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Santos SV, Margarido MRRA, Caires IS, Santos RAN, Souza SG, Souza JMA, Martimiano RR, Dutra CSK, Palha P, Zanetti ACG, Pazin-Filho A. Basic life support knowledge of first-year university students from Brazil. ACTA ACUST UNITED AC 2015; 48:1151-5. [PMID: 26397971 PMCID: PMC4661033 DOI: 10.1590/1414-431x20154667] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 06/22/2015] [Indexed: 11/22/2022]
Abstract
We aimed to evaluate knowledge of first aid among new undergraduates and whether it
is affected by their chosen course. A questionnaire was developed to assess knowledge
of how to activate the Mobile Emergency Attendance Service - MEAS (Serviço de
Atendimento Móvel de Urgência; SAMU), recognize a pre-hospital emergency situation
and the first aid required for cardiac arrest. The students were also asked about
enrolling in a first aid course. Responses were received from 1038 of 1365 (76.04%)
new undergraduates. The questionnaires were completed in a 2-week period 1 month
after the beginning of classes. Of the 1038 respondents (59.5% studying biological
sciences, 11.6% physical sciences, and 28.6% humanities), 58.5% knew how to activate
the MEAS/SAMU (54.3% non-biological vs 61.4% biological, P=0.02),
with an odds ratio (OR)=1.39 (95%CI=1.07-1.81) regardless of age, sex, origin, having
a previous degree or having a relative with cardiac disease. The majority could
distinguish emergency from non-emergency situations. When faced with a possible
cardiac arrest, 17.7% of the students would perform chest compressions (15.5%
non-biological vs 19.1% biological first-year university students,
P=0.16) and 65.2% would enroll in a first aid course (51.1% non-biological
vs 74.7% biological, P<0.01), with an OR=2.61
(95%CI=1.98-3.44) adjusted for the same confounders. Even though a high percentage of
the students recognized emergency situations, a significant proportion did not know
the MEAS/SAMU number and only a minority had sufficient basic life support skills to
help with cardiac arrest. A significant proportion would not enroll in a first aid
course. Biological first-year university students were more prone to enroll in a
basic life support course.
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Abstract
No mundo todo atualmente busca-se, dentro da moderna ciência educacional médica, tecnologias e métodos de ensino aprendizagem realmente eficazes ao ensino de competências, que envolvam adequadamente as esferas cognitivas, comportamentais e psico-motoras.1 Mais ainda, é desejável a esse fim que se utilize de meios que, ativamente, promovam o desenvolvimento reflexivo do estudante em medicina espelhando o mais próximo possível a prática médica real. É fundamental que se assegure que o processo educacional respeite e garanta de forma inalienável e primordial a segurança física e emocional dos pacientes, no ensino e na assistência. Também é reconhecido largamente que comportamentos não podem ser adequadamente desenvolvidos através somente de memorização e reprodução da teoria médica e ou ética isoladamente. Este artigo pretende em nível introdutório apresentar e descrever o uso da Simulação como metodologia ativa de ensino, demonstrando seu potencial e suas limitações, contextualizando-a para o ensino e avaliação em áreas de saúde.
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Braggion-Santos MF, Volpe GJ, Pazin-Filho A, Maciel BC, Marin-Neto JA, Schmidt A. Sudden cardiac death in Brazil: a community-based autopsy series (2006-2010). Arq Bras Cardiol 2014; 104:120-7. [PMID: 25424162 PMCID: PMC4375655 DOI: 10.5935/abc.20140178] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 06/27/2014] [Indexed: 11/20/2022] Open
Abstract
Background Sudden cardiac death (SCD) is a sudden unexpected event, from a cardiac cause,
that occurs in less than one hour after the symptoms onset, in a person without
any previous condition that would seem fatal or who was seen without any symptoms
24 hours before found dead. Although it is a relatively frequent event, there are
only few reliable data in underdeveloped countries. Objective We aimed to describe the features of SCD in Ribeirão Preto, Brazil (600,000
residents) according to Coroners’ Office autopsy reports. Methods We retrospectively reviewed 4501 autopsy reports between 2006 and 2010, to
identify cases of SCD. Specific cause of death as well as demographic information,
date, location and time of the event, comorbidities and whether cardiopulmonary
resuscitation (CPR) was attempted were collected. Results We identified 899 cases of SCD (20%); the rate was 30/100000 residents per year.
The vast majority of cases of SCD involved a coronary artery disease (CAD) (64%)
and occurred in men (67%), between the 6th and the 7th
decades of life. Most events occurred during the morning in the home setting
(53.3%) and CPR was attempted in almost half of victims (49.7%). The most
prevalent comorbidity was systemic hypertension (57.3%). Chagas’ disease was
present in 49 cases (5.5%). Conclusion The majority of victims of SCD were men, in their sixties and seventies and the
main cause of death was CAD. Chagas’ disease, an important public health problem
in Latin America, was found in about 5.5% of the cases.
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Gonzalez MM, Timerman S, Gianotto-Oliveira R, Polastri TF, Canesin MF, Schimidt A, Siqueira AW, Pispico A, Longo A, Pieri A, Reis A, Tanaka ACS, Santos AM, Quilici AP, Ribeiro ACL, Barreto ACP, Pazin-Filho A, Timerman A, Machado CA, Franchin Neto C, Miranda CH, Medeiros CR, Malaque CMS, Bernoche C, Gonçalves DM, Sant'Ana DG, Osawa EA, Peixoto E, Arfelli E, Evaristo EF, Azeka E, Gomes EP, Wen FH, Ferreira FG, Lima FG, Mattos FR, Galas FG, Marques FRB, Tarasoutchi F, Mancuso FJN, Freitas GR, Feitosa-Filho GS, Barbosa GC, Giovanini GR, Miotto HC, Guimarães HP, Andrade JP, Oliveira-Filho J, Fernandes JG, Moraes Junior JBMX, Carvalho JJF, Ramires JAF, Cavalini JF, Teles JMM, Lopes JL, Lopes LNGD, Piegas LS, Hajjar LA, Brunório L, Dallan LAP, Cardoso LF, Rabelo MMN, Almeida MFB, Souza MFS, Favarato MH, Pavão MLRC, Shimoda MS, Oliveira Junior MT, Miura N, Filgueiras Filho NM, Pontes-Neto OM, Pinheiro PAPC, Farsky OS, Lopes RD, Silva RCG, Kalil Filho R, Gonçalves RM, Gagliardi RJ, Guinsburg R, Lisak S, Araújo S, Martins SCO, Lage SG, Franchi SM, Shimoda T, Accorsi TD, Barral TCN, Machado TAO, Scudeler TL, Lima VC, Guimarães VA, Sallai VS, Xavier WS, Nazima W, Sako YK. [First guidelines of the Brazilian Society of Cardiology on Cardiopulmonary Resuscitation and Cardiovascular Emergency Care]. Arq Bras Cardiol 2014; 101:1-221. [PMID: 24030145 DOI: 10.5935/abc.2013s006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Facchin LT, Gir E, Pazin-Filho A, Hayashida M, da Silva Canini SRM. Under-reporting of accidents involving biological material by nursing professionals at a Brazilian emergency hospital. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2014; 19:623-9. [PMID: 24321641 DOI: 10.1080/10803548.2013.11077011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pathogens can be transmitted to health professionals after contact with biological material. The exact number of infections deriving from these events is still unknown, due to the lack of systematic surveillance data and under-reporting. METHODS A cross-sectional study was carried out, involving 451 nursing professionals from a Brazilian tertiary emergency hospital between April and July 2009. Through an active search, cases of under-reporting of occupational accidents with biological material by the nursing team were identified by means of individual interviews. The Institutional Review Board approved the research project. RESULTS Over half of the professionals (237) had been victims of one or more accidents (425 in total) involving biological material, and 23.76% of the accidents had not been officially reported using an occupational accident report. Among the underreported accidents, 53.47% were percutaneous and 67.33% were bloodborne. The main reason for nonreporting was that the accident had been considered low risk. CONCLUSIONS The under-reporting rate (23.76%) was low in comparison with other studies, but most cases of exposure were high risk.
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Cury Pavao MLR, Arfelli E, Scorzoni-Filho A, Silva-Jr JR, Pazin-Filho A, Marin-Neto JA, Schmidt A. Feasibility and safety of defibrillation threshold testing and fist event characteristics in patients with Chagas heart disease. Registry from a university hospital. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Borges DGS, Monteiro RA, Schmidt A, Pazin-Filho A. World soccer cup as a trigger of cardiovascular events. Arq Bras Cardiol 2013; 100:546-52. [PMID: 23657272 DOI: 10.5935/abc.20130105] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 02/15/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Acute coronary syndromes are the major cause of death in Brazil and in the world. External stimuli, known also as triggers, such as emotional state and activity, may generate physiopathological changes that can trigger acute coronary syndromes. Among the studied triggers, the impact of stressful events, such as soccer championships, are controversial in literature and there is no effective data on the Brazilian population. OBJECTIVE To evaluate the acute effects of environmental stress induced by soccer games of the World Soccer Cup on increased incidence of cardiovascular diseases in Brazil. METHODS Public data were obtained from the Unified Health System (Sistema Único de Saúde), regarding hospital admissions that had the International Code Disease of acute coronary syndromes from May to August, in 1998, 2002, 2006 and 2010 (155,992 admissions). Analysis was restricted to patients older than 35 years and admitted by clinical specialties. The incidence of myocardial infarction, angina and mortality were compared among days without World Cup soccer games (Group I: 144,166; 61.7 ± 12.3; 59.4% males); on days when there were no Brazil's soccer team matches (Group II: 9,768; 61.8 ± 12.3; 60.0% males); and days when there were Brazil's soccer team matches (Group III; 2,058; 61.6 ± 12.6; 57.8% males). Logistic regression was used to adjust to age, gender, population density and number of medical assistance units. RESULTS The incidence of myocardial infarction increased during the period of World Cup soccer games (1.09; 95%CI = 1.05-1.15) and days when there were Brazil's matches (1.16; 95%CI = 1.06-1.27). There was no impact on mortality during the Cup (1.00; CI 95% = 0.93-1.08) and Brazil's matches (1.04; 95%CI = 0.93-1.22). CONCLUSION World Cup soccer games and, specially, Brazil's matches have an impact on the incidence of myocardial infarction, but not on in-hospital mortality.
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Neves FF, Cupo P, Muglia VF, Elias Junior J, Nogueira-Barbosa MH, Pazin-Filho A. Body packing by rectal insertion of cocaine packets: a case report. BMC Res Notes 2013; 6:178. [PMID: 23641965 PMCID: PMC3679833 DOI: 10.1186/1756-0500-6-178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 04/24/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Body packing is used for international drug transport, immediate drug concealment during a police searching or introducing drugs inside prisons. Despite the high level of specialization of dealers who have started to manufacture more complex packs, up to 5% of patients could develop intoxication due to pack rupture. Bowel obstruction is another acute complication. CASE PRESENTATION A 27-year-old black male patient was sent to the hospital by court order for clinical evaluation and toxicological examination. The patient was conscious, oriented, had good color, normal arterial pressure and heart rate, and no signs of acute intoxication. Abdominal examination revealed discrete pain upon deep palpation and a small mass in the left iliac fossa. A plain abdominal radiograph revealed several oval structures located in the rectum and sigmoid. Fasting and a 50 g dose of activated charcoal every six hours were prescribed. After three days, the patient spontaneously evacuated 28 cocaine packs. CONCLUSION Adequate clinical management and prompt identification of potential complications are of fundamental importance in dealing with body packing.
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Barroso-Sousa R, Lobo RR, Mendonça PR, Memória RR, Spiller F, Cunha FQ, Pazin-Filho A. Decreased levels of alpha-1-acid glycoprotein are related to the mortality of septic patients in the emergency department. Clinics (Sao Paulo) 2013; 68:1134-9. [PMID: 24037010 PMCID: PMC3752623 DOI: 10.6061/clinics/2013(08)12] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 04/11/2013] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To determine the validity of alpha-1-acid glycoprotein as a novel biomarker for mortality in patients with severe sepsis. METHODS We prospectively included patients with severe sepsis or septic shock at the emergency department at a single tertiary referral teaching hospital. All of the patients were enrolled within the first 24 hours of emergency department admission, and clinical data and blood samples were obtained. As the primary outcome, we investigated the association of serum levels of alpha-1-acid glycoprotein and 96-hour mortality with logistic regression analysis and generalized estimating equations adjusted for age, sex, shock status and Acute Physiology and Chronic Health Evaluation II score. RESULTS Patients with septic shock had lower alpha-1-acid glycoprotein levels at the time of emergency department admission compared to patients without shock (respectively, 149.1 ±42.7 vs. 189.8 ±68.6; p = 0.005). Similarly, non-survivors in the first 96 hours were also characterized by lower levels of alpha-1-acid glycoprotein at the time of emergency department admission compared to survivors (respectively, 132.18 ±50.2 vs. 179.8 ±61.4; p = 0.01). In an adjusted analysis, alpha-1-acid glycoprotein levels ≤120 mg/dL were significantly associated with 96-hour mortality (odds ratio = 14.37; 95% confidence interval = 1.58 to 130.21). CONCLUSION Septic shock patients exhibited lower circulating alpha-1-acid glycoprotein levels than patients without shock. Alpha-1-acid glycoprotein levels were independently associated with 96-hour mortality in individuals with severe sepsis.
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Ribeiro KB, Miranda CH, Andrade JM, Galli LG, Tiezzi DG, Oliveira HF, Zola FE, Volpe G, Pazin-Filho A, Peria FM. Trastuzumab-induced myocardiotoxicity mimicking acute coronary syndrome. Case Rep Oncol 2012; 5:125-33. [PMID: 22666200 PMCID: PMC3364043 DOI: 10.1159/000337576] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Trastuzumab is an important biological agent in the treatment of HER2-positive breast cancer, with effects on response rates, progression-free survival, overall survival and quality of life. Although this drug is well tolerated in terms of adverse effects, trastuzumab-associated myocardiotoxicity has been described to have an incidence of 0.6–4.5% and in rare cases, the drug can trigger severe congestive heart failure with progression to death or even mimic acute coronary syndrome with complete left bundle branch blockade. In this paper is reported a case of trastuzumab-associated myocardiotoxicity manifesting as acute coronary syndrome in a 69-year-old female. The patient is currently undergoing a conservative clinical treatment that restricts overexertion. The majority of clinical studies report trastuzumab-induced cardiotoxicity as a rare event, and, when present, characterized by mild to moderate clinical signs, the ease of reversibility with pharmacological measures and the temporary discontinuation of the medication. Conversely, it is vital for the oncologist/cardiologist to consider the possibility that trastuzumab-induced cardiotoxicity may manifest itself as a severe clinical case, mimicking acute coronary syndrome, justifying careful risk stratification and adequate cardiac monitoring, especially in high-risk patients.
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Izeli NL, Crescencio JC, Pazin-Filho A, Gallo L, Schmidt A. Effects of cardiac rehabilitation on left ventricle function and mass evaluated by cardiac magnetic resonance imaging in post myocardial infarction patients. J Cardiovasc Magn Reson 2011. [PMCID: PMC3106928 DOI: 10.1186/1532-429x-13-s1-p167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Lascala T, Pazin-Filho A, Dias Romano M, Almeida Filho O, Schmidt A, Marin Neto J, Maciel B. 39 Value of 2D-Echocardiography in Patients With Chest Pain and Suspected Acute Coronary Syndromes. Ann Emerg Med 2011. [DOI: 10.1016/j.annemergmed.2011.06.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Neves F, Pazin-Filho A. 171 Rationing Critical Care Access From Emergency Department: Electronic Classification System for Critical Care Admission. Ann Emerg Med 2011. [DOI: 10.1016/j.annemergmed.2011.06.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Adolfi Júnior MS, Pallini FM, Pessotti H, Wolf CM, Patelli HT, Capeli RD, Poli-Neto OB, Neves FF, Scarpelini S, Marques PMDA, Pazin-Filho A. Emergency medical coordination using a web platform: a pilot study. Rev Saude Publica 2011; 44:1063-71. [PMID: 21107504 DOI: 10.1590/s0034-89102010000600011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Accepted: 04/26/2010] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe a management system for emergency medical coordination based on the worldwide web of computers. METHODS The emergency coordination system was developed according to an evolving software model for prototype development. Communication between users and the system was implemented by means of web technologies. The system was developed on a personal homepage and the database was developed using MySQL. The prototype was based on the medical coordination process of the Thirteenth Regional Healthcare Division of the State of São Paulo (Southeastern Brazil) and was applied to 26 municipalities within this regional division, for four consecutive weeks in September 2009. The system made it possible to document requests in chronological order, without allowing editing of data already entered, and ensured hierarchical confidential access to the information for each participant in the system. RESULTS The system presented 100% availability, reliability and integrity of information. A total of 1,046 requests were made to the system, of which 703 (68%) were completed. The solicitants already presented 98% adherence to the system in the first week of application, while adherence among service providers gradually increased (37% in the fourth week). The municipalities closest to Ribeirão Preto that did not have high-complexity providers were the ones that most used the system. CONCLUSIONS Medical coordination of emergency requests through the worldwide web of computers was shown to be feasible and reliable, and it enabled transparency within the process and direct access to information for managers. It allowed indicators to be constructed in order to monitor and improve the process, from the perspective of creating semi-automated coordination and advances in system organization.
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Garrido FD, Romano MMD, Schmidt A, Pazin-Filho A. Can course format influence the performance of students in an advanced cardiac life support (ACLS) program? Braz J Med Biol Res 2010; 44:23-8. [PMID: 21085890 DOI: 10.1590/s0100-879x2010007500131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 10/21/2010] [Indexed: 11/22/2022] Open
Abstract
Advanced cardiac life support (ACLS) is a problem-based course that employs simulation techniques to teach the standard management techniques of cardiovascular emergencies. Its structure is periodically revised according to new versions of the American Heart Association guidelines. Since it was introduced in Brazil in 1996, the ACLS has been through two conceptual and structural changes. Detailed documented reports on the effect of these changes on student performance are limited. The objective of the present study was to evaluate the effect of conceptual and structural changes of the course on student ACLS performance at a Brazilian training center. This was a retrospective study of 3266 students divided into two groups according to the teaching model: Model 1 (N = 1181; 1999-2003) and Model 2 (N = 2085; 2003-2007). Model 2 increased practical skill activities to 75% of the total versus 60% in Model 1. Furthermore, the teaching material provided to the students before the course was more objective than that used for Model 1. Scores greater than 85% in the theoretical evaluation and approval in the evaluation of practice by the instructor were considered to be a positive outcome. Multiple logistic regression was used to adjust for potential confounders (specialty, residency, study time, opportunity to enhance practical skills during the course and location where the course was given). Compared to Model 1, Model 2 presented odds ratios (OR) indicating better performance in the theoretical (OR = 1.34; 95%CI = 1.10-1.64), practical (OR = 1.19; 95%CI = 0.90-1.57), and combined (OR = 1.38; 95%CI = 1.13-1.68) outcomes. Increasing the time devoted to practical skills did not improve the performance of ACLS students.
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Sousa R, Souto F, Spiller F, Turato W, Lobo R, Mendonça P, Cunha F, Pazin-Filho A. 345: Reduction of the Expression of Membrane CXCR2 and BLT1 Receptors on Neutrophils Related to Increased Mortality of Septic Patients In the Emergency Department. Ann Emerg Med 2010. [DOI: 10.1016/j.annemergmed.2010.06.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lobo RR, Borges MC, Neves FF, Vidal de Moura Negrini B, Colleto FA, Romeo Boullosa JL, Camila de Miranda Cardoso M, Pazin-Filho A. Impact of implementing an exclusively dedicated respiratory isolation room in a Brazilian tertiary emergency department. Emerg Med J 2010; 28:754-7. [DOI: 10.1136/emj.2009.082321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Matsushita K, Blecker S, Pazin-Filho A, Bertoni A, Chang PP, Coresh J, Selvin E. The association of hemoglobin a1c with incident heart failure among people without diabetes: the atherosclerosis risk in communities study. Diabetes 2010; 59:2020-6. [PMID: 20484138 PMCID: PMC2911067 DOI: 10.2337/db10-0165] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
OBJECTIVE This study sought to investigate an association of HbA1c (A1C) with incident heart failure among individuals without diabetes and compare it to fasting glucose. RESEARCH DESIGN AND METHODS We studied 11,057 participants of the Atherosclerosis Risk in Communities (ARIC) Study without heart failure or diabetes at baseline and estimated hazard ratios of incident heart failure by categories of A1C (<5.0, 5.0-5.4 [reference], 5.5-5.9, and 6.0-6.4%) and fasting glucose (<90, 90-99 [reference], 100-109, and 110-125 mg/dl) using Cox proportional hazards models. RESULTS A total of 841 cases of incident heart failure hospitalization or deaths (International Classification of Disease, 9th/10th Revision, 428/I50) occurred during a median follow-up of 14.1 years (incidence rate 5.7 per 1,000 person-years). After the adjustment for covariates including fasting glucose, the hazard ratio of incident heart failure was higher in individuals with A1C 6.0-6.4% (1.40 [95% CI, 1.09-1.79]) and 5.5-6.0% (1.16 [0.98-1.37]) as compared with the reference group. Similar results were observed when adjusting for insulin level or limiting to heart failure cases without preceding coronary events or developed diabetes during follow-up. In contrast, elevated fasting glucose was not associated with heart failure after adjustment for covariates and A1C. Similar findings were observed when the top quartile (A1C, 5.7-6.4%, and fasting glucose, 108-125 mg/dl) was compared with the lowest quartile (<5.2% and <95 mg/dl, respectively). CONCLUSIONS Elevated A1C (> or =5.5-6.0%) was associated with incident heart failure in a middle-aged population without diabetes, suggesting that chronic hyperglycemia prior to the development of diabetes contributes to development of heart failure.
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Rodrigues de Holanda-Miranda W, Furtado FM, Luciano PM, Pazin-Filho A. Lewis lead enhances atrial activity detection in wide QRS tachycardia. J Emerg Med 2009; 43:e97-9. [PMID: 20022196 DOI: 10.1016/j.jemermed.2009.08.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Revised: 06/28/2009] [Accepted: 08/29/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND The differential diagnosis of wide QRS tachycardia is a challenge for the emergency physician. The major tool is the electrocardiogram (ECG), even though the sensitivity and specificity may be variable, depending on presentation. Additional leads could be used to improve the diagnostic accuracy of the ECG. OBJECTIVE To document the use of the Lewis lead in improving the diagnostic accuracy of the ECG in wide QRS tachycardia. CASE REPORT A 52-year-old woman with rheumatoid arthritis, in treatment with methotrexate, was admitted with progressive dyspnea that evolved to acute respiratory distress and shock at arrival. Pneumonia was diagnosed as the infection and she received antibiotics, and respiratory and inotropic support. She was also using amiodarone for more than 10 years, but she couldn't state the reason. On cardiac monitoring, wide QRS tachycardia was detected and ventricular tachycardia was considered on the differential diagnosis. The standard 12-lead ECG was complemented with the Lewis lead, obtained with higher speed and amplitude, demonstrating atrioventricular concordance and excluding ventricular tachycardia. The patient was treated for septic shock, and she died 2 days later. CONCLUSION The Lewis lead is a simple and easy strategy to enhance atrial activity detection in wide QRS tachycardia.
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Pazin-Filho A, Peitz P, Pianta T, Carson KA, Russell SD, Boulware LE, Coresh J. Heart failure disease management program experience in 4,545 heart failure admissions to a community hospital. Am Heart J 2009; 158:459-66. [PMID: 19699871 DOI: 10.1016/j.ahj.2009.06.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Accepted: 06/13/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND Disease management programs (DMPs) are developed to address the high morbi-mortality and costs of congestive heart failure (CHF). Most studies have focused on intensive programs in academic centers. Washington County Hospital (WCH) in Hagerstown, MD, the primary reference to a semirural county, established a CHF DMP in 2001 with standardized documentation of screening and participation. Linkage to electronic records and state vital statistics enabled examination of the CHF population including individuals participating and those ineligible for the program. METHODS All WCH inpatients with CHF International Classification of Diseases, Ninth Revision code in any position of the hospital list discharged alive. RESULTS Of 4,545 consecutive CHF admissions, only 10% enrolled and of those only 52.2% made a call. Enrollment in the program was related to: age (OR 0.64 per decade older, 95% CI 0.58-0.70), CHF as the main reason for admission (OR 3.58, 95% CI 2.4-4.8), previous admission for CHF (OR 1.14, 95% CI 1.09-1.2), and shorter hospital stay (OR 0.94 per day longer, 95% CI 0.87-0.99). Among DMP participants mortality rates were lowest in the first month (80/1000 person-years) and increased subsequently. The opposite mortality trend occurred in nonenrolled groups with mortality in the first month of 814 per 1000 person-years in refusers and even higher in ineligible (1569/1000 person-years). This difference remained significant after adjustment. Re-admission rates were lower among participants who called consistently (adjusted incidence rate ratio 0.62, 95% CI 0.52-0.77). CONCLUSION Only a small and highly select group participated in a low-intensity DMP for CHF in a community-based hospital. Design of DMPs should incorporate these strong selective factors to maximize program impact.
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Lobo R, Borges M, Neves F, Pazin-Filho A. 63: Respiratory Isolation Rooms in the Emergency Department. Ann Emerg Med 2009. [DOI: 10.1016/j.annemergmed.2009.06.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Franciscon A, Machado J, Schmidt A, Pazin-Filho A. 21: Oral Anticoagulation Quality Index as a Predictor for Bleeding. Ann Emerg Med 2009. [DOI: 10.1016/j.annemergmed.2009.06.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cassani RSL, Nobre F, Pazin-Filho A, Schmidt A. Relationship between blood pressure and anthropometry in a cohort of Brazilian men: a cross-sectional study. Am J Hypertens 2009; 22:980-4. [PMID: 19498339 DOI: 10.1038/ajh.2009.104] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Hypertension, a risk factor for cardiovascular diseases, and obesity are becoming a health problem in many developed and developing countries, as Brazil. Although hypertension and obesity are both closely associated, there is no universal anthropometric marker of this association. This is probably due to distinct population characteristics, and in the case of Brazil, the highly heterogeneous population. We evaluated which anthropometric measurement most closely relates to high blood pressure in a sample of Brazilian factory workers. METHODS A cross-sectional study was designed. In this study, multiple logistic regression and receiver operating characteristics analysis were performed in order to obtain the precise relevance of each anthropometric measurement as a blood pressure marker. Nine hundred and thirteen men, 36 +/- 8 years-old, were submitted to a standardized questionnaire of demographic and risk factors knowledge, anthropometric and conventional blood pressure measurements were taken, and blood sample evaluations of glucose, total cholesterol, LDL-Cholesterol, and triglycerides were performed. RESULTS Overweightness or obesity was identified in 64, 11.1% were smokers and hypertension was detected in 29.2% of the participants. A linear correlation was significant (P < 0.001) between both the systolic and diastolic blood pressure and all anthropometric measurements, except for the systolic blood pressure and waist-to-hip ratio. Waist circumference (WC) was the only independent anthropometric measurement related to hypertension. Hypertensive patients presented all anthropometric measurements larger than normotensives. CONCLUSIONS Age and WC were the only independent predictors of hypertension, indicating that this simple measurement may be useful as a marker of hypertension in the Brazilian male, younger adult population.
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Pazin-Filho A, de Jesus A, Magalhães P, Melato L, Campos D, Maciel B, Maciel L. How frequently should a patient taking amiodarone be screened for thyroid dysfunction? Braz J Med Biol Res 2009; 42:744-9. [DOI: 10.1590/s0100-879x2009000800009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Accepted: 06/08/2009] [Indexed: 11/22/2022] Open
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Pazin-Filho A, Soares CS, Ferrais ADSN, Oliveira e Castro PDT, Bellissimo-Rodrigues F, Nogueira JDA, Passos ADC. Tuberculosis among health care workers in a Brazilian tertiary hospital emergency unit. Am J Emerg Med 2008; 26:796-8. [PMID: 18774046 DOI: 10.1016/j.ajem.2007.10.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2007] [Revised: 09/24/2007] [Accepted: 10/23/2007] [Indexed: 11/18/2022] Open
Abstract
The Brazilian emergency system is being reorganized as a hierarchy in the region of Ribeirão Preto, state of São Paulo. We found increased occupational risk for tuberculosis in this region tertiary reference center--a nurse technician (Incidence rate [IR] 526.3/100,000 inhabitants) had a risk of tuberculosis 12.6 (95% confidence interval [CI], 2.57-37.23) greater than the city population (41.8/100,000 inhabitants). The system reorganization will have to make the centers adequate to deal with this problem.
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