Einstein-Sao Paulo最新文献

A total of 89% of the 3,136 legal demands sought medication. Androgen inhibitors amounted to 78.8% of all lawsuits, particularly abiraterone. There is a growth tendency in judicialization, with a 30-fold increase over 4 years. The estimated annual financial burden of judicialization on the Brazilian United Public Health System has reached BRL 783 million.

Nursing workload is high with patients undergoing extracorporeal membrane oxygenation. The initial 24 hours of extracorporeal membrane oxygenation have the highest workload, quantified using the Nursing Activities Score. Presence of COVID-19 and delayed extracorporeal membrane oxygenation initiation increase the workload in the initial 24 hours of extracorporeal membrane oxygenation. Extracorporeal membrane oxygenation care demands adjustments in the nurse-to-patient ratio in the intensive care unit.

Previous studies have correlated inflammation with complications after percutaneous coronary intervention. In patients with stable coronary disease, percutaneous coronary intervention leads to elevated inflammatory biomarker levels. The inflammatory response is significantly correlated with myocardial injury.

Public hospitals in Brazil performed 37,741 hallux valgus surgery procedures between January 2008 and October 2024. The study population consisted of 79.7% females, with the most common age group being 40-69 years (67.7%). The mean length of stay was 1.7 days. The study population consisted of 79.7% females, with the most common age group being 40-69 years (67.7%). The mean length of stay was 1.7 days. The mean cost per patient was US$ 141.53. The overall mortality count was nine, corresponding to a death rate of 0.024%.

Introduction: The controversy surrounding the potential benefits of the basic saline solution vs. Ringer's lactate solution for patients undergoing phacoemulsification for cataracts prompted a systematic review and meta-analysis for comparing the two solutions.

Objective: This systematic review and meta-analysis aimed to compare the basic saline solution with Ringer's lactate for irrigation in phacoemulsification for cataracts.

Methods: We searched the Embase, PubMed, and Cochrane databases for randomized controlled trials comparing basic saline solution with Ringer's lactate in relation to central corneal thickness and loss of endothelial cell density after elective cataract surgery.

Results: Four studies involving 322 patients who underwent phacoemulsification were included in the analysis. Of the participants, 161 (50%) received Ringer's lactate as the irrigation solution, and 161 (50%) received basic saline solution. No differences were noticed between Ringer's lactate and basic saline solution regarding the loss of endothelial cell density within 28 days.

Conclusion: In patients undergoing phacoemulsification for cataracts, no significant differences in the loss of endothelial cell density and changes in central corneal thickness were observed between groups irrigated with Ringer's lactate and balanced salt solution.Prospero database registration: ID CRD42024554821.

Objective: To analyze the sociodemographic and clinical characteristics, comorbidities, therapeutic resources, and mortality rates of elderly patients with COVID-19 admitted to an intensive care unit.

Methods: This retrospective cohort study included patients admitted to the intensive care unit of a large hospital in São Paulo, Brazil, from March 1, 2020, to March 31, 2021. Patients were categorized as adults (≥18 years) and elderly (≥60 years).

Results: Of the 504 patients, 326 (64.7%) were elderly. Compared to the adults, elderly patients had significantly higher Simplified Acute Physiology Score 3 and Sequential Organ Failure Assessment scores on admission (p<0.001). They also had a greater prevalence of comorbidities, as reflected by a higher Charlson Comorbidity Index (p<0.001) and were frailer according to the Modified Frailty Index (p<0.001). The elderly group had a longer intensive care unit stay, with an average of 17±19 days and a hospital stay of 40±39 days, compared to the adults who had an average intensive care unit stay of 14±16 days and a hospital stay of 28±25 days. Hospital mortality was significantly higher among elderly patients (37.7%) than among adults (12.4%) (p<0.001), especially in those who developed acute kidney injury and required vasopressors and extracorporeal membrane oxygenation. The other independent risk factors for mortality were frailty, arrhythmias, and prior organ transplantation.

Conclusion: Frail elderly intensive care unit patients with multiple comorbidities require more resources, have longer hospital stays, and face higher mortality rates. Early interventions targeting this population could improve survival.

Objective: This study aimed to evaluate the association between pre-transplant parathyroid hormone levels and renal function 1-year after kidney transplantation.

Methods: This retrospective cohort study was conducted at a tertiary public university hospital and included all patients who underwent kidney transplantation between May 2012 and September 2020. Patients under 18 years of age and those who received a transplant from a living donor were excluded. The primary outcome was renal function at 1 year, as assessed using the CKD-EPI formula. Univariate and multivariate analyses were performed to identify predictors of graft function at one year clinical and laboratory variables.

Results: During the study period, 1,128 kidney transplants were performed. After applying exclusion criteria, 382 patients from six dialysis centers were included in the final analysis. Pre-transplant parathyroid hormone levels were not associated with renal function in either univariate or multivariate analyses (p=0.968 and p=0.616, respectively). In the multivariate analysis, recipient age (Coefficient: -0.41, 95% CI= -0.63 to -0.20, p<0.001) and Kidney Donor Profile Index (Coefficient: -0.44, 95%CI= -0.54 to -0.33, p<0.001) were significantly associated with graft function at 1 year.

Conclusion: Pre-transplant serum levels of intact parathyroid hormone levels were not associated with renal function 1 year after transplantation. Conversely, recipient age and Kidney Donor Profile Index showed significant associations with graft outcomes, highlighting the importance of individualized risk assessment in transplant evaluation.

Objective: To develop and validate a comprehensive mobile health App (mHealth App) to increase the health literacy and care engagement of patients undergoing bariatric surgery.

Methods: App development required identifying patient needs, conducting a literature review, benchmarking, and designing the App through a multi-professional team. A prototype was created and validated by healthcare and information technology specialists, and patients undergoing bariatric surgery.

Results: The Baritrip App contained 188 screens divided into eight sections, covering clinical, surgical, nutritional, mental health, and speech therapy domains. The overall content validity index of the App as assessed by experts was 0.99. Bariatric surgery patients assessed the layout, language, content organization, and engagement of the App, with an overall agreement rate of 89.1%.

Conclusion: The Baritrip mobile health App showed good content validity and cultural appropriateness for bariatric surgery patients.

Introduction: Cataracts are the leading cause of reversible blindness worldwide, with age-related cataracts being the most common type. With advancements in digital workflows, new alternative surgical processes aim to enhance efficiency and patient outcomes.

Objective: This study aimed to evaluate the effectiveness of digital versus manual workflows for cataract surgery through a systematic review and meta-analysis focusing on preoperative assessment time, surgery planning time, intraoperative duration, and transcription frequency.

Methods: The study was performed in accordance with PRISMA guidelines and identified relevant studies published until July 2024 in the PubMed, Embase, Web of Science, and Cochrane databases.

Results: Digital workflows significantly reduced preoperative assessment and intraoperative times for astigmatic cataracts (mean difference (MD)=80.94 s, p<0.01; MD=107.13 s, p=0, respectively) and planning times (MD=130.52 s, p=0.43). Additionally, digital workflows decreased transcription requirements for conventional and post-refractive cataracts. Heterogeneity was notable, especially in the preoperative assessments (I2 >90%).

Conclusion: The findings suggest that digital workflows for cataract surgery improve efficiency; however, further large-scale, long-term studies are required to assess the broader applicability and cost-effectiveness of these workflows. Digitalization has the potential to streamline the surgical management of cataracts and enhance patient outcomes.

Prospero database registration: ID CRD42024590552.

Objective: To analyze the post-exercise effects of self-selected exercise intensity compared with the intensity recommended by guidelines on blood pressure and heart rate variability in participants with peripheral artery disease.

Methods: This was a randomized crossover trial. Twenty participants with peripheral artery disease (52.6% men; 69.1±7.9 years; ankle-brachial index 0.59±0.15) underwent three experimental sessions: self-selected exercise intensity, intensity recommended by guidelines, and a control session (no exercise). Blood pressure (auscultatory method), heart rate, and heart rate variability were measured before and after the intervention.

Results: Acute reductions in systolic blood pressure were observed in the exercise sessions compared to the control (p<0.005). The heart rate decreased after control and increased after exercise sessions (p<0.001). The absolute heart rate increase after exercise sessions were higher than that in the Control Group p<0.001. Heart rate recovery showed a progressive decrease post-session over 300 s (p<0.001), with the root mean square of successive differences significantly decreasing up to 60 seconds in both exercise sessions (p<0.05).

Conclusion: Acute walking exercise sessions prescribed at self-selected exercise intensity had similar effects on reducing systolic blood pressure and heart rate recovery compared with walking exercise session performed at the guideline-recommended intensity.

Clinicaltrials.gov identifier: NCT04333615.