José Carlos Rebuglio Vellosa

Introdução: A pandemia causada pelo coronavírus (COVID-19) resultou em fechamentos e restrições a diversas situações do cotidiano, incluindo os serviços de saúde. Houve adiamentos e cancelamentos de ações para rastreamento de câncer de mama em muitos países. Aos poucos está se conhecendo mais sobre os impactos causados pela doença. Objetivos: Avaliar se a pandemia interferiu no atendimento a pacientes com câncer de mama. Materiais e Métodos: Foram analisados 248 prontuários de mulheres diagnosticadas com neoplasia maligna da mama entre janeiro de 2018 a dezembro de 2021 em uma clínica especializada em oncologia na região sul do Brasil. Resultados: Houve redução significativa no número de óbitos durante a pandemia. Constataram-se alterações no protocolo de atendimento, mas sem suspensão de tratamentos essenciais. Houve somente adiamentos e remarcações de consultas. Não houve diferença em número de atendimentos nos convênios particulares ou públicos, entre os períodos. O volume de atendimentos realizado antes e durante a pandemia foi semelhante, apesar das dificuldades impostas pela doença. O número de faltas às consultas e tratamentos diminuiu durante a pandemia, evidenciando a continuidade no tratamento, apesar dos riscos. Pacientes infectadas pelo SARSCoV-2 tiveram desfechos favoráveis. Conclusão: De forma geral, não houve impacto da pandemia nesse serviço de saúde. Houve alterações no protocolo de atendimento, mas não ocorreram interrupções nos atendimentos e nos tratamentos para neoplasia maligna da mama.

Chronic kidney disease (CKD) has been increasing globally, with hemodialysis (HD) being the most commonly used treatment. However, HD can lead to episodes of hypotension, affecting cerebral perfusion and intracranial pressure (ICP), potentially compromising cerebral compliance. In this context, non-invasive ICP monitoring becomes a valuable tool for the early detection of such changes. This report describes a 58-year-old patient on HD for three years, whose cerebral compliance was assessed before and after dialysis sessions. A significant reduction in systolic blood pressure (SBP) was observed, possibly influencing ICP dynamics and the P2/P1 ratio. Since HD can cause osmotic imbalances and cardiovascular effects that impact cerebral perfusion, continuous ICP monitoring using non-invasive methods may enhance clinical management and reduce neurological risks in individuals with CKD.

Introduction: Propofol and midazolam are the main options for moderate sedation in clinical practice. In addition, these drugs are used to reduce intracranial pressure in cases of intracranial hypertension, and their use in these situations is guided by limited evidence. Objective: To compare the effects of propofol and midazolam on intracranial pressure wave morphology in moderate sedation in patients undergoing upper digestive endoscopy. Methods: Sixty patients were included in this study, being divided into two groups, propofol and midazolam group. Intracranial pressure was monitored during and after upper digestive endoscopy, using non-invasive monitoring equipment developed by the company Brain4care. Arterial pressure was measured before and after the exam. Results: The propofol group had lower intracranial pressure (p=0.037) during moderate sedation compared to intracranial pressure after endoscopy and a significant decrease in systolic (p=0.0001) and diastolic pressure (p=0.001) after sedation. Midazolam, on the other hand, reduced systolic pressure (p=0.001), but didn’t change the other parameters after the procedure. There wasn’t a significant difference between the propofol and midazolam groups. Conclusion: There was no significant difference between the groups studied, however, analyses within the propofol and midazolam groups indicate that propofol, but not midazolam, causes changes in intracranial pressure in moderate sedation.

Biomarcadores de inflamação derivados do hemograma como a razão neutrófilos/linfócitos (NLR), a razão plaquetas/linfócitos (PLR), a razão neutrófilos/plaquetas (NPR) e o índice de inflamação imune sistêmico (SII) já foram investigados como preditores de prognóstico de doenças inflamatórias sistêmicas, cardiovasculares, malignas, etc., e com a ocorrência da pandemia de SARS-CoV-2, também passaram a ser estudadas como biomarcadores de interesse nessa doença. Objetivo: Comparar retrospectivamente o valor dessas 4 razões hematimétricas durante os dois anos da pandemia (2020-2021), com o período anterior (os anos de 2018-2019), em uma população de pacientes doentes renais em hemodiálise. Métodos: Esta pesquisa foi submetida ao Comitê de Ética e Pesquisa da Universidade Estadual de Ponta Grossa (CEP-UEPG) e foi aprovada sob o número do parecer 5.024.864. Foram incluídos pacientes tratados no setor de Terapia Renal Substitutiva do Hospital Santa Casa de Ponta Grossa durante os anos 2018 – 2021, com n amostral de 155 pacientes. A coleta dos dados se baseou na consulta de prontuários eletrônicos. O valor das razões NLR, NPR, PLR e SII foram calculados a partir da contagem dos neutrófilos, linfócitos e plaquetas dos hemogramas, considerou-se um hemograma a cada trimestre nesse intervalo de 4 anos. Como a normalidade dos dados não foi atestada, seguiu-se a metodologia não-paramétrica, o valor de α foi fixado em 0,05. Resultados: O teste de Skillings-Mack apresentou um valor de p-simulado significativo (< 2.2e-16) na comparação de cada uma das quatro razões. Na análise post-hoc, as comparações trimestrais das medianas do SII, não apresentaram diferença significativa, as razões PLR, NPR e NLR apresentaram respectivamente, duas, três e seis, comparações com diferenças significativas. Conclusão: Houve comparações com diferenças significativas pontuais, não houve um aumento geral no valor das razões SII, PLR, NPR e NLR durante o período de pandemia (2020 - 2021) entre os pacientes em hemodiálise.

Among the complications related to chronic kidney disease (CKD), those of a neurological nature stand out, and for a better quality of life for patients, the diagnosis and treatment of these complications is fundamental.

Population aging is reality and indicates the need for a better quality of life. Aging brings loss of functions, neurological changes and comorbidities. Studies have sought to reduce the progression of diseases in the elderly and some suggest diseases may have their development related to high intracranial pressures (ICP). The aim of this study was to evaluate for the first time ICP morphology in residents of a Long-Term Institution for the Elderly, using a non-invasive technology. Of the 91 elderly people evaluated, 88% had ICP alterations, 58% are dependent to daily activities, 23% are wheelchair users and 79% have a mental state as compromised. As for comorbidities, frequently identified chronic-degenerative diseases were arterial hypertension (50%), depression (27%), diabetes (24%) and dementia (14%), in addition to polypharmacy. There was a significant difference in the prevalence of altered ICP for wheelchair users and for residents who do not walk . A high rate of altered ICP was observed in the population studied, highlighting the importance of assessing intracranial compliance in understanding the aging and future follow-up studies of the elderly at different stages of diseases, especially neurological ones.

Background: Cerebral edema (CE) and intracranial hypertension (IHT) are complications of numerous neurological pathologies. However, the study of CE and noninvasive methods to predict IHT remains rudimentary. This study aims to identify in traumatic brain injury (TBI) patients the relationship between the volume of the lateral ventricles and the parameters of the noninvasive intracranial pressure waveform (nICPW). Methods: This is an analytical, descriptive, and cross-sectional study with nonsurgical TBI patients. The monitoring of nICPW was performed with a mechanical strain gauge, and the volumetry of the lateral ventricles was calculated using the free 3D Slicer software, both during the acute phase of the injury. The linear model of fixed and random mixed effects with Gamma was used to calculate the influence of nICPW parameters (P2/P1 and time-to-peak [TTP]) values on volumetry. Results: Considering only the fixed effects of the sample, there was P = 0.727 (95% CI [−0.653; 0.364]) for the relationship between P2/P1 and volumetry and 0.727 (95% CI [−1.657; 1.305]) for TTP and volumetry. Considering the fixed and random effects, there was P = 8.5e-10 (95% CI [−0.759; 0.355]) for the relationship between P2/P1 and volumetry and 8.5e-10 (95% CI [−2.001; 0.274]) for TTP and volumetry. Conclusion: The present study with TBI patients found association between nICPW parameters and the volume of the lateral ventricles in the 1^st days after injury.

In the course of cardiac surgery with cardiopulmonary bypass (CPB) many factors come into play. A lot of care is needed, in addition to the surgery itself, especially with regard to blood oxygenation, blood pressure and the formation of microemboli, which will directly influence the pathogenesis of neurological abnormalities found in the postoperative period. Elevations in the values ​​of intracranial pressure (ICP) in adults can be small to severe, and may pose a threat to the patient's life, according to this increase. The objective of the present study is to discuss possible changes in the ICP of patients who underwent cardiac surgery as possible consequences of CPB. Since perfusion triggers the Systemic Inflammatory Response Syndrome, directly and indirectly interfering with the mechanisms that maintain brain compliance, such changes in ICP may occur as a consequence of CPB, however, investigations are needed to explain this possible relationship.

Monitoring and treatment of intracranial pressure are extremely important procedures in the management of patients with traumatic brain injury. The monitoring methods currently marketed are invasive and are not suitable for all patients. In addition to the risks offered, they are not available on all services. This study aims to describe the cases of five patients with traumatic brain injury of different severity who underwent noninvasive monitoring of intracranial pressure in the acute phase of the injury, relating the changes identified with the clinical picture presented. Patients showed important changes in intracranial pressure wave morphology, possibly related to the lesions, clinical presentation and therapeutic interventions used.

Objetivo: Verificar se há perturbação da autorregulação da complacência intracraniana em pacientes com doença renal crônica (DRC), quando estes apresentam alteração de pressão arterial (PA). Metodologia: Foram realizadas monitorizações da pressão intracraniana (PIC) em pacientes renais crônicos por meio de um sensor não invasivo, desenvolvido pela empresa Brain4care®. Os dados dos pacientes monitorizados foram analisados estatisticamente e testou-se a correlação entre os parâmetros de PIC com pressão arterial (PA) e batimentos por minuto (BPM), correlação entre a filtração glomerular com PA e BPM, e comparação entre os grupos DRC em relação à PA, BPM e PIC. Resultados: Não se observou diferença entre os estágios da DRC, e não houve correlação entre a PIC (razão P2/P1 e TTP) e a PA. Entretanto, houve forte correlação entre as pressões sistólica (PAS) e diastólica (PAD) e os parâmetros da PIC. Conclusão: Como houve forte correlação entre as pressões sistólica e diastólica e os parâmetros da PIC, há indício de prejuízo na complacência intracraniana destes pacientes, evidenciando que o portador da DRC tem sua homeostasia prejudicada quando em presença HAS.