (31.5%), graft dysfunction in 6 (31.5%), rejection in 4 (21.1%), sudden death 2 (10.5%), and due to ABO mismatch in 1 (5.3%) case. Late mortality was in 24.3% (26 cases) during study period: 6 (22.2%) due to rejection, 6 (22.2%) infection, 4 (14.8%) lymphoma, 2 (7.4%) Kaposi, 2 (7.4%) constrictive pericarditis, and 1 (7.1%) for Chagas’ disease reactivation into central nervous system.ConclusionsHeart transplantation is unique form to modify the natural evolution of the terminal chagasic cardiomyopathy; however, the operation is faced with peculiar problems that differ others patients by possibility of the disease reactivation and increase of neoplasias. The reactivation of the disease is a real problem which is easily reversed by introduction of specific pharmacological therapy, restoring the normal histological patterns without myocardial sequelae. immunosuppression, especially steroids, predisposes to neoplasias and reactivation of the disease, thus requiring special attention as to its use

Endovascular correction of isolated descending thoracic aortic disease: a descriptive analysis of 1,344 procedures over 10 years in the public health system of São Paulo

OBJECTIVES: In Brazil, descending thoracic aorta disease (TAD), including aneurysms and dissection, are preferentially managed by endovascular treatment (TEVAR) due to the feasibility and good results of this technique. In this study, we analyzed endovascular treatment of isolated TAD (ITAD) in the public health system over a 10-year period in Sa˜o Paulo, a municipality in Brazil in which more than 5 million inhabitants depend on the governmental health system. METHODS: Public data from procedures performed between 2008 and 2019 were extracted using web scraping techniques. The following types of data were analyzed: demographic data, operative technique, elective or urgent status, number of surgeries, in-hospital mortality, length of hospital stay, mean length of stay in the intensive care unit, and reimbursement values paid by the government. Trauma cases and congenital diseases were excluded. RESULTS: A total of 1,344 procedures were analyzed; most patients were male and aged X65 years. Most individuals had a residential address registered in the city. Approximately one-third of all surgeries were urgent cases. There were 128 in-hospital deaths (9.52%), and in-hospital mortality was lower for elective than for urgent surgeries (7.29% vs. 14.31%, p=0.031). A total of R$24.766.008,61 was paid; an average of R$ 17.222,98 per elective procedure and R$18.558,68 per urgent procedure. Urgent procedures were significantly more expensive than elective surgeries (p=0.029). CONCLUSION: Over a 10-year period, the total cost of ITAD interventions was R$ 24.766.008,61, which was paid from the governmental system. Elective procedures were associated with lower mortality and lower investment from the health system when compared to those performed in an urgent scenario

Proposed public policies to improve outcomes in vascular surgery: an experts’ forum

ABSTRACT Objective To evaluate outcomes of vascular surgeries and identify strategies to improve public vascular care. Methods This was a descriptive, qualitative, and cross-sectional survey involving 30 specialists of the Hospital Israelita Albert Einstein via Zoom. The outcomes of vascular procedures performed in the Public Health System extracted through Big Data analysis were discussed, and 53 potential strategies to improve public vascular care to improve public vascular care. Results There was a consensus on mandatory reporting of some key complications after complex arterial surgeries, such as stroke after carotid revascularization and amputations after lower limb revascularization. Participants agreed on the recommendation of screening for diabetic feet and infrarenal abdominal aortic aneurysms. The use of Telemedicine as a tool for patient follow-up, auditing of centers for major arterial surgeries, and the concentration of complex arterial surgeries in reference centers were also points of consensus, as well as the need to reduce the values of endovascular materials. Regarding venous surgery, it was suggested that there should be incentives for simultaneous treatment of both limbs in cases of varicose veins of the lower limbs, in addition to the promotion of ultrasound-guided foam sclerotherapy in the public system. Conclusion After discussing the data from the Brazilian Public System, proposals were defined for standardizing measures in population health care in the area of vascular surgery