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Amaral LDF, Lana RM, Bastos LS. Was the COVID-19 epidemic synchronous in space? An analysis in the health regions of the Rio de Janeiro state, 2020-2022. Rev Bras Epidemiol 2024; 27:e240010. [PMID: 38422234 PMCID: PMC10896236 DOI: 10.1590/1980-549720240010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/04/2023] [Accepted: 12/13/2023] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE To analyze the spatio-temporal dynamics of COVID-19 in the Rio de Janeiro state within the nine health regions, between March 2020 and December 2022. METHODS The Poisson model with random effects was used to smooth and estimate the incidence of COVID-19 hospitalizations reported in the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe) to verify the synchronicity of the epidemic in the state. RESULTS The COVID-19 epidemic in the state is characterized by the presence of seven peaks during the analyzed period corresponding to seven found. An asynchrony in hospitalizations was identified, varying according to the different virus variants in the nine health regions of the state. The incidence peaks of hospitalizations ranged from 1 to 12 cases per 100,000 inhabitants during the pandemic. CONCLUSION This spatio-temporal analysis is applicable to other scenarios, enabling monitoring and decision-making for the control of epidemic diseases in different areas.
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Affiliation(s)
- Léa de Freitas Amaral
- Fundação Oswaldo Cruz, National School of Public Health - Rio de Janeiro (RJ), Brazil
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Bergantini LS, Ichisato SMT, Salci MA, Birolim MM, dos Santos MLA, Höring CF, Rossa R, Facchini LA. Factors associated with hospitalizations and deaths of pregnant women from Paraná due to COVID-19: a cross-sectional study. Rev Bras Epidemiol 2024; 27:e240005. [PMID: 38324869 PMCID: PMC10846414 DOI: 10.1590/1980-549720240005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/14/2023] [Accepted: 11/14/2023] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVE To analyze the factors associated with hospitalization in the ward and intensive care unit (ICU), and with death from COVID-19 in pregnant women with confirmed cases. METHODS Observational, cross-sectional study, carried out with data from pregnant women with a confirmed case of COVID-19 from the Influenza Epidemiological Surveillance Information System and the Paraná's state COVID-19 notification system. The association between the independent and dependent variables (hospitalization in the ward and ICU, and death) was investigated using the Poisson regression model with robust variance. RESULTS 4,719 pregnant women comprised the study population. 9.6 and 5.1% were hospitalized in wards and ICU, respectively. 1.9% died. There was an association between advanced maternal age and hospitalization in wards (PR=1.36; 95%CI 1.10-1.62) and ICU (PR=2.25; 95%CI 1.78-2.71), and death (PR=3.22; 95%CI 2.30-4.15). An association was found between the third trimester and hospitalization in wards (PR=5.06; 95%CI 2.82-7.30) and ICU (PR=6.03; 95%CI 3.67-8.39) and death (PR=13.56; 95%CI 2.90-24.23). The second trimester was associated with ICU admission (PR=2.67; 95%CI 1.36-3.99). Pregnant women with cardiovascular disease had a higher frequency of hospitalization in wards (PR=2.24; 95%CI 1.43-3.05) and ICU (PR=2.66; 95%CI 1.46-3.87). Obesity was associated with ICU admission (PR=3.79; 95%CI 2.71-4.86) and death (PR=5.62; 95%CI 2.41-8.83). CONCLUSIONS Advanced maternal age, the end of the gestational period and comorbidities were associated with severe COVID-19.
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Affiliation(s)
- Larissa Silva Bergantini
- Universidade Estadual de Maringá, Postgraduate Program in Physiological Sciences – Maringá (PR), Brazil
| | | | - Maria Aparecida Salci
- Universidade Estadual de Maringá, Postgraduate Program in Nursing – Maringá (PR), Brazil
| | - Marcela Maria Birolim
- Centro Universitário Guairacá, Postgraduate Program in Health Promotion – Guarapuava (PR), Brazil
| | | | | | - Roberta Rossa
- Universidade Estadual de Maringá, Postgraduate Program in Nursing – Maringá (PR), Brazil
| | - Luiz Augusto Facchini
- Universidade Federal de Pelotas, Department of Social Medicine – Pelotas (RS), Brazil
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Inoue LH, Baccon WC, Pesce GB, Pereira ND, Silva IVTC, Salci MA, Vissoci JRN, Facchini LA, Carreira L. Prevalence and factors associated with the death of older people hospitalized due to Covid-19 in the state of Paraná. Rev Esc Enferm USP 2024; 57:e20230036. [PMID: 38265117 PMCID: PMC10807406 DOI: 10.1590/1980-220x-reeusp-2023-0036en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 11/14/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE To estimate the prevalence and to analyze the factors associated with the death of older people hospitalized due to Covid-19 in the state of Paraná. METHOD Cross-sectional study conducted with secondary data from older people with a positive diagnosis of Covid-19 living in the State of Paraná, collected from March 1, 2020 to August 31, 2021. Prevalence ratios were obtained by adjusting the regression model. RESULTS A total of 16,153 deaths of older people hospitalized in the State of Paraná were analyzed. The adjusted model revealed an association between death and some factors such as: belonging to the age group of 75 to 84 years (PR = 1.28; CI95% = 1.24-1.32) and 85 years or over (PR = 1.52; CI95% = 1.45-1.59); male (PR = 1.17; CI95% = 1.13-1.21); obesity (PR = 1.23; CI95% = 1.16-1.29); other morbidities (PR = 1.25; CI95% = 1.20-1.30); and having used ventilatory support (PR = 2.60; CI95% = 2.33-2.86). Older people vaccinated against influenza had a probability of death reduced by 11% (PR = 0.89; CI95% = 0.86-0.93). CONCLUSION The association of age, sex, and diagnosis of previous comorbidities with unfavorable outcomes from Covid-19 was identified. Having received the flu vaccine provided protection to elderly people who contracted SARS-CoV-2.
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Temtem M, Monteiro JP, Serrão MG, Freitas D. Beat-to-Beat Alternating Bundle-Branch Block. Arq Bras Cardiol 2024; 120:e20230162. [PMID: 38198359 PMCID: PMC10735210 DOI: 10.36660/abc.20230162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 10/04/2023] [Indexed: 01/12/2024] Open
Affiliation(s)
- Margarida Temtem
- Hospital Dr. Nélio MendonçaFunchalPortugalHospital Dr. Nélio Mendonça, Funchal – Portugal
| | - Joel Ponte Monteiro
- Hospital Dr. Nélio MendonçaFunchalPortugalHospital Dr. Nélio Mendonça, Funchal – Portugal
| | - Marco Gomes Serrão
- Hospital Dr. Nélio MendonçaFunchalPortugalHospital Dr. Nélio Mendonça, Funchal – Portugal
| | - Drumond Freitas
- Hospital Dr. Nélio MendonçaFunchalPortugalHospital Dr. Nélio Mendonça, Funchal – Portugal
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da Costa LF, Sampaio TL, de Moura L, Rosa RDS, Iser BPM. Time trend and costs of hospitalizations with diabetes mellitus as main diagnosis in the Brazilian National Health System, 2011 to 2019. Epidemiol Serv Saude 2024; 32:e2023509. [PMID: 38198367 PMCID: PMC10768797 DOI: 10.1590/s2237-96222023000400006.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/24/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVE To analyze the diabetes mellitus (DM) temporal trend and hospitalization costs in Brazil, by region, Federative Units (FUs) and population characteristics, from 2011 to 2019. METHODS This was an ecological study with data from the Hospital Information System, analyzing the annual trend in hospitalization rates for DM according to sex, age, race/skin color and region/FU by Prais-Winsten generalized linear regression. RESULTS A total of 1,239,574 DM hospitalizations were recorded in the country and the hospitalization rates was 6.77/10,000 inhabitants in the period. The DM hospitalization rates trend was falling for both sexes and in most regions, while it was rising in the younger population and for length of stay (average 6.17 days). Total expenditure was US$ 420,692.23 and it showed a rising trend. CONCLUSION The temporal trend of hospitalization rates due to DM was falling, with differences according to region/FU and age group. Average length of stay and expenditure showed a rising trend. MAIN RESULTS From 2011 to 2019, the diabetes mellitus hospitalization rate was 6.77 per 10,000 inhabitants, with a falling trend. Total expenditure was US$420,692.23 and it showed a rising trend. IMPLICATIONS FOR SERVICES The study warns of the increase in child and adolescent hospitalizations, which indicates the need to invest in preventive actions and early diagnosis. PERSPECTIVES The increase in length of hospital stay and related costs indicates a worrying scenario for the Brazilian National Health System and emphasizes the need to improve access to and quality of care, with a focus on diabetes education, so as to avoid complications and hospitalizations.
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Affiliation(s)
| | - Taisa Lara Sampaio
- Universidade do Sul de Santa Catarina, Curso de graduação em Medicina, Tubarão, SC, Brazil
| | - Lenildo de Moura
- Pan-American Health Organization, Coordenação de Doenças Crônicas Não Transmissíveis e Saúde Mental, Asunción, Departamento Central, Paraguay
| | - Roger dos Santos Rosa
- Universidade Federal do Rio Grande do Sul, Departamento de Medicina Social, Porto Alegre, RS, Brazil
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Rodrigues JAM, Lenardt MH, Cechinel C, Cruz EDDA, Tsunoda AT, Kuznier TP. Hospital admission and the occurrence of delirium in older adults with physical frailty: cross-sectional study. Rev Esc Enferm USP 2023; 57:e20230156. [PMID: 38100603 PMCID: PMC10723772 DOI: 10.1590/1980-220x-reeusp-2023-0156en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/05/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVE To analyze the relationship between hospitalization and the occurrence of delirium in older adults with physical frailty. METHOD Cross-sectional study carried out in a public hospital in southern Brazil. Hospitalized older adults aged ≥ 60 years participated. Sociodemographic and clinical data were collected, physical frailty phenotype tests were performed and the Confusion Assessment Method was used. Descriptive analyzes were carried out and odds ratio values were estimated for the frailty and delirium variables. RESULTS Of the 320 older adults evaluated, 21.14% presented delirium, 49% were identified as pre-frail and 36.2% as frail. Of those affected by delirium, 71.6% were classified as frail and 28.3% as pre-frail (p < 0.001). An association was observed between the occurrence of delirium and frailty (OR 1.22; 95% CI 1.07 to 1.38), age ≥ 80 years (OR 1.14; 95% CI 1.01 to 1.32), epilepsy (OR 1.38; 95% CI 1.09 to 1.76), dementia (OR 1.58; 95% CI 1.37 to 1.82), and history of stroke (OR 1.14; 95% CI 1.03 to 1.26). CONCLUSION There was a high frequency of pre-frail and frail older adults, and the occurrence of delirium in frail was significantly higher. Special attention should be paid to frail older adults to prevent the occurrence of delirium during hospitalization.
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Affiliation(s)
| | - Maria Helena Lenardt
- Universidade Federal do Paraná, Programa de Pós-graduação em Enfermagem, Curitiba, PR, Brazil
| | - Clovis Cechinel
- Universidade Federal do Paraná, Programa de Pós-graduação em Enfermagem, Curitiba, PR, Brazil
| | | | - Audrey Tieko Tsunoda
- Pontifícia Universidade Católica do Paraná, Programa de Pós-graduação em Tecnologias em Saúde, Curitiba, PR, Brazil
| | - Tatiane Prette Kuznier
- Universidade Federal do Paraná, Programa de Pós-graduação em Enfermagem, Curitiba, PR, Brazil
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Góes RP, Pedreira LC, Tavares JPDA, Oliveira SDS, Souza EDO, dos Santos FC. Validation of the hospital resources assessment scale for the preservation of urinary continence in the elderly. Rev Bras Enferm 2023; 76:e20220805. [PMID: 38018621 PMCID: PMC10680382 DOI: 10.1590/0034-7167-2022-0805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 06/20/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVES to validate the internal structure of the Hospital Resources Assessment Scale for the Preservation of Urinary Continence in the Elderly. METHODS validation study of the internal structure of a scale constructed based on the Donabedian conceptual model and an integrative review, with prior content validation. The scale was applied to the target population, and 124 nurses responded to the questionnaire. Exploratory Factor Analysis was performed using the FACTOR software, employing multiple techniques. RESULTS a factorial model with 11 items organized into two dimensions (support for human resources and material resources) was obtained. The "physical structure" dimension was removed from the initial model and adopted as a complementary checklist to the instrument, as it was not possible to obtain a factorable model with this dimension. CONCLUSIONS we provide a valid scale that can measure indicators, identifying weaknesses and/or strengths related to hospital resources for the preservation of urinary continence in the elderly.
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Affiliation(s)
| | | | | | | | - Elaine de Oliveira Souza
- Universidade Federal da Bahia. Salvador, Bahia, Brazil
- Universidade do Estado da Bahia. Salvador, Bahia, Brazil
| | - Fernanda Cajuhy dos Santos
- Universidade Federal da Bahia. Salvador, Bahia, Brazil
- Empresa Brazileira de Servicos Hospitalares, Hospital Universitário Professor Edgard Santos. Salvador, Bahia, Brazil
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de Andrade LH, dos Santos GG, de Sordi MADP, Nunes HRDC, Parada CMGDL. Factors associated with the evolution of COVID-19 in pregnant women: a Brazilian population-based study. Rev Esc Enferm USP 2023; 57:e202320042. [PMID: 38051223 PMCID: PMC10697140 DOI: 10.1590/1980-220x-reeusp-2023-0042en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/20/2023] [Indexed: 12/07/2023] Open
Abstract
OBJECTIVE To assess the evolution of COVID-19 among Brazilian pregnant women, identifying sociodemographic and clinical predictors related to admission to ICU - Intensive Care Unit and death. METHOD Cross-sectional, population-based study, carried out with a secondary database, based on data from the Influenza Epidemiological Surveillance Information System. Descriptive analysis was performed, followed by multiple linear regression with Poisson response, adopting critical p < 0.05. RESULTS Intensive care admission rates of 28.2% and death rates of 9.5% were identified. Region of residence, gestational trimester, number of comorbidities and respiratory signs and symptoms were associated with the risk of admission to intensive care. Age over 34 years, comorbidities, oxygen saturation equal to or less than 95%, admission to intensive care and ventilatory support, invasive or not, increased the risk of death. CONCLUSION Sociodemographic and clinical predictors showed an association with hospitalization in intensive care and death of pregnant women with COVID-19.
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Affiliation(s)
- Luis Henrique de Andrade
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Medicina de Botucatu, Programa de Pós-graduação. Botucatu, SP, Brasil
| | - Gustavo Gonçalves dos Santos
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Programa de Pós-graduação em Enfermagem em Saúde Pública. Ribeirão Preto, SP, Brasil
| | - Mônica Aparecida de Paula de Sordi
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Medicina de Botucatu, Programa de Pós-graduação. Botucatu, SP, Brasil
| | - Hélio Rubens de Carvalho Nunes
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Medicina de Botucatu, Programa de Pós-graduação. Botucatu, SP, Brasil
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9
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Fuentes LBEH, Gardim L, da Silva TO, de Moura AA, Bernardes A. Applying Lean Healthcare in the hospitalization and patient discharge process: an integrative review. Rev Bras Enferm 2023; 76:e20220751. [PMID: 37970967 PMCID: PMC10637270 DOI: 10.1590/0034-7167-2022-0751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/02/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES to identify scientific evidence regarding the use of Lean Healthcare approach in the hospitalization and patient discharge process. METHODS this is an Integrative Review conducted in the PubMed, LILACS, SCOPUS, CINAHL, Web of Science, and Embase databases. RESULTS out of 904 records identified, three were included in this review. The studies demonstrated that when applied to discharge planning, the Lean philosophy brings favorable results, promoting improvements in the communication process, as well as assisting in workflow organization, with a reduction in length of stay and improvement in the quality of care. FINAL CONSIDERATIONS although the Lean methodology presents positive results, it is considered that the application of the philosophy in healthcare institutions is still not sustainable, as it is often restricted to specific departments or services. Thus, to maximize the success of implementation, the Lean philosophy needs to be incorporated into the organizational culture, representing the greatest challenge.
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Affiliation(s)
| | - Lucas Gardim
- Universidade de São Paulo. Ribeirão Preto, São Paulo, Brazil
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Dantas MNP, de Sousa ES, Faustino SLF, de Azevedo IC, Santos VEP. Transition of care in post-hospitalization patients due to covid-19 in a hospital in northeastern Brazil. Rev Bras Enferm 2023; 76Suppl 1:e20230030. [PMID: 37820107 PMCID: PMC10561925 DOI: 10.1590/0034-7167-2023-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/23/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE To analyze the transition of care for post-hospitalization patients due to covid-19 in a hospital in northeastern Brazil. METHODS Quantitative, cross-sectional, descriptive, and analytical study carried out between 2020 and 2021. The sample had 78 patients. Data collection took place by telephone with the support of a sociodemographic questionnaire and the care transition assessment instrument (Care Transitions Measure). RESULTS The average length of stay was 24.04 days. The average score for care transition was 71.68 (±11.71). "Self-management training" and "Understanding of medications" had higher averages, 75.15 (±13.76) and 74.10 (±16.20). CONCLUSIONS The average length of stay was 24.04 days. The average score for care transition was 71.68 (±11.71). "Self-management training" and "Understanding of medications" had higher averages, 75.15 (±13.76) and 74.10 (±16.20).
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Herrera-Añazco P, Segura MA, Bravo-Zúñiga J, Vásquez JL, Taype-Rondán A. Hospitalization and mortality during the pandemic in chronic hemodialysis patients and the general population in Peru. J Bras Nefrol 2023; 45:440-448. [PMID: 37186943 PMCID: PMC10726660 DOI: 10.1590/2175-8239-jbn-2022-0149en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/10/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Patients with chronic kidney disease have a higher risk of severe disease and mortality from COVID-19 than the general population. OBJECTIVE To compare hospitalization and mortality rates during the pandemic among chronic hemodialysis (HD) patients and the general population in Lima (Peru). METHODS This retrospective cohort included an assessment of the database of chronic HD patients of the health service providers of the social health insurance benefit networks of Lima and Callao between 2019 and 2021. Hospitalization and mortality rates were obtained for every 1,000 individuals, and variations in the percentages of COVID-19 cases and deaths were calculated. These rates were compared with those of the general population data and standardized by age and sex. RESULTS An average of 3,937 chronic HD patients were evaluated each month. Of these, 4.8% had COVID-19 and 64.97% were mild cases. The hospitalization rates per 1,000 patients were 19.5, 29.28, and 36.7 in 2019, 2020, and 2021, respectively. The mortality rates per 1,000 patients were 5.9, 9.74, and 11.49 in 2019, 2020, and 2021, respectively. When compared to the standardized general population, the peaks of both rates coincided with the plateaus of the waves during the pandemic. The hospitalization rate for COVID-19 was 12 times higher in HD patients than in the general population, and the mortality rate for COVID-19 was twice as high. CONCLUSION HD patients had higher hospitalization and standardized mortality rates than the general population. Peaks in hospitalizations and mortality coincided with the plateaus of the first and second waves of the pandemic.
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Affiliation(s)
- Percy Herrera-Añazco
- Universidad Privada del Norte, Trujillo, Peru
- Red Peruana de Salud Colectiva, Lima, Peru
| | | | - Jessica Bravo-Zúñiga
- Hospital Nacional Edgardo Rebagliati Martins, Departamento de Nefrología, Lima, Peru
| | | | - Alvaro Taype-Rondán
- Universidad San Ignacio de Loyola, Unidad de Investigación Para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
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Taş Ü, Taş S, Edem E. The Relationship between Nocturnal Dipping Status, Morning Blood Pressure Surge, and Hospital Admissions in Patients with Systolic Heart Failure. Arq Bras Cardiol 2023; 120:e20220932. [PMID: 37729291 PMCID: PMC10519354 DOI: 10.36660/abc.20220932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/27/2023] [Accepted: 07/17/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Hypertension is a known risk factor for developing heart failure. However, there is limited data to investigate the association between morning blood pressure surge (MBPS), dipping status, echocardiographic parameters, and hospital admissions in patients with systolic heart failure. OBJECTIVES To evaluate the relationship between morning blood pressure surge, non-dipper blood pressure pattern, echocardiographic parameters, and hospital admissions in patients with systolic heart failure. METHODS We retrospectively analyzed data from 206 consecutive patients with hypertension and a left ventricular ejection fraction below 40%. We divided the patients into two groups according to 24-hour ambulatory blood pressure monitoring (ABPM) results: dippers (n=110) and non-dippers (n=96). Morning blood pressure surge was calculated. Echocardiographic findings and hospital admissions during follow-up were noted. Statistical significance was defined as p < 0.05. RESULTS The study group comprised 206 patients with a male predominance and mean age of 63.5 ± 16.1 years. The non-dipper group had significantly more hospital admissions compared to dippers. There was a positive correlation between MBPS and left atrial volume index (r=0.331, p=0.001), the ratio between early mitral inflow velocity and flow propagation velocity (r= 0.326, p=0.001), and the ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/Em) (r= 0.314, p=0.001). Non-dipper BP, MBPS, and E/Em pattern were found to be independently associated with increased hospital admissions. CONCLUSION MBPS is associated with diastolic dysfunction and may be a sensitive predictor of hospital admission in patients with systolic heart failure.
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Affiliation(s)
- Ümmü Taş
- Izmir Demokrasi UniversitesiKarabaglarTurquiaIzmir Demokrasi Universitesi – Cardiology, Karabaglar – Turquia
| | - Sedat Taş
- Manisa Celal Bayar UniversityManisaTurquiaManisa Celal Bayar University – Cardiology, Manisa – Turquia
| | - Efe Edem
- İzmir Tınaztepe UniversityİzmirTurquiaİzmir Tınaztepe University – Cardiology, İzmir – Turquia
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Bernardes DDS, Santos MS, Mantovani VM, Almeida Neto OPD, Goldraich LA, Clausell N, Rabelo-Silva ER. Use of the ADHERE Risk Model as a Predictor of Risk of in-Hospital Worsening Heart Failure in a Cohort. Arq Bras Cardiol 2023; 120:e20220584. [PMID: 37672471 PMCID: PMC10519228 DOI: 10.36660/abc.20220584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 05/20/2023] [Accepted: 06/14/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Patients admitted with acute decompensated heart failure (HF) are subject to developing worsening episodes that require more complex interventions. The Acute Decompensated Heart Failure National Registry (ADHERE) risk model was developed in the United States to predict the risk of in-hospital worsening HF. OBJECTIVE To use the ADHERE risk model in the assessment of risk of in-hospital worsening HF and to determine its sensitivity and specificity in hospitalized patients. METHODS This cohort study was conducted at a Brazilian public university hospital, and data from 2013 to 2020 were retrospectively collected. P values < 0.05 were considered statistically significant. RESULTS A total of 890 patients with a mean age of 74 ± 8 years were included. The model showed that, in the group of 490 patients at risk, 254 (51.8%) developed in-hospital worsening HF. In the group of 400 patients not at risk, only 109 (27.2%) experienced worsening HF. The results demonstrated a statistically significant curve (area under the curve = 0.665; standard error = 0.018; P < 0.01; confidence interval = 0.609 to 0.701), indicating good accuracy. The model had a sensitivity of 69.9% and a specificity of 55.2%, with a positive predictive value of 52% and a negative predictive value of 72.7%. CONCLUSIONS In this cohort, we showed that the ADHERE risk model was able to discriminate patients who in fact developed worsening HF during the admission period, from those who did not.
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Affiliation(s)
- Daniela de Souza Bernardes
- Programa de Pós-Graduação em Ciências da Saúde: Cardiologia e Ciências Cardiovasculares, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | - Marina Scherer Santos
- Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | | | - Omar Pereira de Almeida Neto
- Programa de Pós-Graduação em Ciências da Saúde: Cardiologia e Ciências Cardiovasculares, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil
- Departamento de Enfermagem, Universidade Federal de Uberlândia, Uberlândia, MG - Brasil
| | - Livia Adams Goldraich
- Divisão de Cardiologia, Grupo de Insuficiência Cardíaca e Transplante Cardíaco, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS - Brasil
| | - Nadine Clausell
- Divisão de Cardiologia, Grupo de Insuficiência Cardíaca e Transplante Cardíaco, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS - Brasil
| | - Eneida Rejane Rabelo-Silva
- Programa de Pós-Graduação em Ciências da Saúde: Cardiologia e Ciências Cardiovasculares, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil
- Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil
- Divisão de Cardiologia, Grupo de Insuficiência Cardíaca e Transplante Cardíaco, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS - Brasil
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14
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Sant`Anna RT, de Lima GG, Saffi MAL, Kruse ML, Leiria TLL. Atrial Fibrillation Ablation: Impact of Intracardiac Echocardiography in Reducing Procedure Time and Hospitalization. Arq Bras Cardiol 2023; 120:e20220306. [PMID: 37194828 PMCID: PMC10263395 DOI: 10.36660/abc.20220306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 11/07/2022] [Accepted: 02/15/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Intracardiac echocardiography (ICE) allows visualization of cardiac structures and recognition of complications during atrial fibrillation ablation (AFA). Compared to transesophageal echocardiography (TEE), ICE is less sensitive to detecting thrombus in the atrial appendage but requires minimal sedation and fewer operators, making it attractive in a resource-constrained setting. OBJECTIVE To compare 13 cases of AFA using ICE (AFA-ICE group) with 36 cases of AFA using TEE (AFA-TEE group). METHODS This is a single-center prospective cohort study. The main outcome was procedure time. Secondary outcomes: fluoroscopy time, radiation dose (mGy/cm2), major complications, and length of hospital stay in hours. The clinical profile was compared using the CHA2DS2-VASc score. A p-value <0.05 was considered a statistically significant difference between groups. RESULTS The median CHA2DS2-VASc score was 1 (0-3) in the AFA-ICE group and 1 (0-4) in the AFA-TEE group. The total procedure time was 129 ± 27 min in the AFA-ICE group and 189 ± 41 min in the AFA-TEE group (p<0.001); the AFA-ICE group received a lower dose of radiation (mGy/cm2, 51296 ± 24790 vs. 75874 ± 24293; p=0.002), despite the similar fluoroscopy time (27.48 ± 9. 79 vs. 26.4 ± 9.32; p=0.671). The median length of hospital stay did not differ; 48 (36-72) hours (AFA-ICE) and 48 (48-66) hours (AFA-TEE) (p=0.27). CONCLUSIONS In this cohort, AFA-ICE was related to shorter procedure times and less exposure to radiation without increasing the risk of complications or the length of hospital stay.
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Affiliation(s)
- Roberto Tofani Sant`Anna
- Instituto de CardiologiaPorto AlegreRSBrasil Instituto de Cardiologia , Porto Alegre , RS – Brasil
| | - Gustavo Glotz de Lima
- Instituto de CardiologiaPorto AlegreRSBrasil Instituto de Cardiologia , Porto Alegre , RS – Brasil
- Universidade Federal de Ciências da Saúde de Porto AlegrePorto AlegreRSBrasil Universidade Federal de Ciências da Saúde de Porto Alegre , Porto Alegre , RS – Brasil
| | - Marco Aurélio Lumertz Saffi
- Hospital de Clínicas de Porto AlegrePorto AlegreRSBrasil Hospital de Clínicas de Porto Alegre , Porto Alegre , RS – Brasil
| | - Marcelo Lapa Kruse
- Instituto de CardiologiaPorto AlegreRSBrasil Instituto de Cardiologia , Porto Alegre , RS – Brasil
| | - Tiago Luiz Luz Leiria
- Instituto de CardiologiaPorto AlegreRSBrasil Instituto de Cardiologia , Porto Alegre , RS – Brasil
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15
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Dutra GP, Gomes BFDO. Does the BUN/Cr Ratio Confer a Worse Prognosis in All Ejection Fraction Spectra? Arq Bras Cardiol 2023; 120:e20230107. [PMID: 37042879 PMCID: PMC10263454 DOI: 10.36660/abc.20230107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Affiliation(s)
| | - Bruno Ferraz de Oliveira Gomes
- Hospital Barra D’OrRio de JaneiroRJBrasilHospital Barra D’Or, Rio de Janeiro, RJ – Brasil
- Universidade Federal do Rio de JaneiroRio de JaneiroRJBrasilUniversidade Federal do Rio de Janeiro, Rio de Janeiro, RJ – Brasil
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16
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Fabrin C, Boing AC, Garcia LP, Boing AF. Socioeconomic inequality in hospital case fatality rate and care among children and adolescents hospitalized for COVID-19 in Brazil. Rev Bras Epidemiol 2023; 26:e230015. [PMID: 36820752 PMCID: PMC9949490 DOI: 10.1590/1980-549720230015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/23/2022] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVE To analyze the association of hospital case fatality rate and care received by children and adolescents hospitalized for COVID-19 with the gross domestic product (GDP) per capita of Brazilian municipalities and regions of residence. METHODS Data were collected from the Influenza Epidemiological Surveillance Information System and the Brazilian Institute of Geography and Statistics. The dichotomous outcomes analyzed were hospital case fatality rate of COVID-19, biological samples collected for COVID-19 diagnosis, X-rays, computed tomography (CT) scans, use of ventilatory support, and intensive care unit hospitalization. The covariates were municipal GDP per capita and the Brazilian region of residence. Poisson regression was used for the outcomes recorded in 2020 and 2021 in Brazil, covering the two COVID-19 waves in the country, adjusted for age and gender. RESULTS The hospital case fatality rate was 7.6%. In municipalities with lower GDP per capita deciles, the case fatality rate was almost four times higher among children and twice as high in adolescents compared to cities with higher deciles. Additionally, residents of municipalities with lower GDP per capita had fewer biological samples collected for diagnosis, X-ray examinations, and CT scans. We found regional disparities associated with case fatality rate, with worse indicators in the North and Northeast regions. The findings remained consistent over the two COVID-19 waves. CONCLUSION Municipalities with lower GDP per capita, as well as the North and Northeast regions, had worse indicators of hospital case fatality rate and care.
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Affiliation(s)
- Caroline Fabrin
- Universidade Federal de Santa Catarina, Graduate Program in Collective Health – Florianópolis (SC), Brazil
| | - Alexandra Crispim Boing
- Universidade Federal de Santa Catarina, Graduate Program in Collective Health – Florianópolis (SC), Brazil
| | | | - Antonio Fernando Boing
- Universidade Federal de Santa Catarina, Graduate Program in Collective Health – Florianópolis (SC), Brazil
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17
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Villela PB. Improving Cardiopulmonary Resuscitation. Arq Bras Cardiol 2023; 120:e20220900. [PMID: 36790263 PMCID: PMC10389115 DOI: 10.36660/abc.20220900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Paolo Blanco Villela
- Universidade Federal do Rio de JaneiroRio de JaneiroRJBrasilUniversidade Federal do Rio de Janeiro, Rio de Janeiro, RJ – Brasil
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18
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Honorato MO, Sousa Filho JTD, Honorato Junior LFB, Watanabe N, Goulart GM, Prado RRD. Atrial Fibrillation and Sepsis in Elderly Patients and Their Associaton with In-Hospital Mortality. Arq Bras Cardiol 2023; 120:e20220295. [PMID: 36921155 PMCID: PMC9972940 DOI: 10.36660/abc.20220295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 11/16/2022] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) affects about 2% to 4% of the world population, and in patients hospitalized in intensive care units, this incidence can reach up to 23% in those with septic shock. The impact of AF in patients with sepsis is reflected in worse clinical outcomes, and the identification of the triggering factors can be a target for future prevention and treatment strategies. OBJECTIVES To verify the relationship between the development of AF and mortality in patients over 80 years of age included in the sepsis protocol and to identify the risk factors that contribute to the development of AF in this population. METHODS Retrospective observational study, with a review of electronic medical records and inclusion of 895 patients aged 80 years or older, included in the sepsis protocol of a high-complexity private hospital in São Paulo, SP, from January 2018 to December 2020. All tests were performed with a significance level of 5%. RESULTS The incidence of AF in the sample was 13%. After multivariate analysis, using multiple logistic regression, it was possible to demonstrate an association of mortality, in the studied population, with the SOFA score (odds ratio [OR] 1.21 [1.09 - 1.35]), higher values of C-reactive protein (OR 1.04 [1.01 - 1.06]), need for vasoactive drugs (OR 2.4 [1.38 - 4.18]), use of mechanical ventilation (OR 3.49 [1.82 - 6.71]), and mainly AF (OR 3.7 [2.16 - 6.31]). CONCLUSION In very elderly patients (80 years of age and older) with sepsis, the development of AF was shown to be an independent risk factor for in-hospital mortality.
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19
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de Azevedo HMJ, dos Santos NWF, Lafetá ML, de Albuquerque ALP, Tanni SE, Sperandio PA, Ferreira EVM. Persistence of symptoms and return to work after hospitalization for COVID-19. J Bras Pneumol 2022; 48:e20220194. [PMID: 36449816 PMCID: PMC9747179 DOI: 10.36416/1806-3756/e20220194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/16/2022] [Indexed: 11/12/2022] Open
Abstract
Many patients hospitalized with COVID-19 were unable to return to work or their return was delayed due to their health condition. The aim of this observational study was to evaluate the impact of moderate-to-severe and critical COVID-19 infection on persistence of symptoms and return to work after hospital discharge. In this study, two thirds of hospitalized patients with pulmonary involvement reported persistence of symptoms six months after COVID-19 infection, such as memory loss (45.5%), myalgia (43.9%), fatigue (39.4%), and dyspnea (25.8%), and 50% slowly returned to work, with repercussions due to fatigue and/or loss of energy.
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Affiliation(s)
- Helena Moraes Jardim de Azevedo
- . Faculdades Metropolitanas Unidas, São Paulo (SP) Brasil
- . Disciplina de Pneumologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, - EPM/Unifesp - São Paulo (SP) Brasil
| | - Nataly Winni Fernandes dos Santos
- . Faculdades Metropolitanas Unidas, São Paulo (SP) Brasil
- . Setor de Função Pulmonar e Fisiologia Clínica do Exercício - SEFICE - Disciplina de Pneumologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, - EPM/Unifesp - São Paulo (SP) Brasil
| | - Mariana Lima Lafetá
- . Setor de Função Pulmonar e Fisiologia Clínica do Exercício - SEFICE - Disciplina de Pneumologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, - EPM/Unifesp - São Paulo (SP) Brasil
| | - André Luis Pereira de Albuquerque
- . Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Suzana Erico Tanni
- . Disciplina de Pneumologia, Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu (SP) Brasil
| | - Priscila Abreu Sperandio
- . Setor de Função Pulmonar e Fisiologia Clínica do Exercício - SEFICE - Disciplina de Pneumologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, - EPM/Unifesp - São Paulo (SP) Brasil
| | - Eloara Vieira Machado Ferreira
- . Setor de Função Pulmonar e Fisiologia Clínica do Exercício - SEFICE - Disciplina de Pneumologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, - EPM/Unifesp - São Paulo (SP) Brasil
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Affiliation(s)
- Daniel Ferreira
- Hospital da Luz DigitalLisboaPortugalHospital da Luz Digital, Lisboa – Portugal
- Hospital da Luz LisboaServiço de Medicina IntensivaLisboaPortugalServiço de Medicina Intensiva – Hospital da Luz Lisboa, Lisboa – Portugal
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21
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Bianco HT, Povoa R, Izar MC, Alves CMR, Barbosa AHP, Bombig MTN, Gonçalves I, Luna B, Aguirre AC, Moraes PIDM, Almeida D, Moreira FT, Povoa FF, Stefanini E, Caixeta AM, Bacchin AS, Moisés VA, Fonseca FA. Pharmaco-invasive Strategy in Myocardial Infarction: Descriptive Analysis, Presentation of Ischemic Symptoms and Mortality Predictors. Arq Bras Cardiol 2022; 119:691-702. [PMID: 36453760 PMCID: PMC9750212 DOI: 10.36660/abc.20211055] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/15/2022] [Accepted: 06/01/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND ST-segment elevation myocardial infarction (STEMI) is defined by symptoms accompanied by typical electrocardiogram changes. However, the characterization of ischemic symptoms is unclear, especially in subgroups such as women and the elderly. OBJECTIVES To analyze the typification of ischemic symptoms, temporal metrics and observe the occurrence of in-hospital outcomes, in the analysis of predictive scores, in patients with STEMI, in a drug-invasive strategy. METHODS Study involving 2,290 patients. Types of predefined clinical presentations: typical pain, atypical pain, dyspnea, syncope. We measured the time between the onset of symptoms and demand for care and the interval between arrival at the medical unit and thrombolysis. Odds-ratios (OR; CI-95%) were estimated in a regression model. ROC curves were constructed for mortality predictors. The adopted significance level (alpha) was 5%. RESULTS Women had a high prevalence of atypical symptoms; longer time between the onset of symptoms and seeking care; delay between arrival at the emergency room and fibrinolysis. Hospital mortality was 5.6%. Risk prediction by Killip-Kimball classification: AUC: [0.77 (0.73-0.81)] in class ≥II. Subgroups studied [OR (CI-95%)]: women [2.06 (1.42-2.99); p=0.01]; chronic renal failure [3.39 (2.13-5.42); p<0.001]; elderly [2.09 (1.37-3.19) p<0.001]; diabetics [1.55 (1.04-2.29); p=0.02]; obese 1.56 [(1.01-2.40); p=0.04]: previous stroke [2.01 (1.02-3.96); p=0.04] correlated with higher mortality rates. CONCLUSION Despite higher mortality rates in some subgroups, significant disparity persists in women, with delays in symptom recognition and prompt thrombolysis. We highlight the applicability of the Killip-Kimball score in prediction, regardless of the clinical presentation.
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Affiliation(s)
- Henrique Tria Bianco
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Rui Povoa
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Maria Cristina Izar
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
| | - Claudia Maria Rodrigues Alves
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
| | - Adriano Henrique Pereira Barbosa
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
| | - Maria Teresa Nogueira Bombig
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Iran Gonçalves
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Bráulio Luna
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Ana Caroline Aguirre
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Pedro Ivo de Marqui Moraes
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Dirceu Almeida
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Flávio Tocci Moreira
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
| | - Fernando Focaccia Povoa
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
| | - Edson Stefanini
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
| | - Adriano Mendes Caixeta
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
| | - Amanda S. Bacchin
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Valdir Ambrósio Moisés
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
| | - Francisco A.H. Fonseca
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
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Cechinel C, Lenardt MH, Rodrigues JAM, Binotto MA, Aristides MM, Kraus R. Frailty and delirium in hospitalized older adults: A systematic review with meta-analysis. Rev Lat Am Enfermagem 2022; 30:e3687. [PMID: 36287400 PMCID: PMC9580989 DOI: 10.1590/1518-8345.6120.3687] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/17/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to estimate the prevalence and synthesize diverse evidence about the relationship between frailty and delirium in hospitalized older adults. METHOD a systematic review with meta-analysis in which observational studies conducted with older adults about frailty, delirium and hospitalization, were selected without time of language restrictions. The search was conducted in the MEDLINE, EMBASE, CINAHL, Scopus, Web of Science and CENTRAL databases during August 2021. The precepts set forth by the Joanna Briggs Institute (JBI) - Evidence Synthesis Groups were followed. The meta-analysis model estimated the relative risk corresponding to the prevalence of frailty and delirium. The inverse variance method for proportions was used to estimate the prevalence values and relative risks for binary outcomes. RESULTS initially, 1,244 articles were identified, of which 26 were included in the meta-analysis (n=13,502 participants), with 34% prevalence of frailty (95% CI:0.26-0.42; I 2=99%; t 2=0.7618, p=0) and 21% for delirium (95% CI:0.17-0,25; I 2=95%; t 2=0.3454, p<0.01). The risk for hospitalized older adults to develop delirium was 66% (RR: 1.66; 95% CI:1.23-2.22; I2=92%; t2=0.4154; p<0.01). CONCLUSION 34% prevalence of frailty and 21% of delirium in hospitalized older adults, with frailty being an independent risk factor for developing delirium, with an increased chance of 66% when compared to non-frail individuals.
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Affiliation(s)
- Clovis Cechinel
- Universidade Federal do Paraná, Curitiba, PR, Brazil.,Secretaria Municipal de Saúde, Hospital Municipal do Idoso Zilda Arns, Curitiba, PR, Brazil
| | | | | | - Maria Angélica Binotto
- Universidade Estadual do Centro-Oeste, Departamento de Educação Fisica, Irati, PR, Brazil
| | | | - Rosane Kraus
- Universidade Federal do Paraná, Curitiba, PR, Brazil., Fundação Estatal de Atencão a Saúde, Hospital Municipal do Idoso Zilda Arns, Curitiba, PR, Brazil
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de Paiva KM, Hillesheim D, Rech CR, Delevatti RS, Brown RVS, Gonzáles AI, Haas P. Prevalence and Associated Factors of SARS by Covid-19 in Adults and Aged People with Chronic Cardiovascular Disease. Arq Bras Cardiol 2021; 117:968-975. [PMID: 34161421 PMCID: PMC8682099 DOI: 10.36660/abc.20200955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/22/2020] [Accepted: 11/11/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The presence of Cardiovascular Disease (CVD) in individuals infected with COVID-19 may imply a worse prognosis. OBJECTIVE To describe the prevalence of Severe Acute Respiratory Syndrome (SARS) by COVID-19 and to analyze the factors associated with this condition in adults and the elderly with cardiovascular disease in Brazil until the 30th Epidemiological Week of 2020. METHODS Cross-sectional study conducted with data from the Influenza Epidemiological Surveillance Information System (Sistema de Informação de Vigilância Epidemiológica da Gripe - SIVEP-Gripe), referring to the SARS notification forms of hospitalized individuals in Brazil, between the 1st and 30th Epidemiological Week of 2020. Adults and the aged (≥ 18 years old) with CVD. The dependent variable was SRAG confirmation by COVID-19 and factors related to sociodemographic characteristics, signs and symptoms, and clinical factors were analyzed. Poisson regression with robust variance was applied. The level of significance adopted was 5%. RESULTS Notifications from 116,343 individuals were analyzed. Of these, 61.9% were diagnosed with SARS by COVID-19. The prevalence of the outcome was 4% lower in women (95%CI: 0.94-0.99) and 18% lower in rural areas (95%CI: 0.77-0.87). There was a higher prevalence in the 50 to 59 age group (95%CI: 1.09-1.48) and in the northeast region (95%CI: 1.72-1.91). Fever, cough, admission to the ICU, use of ventilatory support, and nosocomial cases were also significantly associated with a higher probability of SRAS by COVID-19 in these individuals. CONCLUSION There is a high prevalence of SARS by COVID-19 in adults and aged people with CVD in Brazil. Factors associated with sociodemographic and clinical characteristics, signs, and symptoms were associated.
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Affiliation(s)
- Karina Mary de Paiva
- Universidade Federal de Santa CatarinaFlorianópolisSCBrasilUniversidade Federal de Santa Catarina (UFSC), Florianópolis, SC – Brasil
| | - Danúbia Hillesheim
- Universidade Federal de Santa CatarinaFlorianópolisSCBrasilUniversidade Federal de Santa Catarina (UFSC), Florianópolis, SC – Brasil
| | - Cassiano Ricardo Rech
- Universidade Federal de Santa CatarinaFlorianópolisSCBrasilUniversidade Federal de Santa Catarina (UFSC), Florianópolis, SC – Brasil
| | - Rodrigo Sudatti Delevatti
- Universidade Federal de Santa CatarinaFlorianópolisSCBrasilUniversidade Federal de Santa Catarina (UFSC), Florianópolis, SC – Brasil
| | - Rodrigo Vasconi Sáez Brown
- Universidade Federal de Santa CatarinaFlorianópolisSCBrasilUniversidade Federal de Santa Catarina (UFSC), Florianópolis, SC – Brasil
| | - Ana Inês Gonzáles
- Universidade Federal de Santa CatarinaFlorianópolisSCBrasilUniversidade Federal de Santa Catarina (UFSC), Florianópolis, SC – Brasil
- Centro Universitário Estácio de Santa CatarinaSão JoséSCBrasilCentro Universitário Estácio de Santa Catarina, São José, SC – Brasil
| | - Patricia Haas
- Universidade Federal de Santa CatarinaFlorianópolisSCBrasilUniversidade Federal de Santa Catarina (UFSC), Florianópolis, SC – Brasil
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Costa R, da Silva KR, Saucedo SCM, Silva LA, Crevelari ES, Nascimento WTJ, Silveira TG, Fiorelli A, Martinelli M, Jatene FB. Impact of the COVID-19 Pandemic on Cardiac Implantable Electronic Devices Procedures in a Tertiary Referral Center. Arq Bras Cardiol 2021; 117:765-769. [PMID: 34709303 PMCID: PMC8528374 DOI: 10.36660/abc.20201378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/22/2021] [Accepted: 05/12/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Roberto Costa
- Universidade de São PauloInstituto do CoraçãoUnidade de Estimulação Elétrica e MarcapassoSão PauloSPBrasilUniversidade de São Paulo Instituto do Coração - Unidade de Estimulação Elétrica e Marcapasso, São Paulo, SP – Brasil
| | - Katia Regina da Silva
- Universidade de São PauloInstituto do CoraçãoUnidade de Estimulação Elétrica e MarcapassoSão PauloSPBrasilUniversidade de São Paulo Instituto do Coração - Unidade de Estimulação Elétrica e Marcapasso, São Paulo, SP – Brasil
| | - Sarah Caroline Martins Saucedo
- Universidade de São PauloInstituto do CoraçãoUnidade de Estimulação Elétrica e MarcapassoSão PauloSPBrasilUniversidade de São Paulo Instituto do Coração - Unidade de Estimulação Elétrica e Marcapasso, São Paulo, SP – Brasil
| | - Laisa Arruda Silva
- Universidade de São PauloInstituto do CoraçãoUnidade de Estimulação Elétrica e MarcapassoSão PauloSPBrasilUniversidade de São Paulo Instituto do Coração - Unidade de Estimulação Elétrica e Marcapasso, São Paulo, SP – Brasil
| | - Elizabeth Sartori Crevelari
- Universidade de São PauloInstituto do CoraçãoUnidade de Estimulação Elétrica e MarcapassoSão PauloSPBrasilUniversidade de São Paulo Instituto do Coração - Unidade de Estimulação Elétrica e Marcapasso, São Paulo, SP – Brasil
| | - Wagner Tadeu Jurevicius Nascimento
- Universidade de São PauloInstituto do CoraçãoUnidade de Estimulação Elétrica e MarcapassoSão PauloSPBrasilUniversidade de São Paulo Instituto do Coração - Unidade de Estimulação Elétrica e Marcapasso, São Paulo, SP – Brasil
| | - Thiago Gonçalves Silveira
- Universidade de São PauloInstituto do CoraçãoUnidade de Estimulação Elétrica e MarcapassoSão PauloSPBrasilUniversidade de São Paulo Instituto do Coração - Unidade de Estimulação Elétrica e Marcapasso, São Paulo, SP – Brasil
| | - Alfredo Fiorelli
- Universidade de São PauloInstituto do CoraçãoUnidade de Estimulação Elétrica e MarcapassoSão PauloSPBrasilUniversidade de São Paulo Instituto do Coração - Unidade de Estimulação Elétrica e Marcapasso, São Paulo, SP – Brasil
| | - Martino Martinelli
- Universidade de São PauloInstituto do CoraçãoUnidade de Estimulação Elétrica e MarcapassoSão PauloSPBrasilUniversidade de São Paulo Instituto do Coração - Unidade de Estimulação Elétrica e Marcapasso, São Paulo, SP – Brasil
| | - Fabio Biscegli Jatene
- Universidade de São PauloFaculdade de MedicinaHospital das ClinicasSão PauloSPBrasilUniversidade de São Paulo Faculdade de Medicina Hospital das Clinicas Instituto do Coração, São Paulo, SP – Brasil
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25
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Noya-Rabelo MM, de Azevedo DFC, de Souza OF. Predictive Models to Enhance our Knowledge: Is It Necessary? Arq Bras Cardiol 2021; 117:624-625. [PMID: 34709289 PMCID: PMC8528350 DOI: 10.36660/abc.20210733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Marcia M. Noya-Rabelo
- Instituto D’Or de Pesquisa e EnsinoSalvadorBABrazilInstituto D’Or de Pesquisa e Ensino (IDOR), Salvador, BA - Brazil
- Hospital AliançaSalvadorBABrazilHospital Aliança, Salvador, BA - Brazil
- Escola Bahiana de Medicina e Saúde PúblicaSalvadorBABrazilEscola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brazil
| | - Diogo Freitas Cardoso de Azevedo
- Instituto D’Or de Pesquisa e EnsinoSalvadorBABrazilInstituto D’Or de Pesquisa e Ensino (IDOR), Salvador, BA - Brazil
- Hospital AliançaSalvadorBABrazilHospital Aliança, Salvador, BA - Brazil
| | - Olga Ferreira de Souza
- Instituto D’Or de Pesquisa e EnsinoSalvadorBABrazilInstituto D’Or de Pesquisa e Ensino (IDOR), Salvador, BA - Brazil
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26
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Affiliation(s)
- Eduardo Arrais Rocha
- Universidade Federal do CearáFaculdade de MedicinaFortalezaCEBrasilFaculdade de Medicina da Universidade Federal do Ceará, Fortaleza, CE - Brasil.
- Centro de Arritmia do CearáFortalezaCEBrasilCentro de Arritmia do Ceará, Fortaleza, CE - Brasil.
| | - Camila Pinto Cavalcante Miná
- Hospital de Messejana Dr. Carlos Alberto Studart GomesFortalezaCEBrasilHospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, CE - Brasil.
| | - Maria Eduarda Quidute Arrais Rocha
- Universidade de FortalezaCentro de Ciências da SaúdeFortalezaCEBrasilUniversidade de Fortaleza Centro de Ciências da Saúde, Fortaleza, CE - Brasil.
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Affiliation(s)
- Ana Teresa Timóteo
- Centro Hospitalar Universitário Lisboa CentralHospital Santa MartaLisboaPortugalHospital Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisboa - Portugal.
- Faculdade de Ciências MédicasNOVA Medical SchoolLisboaPortugalNOVA Medical School - Faculdade de Ciências Médicas, Lisboa – Portugal.
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28
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Correia ETDO, Barbetta LMDS, Mesquita ET. Is It Time for a New Standard Therapy for Heart Failure with Reduced Ejection Fraction? Arq Bras Cardiol 2021; 117:149-152. [PMID: 34320086 PMCID: PMC8294725 DOI: 10.36660/abc.20200983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 01/21/2021] [Accepted: 02/24/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
| | | | - Evandro Tinoco Mesquita
- Complexo Hospitalar de NiteróiNiteróiRJBrasilComplexo Hospitalar de Niterói,Niterói, RJ - Brasil
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29
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Zhu Q, Gao P, Fu S, Wang H, Bai Y, Luo L, Ye P. Prognostic Value of Plasma NT-proBNP levels in Hospitalized Patients Older than 80 Years of Age in a Hospital in Beijing, China. Arq Bras Cardiol 2021; 116:1027-1036. [PMID: 34133582 PMCID: PMC8288545 DOI: 10.36660/abc.20190158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 03/27/2020] [Accepted: 05/06/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite growing evidence that N-terminal pro-brain natriuretic peptide (NT-proBNP) has an important prognostic value in older adults, there is limited data on its prognostic predictive value. OBJECTIVES The aim of this study is to evaluate the clinical significance of NT-proBNP in hospitalized patients older than 80 years of age in Beijing, China. METHODS This prospective, observational study was conducted in 724 very elderly patients in a geriatric ward (age ≥80 years, range, 80100 years, mean, 86.6 3.0 years). Multivariate linear regression analysis was used to screen for factors independently associated with NT-proBNP, and the Cox proportional hazard regression model was used to screen for relationships between NT-proBNP levels and major endpoints. The major endpoints assessed were all-cause death and MACEs. P values < 0.05 were considered statistically significant. RESULTS The prevalence rates of coronary heart disease, hypertension, and diabetes mellitus were 81.4%, 75.1%, and 41.2%, respectively. The mean NT-proBNP level was 770 ± 818 pg/mL. Using multivariate linear regression analyses, correlations were found between plasma NT-proBNP and body mass index, atrial fibrillation, estimated glomerular filtration rate, left atrial diameter, left ventricular ejection fraction, use of betablocker, levels of hemoglobin, plasma albumin, triglycerides, serum creatinine, and blood urea nitrogen. The risk of all-cause death (HR, 1.63; 95% CI, 1.0052.642; P = 0.04) and major adverse cardiovascular events (MACE; HR, 1.77; 95% CI, 1.2893.531; P = 0.04) in the group with the highest NT-proBNP level was significantly higher than that in the group with the lowest level, according to Cox regression models after adjusting for multiple factors. As expected, echocardiography parameters adjusted the prognostic value of NT-proBNP in the model. CONCLUSIONS NT-proBNP was identified as an independent predictor of all-cause death and MACE in hospitalized patients older than 80 years of age.
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Affiliation(s)
- Qiwei Zhu
- Chinese People’s Liberation Army General HospitalBeijingChina Chinese People’s Liberation Army General Hospital , Beijing - China
- Department of Geriatric CardiologyChinese People’s Liberation Army General HospitalBeijingChina Department of Geriatric Cardiology , Chinese People’s Liberation Army General Hospital , Beijing - China
| | - Peng Gao
- Chinese People’s Liberation Army General HospitalBeijingChina Chinese People’s Liberation Army General Hospital , Beijing - China
- Department of Geriatric CardiologyChinese People’s Liberation Army General HospitalBeijingChina Department of Geriatric Cardiology , Chinese People’s Liberation Army General Hospital , Beijing - China
| | - Shihui Fu
- Chinese People’s Liberation Army General HospitalBeijingChina Chinese People’s Liberation Army General Hospital , Beijing - China
- Department of Geriatric CardiologyChinese People’s Liberation Army General HospitalBeijingChina Department of Geriatric Cardiology , Chinese People’s Liberation Army General Hospital , Beijing - China
| | - Hao Wang
- Chinese People’s Liberation Army General HospitalBeijingChina Chinese People’s Liberation Army General Hospital , Beijing - China
- Department of Geriatric CardiologyChinese People’s Liberation Army General HospitalBeijingChina Department of Geriatric Cardiology , Chinese People’s Liberation Army General Hospital , Beijing - China
| | - Yongyi Bai
- Chinese People’s Liberation Army General HospitalBeijingChina Chinese People’s Liberation Army General Hospital , Beijing - China
- Department of Geriatric CardiologyChinese People’s Liberation Army General HospitalBeijingChina Department of Geriatric Cardiology , Chinese People’s Liberation Army General Hospital , Beijing - China
| | - Leiming Luo
- Chinese People’s Liberation Army General HospitalBeijingChina Chinese People’s Liberation Army General Hospital , Beijing - China
- Department of Geriatric CardiologyChinese People’s Liberation Army General HospitalBeijingChina Department of Geriatric Cardiology , Chinese People’s Liberation Army General Hospital , Beijing - China
| | - Ping Ye
- Chinese People’s Liberation Army General HospitalBeijingChina Chinese People’s Liberation Army General Hospital , Beijing - China
- Department of Geriatric CardiologyChinese People’s Liberation Army General HospitalBeijingChina Department of Geriatric Cardiology , Chinese People’s Liberation Army General Hospital , Beijing - China
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Normando PG, Araujo-Filho JDA, Fonseca GDA, Rodrigues REF, Oliveira VA, Hajjar LA, Almeida ALC, Bocchi EA, Salemi VMC, Melo M. Reduction in Hospitalization and Increase in Mortality Due to Cardiovascular Diseases during the COVID-19 Pandemic in Brazil. Arq Bras Cardiol 2021; 116:371-380. [PMID: 33566937 PMCID: PMC8159562 DOI: 10.36660/abc.20200821] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 10/14/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In the COVID-19 pandemic, the increase in the incidence of cardiovascular diseases (CVD) and mortality from them has been recognized worldwide. In Brazil, the impact of COVID-19 on CVD must be evaluated. OBJECTIVES To assess the impact of the current pandemic on the numbers of hospital admissions (HA), in-hospital deaths (ID), and in-hospital fatality (IF) from CVD by use of national epidemiological data from the Brazilian Unified Public Health System. METHODS Time-series observational study using comparative analysis of the HA, ID, and IF due to CVD recorded from January to May 2020, having as reference the values registered in the same period from 2016 to 2019 and the values projected by linear regression methods for 2020. The statistical significance level applied was 0.05. RESULTS Compared to the same period in 2019, there was a 15% decrease in the HA rate and a 9% decrease in the total ID due to CVD between March and May 2020, followed by a 9% increase in the IF rate due to CVD, especially among patients aged 20-59 years. The HA and IF rates registered in 2020 differed significantly from the projected trend for 2020 (p = 0.0005 and 0.0318, respectively). CONCLUSIONS During the first months of the pandemic, there were a decline in HA and an increase in IF due to CVD in Brazil. These data might have resulted from the inadequate planning of the CVD management during the pandemic. Thus, immediate actions are required to change this scenario. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0).
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Affiliation(s)
- Paulo Garcia Normando
- Universidade Federal da ParaíbaJoão PessoaPBBrasil Universidade Federal da Paraíba
,
João Pessoa
,
PB
-
Brasil
| | | | | | | | - Victor Agripino Oliveira
- Universidade Federal da ParaíbaJoão PessoaPBBrasil Universidade Federal da Paraíba
,
João Pessoa
,
PB
-
Brasil
| | - Ludhmila Abrahão Hajjar
- Instituto de Coração – CardiopneumologiaSão PauloSPBrasil Instituto de Coração – Cardiopneumologia
,
São Paulo
,
SP
-
Brasil
| | - André Luiz Cerqueira Almeida
- Santa Casa de Misericórdia de Feira de SantanaFeira de SantanaBABrasil Santa Casa de Misericórdia de Feira de Santana
– Cardiologia,
Feira de Santana
,
BA
-
Brasil
| | - Edimar Alcides Bocchi
- Universidade de São PauloInstituto do Coração - Centro de Diagnóstico por ImagemSão PauloSPBrasil Universidade de São Paulo
Instituto do Coração - Centro de Diagnóstico por Imagem
,
São Paulo
,
SP
-
Brasil
| | - Vera Maria Cury Salemi
- Universidade de São PauloInstituto do Coração - Centro de Diagnóstico por ImagemSão PauloSPBrasil Universidade de São Paulo
Instituto do Coração - Centro de Diagnóstico por Imagem
,
São Paulo
,
SP
-
Brasil
| | - Marcelo Melo
- Universidade Federal da ParaíbaJoão PessoaPBBrasil Universidade Federal da Paraíba
,
João Pessoa
,
PB
-
Brasil
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Nascimento JHP, da Costa RL, Simvoulidis LFN, de Pinho JC, Pereira RS, Porto AD, Silva ECDF, Oliveira LP, Ramos MRF, de Oliveira GMM. COVID-19 and Myocardial Injury in a Brazilian ICU: High Incidence and Higher Risk of In-Hospital Mortality. Arq Bras Cardiol 2021; 116:275-282. [PMID: 33470333 PMCID: PMC7909969 DOI: 10.36660/abc.20200671] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/31/2020] [Accepted: 08/12/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The incidence of myocardial injury (MI) in patients with COVID-19 in Brazil and the prognostic impact of MI have not been elucidated. OBJECTIVES To describe the incidence of MI in patients with COVID-19 in the intensive care unit (ICU) and to identify variables associated with its occurrence. The secondary objective was to assess high-sensitivity troponin I as a predictor of in-hospital mortality. METHODS Retrospective, observational study conducted between March and April 2020 with cases of confirmed COVID-19 admitted to the ICU. Numerical variables were compared by using Student t test or Mann-Whitney U test. The chi-square test was used for categorical variables. Multivariate analysis was performed with variables associated with MI and p<0.2 to determine predictors of MI. The ROC curve was used to determine the troponin value capable of predicting higher in-hospital mortality. Survival functions were estimated by use of the Kaplan-Meier method from the cut-off point indicated in the ROC curve. RESULTS This study assessed 61 patients (63.9% of the male sex, mean age of 66.1±15.5 years). Myocardial injury was present in 36% of the patients. Systemic arterial hypertension (HAS) [OR 1.198; 95%CI: 2.246-37.665] and body mass index (BMI) [OR 1.143; 95%CI: 1.013-1.289] were independent risk predictors. High-sensitivity troponin I >48.3 ng/mL, which was determined in the ROC curve, predicts higher in-hospital mortality [AUC 0.786; p<0.05]. Survival in the group with high-sensitivity troponin I >48.3 ng/mL was lower than that in the group with values ≤48.3 ng/dL [20.3 x 43.5 days, respectively; p<0.05]. CONCLUSION There was a high incidence of MI in severe COVID-19 with impact on higher in-hospital mortality. The independent risk predictors of MI were SAH and BMI. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).
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Affiliation(s)
- Jorge Henrique Paiter Nascimento
- Universidade Federal do Rio de JaneiroRio de JaneiroRJBrasil Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ - Brasil
- Hospital Unimed-RioRio de JaneiroRJBrasilHospital Unimed-Rio, Rio de Janeiro, RJ - Brasil
| | - Rafael Lessa da Costa
- Hospital Unimed-RioRio de JaneiroRJBrasilHospital Unimed-Rio, Rio de Janeiro, RJ - Brasil
| | | | - João Carlos de Pinho
- Hospital Unimed-RioRio de JaneiroRJBrasilHospital Unimed-Rio, Rio de Janeiro, RJ - Brasil
| | - Roberta Santos Pereira
- Hospital Unimed-RioRio de JaneiroRJBrasilHospital Unimed-Rio, Rio de Janeiro, RJ - Brasil
| | - Andrea Dornelles Porto
- Hospital Unimed-RioRio de JaneiroRJBrasilHospital Unimed-Rio, Rio de Janeiro, RJ - Brasil
| | | | | | | | - Gláucia Maria Moraes de Oliveira
- Universidade Federal do Rio de JaneiroRio de JaneiroRJBrasil Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ - Brasil
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Abstract
OBJECTIVE to identify the predictors of functional decline in hospitalized individuals aged 70 or over, between: baseline and discharge; discharge and follow-up, and baseline and three-month follow-up. METHOD a prospective cohort study conducted in internal medicine services. A questionnaire was applied (clinical and demographic variables, and predictors of functional decline) at three moments. The predictors were determined using the binary logistic regression model. RESULTS the sample included 101 patients, 53.3% female, mean age of 82.47 ± 6.57 years old. The predictors that most contributed to decline in hospitalization were the following: previous hospitalization (OR=1.8), access to social support (OR=4.86), cognitive deficit (OR=6.35), mechanical restraint (OR=7.82), and not having a partner (OR=4.34). Age (OR=1.18) and medical diagnosis (OR=0.10) were the predictors between discharge and follow-up. Being older, delirium during hospitalization (OR=5.92), and presenting risk of functional decline (OR=5.53) were predictors of decline between the baseline and follow-up. CONCLUSION the most relevant predictors were age, previous hospitalization, cognitive deficit, restraint, social support, not having a partner, and delirium. Carrying out interventions aimed at minimizing the impact of these predictors can be an important contribution in the prevention of functional decline.
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Affiliation(s)
- Gabriel Porto Soares
- Universidade Federal do Rio de JaneiroRio de JaneiroRJBrasilUniversidade Federal do Rio de Janeiro, Rio de Janeiro, RJ - Brasil
- Universidade Severino SombraCurso de MedicinaVassourasRJBrasilUniversidade Severino Sombra - Curso de Medicina, Vassouras, RJ – Brasil
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34
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Góes RP, Pedreira LC, Valente CO, Mussi FC, de Souza ML, do Amaral JB. Construction and validation of an instrument for the structural assessment of wards for urinary continence in older adults. Rev Lat Am Enfermagem 2020; 28:e3374. [PMID: 33084776 PMCID: PMC7575244 DOI: 10.1590/1518-8345.3361.3374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 06/12/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to build and validate an instrument for structural assessment of wards for the preservation of urinary continence in hospitalized older adults. METHOD this is a methodological study divided into two stages. The first corresponded to an integrative literature review that guided the construction of the instrument. The second consisted of the content validation stage of the instrument, by means of expert consensus, using the Delphi technique. The selected experts were recognized in the field and authors of the articles included in the integrative review. RESULTS six experts participated in the content validation, which resulted in the "Instrument for Structural Assessment of Wards for the Preservation of Urinary Continence in Older Adults", composed of 27 items, distributed in three dimensions: "physical structure", "human resources", and "material resources". Two Delphi rounds were carried out for validation, resulting in a final version with 83% agreement among the experts. CONCLUSION the instrument reached content validity, requiring application for clinical validation. However, it can be used by researchers and health staff in hospital settings, in order to identify structural weaknesses and guide the priority of interventions for the quality and safety of this care.
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Askin L, Tanrıverdi O, Askin HS. The Effect of Coronavirus Disease 2019 on Cardiovascular Diseases. Arq Bras Cardiol 2020; 114:817-822. [PMID: 32491073 PMCID: PMC8386999 DOI: 10.36660/abc.20200273] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a global pandemic affecting the world, seen in more than 1,300,000 patients. COVID-19 acts through the angiotensin-converting enzyme 2 (ACE2) receptor. Cardiovascular comorbidities are more common with COVID-19, and nearly 10% of cases develop myocarditis (22% of critical patients). Further research is needed to continue or discontinue ACE inhibitors and angiotensin receptor blockers, which are essential in hypertension and heart failure in COVID-19. Intensive research is promising for the treatment and prevention of COVID-19.
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Affiliation(s)
- Lutfu Askin
- Adiyaman Universitesi Egitim ve Arastirma HastanesiAdıyamanCentryTurquiaAdiyaman Universitesi Egitim ve Arastirma Hastanesi – Cardiology,Adıyaman, Centry – Turquia
| | - Okan Tanrıverdi
- Adiyaman Universitesi Egitim ve Arastirma HastanesiAdıyamanCentryTurquiaAdiyaman Universitesi Egitim ve Arastirma Hastanesi – Cardiology,Adıyaman, Centry – Turquia
| | - Husna Sengul Askin
- Adiyaman Universitesi Egitim ve Arastirma HastanesiAdıyamanCentryTurquiaAdiyaman Universitesi Egitim ve Arastirma Hastanesi - Infectious Disease,Adıyaman, Centry – Turquia
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Dantas RCDO, da Silva JPT, Dantas DCDO, Roncalli ÂG. Factors associated with hospital admissions due to hypertension. Einstein (Sao Paulo) 2018; 16:eAO4283. [PMID: 30281763 PMCID: PMC6178859 DOI: 10.1590/s1679-45082018ao4283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 04/11/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To study the temporality of hospital admissions due to arterial hypertension and its associated factors. METHODS An ecological study with secondary data on hospital admissions due to essential arterial hypertension - ICD 10, from the Hospital Information System, the Mortality Information System and and the Primary Care Information System, between 2010 and 2015. Descriptive analysis using means, proportions and linear regression. RESULTS We recorded 493,299 hospitalizations due to arterial hypertension from 2010 to 2015, with an average annual progressive cost decrease of -7.76% and -24.21%. Of the patients admitted, 59.2% were women, 60.2% were non-white and 54.7% were older than 60 years. The mean length of stay was 4.2 days, and the hospitalization cost was R$307.60. The multiple linear regression variables that remained significant were the percentage of admissions due to primary care-sensitive conditions, the per capita income and the City Human Development Index. CONCLUSION Hospital admissions due to arterial hypertension have an impact on the percentage of admissions due to primary care- sensitive conditions. Intensifying primary care activities, raising-awareness among professionals to the importance of integrated care, and investing in social development are crucial to change the reality of hypertension in terms of its control and complications.
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Arantes LJ, Shimizu HE, Merchán-Hamann E. Ambulatory care sensitive hospitalizations after implementation of the master plan in Minas Gerais. Rev Saude Publica 2018; 52:78. [PMID: 30066817 PMCID: PMC6063608 DOI: 10.11606/s1518-8787.2018052017330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 10/18/2017] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To describe the rate of ambulatory care sensitive hospitalizations in groups of cities according to population size and to analyze its association with the coverage of the Family Health Strategy after the implementation of the Master Plan for Primary Health Care in Minas Gerais, Brazil. METHODS This is an ecological study with 452 cities grouped according to population size, with data from 2004 to 2007 and 2010 to 2013. We used the Kolmogorov-Smirnov test to verify the distribution of the data in the groups. We used the Wilcoxon test for paired data or the paired Student's t-test to compare the rate of ambulatory care sensitive hospitalizations before and after the Master Plan for Primary Health Care. We used the simple linear regression test to analyze the association between variables. We performed statistical analyses using the Statistical Package for the Social Sciences, with a significance level of 5%. RESULTS The rate of ambulatory care sensitive hospitalizations decreased significantly after the Master Plan for Primary Health Care in the large and mid-sized groups (p < 0.05). There were positive correlations between coverage with Family Health Strategy and the rate of ambulatory care sensitive hospitalizations in the mid-sized and large groups (p < 0.05). CONCLUSIONS Actions were carried out to implement the Master Plan for Primary Health Care. However, more investments are needed to improve the effectiveness of the Primary Health Care, with permanent confrontation of complex issues that affect the quality of services, which can lead to a significant reduction of the rates of ambulatory care sensitive hospitalizations.
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Affiliation(s)
- Luciano José Arantes
- Universidade de Brasília. Programa de Pós-Graduação em Ciências da Saúde. Brasília, DF, Brasil
| | - Helena Eri Shimizu
- Universidade de Brasília. Faculdade de Ciências da Saúde. Departamento de Saúde Coletiva. Brasília, DF, Brasil
| | - Edgar Merchán-Hamann
- Universidade de Brasília. Faculdade de Ciências da Saúde. Departamento de Saúde Coletiva. Brasília, DF, Brasil
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Tavares DMDS, Colamego CG, Pegorari MS, Ferreira PCDS, Dias FA, Bolina AF. Cardiovascular risk factors associated with frailty syndrome among hospitalized elderly people: a cross-sectional study. SAO PAULO MED J 2016; 134:393-399. [PMID: 27901241 PMCID: PMC10871849 DOI: 10.1590/1516-3180.2016.0028010616] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 06/01/2016] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE: Identification of frailty syndrome and its relationship with cardiovascular risk factors among hospitalized elderly people is important, since this may contribute towards broadening of knowledge regarding this association within tertiary-level services. This study aimed to evaluate the cardiovascular risk factors associated with frailty syndrome among hospitalized elderly people. DESIGN AND SETTING: Observational cross-sectional study in a public teaching hospital. METHODS: The participants were elderly patients admitted to clinical and surgical wards. The cardiovascular risk factors assessed were: body mass index (BMI), waist circumference, systemic arterial hypertension (SAH), blood glucose, total cholesterol, high-density lipoproteins (HDL), low-density lipoproteins (LDL) and triglycerides. To identify frailty syndrome, the method proposed by Fried was used. The data were analyzed through descriptive statistics, chi-square test (P < 0.10) and multinomial logistic regression (P < 0.05). RESULTS: A total of 205 individuals were evaluated. It was found that 26.3% (n = 54) of the elderly people were frail, 51.7% (n = 106) were pre-frail and 22% (n = 45) were non-frail. The preliminary bivariate analysis (P < 0.10) for the regression model showed that frailty was associated with BMI (P = 0.016), LDL cholesterol (P = 0.028) and triglycerides (P = 0.093). However, in the final multivariate model, only overweight remained associated with the pre-frail condition (odds ratio, OR = 0.44; 95% confidence interval, CI = 0.20-0.98; P = 0.045). CONCLUSION: States of frailty were highly present in the hospital environment. The pre-frail condition was inversely associated with overweight.
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Affiliation(s)
- Darlene Mara dos Santos Tavares
- RN, PhD. Associate Professor, Department of Nursing Education and Postgraduate Program on Community Health Nursing, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, MG, Brazil.
| | - Camila Gigante Colamego
- Undergraduate Student, Physiotherapy Course, Universidade Federal do Triangulo Mineiro (UFTM), Uberaba, MG, Brazil.
| | - Maycon Sousa Pegorari
- MSc, PhD. Assistant Professor, Physiotherapy Course, Universidade Federal do Amapá (UNIFAP), Macapá, AP, Brazil.
| | | | - Flávia Aparecida Dias
- RN, MSc. Doctoral Student, Postgraduate Course on Healthcare, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, MG, Brazil.
| | - Alisson Fernandes Bolina
- RN, MSc. Doctoral student, Ribeirão Preto School of Nursing, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil.
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Rudge MVC, Lima SAM, Dib RPE, Marini G, Magalhães C, Calderon IDMP. Effect of ambulatory versus hospital treatment for gestational diabetes or hyperglycemia on infant mortality rates: a systematic review. SAO PAULO MED J 2013; 131:331-7. [PMID: 24310802 PMCID: PMC10876319 DOI: 10.1590/1516-3180.2013.1315560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 06/27/2013] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Pregnancies complicated by diabetes are associated with increased neonatal and maternal complications. The most serious maternal complication is the risk of developing type 2 diabetes, 10-12 years after the delivery. For rigorous control over blood glucose, pregnant women are treated through ambulatory management or hospitalization. The aim of this study was to evaluate the effectiveness of ambulatory management versus hospitalization in pregnancies complicated by diabetes or hyperglycemia. DESIGN AND SETTING Systematic review conducted in a public university hospital. METHODS A systematic review of the literature was performed and the main electronic databases were searched. The date of the most recent search was September 4, 2011. Two authors independently selected relevant clinical trials, assessed their methodological quality and extracted data. RESULTS Only three studies were selected, with small sample sizes. There was no statistically significance different between ambulatory management and hospitalization, regarding mortality in any of the subcategories analyzed: perinatal and neonatal deaths (relative risk [RR] 0.65; 95% confidential interval [CI]: 0.11 to 3.84; P = 0.63); neonatal deaths (RR 0.29; 95% CI: 0.01 to 6.07; P = 0.43); and infant deaths (RR 0.29; 95% CI: 0.01 to 6.07; P = 0.43). CONCLUSIONS This review, based on studies with high or moderate risk of bias, showed that there was no statistically significant difference between ambulatory management and hospital care, regarding reduction of mortality rates in pregnancies complicated by diabetes or hyperglycemia. It also suggested that there is a need for further randomized controlled trials on this issue.
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Affiliation(s)
- Marilza Vieira Cunha Rudge
- MD, PhD. Full Professor, Department of Gynecology and Obstetrics, Faculdade de Medicina de Botucatu (FMB), Universidade Estadual Paulista (Unesp), Botucatu, São Paulo, Brazil.
| | - Silvana Andréa Molina Lima
- PhD. Professor, Department of Nursing, Faculdade de Medicina de Botucatu (FMB), Universidade Estadual Paulista (Unesp), Botucatu, São Paulo, Brazil.
| | - Regina Paolucci El Dib
- PhD. Professor, Department of Anaesthesiology, Faculdade de Medicina de Botucatu (FMB), Universidade Estadual Paulista (Unesp), Botucatu, São Paulo, Brazil.
| | - Gabriela Marini
- Research Collaborator of the McMaster Institute of Urology, at St. Joseph's Healthcare, Hamilton, Canada.
| | - Claudia Magalhães
- Postgraduate Student, Department of Gynecology and Obstetrics, Faculdade de Medicina de Botucatu (FMB), Universidade Estadual Paulista (Unesp), Botucatu, São Paulo, Brazil.
| | - Iracema de Mattos Paranhos Calderon
- MD, PhD. Full Professor, Department of Gynecology and Obstetrics, Faculdade de Medicina de Botucatu (FMB), Universidade Estadual Paulista (Unesp), Botucatu, São Paulo, Brazil.
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Oshikoya KA, Chukwura H, Njokanma OF, Senbanjo IO, Ojo I. Incidence and cost estimate of treating pediatric adverse drug reactions in Lagos, Nigeria. SAO PAULO MED J 2011; 129:153-64. [PMID: 21755250 PMCID: PMC10866312 DOI: 10.1590/s1516-31802011000300006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Revised: 10/13/2009] [Accepted: 02/09/2011] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND OBJECTIVES Adverse drug reactions (ADRs) may cause prolonged hospital admissions with high treatment costs. The burden of ADRs in children has never been evaluated in Nigeria. The incidence of pediatric ADRs and the estimated cost of treatment over an 18-month period were determined in this study. DESIGN AND SETTING Prospective observational study on children admitted to the pediatric wards of the Lagos State University Teaching Hospital (LASUTH) in Nigeria, between July 2006 and December 2007. METHODS Each patient was assessed for ADRs throughout admission. Medical and non-medical costs to the hospital and patient were estimated for each ADR by reviewing the medical and pharmacy bills, medical charts and diagnostic request forms and by interviewing the parents. Cost estimates were performed in 2007 naira (Nigeria currency) from the perspectives of the hospital (government), service users (patients) and society (bearers of the total costs attributable to treating ADRs). The total estimated cost was expressed in 2007 United States dollars (USD). RESULTS Two thousand and four children were admitted during the study; 12 (0.6%) were admitted because of ADRs and 23 (1.2%) developed ADR(s) during admission. Forty ADRs were suspected in these 35 patients and involved 53 medicines. Antibiotics (50%) were the most suspected medicines. Approximately 1.83 million naira (USD 15,466.60) was expended to manage all the patients admitted due to ADRs. CONCLUSIONS Treating pediatric ADRs was very expensive. Pediatric drug use policies in Nigeria need to be reviewed so as to discourage self-medication, polypharmacy prescription and sales of prescription medicines without prescription.
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Galvão TF, Silva MT, Silva CD, Barotto AM, Gavioli IL, Bucaretchi F, Atallah AN. Impact of a poison control center on the length of hospital stay of poisoned patients: retrospective cohort. SAO PAULO MED J 2011; 129:23-9. [PMID: 21437505 PMCID: PMC10865900 DOI: 10.1590/s1516-31802011000100005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Revised: 05/14/2010] [Accepted: 09/30/2010] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Poison control centers play an essential role in caring for poisoned patients, albeit without secure funding for their activities. The aim here was to investigate differences in length of hospital stay among poisoned patients, between those who received remote assistance from a poison control center and those who did not. DESIGN AND SETTING A retrospective cohort including all poisoned patients hospitalized at an emergency service in Manaus between 2005 and 2007 was set up, and the local poison control center database was checked to see whether they received such assistance. METHODS Patients presenting a known toxic agent, with less than 12 hours since exposure and without severe comorbidities, were selected. Their severity of poisoning was evaluated by two independent reviewers and divergences were resolved by another reviewer. RESULTS One hundred and ninety-eight patients were included. Those who received remote assistance from a poison control center stayed in hospital on average for 3.43 days less than those without poison control center assistance (95% confidence interval, CI: -6.10 to -0.77). Severity was assessed in the cases of 90 patients: there was no statistical difference in severity between the patients with and without poison control center assistance (P > 0.5). CONCLUSION Patients with remote assistance from a poison control center had a shorter length of stay then patients without this aid. The poison control center may have reduced the length of stay of the poisoned patients.
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Affiliation(s)
- Taís Freire Galvão
- Amazonas Poison Control Center, Getúlio Vargas University Hospital, Universidade Federal do Amazonas, Manaus, Amazonas, Brazil.
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