Prática em saúde baseada em evidências: análise de dano

Esta videoaula (aula 8) aborda conceitos relativos à avaliação de impacto de dano de determinada intervenção e ressalta considerações à cerca de estudos que avaliam dano e a análise crítica desses estudos

Hypothyroidism does not lead to worse prognosis in COVID-19 : findings from the Brazilian COVID-19 registry

Background It is not clear whether previous thyroid diseases influence the course and outcomes of COVID-19. Methods The study is a part of a multicentric cohort of patients with confirmed COVID-19 diagnosis from 37 hospitals. Matching for age, sex, number of comorbidities, and hospital was performed for the paired analysis. Results Of 7,762 patients with COVID-19, 526 had previously diagnosed hypothyroidism and 526 were matched controls. The median age was 70 years, and 68.3% were females. The prevalence of comorbidities was similar, except for coronary and chronic kidney diseases that were higher in the hypothyroidism group (p=0.015 and p=0.001). D-dimer levels were lower in patients with hypothyroid (p=0.037). In-hospital management was similar, but hospital length-of-stay (p=0.029) and mechanical ventilation requirement (p=0.006) were lower for patients with hypothyroidism. There was a trend of lower in-hospital mortality in patients with hypothyroidism (22.1% vs 27.0%; p=0.062). Conclusion Patients with hypothyroidism had a lower requirement of mechanical ventilation and showed a trend of lower in-hospital mortality. Therefore, hypothyroidism does not seem to be associated with a worse prognosis

Description of Factors Related to the Use of the Teleconsultation System of a Large Telehealth Service in Brazil – the Telehealth Network of Minas Gerais

Introduction: The teleconsultation service of Telehealth Network of Minas Gerais (TNMG), Brazil, has expanded gradually since its implementation in 2007. However, since 2013, there has been a decline in the number of teleconsultations. The  objective of this study was to compare features of user and non-user cities and healthcare practitioners, in order to investigate the factors related to non-use of the TNMG teleconsultation service and assess users’ satisfaction  with the service. Methods: Cities were classified as users and non-users according to the utilization of the service from June 2013 to May 2014; 160 healthcare practitioners were interviewed in each group. Among the user cities, 80 user healthcare practitioners (UHP-UC) and 80 non-user healthcare practitioners (NUHP-UC) were selected. Results: There was a significant difference in support and motivation by the local healthcare manager to use the teleconsultation service (67.5% in UHP-UC vs.  34.4% in HP-NUC, p ?0.0001; and 53.8 % in NUHP-UC vs.  34.4% in HP-NUC: p = 0.013), and with respect to training. (67.5% in UHP-UC vs. 45.8% in HP-NUC: p = 0,002). In multinomial logistic regression, (i) male gender, (ii) training and (iii) support and motivation from the local healthcare manager were independently associated with teleconsultation use. Conclusion: This study showed that training, and support and motivation from the local healthcare manager were the most important factors related to the teleconsultation use.  This is an important finding that will assist in future development of approaches to increase the use and quality of teleconsultation services

Paracoccidioidomycosis 40 years after renal transplantation: a case-report: Paracoccidioidomicose 40 anos após transplante renal: um relato de caso

Paracoccidioidomycosis is a systemic mycotic disease caused by termic-dimorphic fungi from the Paracoccidioides sp complex, which are endemic in Brazil and over 90% of cases are presented in the chronic form. It is a rare and severe infection in patients that underwent organ transplantation, according to few reported cases in literature. Our aim is to report a rare occurence of paracoccidioidomycosis in a renal transplant recipient, diagnosed over 40 years after the procedure and to draw attention to the importance of considering the diagnosis in immunosuppressed patients from endemic areas

Triagem da deglutição em pacientes pós AVC agudo

Esta videoaula apresenta uma proposta de triagem da deglutição em pacientes pós AVC agudo. Essa triagem acontece em cinco etapas e permitirá o rastreamento dos sinais de disfagia

Chagas disease and SARS-CoV-2 coinfection does not lead to worse in-hospital outcomes

Epidemiología; Microbiología; SARS-CoV-2Epidemiologia; Microbiologia; SARS-CoV-2Epidemiology; Microbiology; SARS-CoV-2Chagas disease (CD) continues to be a major public health burden in Latina America. Information on the interplay between COVID-19 and CD is lacking. Our aim was to assess clinical characteristics and in-hospital outcomes of patients with CD and COVID-19, and to compare it to non-CD patients. Consecutive patients with confirmed COVID-19 were included from March to September 2020. Genetic matching for sex, age, hypertension, diabetes mellitus and hospital was performed in a 4:1 ratio. Of the 7018 patients who had confirmed COVID-19, 31 patients with CD and 124 matched controls were included (median age 72 (64–80) years-old, 44.5% were male). At baseline, heart failure (25.8% vs. 9.7%) and atrial fibrillation (29.0% vs. 5.6%) were more frequent in CD patients than in the controls (p < 0.05). C-reactive protein levels were lower in CD patients compared with the controls (55.5 [35.7, 85.0] vs. 94.3 [50.7, 167.5] mg/dL). In-hospital management, outcomes and complications were similar between the groups. In this large Brazilian COVID-19 Registry, CD patients had a higher prevalence of atrial fibrillation and chronic heart failure compared with non-CD controls, with no differences in-hospital outcomes. The lower C-reactive protein levels in CD patients require further investigation.This study was supported in part by Minas Gerais State Agency for Research and Development (Fundação de Amparo à Pesquisa do Estado de Minas Gerais—FAPEMIG) [Grant Number APQ-00208-20], National Institute of Science and Technology for Health Technology Assessment (Instituto de Avaliação de Tecnologias em Saúde—IATS)/National Council for Scientific and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnológico—CNPq) [Grant Number 465518/2014-1], and CAPES Foundation (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior) [Grant Number 88887.507149/2020-00]

Zika - Sintomas

Infográfico mostrando os principais sintomas na infecção pelo Zika Vírus

Zika Vírus - Profilaxia

Este infográfico contempla os principais aspectos sobre a profilaxia da infecção pelo Zika Vírus

Zika Vírus - Transmissão

Este infográfico contempla as principais formas de transmissão do Zika Vírus

Avaliação econômica dos novos anticoagulantes para a prevenção de eventos tromboembólicos: análise de custo-minimização

CONTEXT AND OBJECTIVE: Randomized clinical trials have shown that the new oral anticoagulants have at least similar impact regarding reduction of thromboembolic events, compared with warfarin, with similar or improved safety profiles. There is little data on real costs within clinical practice. Our aim here was to perform economic analysis on these strategies from the perspective of Brazilian society and the public healthcare system. DESIGN AND SETTING: Cost-minimization analysis; anticoagulation clinic of Hospital Municipal Odilon Behrens, Belo Horizonte, MG, Brazil. METHODS: Patients at the anticoagulation clinic were recruited between August and October 2011, with minimum follow-up of four weeks. Operational and non-operational costs were calculated and corrected to 2015. RESULTS: This study included 633 patients (59% women) of median age 62 years (interquartile range 49- 73). The mean length of follow-up was 64 ± 28 days. The average cost per patient per month was $54.26 (US dollars). Direct costs accounted for 32.5$ 49.87, $51.40 and$ 52.16 per patient per month, respectively, which was lower than the costs relating to warfarin treatment. CONCLUSION: In the Brazilian context, from the perspective of society and the public healthcare system, the cumulative costs per patient using warfarin with follow-up in anticoagulation clinics is currently higher than the strategy of prescribing the new oral anticoagulants.CONTEXTO E OBJETIVO: Estudos clínicos randomizados demonstraram que novos anticoagulantes orais têm pelo menos impacto semelhante em reduzir eventos tromboembólicos quando comparados à varfarina, com perfil de segurança similar ou superior. Há pouca evidência acerca de custos reais na prática clínica. Nosso objetivo é realizar análise econômica dessas estratégias, na perspectiva do sistema de saúde pública e da sociedade brasileiros. TIPO DE ESTUDO E LOCAL: Análise de custo-minimização; Clínica de Anticoagulação do Hospital Municipal Odilon Behrens, Belo Horizonte, MG, Brasil. MÉTODOS: Os pacientes da clínica de anticoagulação foram recrutados de agosto a outubro de 2011, com tempo mínimo de acompanhamento de quatro semanas. Custos operacionais e não operacionais foram computados e corrigidos para 2015. RESULTADOS: Este estudo incluiu 633 pacientes, com idade mediana de 62 (intervalo interquartil 49-73) anos, sendo 59% mulheres. O tempo médio de acompanhamento foi de 64 ± 28 dias. O custo médio por paciente por mês foi de $54.26 (dólares). Custos diretos foram responsáveis por 32,5$ 49.87, $51.40 e$ 52.26 por paciente por mês, valores inferiores aos custos relacionados ao tratamento com varfarina. CONCLUSÃO: No contexto brasileiro, na perspectiva do sistema de saúde pública e da sociedade, os custos cumulativos por paciente em uso de varfarina acompanhados em clínica de anticoagulação são atualmente superiores à estratégia de prescrever novos anticoagulantes orais