Nota: estas Diretrizes se prestam a informar e não a substituir o julgamento clínico do médico que, em última análise, deve determinar o tratamento apropriado para seus pacientes.
Nota: Estas diretrizes se prestam a informar e não a substituir o julgamento clínico do médico que, em última análise, deve determinar o tratamento apropriado para seus pacientes.
Background: Previous studies have shown that COVID-19 In-Hospital Fatality Rate (IHFR) varies between regions and has been diminishing over time. It is believed that the continuous improvement in the treatment of patients, age group of hospitalized, and the availability of hospital resources might be affecting the temporal and regional variation of IHFR. In this study, we explored how the IHFR varied along time and among age groups and federative states in Brazil. In addition, we also assessed the relationship between hospital structure availability and peaks of IHFR.
Methods: A retrospective analysis of all COVID-19 hospitalizations with confirmed outcomes in 21 states between March 01 and September 22, 2020 (N=345,281) was done. We fit GLM binomial models with additive and interaction effects between age groups, epidemiological weeks, and states. We also evaluated the association between the modeled peak of IHFR in each state and the variables of hospital structure using the Spearman rank correlation test.
Results: We found that the temporal variation of the IHFR was heterogeneous among the states, and in general it followed the temporal trends in hospitalizations. In addition, the peak of IHFR was higher in states with a smaller number of doctors and intensivists, and in states in which a higher percentage of people relied on the Public Health System (SUS) for medical care.
Conclusions: Our results suggest that the pressure over the healthcare system is affecting the temporal trends of IHFR in Brazil.
ObjectiveTo compare the efficacy of aspirin and warfarin for prophylaxis of thrombosis in
patients undergoing total cavopulmonary anastomosis. Evaluate whether coagulation
factors (VII, VIII and protein C), clinical data, fenestration or hemodynamic
factors, interfere with postoperative thrombosis.MethodsA prospective, randomized study of 30 patients, randomized into Group I (Warfarin)
and Group II (AAS), underwent total cavopulmonary shunt with extracardiac conduit,
between 2008 and 2011, with follow-up by clinical visits to evaluate side effects
and adhesion. Performed transesophageal echocardiography in post operatory time,
3, 6,12 and 24 months; angiotomography at 6, 12 and 24 months to evaluate changes
in the internal tube wall or thrombi and pulmonary scintigraphy to evaluate
possible PTE.ResultsTwo deaths in group I; 33.3% of patients had thrombus (46.7% in Group II). The
previous occurrence of thrombus and low levels of coagulation protein C were the
only factors that influenced the time free of thrombus (P=0.035 and 0.047).
Angiotomographic evaluation: 35.7% in group II presented material accumulation
greater than 2 mm (P=0.082). Scintigraphy: two patients had PTE in group II. Five
patients had difficulty to comply with the treatment, 4 in group I with INR
ranging from 1 to 6.4.ConclusionThe previous occurrence of thrombus is a risk factor for thrombosis in the
postoperative period. Patients using AAS tend to deposit material in the tube
wall. The small sample size did not allow to conclude which is the most effective
drug in the prevention of thrombosis in this population.
A amiloidose é uma doença infiltrativa sistêmica
caracterizada pela deposição extracelular de fibrilas amiloides.
O envolvimento cardíaco é comum e está associado a
prognóstico desfavorável. Os tipos mais predominantes
de amiloidose cardíaca (AC) são por cadeias leves de
imunoglobulinas (AL) e por transtirretina (ATTR). O diagnóstico
de AC e a diferenciação entre os tipos são importantes para o
prognóstico, terapia e aconselhamento genético. A AC-ATTR
é uma causa subdiagnosticada de insuficiência cardíaca. No
entanto, grandes conquistas nos métodos de imagem não
invasivos, bem como a possibilidade de tratamento clínico
eficaz, transformaram a AC-ATTR de uma doença rara e
intratável em uma condição que os médicos clínicos devem
considerar diariamente. O advento da cintilografia com
traçadores ósseos permitiu o diagnóstico da AC-ATTR com
alta precisão, uma vez que as gamopatias monoclonais foram
excluídas. A interpretação de cintilografia com traçadores
ósseos requer expertise, e propusemos um guia passo a passo
para a realização desse exame na prática clínica de acordo
com as diretrizes mais recentes. Além disso, revisamos alguns
pontos cruciais que acreditamos serem de suma importância
na prática clínica e nos desfechos dos pacientes.
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