Pub Date : 2024-08-09eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024AO0783
Mariana Santos Alecrim Molina, Eduardo Cordioli, Thomaz Bittencourt Couto, Joyce Kelly Silva Barreto, Rita de Cássia Sanchez
Objective: This study aimed to analyze the relationship between the participation of professionals in simulation-based training and an increase in the rate of vaginal deliveries.
Methods: This retrospective observational study analyzed professionals' participation in high-fidelity simulation training during the pilot phase of the Appropriate Delivery Project, spanning from May 21, 2015 to May 21, 2016, along with the rates of vaginal deliveries across various hospitals. Data for participation by nurses and physicians were examined using a gamma distribution model to discern the predictors influencing the changes in the percentage of vaginal births.
Results: Data from 27 hospitals involved in the project were analyzed. A total of 339 healthcare professionals, including 147 nurses and 192 doctors, underwent the simulation-based training. During the pilot test, the percentage of vaginal births increased from 27.8% to 36.1%, which further increased to 39.8% in the post-intervention period, particularly when the participation rate of nurses exceeded the median.
Conclusion: This study suggests that simulation-based training is a valuable strategy for achieving positive changes in obstetric practice, specifically an increase in the rate of vaginal births. These findings underscore the potential advantages of incorporating simulation training into improvement initiatives, as evidenced by the correlation between higher training adoption rates and substantial and sustained enhancements in vaginal birth rates.
{"title":"Appropriate Delivery Project: Impact of Simulation Training on the Increase in Vaginal Births in Hospitals in Brazil.","authors":"Mariana Santos Alecrim Molina, Eduardo Cordioli, Thomaz Bittencourt Couto, Joyce Kelly Silva Barreto, Rita de Cássia Sanchez","doi":"10.31744/einstein_journal/2024AO0783","DOIUrl":"10.31744/einstein_journal/2024AO0783","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to analyze the relationship between the participation of professionals in simulation-based training and an increase in the rate of vaginal deliveries.</p><p><strong>Methods: </strong>This retrospective observational study analyzed professionals' participation in high-fidelity simulation training during the pilot phase of the Appropriate Delivery Project, spanning from May 21, 2015 to May 21, 2016, along with the rates of vaginal deliveries across various hospitals. Data for participation by nurses and physicians were examined using a gamma distribution model to discern the predictors influencing the changes in the percentage of vaginal births.</p><p><strong>Results: </strong>Data from 27 hospitals involved in the project were analyzed. A total of 339 healthcare professionals, including 147 nurses and 192 doctors, underwent the simulation-based training. During the pilot test, the percentage of vaginal births increased from 27.8% to 36.1%, which further increased to 39.8% in the post-intervention period, particularly when the participation rate of nurses exceeded the median.</p><p><strong>Conclusion: </strong>This study suggests that simulation-based training is a valuable strategy for achieving positive changes in obstetric practice, specifically an increase in the rate of vaginal births. These findings underscore the potential advantages of incorporating simulation training into improvement initiatives, as evidenced by the correlation between higher training adoption rates and substantial and sustained enhancements in vaginal birth rates.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11319025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-09eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024AO0825
Laila Pinto Coelho, Sylvia Costa Lima Farhat, Rafael da Silva Giannasi Severini, Ana Carolina Amarante Souza, Katharina Reichmann Rodrigues, Fernanda Paixão Silveira Bello, Claudio Schvartsman, Thomaz Bittencourt Couto
Objective: Simulation plays an important role in cardiopulmonary resuscitation training. Comparing postsimulation debriefing with rapid cycle deliberate practice could help determine the best simulation strategy for pediatric cardiopulmonary resuscitation training among pediatric residents.
Methods: This is a single-blind, prospective, randomized controlled study. First- and second year pediatric residents were enrolled and randomized into two groups (1:1 ratio): rapid cycle deliberate practice group (intervention) or postsimulation debriefing group (control). They participated in two rounds of simulated pediatric cardiopulmonary arrest to assess the simulated pediatric cardiopulmonary resuscitation performance gain (round 1) and retention after a 5-6 week washout period (round 2). Scenarios were video-recorded and analyzed by blinded evaluators. The main outcome was the time to initiation of chest compressions. Secondary outcomes included time to recognize a cardiopulmonary arrest, time to recognize a shockable rhythm, time to defibrillation, time to initiation of chest compressions after defibrillation, and chest compression fraction.
Results: Sixteen groups participated in the first round and fifteen groups in the second one. Time to intiation of chest compressions decreased from preintervention scenario to the round 1 testing scenario and increased from round 1 to round 2 testing scenario. However, no interaction effects nor group effects were observed (p=0.885 and p=0.329, respectively). There were no significant differences between the two groups regarding the secondary outcomes.
Conclusion: Despite an overall improvement in simulated pediatric cardiopulmonary resuscitation performance, we did not observe significant differences between the two groups regarding the analyzed variables. The decline in simulated pediatric cardiopulmonary resuscitation performance after 5 weeks suggests the need for shorter time intervals between training sessions.
{"title":"Rapid cycle deliberate practice versus postsimulation debriefing in pediatric cardiopulmonary resuscitation training: a randomized controlled study.","authors":"Laila Pinto Coelho, Sylvia Costa Lima Farhat, Rafael da Silva Giannasi Severini, Ana Carolina Amarante Souza, Katharina Reichmann Rodrigues, Fernanda Paixão Silveira Bello, Claudio Schvartsman, Thomaz Bittencourt Couto","doi":"10.31744/einstein_journal/2024AO0825","DOIUrl":"10.31744/einstein_journal/2024AO0825","url":null,"abstract":"<p><strong>Objective: </strong>Simulation plays an important role in cardiopulmonary resuscitation training. Comparing postsimulation debriefing with rapid cycle deliberate practice could help determine the best simulation strategy for pediatric cardiopulmonary resuscitation training among pediatric residents.</p><p><strong>Methods: </strong>This is a single-blind, prospective, randomized controlled study. First- and second year pediatric residents were enrolled and randomized into two groups (1:1 ratio): rapid cycle deliberate practice group (intervention) or postsimulation debriefing group (control). They participated in two rounds of simulated pediatric cardiopulmonary arrest to assess the simulated pediatric cardiopulmonary resuscitation performance gain (round 1) and retention after a 5-6 week washout period (round 2). Scenarios were video-recorded and analyzed by blinded evaluators. The main outcome was the time to initiation of chest compressions. Secondary outcomes included time to recognize a cardiopulmonary arrest, time to recognize a shockable rhythm, time to defibrillation, time to initiation of chest compressions after defibrillation, and chest compression fraction.</p><p><strong>Results: </strong>Sixteen groups participated in the first round and fifteen groups in the second one. Time to intiation of chest compressions decreased from preintervention scenario to the round 1 testing scenario and increased from round 1 to round 2 testing scenario. However, no interaction effects nor group effects were observed (p=0.885 and p=0.329, respectively). There were no significant differences between the two groups regarding the secondary outcomes.</p><p><strong>Conclusion: </strong>Despite an overall improvement in simulated pediatric cardiopulmonary resuscitation performance, we did not observe significant differences between the two groups regarding the analyzed variables. The decline in simulated pediatric cardiopulmonary resuscitation performance after 5 weeks suggests the need for shorter time intervals between training sessions.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11319027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-09eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024AO0627
Wander Valadares de Oliveira Júnior, Luciane Teixeira Passos Giarola, Letícia Gonçalves Resende Ferreira, Isabella Viana Gomes Schettini, Sylvia Dias Turani, Arlindo Ribeiro de Oliveira, Maria Aparecida Silva Marinho, Sérgio Wyton Lima Pinto, Melina Barros-Pinheiro, Roberta Carvalho de Figueiredo, Danyelle Romana Alves Rios
Objective: This study aimed to evaluate inflammatory biomarkers in patients undergoing peritoneal dialysis and investigate their association with all-cause mortality or transfer to hemodialysis.
Methods: This prospective cohort study included 43 patients undergoing peritoneal dialysis. Plasma levels of cytokines were measured using flow cytometry and capture enzyme-linked immunosorbent assay. Biomarkers were categorized based on their respective median values. Survival analysis was conducted using the Kaplan-Meier estimator, considering two outcomes: all-cause mortality and transfer to hemodialysis.
Results: After adjusting for confounding factors, plasma levels above the median of the levels of CCL2 and plasma, as well as below the median of TNF-α, and the median of dialysate IL-17 levels, were associated with an increased risk of experiencing the specified outcomes after approximately 16 months of follow-up.
Conclusion: These findings suggest that inflammatory biomarkers may be a valuable tool for predicting all-cause mortality and transfer to hemodialysis in patients undergoing peritoneal dialysis.
{"title":"Inflammation and all-cause mortality in patients undergoing peritoneal dialysis.","authors":"Wander Valadares de Oliveira Júnior, Luciane Teixeira Passos Giarola, Letícia Gonçalves Resende Ferreira, Isabella Viana Gomes Schettini, Sylvia Dias Turani, Arlindo Ribeiro de Oliveira, Maria Aparecida Silva Marinho, Sérgio Wyton Lima Pinto, Melina Barros-Pinheiro, Roberta Carvalho de Figueiredo, Danyelle Romana Alves Rios","doi":"10.31744/einstein_journal/2024AO0627","DOIUrl":"10.31744/einstein_journal/2024AO0627","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate inflammatory biomarkers in patients undergoing peritoneal dialysis and investigate their association with all-cause mortality or transfer to hemodialysis.</p><p><strong>Methods: </strong>This prospective cohort study included 43 patients undergoing peritoneal dialysis. Plasma levels of cytokines were measured using flow cytometry and capture enzyme-linked immunosorbent assay. Biomarkers were categorized based on their respective median values. Survival analysis was conducted using the Kaplan-Meier estimator, considering two outcomes: all-cause mortality and transfer to hemodialysis.</p><p><strong>Results: </strong>After adjusting for confounding factors, plasma levels above the median of the levels of CCL2 and plasma, as well as below the median of TNF-α, and the median of dialysate IL-17 levels, were associated with an increased risk of experiencing the specified outcomes after approximately 16 months of follow-up.</p><p><strong>Conclusion: </strong>These findings suggest that inflammatory biomarkers may be a valuable tool for predicting all-cause mortality and transfer to hemodialysis in patients undergoing peritoneal dialysis.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11323835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-09eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024AO0652
Henrique Andrade Rodrigues Fonseca, Adriano Jose Pereira, Ricardo Kenji Nawa, Viviane Aparecida Rodrigues Sant'Anna, Tatiana Ferreira de Almeida, Hélio Penna Guimarães, Alexandre Pereira Tognon, Lucas Miranda Marques, Lucas Santana Coelho da Silva, Rafaela de Souza Bittencourt, Camila Pachêco Gomes, Priscila de Aquino Martins, Aryadne Lyrio de Oliveira, Eveline Pipolo Milan, Frederico Toledo Campos Dall'Orto, Conrado Roberto Hoffman Filho, Guacyra Almeida, Fábio Barlem Hohmann, Diogo Duarte Fagundes Moia, Luciana Pereira Almeida Piano, Felipe Pinheiro Machado, Ronaldo Vicente Pereira Soares, Lucas Petri Damiani, Silvia Regina Lamas Assis, Edson Amaro Junior, Luiz Vicente Rizzo, Otávio Berwanger
Objective: To evaluate deaths, hospitalizations, and persistence of symptoms in patients with COVID-19 after infection in an outpatient setting during the first COVID-19 wave in Brazil.
Methods: This prospective cohort was between April 2020 and February 2021. Hospitalized or non-hospitalized COVID-19 patients until five days after symptom onset were included. The outcomes measured were incidence of death, hospitalization, and persistence of more than two symptoms 60 days after discharge.
Results: Out of 1,198 patients enrolled in the study, 66.7% were hospitalized. A total of 289 patients died (1 [0.3%] non-hospitalized and 288 [36%] hospitalized). At 60 days, patients non-hospitalized during admission had more persistent symptoms (16.2%) compared to hospitalized (37.1%). The COVID-19 severity variables associated with the persistence of two or more symptoms were increased age (OR= 1.03; p=0.015), respiratory rate at hospital admission (OR= 1.11; p=0.005), length of hospital stay of more than 60 days (OR= 12.24; p=0.026), and need for intensive care unit admission (OR= 2.04; p=0.038).
Conclusion: COVID-19 survivors who were older, tachypneic at admission, had a hospital length of stay >60 days, and were admitted to the intensive care unit had more persistent symptoms than patients who did not require hospitalization in the early COVID-19 waves.ClinicalTrials.gov Identifier: NCT04479488.
{"title":"Mortality, hospitalizations, and persistence of symptoms in the outpatient setting of the first COVID-19 wave in Brazil: results of SARS-Brazil cohort study.","authors":"Henrique Andrade Rodrigues Fonseca, Adriano Jose Pereira, Ricardo Kenji Nawa, Viviane Aparecida Rodrigues Sant'Anna, Tatiana Ferreira de Almeida, Hélio Penna Guimarães, Alexandre Pereira Tognon, Lucas Miranda Marques, Lucas Santana Coelho da Silva, Rafaela de Souza Bittencourt, Camila Pachêco Gomes, Priscila de Aquino Martins, Aryadne Lyrio de Oliveira, Eveline Pipolo Milan, Frederico Toledo Campos Dall'Orto, Conrado Roberto Hoffman Filho, Guacyra Almeida, Fábio Barlem Hohmann, Diogo Duarte Fagundes Moia, Luciana Pereira Almeida Piano, Felipe Pinheiro Machado, Ronaldo Vicente Pereira Soares, Lucas Petri Damiani, Silvia Regina Lamas Assis, Edson Amaro Junior, Luiz Vicente Rizzo, Otávio Berwanger","doi":"10.31744/einstein_journal/2024AO0652","DOIUrl":"10.31744/einstein_journal/2024AO0652","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate deaths, hospitalizations, and persistence of symptoms in patients with COVID-19 after infection in an outpatient setting during the first COVID-19 wave in Brazil.</p><p><strong>Methods: </strong>This prospective cohort was between April 2020 and February 2021. Hospitalized or non-hospitalized COVID-19 patients until five days after symptom onset were included. The outcomes measured were incidence of death, hospitalization, and persistence of more than two symptoms 60 days after discharge.</p><p><strong>Results: </strong>Out of 1,198 patients enrolled in the study, 66.7% were hospitalized. A total of 289 patients died (1 [0.3%] non-hospitalized and 288 [36%] hospitalized). At 60 days, patients non-hospitalized during admission had more persistent symptoms (16.2%) compared to hospitalized (37.1%). The COVID-19 severity variables associated with the persistence of two or more symptoms were increased age (OR= 1.03; p=0.015), respiratory rate at hospital admission (OR= 1.11; p=0.005), length of hospital stay of more than 60 days (OR= 12.24; p=0.026), and need for intensive care unit admission (OR= 2.04; p=0.038).</p><p><strong>Conclusion: </strong>COVID-19 survivors who were older, tachypneic at admission, had a hospital length of stay >60 days, and were admitted to the intensive care unit had more persistent symptoms than patients who did not require hospitalization in the early COVID-19 waves.ClinicalTrials.gov Identifier: NCT04479488.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11323834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-26eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024GS0493
Aline Cremasco Rocha, Bruna Granig Valente, Danilo Wingeter Ramalho, Juliana Baleki Borri, Carlos Augusto de Mattos, Cintia Kelly Bittar
Objective: To describe and analyze the aspects regarding the cost and length of stay for elderly patients with bone fractures in a tertiary reference hospital.
Methods: A cross-sectional retrospective study using data obtained from medical records between January and December 2020. For statistical analysis, exploratory analyses, Shapiro-Wilk test, χ2 test, and Spearman correlation were used.
Results: During the study period, 156 elderly patients (62.2% women) with bone fractures were treated. The main trauma mechanism was a fall from a standing height (76.9%). The most common type of fracture in this sample was a transtrochanteric fracture of the femur, accounting for 40.4% of cases. The mean length of stay was 5.25 days. The total cost varied between R$2,006.53 and R$106,912.74 (average of R$15,695.76) (updated values). The mean daily cost of hospitalization was R$4,478.64. A positive correlation was found between the length of stay and total cost. No significant difference in cost was observed between the two main types of treated fractures.
Conclusion: Fractures in the elderly are frequent, resulting in significant costs. The longer the hospital stay for treatment, the higher the total cost. No correlation was found between total cost and number of comorbidities, number of medications used, and the comparison between the treatment of transtrochanteric and femoral neck fractures.
{"title":"Cost and time of hospitalization for elderly people with bone fractures in a reference hospital.","authors":"Aline Cremasco Rocha, Bruna Granig Valente, Danilo Wingeter Ramalho, Juliana Baleki Borri, Carlos Augusto de Mattos, Cintia Kelly Bittar","doi":"10.31744/einstein_journal/2024GS0493","DOIUrl":"10.31744/einstein_journal/2024GS0493","url":null,"abstract":"<p><strong>Objective: </strong>To describe and analyze the aspects regarding the cost and length of stay for elderly patients with bone fractures in a tertiary reference hospital.</p><p><strong>Methods: </strong>A cross-sectional retrospective study using data obtained from medical records between January and December 2020. For statistical analysis, exploratory analyses, Shapiro-Wilk test, χ2 test, and Spearman correlation were used.</p><p><strong>Results: </strong>During the study period, 156 elderly patients (62.2% women) with bone fractures were treated. The main trauma mechanism was a fall from a standing height (76.9%). The most common type of fracture in this sample was a transtrochanteric fracture of the femur, accounting for 40.4% of cases. The mean length of stay was 5.25 days. The total cost varied between R$2,006.53 and R$106,912.74 (average of R$15,695.76) (updated values). The mean daily cost of hospitalization was R$4,478.64. A positive correlation was found between the length of stay and total cost. No significant difference in cost was observed between the two main types of treated fractures.</p><p><strong>Conclusion: </strong>Fractures in the elderly are frequent, resulting in significant costs. The longer the hospital stay for treatment, the higher the total cost. No correlation was found between total cost and number of comorbidities, number of medications used, and the comparison between the treatment of transtrochanteric and femoral neck fractures.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11239199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141856749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-26eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024AO0549
Lenises de Paula van der Steld, Mario de Seixas Rocha, Ana Marice Teixeira Ladeia, Humberto Lago Livramento, Gervásio Batista Campos, Francisco Carlos da Costa Darrieux, Oscar Campuzano, Ramon Brugada
Objective: This study aimed to provide a long-term follow-up of PRKAG2 syndrome and describe the new phenotypic aspects of the condition. PRKAG2 syndrome is a rare autosomal-dominant glycogen storage disease characterized by cardiac hypertrophy, ventricular pre-excitation, and conduction system disease. Fatal arrhythmias occur frequently.
Methods: A family cohort of 66 participants was recruited. Clinical and genetic analyses were performed.
Results: Median age of 36.97±17.28 years, with 69.9% being men. Nineteen subjects carried the deleterious variant p.K290I of the PRKAG2 gene. This group experienced many malignant events, including eight pacemaker implants, three sudden cardiac deaths, five aborted cardiac arrests, four strokes, four premature neonatal deaths, two spontaneous abortions, five forceps deliveries, and 12 cesarean procedures. Extracardiac involvement, such as in neurocognitive and psychiatric disorders, has been observed only in carriers of mutations. Palpitations, Syncope, atrial fibrillation, atrial flutter, sinus pauses, and bradycardia were strongly and significantly associated with major or severe adverse events (sudden cardiac death, aborted cardiac arrest, pacemaker use, stroke, and congestive heart failure). Early diagnosis and intervention through antiarrhythmic drugs, anticoagulation, pacemaker implantation, radiofrequency catheter ablation, and cesarean section surgery improved the symptoms and survival rates. Mutations carriers were advised to avoid pregnancy.
Conclusion: This study identified that the p.K291I_PRKAG2 mutation is associated with poor prognosis, highlighting the need for early intervention. Further research may uncover the potential connections between intellectual disability, miscarriage, and neonatal death in individuals with this syndrome.
{"title":"PRKAG2 syndrome, a rare hypertrophic cardiomyopathy: a Brazilian long-term follow-up with extracardiac disorders.","authors":"Lenises de Paula van der Steld, Mario de Seixas Rocha, Ana Marice Teixeira Ladeia, Humberto Lago Livramento, Gervásio Batista Campos, Francisco Carlos da Costa Darrieux, Oscar Campuzano, Ramon Brugada","doi":"10.31744/einstein_journal/2024AO0549","DOIUrl":"10.31744/einstein_journal/2024AO0549","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to provide a long-term follow-up of PRKAG2 syndrome and describe the new phenotypic aspects of the condition. PRKAG2 syndrome is a rare autosomal-dominant glycogen storage disease characterized by cardiac hypertrophy, ventricular pre-excitation, and conduction system disease. Fatal arrhythmias occur frequently.</p><p><strong>Methods: </strong>A family cohort of 66 participants was recruited. Clinical and genetic analyses were performed.</p><p><strong>Results: </strong>Median age of 36.97±17.28 years, with 69.9% being men. Nineteen subjects carried the deleterious variant p.K290I of the PRKAG2 gene. This group experienced many malignant events, including eight pacemaker implants, three sudden cardiac deaths, five aborted cardiac arrests, four strokes, four premature neonatal deaths, two spontaneous abortions, five forceps deliveries, and 12 cesarean procedures. Extracardiac involvement, such as in neurocognitive and psychiatric disorders, has been observed only in carriers of mutations. Palpitations, Syncope, atrial fibrillation, atrial flutter, sinus pauses, and bradycardia were strongly and significantly associated with major or severe adverse events (sudden cardiac death, aborted cardiac arrest, pacemaker use, stroke, and congestive heart failure). Early diagnosis and intervention through antiarrhythmic drugs, anticoagulation, pacemaker implantation, radiofrequency catheter ablation, and cesarean section surgery improved the symptoms and survival rates. Mutations carriers were advised to avoid pregnancy.</p><p><strong>Conclusion: </strong>This study identified that the p.K291I_PRKAG2 mutation is associated with poor prognosis, highlighting the need for early intervention. Further research may uncover the potential connections between intellectual disability, miscarriage, and neonatal death in individuals with this syndrome.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11239200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141856750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Chronic kidney disease is a progressive and irreversible loss of kidney function and considerably affects the lives of patients and their families. Its high incidence necessitates efficient public policies for prevention and treatment. However, policies for chronic kidney disease education and awareness are scarce.
Objective: To evaluate global public policies for the prevention and treatment of chronic kidney disease adopted in various regions, aiming to comprehend the differences between various models.
Methods: This integrative review followed PRISMA recommendations and included papers published between 2016 and 2021 across several databases.
Results: The 44 selected articles were categorized into three themes: structural and financial aspects of the organization of renal healthcare, access to renal healthcare or management of chronic kidney disease, and coping strategies for chronic kidney disease or kidney health. Critical analysis of the papers revealed global neglect of kidney disease in political agendas. Considerable policy variations exist between different countries and regions of the same country. Our research highlighted that free and universal health coverage, especially for the most vulnerable patients, is crucial for accessing treatment owing to the prohibitively high treatment costs.
Conclusion: Social, economic, and ethnic inequalities strongly correlate with disease occurrence, primarily affecting minority groups who lack health support, especially for the prevention and treatment of chronic kidney disease.
{"title":"Overview of global healthcare policies for patients with chronic kidney disease: an integrative literature review.","authors":"Letícia Borges Mendonça Soares, Alcimar Barbosa Soares, Janise Braga Barros Ferreira","doi":"10.31744/einstein_journal/2024RW0519","DOIUrl":"10.31744/einstein_journal/2024RW0519","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic kidney disease is a progressive and irreversible loss of kidney function and considerably affects the lives of patients and their families. Its high incidence necessitates efficient public policies for prevention and treatment. However, policies for chronic kidney disease education and awareness are scarce.</p><p><strong>Objective: </strong>To evaluate global public policies for the prevention and treatment of chronic kidney disease adopted in various regions, aiming to comprehend the differences between various models.</p><p><strong>Methods: </strong>This integrative review followed PRISMA recommendations and included papers published between 2016 and 2021 across several databases.</p><p><strong>Results: </strong>The 44 selected articles were categorized into three themes: structural and financial aspects of the organization of renal healthcare, access to renal healthcare or management of chronic kidney disease, and coping strategies for chronic kidney disease or kidney health. Critical analysis of the papers revealed global neglect of kidney disease in political agendas. Considerable policy variations exist between different countries and regions of the same country. Our research highlighted that free and universal health coverage, especially for the most vulnerable patients, is crucial for accessing treatment owing to the prohibitively high treatment costs.</p><p><strong>Conclusion: </strong>Social, economic, and ethnic inequalities strongly correlate with disease occurrence, primarily affecting minority groups who lack health support, especially for the prevention and treatment of chronic kidney disease.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11221832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-19eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024RW0182
Caio de Almeida Lellis, Marco Alejandro Menacho Herbas, Ledismar José da Silva
Objective: To evaluate the psychiatric alterations resulting from deep brain stimulation of the subthalamic nucleus in the management of Parkinson's disease.
Methods: Articles were searched using three databases: Public/Publisher MEDLINE, Virtual Health Library, and Cochrane Library.
Results: Eleven studies were included in the analysis. Manic syndrome alone was reported in two of the 11 studies analyzed. Psychosis alone was not reported in any of them, but it was found in association with other psychiatric alterations in two studies, not including manic syndrome. In one case report, hypersexuality was associated with depression and self-alienation. Depressive disorder was the most frequent psychiatric disorder after deep brain stimulation of the subthalamic nucleus, according to five of the reviewed articles, encompassing 26 patients. In four of these articles, depression was associated with other psychiatric disorders, such as psychosis, suicidal ideation, hypersexuality, and anxiety. Hypomanic syndrome was reported in two cases.
Conclusion: More common psychiatric disorders related to the neuroanatomy of the nucleus were observed, probably because of the microlesions caused by the implantation of deep brain stimulation and the regulation of the stimulation of the device. The most common disorders include depression, mania/hypomania, psychosis, anxiety, suicidal ideation, and hypersexuality.
{"title":"Psychiatric disorders after deep brain stimulation of the subthalamic nucleus in Parkinson's disease: a systematic review.","authors":"Caio de Almeida Lellis, Marco Alejandro Menacho Herbas, Ledismar José da Silva","doi":"10.31744/einstein_journal/2024RW0182","DOIUrl":"10.31744/einstein_journal/2024RW0182","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the psychiatric alterations resulting from deep brain stimulation of the subthalamic nucleus in the management of Parkinson's disease.</p><p><strong>Methods: </strong>Articles were searched using three databases: Public/Publisher MEDLINE, Virtual Health Library, and Cochrane Library.</p><p><strong>Results: </strong>Eleven studies were included in the analysis. Manic syndrome alone was reported in two of the 11 studies analyzed. Psychosis alone was not reported in any of them, but it was found in association with other psychiatric alterations in two studies, not including manic syndrome. In one case report, hypersexuality was associated with depression and self-alienation. Depressive disorder was the most frequent psychiatric disorder after deep brain stimulation of the subthalamic nucleus, according to five of the reviewed articles, encompassing 26 patients. In four of these articles, depression was associated with other psychiatric disorders, such as psychosis, suicidal ideation, hypersexuality, and anxiety. Hypomanic syndrome was reported in two cases.</p><p><strong>Conclusion: </strong>More common psychiatric disorders related to the neuroanatomy of the nucleus were observed, probably because of the microlesions caused by the implantation of deep brain stimulation and the regulation of the stimulation of the device. The most common disorders include depression, mania/hypomania, psychosis, anxiety, suicidal ideation, and hypersexuality.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11221831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-08eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024AO0462
Beatriz Mokwa Dos Santos, Edward Araujo Júnior, Rita Maira Zanine
Objective: This study aimed to evaluate whether severity changes with colposcopic lesion size, regardless of age.
Methods: This retrospective comparative study reviewed the records of 428 women with altered cytopathology reports who were directed by primary health care. Only those women with colposcopic alterations were evaluated (n=411). Histopathological analyses were restricted to patients who underwent excisional treatment (n=345). According to their age, they were grouped into the following: <21, 21-24, 25-35, and >35 years, and also, ≤24 and ≥25 years. The cytopathological, colposcopic, and histopathological findings were grouped according to severity. Lesion size was subjectively assessed from the colposcopic drawing recorded in the chart and according to the number of quadrants of the total cervical surface affected by colposcopic alterations in the transformation zone. Statistical significance was set at p<0.05.
Results: The evaluations suggested that the lesion size was directly related to the severity of the cytopathology, colposcopy, and histopathology reports for the age groups ≤24 or ≥25 years. We observed associations between lesion size and severity of the cytopathology (≤24 years, p=0.037) and histopathology (≥25 years, p=0.003) findings.
Conclusion: The size of the lesion was directly related to the severity of the histopathological lesion in patients aged ≥25 years and cytopathological in patients aged ≤24 years.
{"title":"Is the colposcopic lesion size a predictor of high-grade lesions in young patients?","authors":"Beatriz Mokwa Dos Santos, Edward Araujo Júnior, Rita Maira Zanine","doi":"10.31744/einstein_journal/2024AO0462","DOIUrl":"10.31744/einstein_journal/2024AO0462","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate whether severity changes with colposcopic lesion size, regardless of age.</p><p><strong>Methods: </strong>This retrospective comparative study reviewed the records of 428 women with altered cytopathology reports who were directed by primary health care. Only those women with colposcopic alterations were evaluated (n=411). Histopathological analyses were restricted to patients who underwent excisional treatment (n=345). According to their age, they were grouped into the following: <21, 21-24, 25-35, and >35 years, and also, ≤24 and ≥25 years. The cytopathological, colposcopic, and histopathological findings were grouped according to severity. Lesion size was subjectively assessed from the colposcopic drawing recorded in the chart and according to the number of quadrants of the total cervical surface affected by colposcopic alterations in the transformation zone. Statistical significance was set at p<0.05.</p><p><strong>Results: </strong>The evaluations suggested that the lesion size was directly related to the severity of the cytopathology, colposcopy, and histopathology reports for the age groups ≤24 or ≥25 years. We observed associations between lesion size and severity of the cytopathology (≤24 years, p=0.037) and histopathology (≥25 years, p=0.003) findings.</p><p><strong>Conclusion: </strong>The size of the lesion was directly related to the severity of the histopathological lesion in patients aged ≥25 years and cytopathological in patients aged ≤24 years.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11213560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141564746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-08eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024AO0707
Flavio Tocci Moreira, Tarso Augusto Duenhas Accorsi, Karine De Amicis, Karen Francine Köhler, Renata Albaladejo Morbeck, Eduardo Cordioli, Carlos Henrique Sartorato Pedrotti
Objective: The quality of care and safety for Telemedicine-discharged patients with suspected respiratory infections are closely related to low rates of prescriptions of unjustified and high-risk medications. This retrospective study aimed to assess adherence to the current COVID-19 guidelines in direct-to-consumer telemedicine encounters at a large center using multidrug stewardship protocols.
Methods: A quarterly electronic survey utilizing medical records of individual physician care assessed various quality indicators. Physicians received ongoing adaptive feedback based on personal metrics, with Telemedicine Center recommendations derived from the 2020 Infectious Diseases Society of America guidelines. The study included all consecutive adults with new respiratory symptoms in the last 14 days who sought spontaneous Telemedicine consultations between March 2020 and August 2021. This study analyzed patients with suspected or confirmed COVID-19 and other airway infections.
Results: Of the 221,128 evaluated patients, 42,042 (19%) had confirmed COVID-19; 104,021 (47%) were suspected to have COVID-19; and, 75,065 (33%) had other diagnoses. Patients with suspected or confirmed COVID-19 had a mean (+DP) age of 35±12 years. A total of 125,107 (85.65%) patients were managed at home, 2,552 (1.74%) were referred for non-urgent in-office reassessment, and 17,185 (11.7%) were referred to the emergency department for whom there was no further treatment recommendation. The antibiotic rate in confirmed or suspected COVID-19 cases was 0.46%/0.65% and that for non-evidence-based prescriptions was 0.01%/0.005%.
Conclusion: Guideline training and Telemedicine consultation feedback may lead to lower antibiotic and antimicrobial prescriptions in suspected and confirmed COVID-19 cases. Multidrug stewardship protocols may improve guideline adherence and reinforce the quality of care and safety in Telemedicine encounters.
{"title":"Multidrug stewardship and adherence to guidelines in >200,000 direct-to-consumer Telemedicine encounters.","authors":"Flavio Tocci Moreira, Tarso Augusto Duenhas Accorsi, Karine De Amicis, Karen Francine Köhler, Renata Albaladejo Morbeck, Eduardo Cordioli, Carlos Henrique Sartorato Pedrotti","doi":"10.31744/einstein_journal/2024AO0707","DOIUrl":"10.31744/einstein_journal/2024AO0707","url":null,"abstract":"<p><strong>Objective: </strong>The quality of care and safety for Telemedicine-discharged patients with suspected respiratory infections are closely related to low rates of prescriptions of unjustified and high-risk medications. This retrospective study aimed to assess adherence to the current COVID-19 guidelines in direct-to-consumer telemedicine encounters at a large center using multidrug stewardship protocols.</p><p><strong>Methods: </strong>A quarterly electronic survey utilizing medical records of individual physician care assessed various quality indicators. Physicians received ongoing adaptive feedback based on personal metrics, with Telemedicine Center recommendations derived from the 2020 Infectious Diseases Society of America guidelines. The study included all consecutive adults with new respiratory symptoms in the last 14 days who sought spontaneous Telemedicine consultations between March 2020 and August 2021. This study analyzed patients with suspected or confirmed COVID-19 and other airway infections.</p><p><strong>Results: </strong>Of the 221,128 evaluated patients, 42,042 (19%) had confirmed COVID-19; 104,021 (47%) were suspected to have COVID-19; and, 75,065 (33%) had other diagnoses. Patients with suspected or confirmed COVID-19 had a mean (+DP) age of 35±12 years. A total of 125,107 (85.65%) patients were managed at home, 2,552 (1.74%) were referred for non-urgent in-office reassessment, and 17,185 (11.7%) were referred to the emergency department for whom there was no further treatment recommendation. The antibiotic rate in confirmed or suspected COVID-19 cases was 0.46%/0.65% and that for non-evidence-based prescriptions was 0.01%/0.005%.</p><p><strong>Conclusion: </strong>Guideline training and Telemedicine consultation feedback may lead to lower antibiotic and antimicrobial prescriptions in suspected and confirmed COVID-19 cases. Multidrug stewardship protocols may improve guideline adherence and reinforce the quality of care and safety in Telemedicine encounters.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11213559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141564747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}