Introduction: The coronavirus disease 2019 (COVID-19) has negatively impacted healthcare services worldwide. We hypothesized that the pandemic would affect our case mix and mortality. Our objective ...was to study this impact. Methods: We retrospectively studied all patients who underwent congenital heart surgeries from March 21st to August 21st in 2019 and 2020 using the institutional electronic database. We compared demographic data, preoperative and postoperative length of stay (LOS), risk stratification using Risk Adjustment for Congenital Heart Surgery (RACHS) classification and outcomes in both periods. Results: We observed a 66.7% decrease in our surgical volume (285 × 95 patients). Patients operated in the pre-pandemic period were older (911.3 174.8 - 5953.8 days-old) compared to the pandemic period (275 days-old; P<0.05). When the case mix was compared between periods, the percentage of neonatal surgery was increased in the pandemic era (8% × 21.1%; P<0.05), and the number of RACHS 1-2 surgeries decreased significantly (60.7 × 27.4%; P<0.05). Preoperative LOS was increased in the pandemic period (1.2 × 7 days; P=0.001). There was no significant increment in mortality (P=0.1). Two patients tested positive for COVID-19 in the postoperative period and both died. Conclusion: Our program observed a sudden decrease in surgical volume and a consequent increase in surgical complexity. There was a non-significant increment in mortality.
Abstract Purpose: To investigate the role of omeprazole and nitrites on the gastric mucosa of rats submitted to specific techniques to induce duodenogastric reflux. Methods: One hundred and twenty ...Wistar rats were divided into three groups: Group I (n=40) -gastrotomy; Group II (n=40) - duodenogastric reflux after gastrojejunoanastomosis latero-lateral (DGR); Group III (n=40) - retrograde duodenogastric reflux through the pylorus (DGR-P). The groups were divided into 4 subgroups of 10 animals, respectively treated for 16 weeks with water, omeprazole 1.6 mg / rat / day, nitrite 600 mg / kg / day and omeprazole plus nitrite simultaneously. Results: The proliferative lesions found were: squamous hyperplasia - 69.1%, adenomatous hyperplasia in the anastomosis - 29.1% and prepyloric adenomatous hyperplasia - 42.5%. Adenocarcinomas were registered in 7 animals (5.8%): one in Group I (omeprazole plus nitrite), two in Group II (omeprazole and nitrite plus omeprazole) and four in Group III (water, nitrite, omeprazole and omeprazole plus nitrite). Conclusions: The occurrence of squamous hyperplasia, adenomatous hyperplasia and adenocarcinoma increased after gastrojejunal anastomoses, which cause duodenogastric reflux. The association of omeprazole did not protect the development of proliferative lesions and cancer induced by duodenogastric reflux in rats.
This study aimed to evaluate the microbiological contamination of the different sectors of a university veterinary hospital, the efficiency of the sanitation procedures performed, and the resistance ...to antimicrobials and disinfectants. Fourteen environmental samples and seven swab samples were collected from procedure tables of the different sectors. During analysis, the following microorganisms were found: bacterial species Rothia spp., coagulase-negative Staphylococcus spp., Staphylococcus aureus, and Enterococcus spp. and zygomycete fungi (could not be classified in genus due to the absence of reproductive structures) and other fungal species Cladosporium spp., Epicoccum spp., Drechslera spp., Scopulariopsis spp., and Penicillium spp. The bacterial species were submitted to a sensitivity assessment of the antimicrobials used in routine prescription. Rothia spp. and S. aureus were resistant only to erythromycin (15 µg), coagulase-negative Staphylococcus spp. were resistant to erythromycin (15 µg) and sulfazotrim (25 µg), and Enterococcus spp. were resistant to ampicillin (10 µg). For the effectiveness test of disinfectants, the products used to sanitize hospital surfaces were tested. All microorganisms in this study were resistant to 1% sodium hypochlorite solution. Rothia spp. and Enterococcus spp. were resistant to 70% ethyl alcohol. The best results were found using pure sodium hypochlorite and benzalkonium chloride, pure and diluted to 20%, which showed a bactericidal effect against all tested microorganisms. These data are relevant for knowledge of the hospital microbiota at the intersection of possible cases of hospital infections.
RESUMO: O objetivo desta pesquisa foi avaliar a contaminação microbiológica de diferentes setores de um hospital veterinário universitário, a eficiência dos procedimentos de higienização realizados e a resistência aos antimicrobianos das cepas encontradas. Quatorze amostras ambientais e sete amostras de swabs foram coletadas dos diferentes setores. Durante a análise foram encontradas as seguintes espécies bacterianas: Rothia spp., Staphylococcus spp. coagulase negativa, Staphylococcus aureus e Enterococcus spp.; e os seguintes fungos: zigomicetos, que não puderam ser classificados em gênero devido a ausência de estrutura reprodutiva, os demais foram Cladosporium spp., Epicoccum spp., Drechslera spp., Scopulariopsis spp. e Penicillium spp. As bactérias foram submetidas a uma avaliação de sensibilidade dos antimicrobianos utilizados prescritos na rotina. A avaliação concluiu que Rothia spp. e S. aureus foram resistentes apenas à Eritromicina (15 µg), Staphylococcus coagulase negativa resistente à Eritromicina (15 µg) e Sulfazotrim (25 µg) e Enterococcus spp. mostrou resistência à Ampicilina (10 µg). Para o teste de eficácia dos desinfetantes, foram utilizados os produtos utilizados na higienização das superfícies do hospital. O teste mostrou que todos os microrganismos encontrados no estudo eram resistentes à solução de hipoclorito de sódio diluída a 1%; Rothia spp. e Enterococcus spp. resistentes ao álcool etílico 70%. Os melhores resultados dos testes foram encontrados com hipoclorito de sódio puro e cloreto de benzalcônio puro e diluído a 20%, que apresentou efeito bactericida contra todos os microrganismos testados. Os dados encontrados foram relevantes para o conhecimento da microbiota hospitalar no cruzamento de possíveis casos de infecções hospitalares.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objectives
The goal of this study was to describe and evaluate our simulation training program on biological models for the cardiovascular surgery residency program at our institution.
Material and ...Methods
Since 2016, with the purpose to develop better practical performance and evaluate the improvement of resident's surgical skills, a simulation training program was implemented, composed of some elemental procedures in cardiovascular surgery. It was established with one wet lab session weekly lasting 2 h, coached by two expert cardiovascular surgeons. Bovine and porcine hearts were used as biological models. At the end of the hands‐on program, an objective assessment consisting of two practical modules was applied and performance was rated by way of a 5‐point scale. In addition, to provide a subjective assessment, each resident filled out a questionnaire consisting of three items reviewing the overall quality of the workshops on a 10‐point scale.
Results
The objective evaluation applied at the end of the training program consisted of valve replacement and coronary artery bypass grafting (CABG) modules. The mean performance rating scores for the valve replacement module ranged from 4.2 to 4.79, and CABG, from 4.33 to 4.87. Regarding subjective assessment, all items evaluated, such as expert's didactics, simulation performance, and biological simulator fidelity, received high grades (above 9 on a 10‐point scale).
Conclusions
Simulator training on biological models for cardiac surgery medical residents is a simple and effective learning method of surgical skills.
O objetivo deste trabalho é analisar o valor de consumo de luxo, visando identificar quais valores influenciam e norteiam o consumo de calçados de luxo. Os dados para o estudo foram coletados de 675 ...consumidores e analisados utilizando a técnica de modelagem de equações estruturais. Os resultados indicaram que os fatores hedônicos, emocionais e pessoais influenciam positivamente o valor percebido pelo cliente de calçado de luxo. Além disso, os Valores Interação e Financeiro também mostraram-se significativos, visto que resultados apontam que o consumidores levam em consideração aspectos como preço e a possibilidade de acolhimento e reconhecimento em determinados grupos ao adquirirem calçados de luxo. Em suma, este estudo providencia insights para potencializar/aprimorar as estratégias das marcas de luxo do setor de calçados, favorecendo assim, a criação de novas oportunidades e demandas para o mercado de luxo com vistas à vantagem competitiva.
O avanço tecnológico possibilitou a apropriação de novas tecnologias que permitem romper limitações e viabilizar a inovação no contexto educacional, nas atividades de pesquisa e extensão e, também, ...na inclusão de pessoas com deficiência. A utilização de impressoras 3D no ambiente escolar teve como intuito investigar seu uso como recurso didático e de extensão entre alunos e professores de uma IES do estado de São Paulo. Diante desse cenário, desenvolveu-se projeto para demonstrar a aplicação da impressão 3D na criação e construção de suportes de copos para pacientes acamados em um hospital regional especializado no tratamento de pessoas com câncer. A metodologia adotada foi de natureza aplicada, com abordagem qualitativa, exploratória e descritiva ao propor a utilização da manufatura aditiva em processos de ensino e extensão. Durante o desenvolvimento do protótipo realizaram-se visitas ao hospital para coleta de dados. Logo após selecionou-se um modelo para o teste, sendo que o material escolhido foi o ácido polilático (PLA) antibacteriano, para a confecção dos suportes. Posteriormente produziram-se 10 peças, as quais foram testadas no referido hospital, durante um período de seis meses, com pacientes acamados. Os resultados foram satisfatórios, pois as peças produzidas apresentaram boa resistência e capacidade de absorver impactos. Os relatos dos pacientes destacaram a facilidade em segurar o copo e levá-lo à boca, uma vez que essa atividade requer movimentos bilaterais, o que pode ser desafiador para eles. Além disso, os suportes de copos proporcionaram maior independência e autonomia aos pacientes.
Dengue has affected Rio de Janeiro City since the 1980s. The sequential Zika and chikungunya virus introductions during 2015 aggravated the health scenario, with 97,241 cases of arboviral diseases ...reported in 2015-2016, some with neurological disorders.
Arbovirus-related neurologic cases were descriptively analyzed, including neurological syndromes and laboratory results.
In total, 112 cases with non-congenital neurologic manifestations (Guillain-Barré syndrome, 64.3%; meningoencephalitis, 24.1%; acute demyelinating encephalomyelitis, 8%) were arbovirus-related; 43.7% were laboratory-confirmed, of which 57.1% were chikungunya-positive.
Emerging arbovirus infections brought opportunities to study atypical, severe manifestations. Surveillance responses optimized case identification and better clinical approaches.
Introduction: To support the development of practices and guidelines that might help to reduce adverse events related to human factors, we aimed to study the response and perception by members of a ...cardiovascular surgery team of various error-driven or adverse features that might arise in the operating room (OR). Methods: A previously validated Disruptions in Surgery Index (DiSI) questionnaire was completed by individuals working together in a cardiovascular surgical unit. Results were submitted to reliability analysis by calculating the Cronbach’s alpha coefficient. Non-parametric Kruskal-Wallis test and Dunn’s post-test were performed to estimate differences in perceptions of adverse events or outcomes between the groups (surgeons, nurses, anesthesiologists, and technicians). P<0.05 was considered statistically significant. Results: Cronbach’s alpha reliability coefficients showed consistency within the recommended range for all disruption types assessed in DiSI: an individual’s skill (0.85), OR environment (0.88), communication (0.81), situational awareness (0.92), patient-related disruption (0.89), team cohesion (0.83), and organizational disruption (0.83). Nurses (27.4%) demonstrated significantly higher perception of disruptions than surgeons (25.4%), anesthetists (23.3%), and technicians (23.0%) (P=0.005). Study participants were more observant of their colleagues’ disruptive behaviors than their own (P=0.0001). Conclusion: Our results revealed that there is a tendency among participants to hold a positive self-perception position. DiSI appears to be a reliable and useful tool to assess surgical disruptions in cardiovascular OR teams, identifying negative features that might imperil teamwork and safety in the OR. And human factors training interventions are available to develop team skills and improve safety and efficiency in the cardiovascular OR.
To analyze mucosal proliferation and its characteristics, through specific models of duodenogastric reflux, in the stomach of Wistar rats.
Seventy-five healthy and adult male rats were divided into ...three groups: group I--control (n = 25 animals), submitted to gastrotomy of the posterior wall of the glandular stomach; group II--DGR (n = 25 animals), submitted to duodenogastric reflux through latero-lateral gastrojejunal anastomosis in the posterior wall of the glandular stomach and group III--DGR-P (n = 25 animals), submitted to duodenogastric reflux through the pylorus following the same procedure of group II, sectioning and closing the afferent loop. The animals were observed during 36 weeks and subsequently the mucosal lesions were analyzed, with macroscopic and microscopic examination of the prepyloric, the gastrojejunostomy and the squamous area of the stomach.
Group I did not present any kind of lesion. Macroscopic lesions of the prepyloric area in groups II and III were 0% and 20%, respectively. Macroscopic lesions of the gastrojejunal stoma in groups II and III were 36% and 88%, respectively, and 12% and 28%, respectively, in the squamous area. Microscopically, adenomatous hyperplasia (AH), squamous hyperplasia (SH) and adenocarcinoma (AC) were diagnosed. The occurrence of AH at the prepyloric area in groups II and III was 0% and 40%, respectively, and in the gastrojejunal stoma, 40% and 72%, respectively. The occurrence of SH in the squamous area in groups II and III was 12% and 20%, respectively, without statistical differences between the groups. AC was found only in three animals of groups III (12%).
The duodenogastric reflux in this experimental model caused high frequency of proliferative lesions of the gastrojejunal stoma and in the prepyloric area, while adenocarcinoma was a rare occurrence.
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