OBJETIVOS: Avaliar a associação entre comorbidades e risco de morte e reinternação em idosos após alta de enfermarias de clínica médica de um hospital universitário. MÉTODOS: Estudo de coorte de idosos que receberam alta do Hospital Universitário Lauro Wanderley. Foram utilizados o Índice de Comorbidade de Charlson (ICC) e o ICC associado à idade (ICIC). O desfecho primário foi mortalidade pós-hospitalização e o secundário, ocorrência de reinternações. RESULTADOS: Foram acompanhados 104 pacientes por 40,9±27,6 semanas; 31 (29,8%) morreram e 38 (36,5%) foram reinternados. A curva de sobrevida foi descendente com proporção acumulada de 50%. Óbito relacionou-se com idade (p=0,04), número de prescrições hospitalares (p=0,01), ICC (p=0,001) e ICIC (p=0,001). Não houve associação de ICC com reinternação. CONCLUSÕES: A gravidade das comorbidades em idosos relacionou-se com maior risco de morte pós-hospitalização. Salienta-se a necessidade de se disporem de dados de comorbidade para avaliar cuidados a essa clientela.
IntroducciónLa pedagogía médica en Brasil se basa en un proceso enseñanza-aprendizaje compuesto por tres elementos: profesor, estudiante y paciente, con naturaleza, funciones y expectativas diferentes [1]. En el centro de esta triple relación hay un ser humano que sufre y, por lo tanto, merece una doble preocupación: la que se debe a la dignidad de un ser humano y la debida a la condición de sufrimiento humano [2].En este contexto, es importante reflexionar sobre las implicaciones pedagógicas y éticas involucradas en esta relación pedagógica [3]. ¿Cuál es la autonomía de estos pacientes durante la hospitalización en una institución de enseñanza? ¿Les gustaría rechazar ciertos procedimientos que forman parte de la instrucción práctica de los estudiantes de medicina?La ética de la educación médica ha generado hasta ahora escasa atención y reflexión [3] Patients and methods. An observational and qualitative study with interviews of patients by students from the School of Medicine at the UFPB.Results. The age of the 54 patients ranged from 20 to 77, 57,1% men and 5.0 ± 3.6 years of schooling, 85,7% said they were not uncomfortable in participating in classes, 51,8% indicated they would accept to participate even if you submit a brief discomfort, 50% have replied that they did not request consent by students.Conclusions. The perception of the patients was positive, but they seemed ambivalent in some ways. Guidelines for direct patient participation in teaching practice are necessary to preserve its training function, without harming the patient.Key words. Bioethics. Education. Inpatients. Medical. Undergraduate.Objetivo. Evaluar la percepción del paciente como participante de lecciones prácticas de medicina del hospital de la Universidad Federal de Paraíba (UFPB), Brasil.Pacientes y métodos. Estudio observacional de abordaje cuantitativo con realización de entrevistas de pacientes por estudiantes de la Escuela de Medicina de la UFPB.Resultados. La edad de los 54 pacientes osciló entre 20 y 77 años, 57,1% hombres, con 5,0 ± 3,6 años de escolaridad. El 87,9% dijeron que no se sentían incómodos en participar en las clases. El 43,9% indicaron que aceptarían participar incluso si presentaran un breve malestar. El 50% contestó que no se les había solicitado su consentimiento por parte de los estudiantes.Conclusiones. La percepción de los pacientes fue positiva, pero parecieron ambivalentes en algunos aspectos. Se precisan directrices para orientar la participación del paciente en la enseñanza práctica con el fin de preservar su función didáctica sin dañar al paciente.Palabras clave. Bioética. Educación de pregrado en medicina. Pacientes internos.
Intraoperative ultrasound navigation was initially introduced in the neurosurgical field for brain tumor surgery and was then extended to arteriovenous malformation surgery with good success. This tool provides real-time intraoperative images.1 Moreover, Doppler ultrasound permits early identification of feeding arteries and supplies the surgeon with a global impression of the flow dynamics.2 A further use of doppler is to check for residual nidus. Other advantages are the capacity to identify intracerebral hemorrhage.2
In this video, we demonstrate the case of a 15-yr-old patient who presented intracranial hemorrhage. Magnetic resonance imaging revealed the presence of left frontoparietal hematoma associated with an image suggestive of cerebral arteriovenous malformation (AVM). Arteriography confirmed the diagnosis of AVM fed by branches of the anterior cerebral and superficial drainage for the superior sagittal sinus.
The patient was placed in dorsal decubitus with his head turned to the right and a left parietal-frontal craniotomy was performed. After the dura mater was opened, cortical mapping was performed to locate the motor and sensory cortex. After the mapping, ultrasound with doppler was performed to locate the AVM and the hematoma and determine its relation to the motor and sensory cortex. At the end of the surgery, doppler ultrasound was used again to ensure complete resection of the AVM.
Intraoperative Ultrasound navigation with doppler is an inexpensive technology that can be used in the treatment of AVMs, especially in the subcortex, as it assists in locating the nidus and confirms its complete resection.
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