Fábio Ferreira Amorim

Introduction: Ventilator-induced diaphragmatic dysfunction is increasingly recognised as an important complication of prolonged mechanical ventilation (MV) and a major contributor to difficult weaning and extubation failure. Although bedside diaphragmatic ultrasound has emerged as a useful tool for assessing diaphragm function, conventional indices such as diaphragm excursion and thickening fraction may be influenced by ventilatory mechanics and patient effort. Speckle-tracking ultrasound (STU), a deformation-based technique adapted from echocardiography, allows assessment of diaphragmatic strain and strain rate and may provide a more accurate evaluation of diaphragmatic contractility. However, the predictive utility of diaphragmatic STU for successful liberation from MV remains uncertain. This study aims to systematically review the available evidence on the predictive performance of diaphragmatic speckle-tracking ultrasound for successful weaning from MV in adult patients. Methods: This protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and is registered in the PROSPERO database. A comprehensive search will be conducted in MEDLINE (via PubMed), Embase, Scopus, Web of Science, LILACS/BVS and CENTRAL without restrictions on language or publication date. Observational studies and clinical trials evaluating diaphragmatic speckle-tracking ultrasound during the weaning process in adults receiving invasive MV for more than 24 hours will be eligible. Two reviewers will independently select studies, extract data and assess the risk of bias using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool for diagnostic and predictive accuracy studies and the Cochrane Risk of Bias 2 tool for randomised trials. When feasible, meta-analysis will be conducted using Review Manager software. The certainty of the evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE)approach. Ethics and dissemination: Ethics approval is not applicable for this study since no original data will be collected. The results will be disseminated through peer-reviewed publication and conference presentations. Prospero registration number: CRD420261338352.

Background and Aims: Cervical cancer (CC) remains a major public health problem despite effective screening and vaccination strategies. This study aimed to assess women's knowledge and awareness of human papillomavirus (HPV), HPV vaccination, and CC in a Brazilian community‐based Family Health Strategy/Primary Health Care (FHS/PHC) setting, and to evaluate factors associated with knowledge of HPV transmission, awareness of the HPV‐CC association, and certainty about vaccinating children against HPV. Methods: A community‐based cross‐sectional survey was conducted from August 2023 to February 2024 among women aged ≥ 18 years registered at a Brazilian FHS/PHC unit, using a structured closed‐ended questionnaire that included a health services evaluation component based on the Brazilian version of the Primary Care Assessment Tool. Results: Three hundred and two women participated, most with low educational attainment and low household income. Overall, 56.6% were aware of HPV, whereas only 18.5% were aware of the HPV‐CC association. Although 96.4% had heard of the Pap smear test, only 19.9% reported screening according to the recommended protocol. Among women aged ≤ 22 years, 87.5% reported HPV vaccination. Women aged ≤ 22 years had lower awareness across several preventive domains and of the HPV‐CC association than women aged ≥ 23 years ( p = 0.047). Increasing age was independently associated with lower knowledge of the HPV transmission through unprotected sexual intercourse (OR: 0.962; 95%CI: 0.904–0.984; p < 0.001), whereas higher income was associated with greater knowledge (OR: 2.404; 95%CI: 1.556–3.715; p < 0.001). Greater certainty about vaccinating children was independently associated with television as an information source (OR: 2.295; 95%CI: 1.335–3.950; p = 0.003) and awareness of the HPV‐CC association (OR: 2.376; 95%CI: 1.086–5.200; p = 0.030). Conclusion: These findings suggest that substantial knowledge and awareness gaps persist despite favorable vaccination attitudes, reinforcing the need to strengthen health education, screening adherence, and communication strategies within FHS/PHC services.

To analyze how different subnational governments, based on common national guidelines, have developed their own models for regulating access to specialized care, with varying degrees of innovation, institutionalization, and integration of telehealth. A descriptive and exploratory study with a qualitative approach that comparatively analyzes the implementation of regulations governing access to specialized care. Data were collected through document analysis, literature review, and, in some cases, interviews with key stakeholders, consolidated into detailed descriptions of each scenario to form the research corpus. Analysis was conducted using the Consolidated Framework for Implementation Research (CFIR). Experiences were selected from the municipalities of Curitiba (PR), Belo Horizonte (MG), Porto Alegre (RS), and São Paulo (SP), as well as the states of Ceará, Santa Catarina, Rio Grande do Sul, and the Federal District. The eight Brazilian experiences with outpatient regulation are characterized by diversity in organizational models, degrees of institutionalization of teleconsultation, and integration across levels of care. The adoption of technologies, access regulation protocols, and computerized systems varied across locations, influenced by structural, regulatory, and contextual factors. When integrated, teleconsultation improved the quality of referrals and increased problem-solving capacity in primary care, but its implementation remains uneven across the country. The implementation of access regulation to specialized care in the Unified Health System varied according to institutional, organizational, and technological capacities. Weaknesses were identified in the integration of health information systems in the organization and delivery of specialized care, with structural inequalities; in governance, with low standardization of protocols; limited integration between Primary Health Care and specialized care; and professional resistance to change. Regions with better outcomes integrated teleconsultation into outpatient regulation; clinical and access protocols adopted health information systems integrated with analytical intelligence resources and institutionalized regulatory guidelines. The CFIR highlighted the influence of contexts, actors, and processes, reinforcing the importance of national guidelines for improving local organizations.

BACKGROUND Perioperative hyperglycemia is a common metabolic response to surgical stress and has been shown to be associated with adverse outcomes after cardiac surgery. However, the optimal glycemic target in this setting remains uncertain, since both hyperglycemia and hypoglycemia can be harmful. This study aimed to evaluate the association between perioperative glucose levels and postoperative infection and in-hospital mortality in patients undergoing cardiac surgery at a tertiary cardiovascular center. MATERIAL AND METHODS This study included consecutive adult patients who underwent elective or emergency cardiac surgery between January 2021 and December 2022 at a tertiary cardiovascular center in Brazil. Perioperative glycemic exposure was defined using all glucose measurements recorded from anesthesia induction until hospital discharge or in-hospital death. Compliance with the blood glucose target (BGT) was defined as values within 70 to 180 mg/dL in ≥70% of measurements. Hypoglycemia and hyperglycemia were defined as at least 1 glucose measurement 180 mg/dL, respectively. Primary outcomes were postoperative infection and in-hospital mortality. Multivariable logistic regression was used to identify independent associations. RESULTS A total of 157 patients were included (mean age 59.7±13.0 years). Postoperative infection occurred in 59.9% (n=94), and in-hospital mortality occurred in 8.9% (n=14). BGT compliance was observed in 78.3% of patients. Hypoglycemia occurred in 31.8%, and hyperglycemia in 82.8%. BGT compliance was independently associated with lower in-hospital mortality (OR 0.10, 95% CI 0.02-0.59; P=0.011). At least one episode of hyperglycemia was independently associated with postoperative infection (OR 3.77, 95% CI 1.38-10.35; P=0.010). CONCLUSIONS Perioperative glycemic patterns were associated with clinically relevant outcomes after cardiac surgery. Compliance with a moderate blood glucose target range (70-180 mg/dL) was associated with lower in-hospital mortality, whereas hyperglycemia >180 mg/dL was associated with postoperative infection. These findings should be interpreted as hypothesis-generating and need confirmation in larger prospective studies.

Practice pointsAA students at ESCS had lower socioeconomic indicators than RP peers but similar final performance after adjustment.Univariate gaps disappeared in multivariate analysis.Younger admis...

OBJETIVO: avaliar a confiabilidade do Sistema de Informações Hospitalares (SIH) para estimar a incidência de agravos para a população geral ou para internações hospitalares comparando-o com o Sistema de Informação sobre Mortalidade (SIM). MÉTODOS: Foram coletados conjuntos de dados equiparáveis entre o SIH e o SIM acerca dos óbitos ocorridos em hospitais entre 2008 e 2020 a partir da interface TABNET do Ministério da Saúde. RESULTADOS: Foram obtidos dados de 10.872.624 mortes intra-hospitalares registradas no SIM e 5.991.342 no SIH entre os anos de 2008 e 2020, o que corresponde a uma acurácia de 55,1% (IC 95%: 55,08% a 55,13). O padrão é repetido em níveis diferentes com significância estatística (p < 0,001). Análises por grupos de CID10 mostraram diferenças variáveis. CONCLUSÃO: Apesar do uso regular de dados do SIH para inferir incidências populacionais, esse método é desaconselhável devido ao amplo sub registro.

COVID-19 on Elective Surgery Outcomes in a Brazilian Tertiary Hospital: A Retrospective Cohort Study - Article abstract #950488