Trabalhos Acadêmicos
URI permanente desta comunidadehttps://repositorio.cmmg.edu.br/handle/123456789/5
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Item Custos da cirurgia robótica: revelando os verdadeiros vilões(Faculdade Ciências Médicas de Minas Gerais, 2021-04-06) Martins, Yves Melo Rodrigues; Wainstein, Alberto Julius Alves; Santos, Fernando Augusto de VasconcellosINTRODUCTION: High costs of robot-assisted radical prostatectomy (RARP) represent a major drawback of this technology. Considering the financial impact arising from new health care technologies, it is essential to improve the knowledge of factors that influence costs. OBJECTIVE: This study aimed to evaluate the main drivers of RARP hospitalization costs, in addition to assess the relation between clinical, pathological, intraoperative and postoperative variables and the hospitalization costs. MATERIALS AND METHODS: Cross-sectional study of a single private healthcare institution, in which 474 hospitalizations related to RARP between February 2018 and December 2019 were analyzed. Clinical, pathological, intraoperative and postoperative characteristics were considered in the study, including surgical experience. The association between variables and total direct costs was analyzed by simple and multiple linear regression. RESULTS: The main driver of RARP hospitalization costs was the robotic surgical supplies (60.5%), followed by the operation room (OR) time (15.2%). Procedures performed by surgeons with 15 or more cases of surgical experience were associated with a 6.9% decrease in costs in simple linear regression analysis. In multiple linear regression analysis, the following variables were associated with increased costs: American Society of Anesthesiologists (ASA) score 3 (p< 0.001), a one-hour increase in OR time (p < 0.001), increased utilization of polymeric clips packs (p < 0.001), longer length of hospital stay (p< 0.001) and. There was a 11.5% reduction in costs with the use of four robotic instruments instead of five (p < 0.001). CONCLUSIONS: Among clinical and pathological characteristics, only the severity of comorbidities was associated with hospitalization costs. Surgical experience may have an important role in reducing costs. The costs of hospitalization were mainly influenced by the OR time, use of surgical supplies and length of hospital stay. Reducing the number of robotic instruments used in RARP represented the potentially modifiable factor with the greatest impact on cost reduction.Item Preditores de mortalidade hospitalar nos pacientes submetidos a angioplastia primária(Faculdade Ciências Médicas de Minas Gerais, 2021-04-23) Castro, Pedro Paulo Neves de; Moura, Isabel Cristina Gomes; Pena, José Luiz BarrosIntroduction: Cardiovascular diseases (CVD) are the main cause of morbidity and mortality in Brazil. Ischemic heart disease is the cause of the highest number of deaths among CVDs. The primary angioplasty (PCI) consists of a mechanical treatment to reopen a blocked coronary artery related to acute myocardial infarction with ST-segment elevation. It´s the preferred treatment strategy since it can be performed promptly. Stratifying the risk of death of patients in this context is essential for decision-making and clinical research. Objectives: identify factors related to the outcome of death in patients undergoing PCI. Material and methods: Case-control study, using a national registry as a data source. This registry as a result of the voluntary collaboration of the members of the Brazilian society of hemodynamics and interventional cardiology called the National Cardiovascular Interventions Center (CENIC). The patients were divided into two groups, in the first (cases) the data on patients who died and in the second group (control), patients who underwent the procedure and who survived were allocated. The variables were selected based on previous studies. The association between each variable and the death outcome was assessed using a simple logistic regression model, variables with p <0.20 were included in multiple models using the stepwise strategy. The fit quality was assessed using the Hosmer-Lemeshow test. The results were presented as odds ratios (OR) with the respective 95% confidence intervals (95% CI). It was considered significant p <0.05. Results: 26,990 records were analyzed, of which 18,834 (69.8%) were male, with a mean age of 61.5 ± 12 years. The total number of deaths was 904 and the overall mortality rate was 3.3%. In the multivariate analysis, the main variables related to the death outcome were age> 60 years (60 to 69 years with OR 2,004 [1,336; 3,076], 70 to 79 years OR 2,462 [1,635; 3,789], and ≥ 80 years OR 3,688 [2,384; 5,812], Killip II, III and IV (II with OR 2,718 [1,919; 3,827], III OR 8,139 [5,672; 11,637] and IV OR 19,833 [14,851; 26,688]), severe ventricular dysfunction (OR 3,625 [2,393; 5,675]) and infarction after the intervention (OR 5.006 [2,568; 9,460]) were associated with a lower risk of death, male gender (OR 0.789 [0.635; 0.981]), dyslipidemia (OR 0.689 [0.558; 0.850]), TIMI 2 and 3 (2 with OR 0.593 [0.409; 0.857] and 3 OR) 0.176 [0.133; 0.235]) and the number of lesions treated (OR 0.859 [0.785; xi 0.938]). Conclusion: The predictors of mortality in patients undergoing PCI were: Killip classification, reinfarction, advanced age, severe global left ventricular dysfunction, female, and post-intervention TIMI 0 / I flow. The identification of these data can be useful in stratification and care for patients with coronary diseaseItem Papel da Ecocardiografia no Diagnóstico Diferencial entre Síndrome do PRKAG2 e Doença de Fabry(Faculdade Ciências Médicas de Minas Gerais, 2021-10-15) Diniz, Marcos Victor Prosdocimi; Pena, José Luiz BarrosBackground: Storage of glycogen and glycosphingolipids occurs in the heart of patients with PRKAG2 Syndrome and Fabry Disease (FD), respectively. Identification of specific echocardiographic parameters could contribute to early diagnosis, which is fundamental to initiate appropriate treatment and improve prognosis. Material and methods: Cross- sectional study involving 45 patients (pts), 30 genetically identified with the PRKAG2 gene mutation and 15 with FD. Conventional transthoracic, bi-, and tridimensional echocardiography as well as strain/strain rate speckle tracking were measured during one examination. Specific echocardiographic measurements were obtained and the data exported to a workstation for subsequent evaluation. Analyses were performed with 5% significance using the R program, version 3.1.3. Results: Compared to FD patients, PRKAG2 pts presented increased left atrium volume index (p=0.031), mean LV septum (p=0.001), posterior wall thickness, right ventricle (RV) dimensional values, and RV thickness in diastole (p = 0.001). LV hypertrophy was found in varying degrees in 25 (86%) of PRKAG2 and 8 (53%) of FD pts. We detected a binary appearance of LV endocardial border (“binary sign”) and hypertrophy of the anterolateral papillary muscle in 60% of FD pts. PRKAG2 pts showed reduced global longitudinal strain (2DGLS), 3D GLS (p<0.001) 3D global radial strain (GRS), and aortic diameter compared to FD pts. In PRKAG2 pts the bull’s-eye plot showed a stripe like pattern. In FD pts, however, it showed a peak systolic strain reduction in basal and xi mid- anterolateral segments. Conclusion: Echocardiography is an important technique in differentiating both diseases to determine adequate treatment and prognosis. We have demonstrated that PRKAG2 pts present moderately greater cardiac involvement than FD ptsItem Simulação de alta e baixa fidelidade para o ensino de suporte avançado de vida cardiovascular: satisfação e autoconfiança(Faculdade Ciências Médicas de Minas Gerais, 2021-03-29) Chaves, Marcos Lázaro Avelar; Scalabrini Neto, Augusto; Almeida, Alessandra MacielIntroduction: The importance of simulation in increasing students’ satisfaction and self-confidence has been demonstrated, emphasizing the value of the assessment in learning as factor to encourage motivation. Methods: This is an experimental study conducted at the Faculty of Medical Sciences of Minas Gerais (FCM-MG), Brazil, from July 2018 to July 2019. The 51 participants were randomly assigned to 9 groups of 5-6 medical students: (High -Fidelity – HF) (5 teams) and (Low- Fidelity – LF) (4 teams) using a randomized sequence with permuted blocks. The groups underwent initial training, practical evaluation, and assessment of satisfaction/self-confidence. The practical evaluation was carried out with a checklist elaborated and validated by the researchers for assessment of performing the necessary skills in the scenario, and only the team-related items were considered for this study. After debriefing or feedback, students were asked to respond to the Student Satisfaction and Self Confidence in Learning Scale (SSSCL) validated in Portuguese. Results: The satisfaction and self-confidence levels were similar between the HF and LF groups. Considering the team-related items in HF, a positive correlation was observed between team´s communication and student satisfaction/self-confidence. Also, for HF, a positive correlation was found among the dimensions of the Satisfaction and Self-Confidence in SSSCL. Conclusion: No differences were observed in satisfaction and self-confidence levels comparing HF with LF scenarios. However, in the HF scenario, the greater the self-confidence, the greater the satisfaction is, and the greater the team’s communication, the greater the student satisfaction/self confidence is.Item Perfil de pacientes com sarcoma de partes moles tratados no Sistema Único de Saúde (SUS) do Brasil no período de 2000 a 2015(Faculdade Ciências Médicas de Minas Gerais, 2021-09-22) Figueiredo, Luiza Ohasi de; Rodrigues, Angélica NogueiraIntroduction: Little is known about soft tissue sarcomas (STS) in Brazil, once the federal statistics regarding estimates on incidence and mortality of the most common cancers that affect the Brazilian population currently do not include STS. This study aims to perform a broad evaluation and description of the epidemiological profile, access to treatment and main clinical outcomes of the Brazilian STS patient. Methods: A population-based cohort study of 66,825 patients who underwent procedures related to STS treatment registered in the Brazilian public health system (Sistema Único de Saúde, SUS) databases. Results: Median age was 57 years, 30% of them older than 65 years, and 50.7% of the cohort was female. The majority, 50,383 patients (75.4%), was diagnosed between 2008 and 2015. Most prevalent anatomic sites were head and neck (13.6%) and upper and lower limbs (12.6%). The registry of sarcomas without a specific location comprehended 29.7% of the cohort. The majority of patients resided in the Northeast (40.2% of the patients). Surgery was the first treatment modality in 77.7% of the cases. The 1,5 and 10 y survival were: 82%, 57% and 42%, in line with international data. Male gender, age above 65 years old and with STS of the peritoneum and retroperitoneum, thorax and torso, were identified as negative prognostic predictors. Conclusion: This 66,825 patient cohort demonstrates Brazilian’s reality about the epidemiology and treatment of the STS, and may contribute to a reorganization of the health system, as well as provide a positive impact on the patients’ clinical outcomesItem Capacidade Funcional e Rigidez Arterial em Indivíduos Pós Acidente Vascular Encefálico Crônico(Faculdade Ciências Médicas de Minas Gerais, 2021-07-14) Procópio, Cléucia Coelho Lage; Machado, Maria da Glória Rodrigues; Polese, Janaine CunhaIntroduction: Stroke is a cardiovascular health condition with neurological impairment, characterized by motor impairment, resulting from vascular changes. Individuals after chronic stroke often present motor disabilities resulting from brain injury, which can lead to changes in the functional capacity of these individuals. Concomitantly, vascular changes lead to increase in arterial stiffness in individuals after chronic stroke when compared to healthy individuals. Structural and functional changes in arteries related to arterial stiffness, establish pathophysiological mechanisms that hinder the propagation of pulse waves, in which they contribute to brain damage. Objective: To investigate the association between the functional capacity and arterial stiffness between individuals after chronic stroke, in addition to comparing arterial stiffness stratified in worse and better functional capacity. Methods: This is a cross- sectional study, composed of individuals diagnosed with chronic stroke, both sexes, over 18 years age. Functional capacity was assessed using the Duke Activity Status Index (DASI) questionnaire. The individuals were stratified into worse functional capacity (˂31,95 points) and better functional capacity (≥ 31,95 points). Arterial stiffness was assessed by means of arterial stiffness indices, using the Augmentation Index corrected by the heart rate 75 beats per minute (Alx@75). Arterial stiffness was assessed in the paretic arm, non-invasively, using the Mobil-O-Graph® equipment. Pearson’s correlation was used to verify the association between functional capacity and arterial stiffness and the T test (CI95%) was used to compared Alx@75 between individuals with worse and better functional capacity. All variables were analyzed using the SPSS version 17.0 statistical package, with a significance level of 5%. Results: The sample consisted of twenty-eight individuals with chronic stroke, mean age of 57.7 ±17.0 years, 61% of the sample consisting of men. Individuals had a mean of 51.1 ±54.1 months since stroke and 84% of the sample had ischemic stroke. The average of the DASI score was 29±19 METS and the mean Alx@75 was 23.8 ±11.4%. There was a significant, negative and reasonably magnitude correlation (r: -0.53; p: 0.01) between functional capacity and arterial stiffness. Eighteen individuals were categorized with worse functional capacity. There was a statistically significant difference between groups (mean difference 10.04 [CI95% 2.44 to 17.64]). Conclusion: The present study demonstrated association between functional capacity and arterial stiffness in individuals with chronic stroke. Individuals with better functional capacity have lower arterial stiffness indices.Item Percepção dos indivíduos com Doença de Parkinson sobre a funcionalidade após Cirurgia de Estimulação Cerebral Profunda(Faculdade Ciências Médicas de Minas Gerais, 2021-12-14) Bispo, Flávia Meire Marques; Lana, Raquel de Carvalho; Polese, Janaine CunhaIntroduction: Parkinson's disease (PD) is a progressive neurodegenerative disease that can compromise the functioning of individuals. The Deep Brain Stimulation Surgery (DBS) has as main objective to improve the motor function of individuals who present important alterations in PD. Although tests are performed before and after DBS in order to compare the results of surgery, the literature is scarce regarding the perception of individuals about their functioning after DBS. Objective: To evaluate the perception of individuals with PD about the effects of DBS on their functioning. Material and Methods: Cross-sectional observational study, which included individuals with PD submitted to DBS. A questionnaire was designed using the Delphi technique to assess the perception of individuals with PD about their functioning after DBS surgery. After two rounds of adjustments to the questionnaire, fifteen experts agreed on at least 80% of the items. The questionnaire was composed of 13 questions related to the perception of the individuals' functioning. The answers ranged from 0 (zero) to 10 (ten), with higher values corresponding to a better perception of functioning. Descriptive statistics was used, using mean and standard deviation, as well as percentages for all variables. The software SPSS for Windows version 17.0 was used. Results: 51 individuals, mean age 60±9 years, mean time of disease 13±4 years and mean time of surgery 2.7±1.4 years were included in this study. 80% underwent surgery in a private hospital and 82% received a bilateral implant. Overall, the perceived functioning of individuals with PD showed a 70% improvement. The item that showed the most improvement was the activity of unassisted bathing (9.3 SD1.9). The item that showed the least improvement was writing (6.6 SD3.3). Conclusion: Individuals with PD who had undergone DBS surgery noticed an improvement in functioning, especially in the activity of bathing without help and a smaller improvement in writing.