Vergílio Pereira Carvalho

In cardiac surgery, poststernotomy pain is a significant issue, peaking within 48 h and requiring proper analgesia for both acute relief and avoidance of chronicization. Opioids are commonly used for pain management postsurgery but pose risks such as adverse effects and dependency. Post-cardiac surgery pain can stem from various sources—somatic, visceral, and neuropathic—making opioid reliance a concern. Multimodal analgesia, which combines different medications and regional anesthesia techniques, is increasingly recommended to decrease opioid use and its related problems. Strategies include acetaminophen, gabapentinoids, NMDA antagonists, alpha-2 agonists, intravenous lidocaine, anti-inflammatory drugs, and regional anesthesia. These approaches can enhance pain control, reduce opioid reliance, and improve cardiac surgery outcomes. The ERAS^® Cardiac Society strongly advocates for an opioid-sparing multimodal approach to improve patient recovery by reducing complications and increasing patient satisfaction. This review aims to consolidate current evidence to assist healthcare providers in customizing pain management for patients post-cardiac surgery, emphasizing reduced opioid use and optimizing the recovery process.

In cardiac surgery, post-sternotomy pain is a significant issue, peaking within 48 hours and requiring proper analgesia for both acute relief and to avoid chronicization. Opioids are commonly used for pain management post-surgery but pose risks like adverse effects and dependency. Post-cardiac surgery pain can stem from various sources - somatic, visceral, and neuropathic, making opioid reliance a concern. Multimodal analgesia, combining different medications and regional anesthesia techniques, is increasingly recommended to decrease opioid use and its related problems. Strategies include acetaminophen, gabapentinoids, NMDA antagonists, alpha-2 agonists, intravenous lidocaine, anti-inflammatory drugs, and regional anesthesia. Implementing these approaches can enhance pain control, lessen opioid reliance, and improve cardiac surgery outcomes. The ERAS® Cardiac Society strongly advocates for an opioid-sparing multimodal approach to benefit patient recovery by reducing complications and enhancing satisfaction. This review aims to consolidate current evidence to assist healthcare providers in customizing pain management for patients post-cardiac surgery, emphasizing reduced opioid use and optimizing the recovery process.

The novel virus severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) is highly virulent and causes coronavirus disease 2019 (COVID-19), resulting in high morbidity and mortality mainly associated with pulmonary complications. Because this virus is highly transmissible, it was quickly spread globally, resulting in COVID-19 being declared as a pandemic. This study aimed to analyze the prevalence of mortality and the factors related to mortality due to COVID-19 in patients with severe acute respiratory syndrome (SARS) at a university hospital in the Central—West region of Brazil. This retrospective cross-sectional study was based on an analysis of the medical records of patients with SARS aged >18 years and admitted to an intensive care unit due to COVID-19 with the requirement of invasive mechanical ventilation. Hospital death was considered as an outcome variable in this study. Moreover, demographic and lifestyle-related variables as well as the therapeutic measures used during the hospital stay were recorded and correlated with the death outcome. After excluding 188 medical records, 397 were analyzed. Most of the participants were men (59.7%), and the mortality rate in patients with SARS due to COVID-19 was 46.1%. Multiple regression analysis indicated that the independent factors associated with mortality in patients with SARS due to COVID-19 were the age of >60 years (p < 0.001) and the use of azithromycin (p = 0.012). Protective factors for mortality were considered as not having the following diseases: hyperthyroidism, asthma, hepatic inheritance, and not being a smoker. The mortality rate in patients with SARS due to COVID-19 was associated with older age and the use of azithromycin.

The novel virus severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) is highly virulent and causes coronavirus disease 2019 (COVID-19), resulting in high morbidity and mortality mainly associated with pulmonary complications. Because this virus is highly transmissible, it was quickly spread globally, resulting in COVID-19 being declared as a pandemic. This study aimed to analyze the prevalence of mortality and factors related to mortality due to COVID-19 in patients with severe acute respiratory syndrome (SARS) at a university hospital in the Central-West region of Brazil. This retrospective cross-sectional study was based on an analysis of the medical records of patients with SARS aged >18 years and admitted to an intensive care unit due to COVID-19 with the requirement of invasive mechanical ventilation. Hospital death was considered as an outcome variable in this study. Moreover, demographic and lifestyle-related variables as well as the therapeutic measures used during the hospital stay were recorded and correlated with the death outcome. After excluding 188 medical records, 397 were analyzed. Most participants were men (59.7%), and the mortality rate in patients with SARS due to COVID 19 was 46.1%. Multiple regression analysis indicated that the independent factors associated with mortality in patients with SARS due to COVID 19 were the age of >60 years (p = 0.000) and use of azithromycin (p = 0.012). The mortality rate in patients with SARS due to COVID 19 and mortality was associated with older age and use of azithromycin.

A obra tem como propósito fazer uma retrospectiva dos principais achados e estudos terapêuticos pertinentes ao tratamento da Covid-19. Na tentativa de melhorar o desfecho e o prognóstico dos pacientes, muitas foram as apostas em inúmeros medicamentos e também em intervenções. Logo faz-se necessário que o profissional da área da saúde tenha conhecimento de todas as particularidades desse processo, tendo em mente quais estudos obtiveram bons resultados e demonstraram potencial na coadjuvação de um protocolo de atendimento satisfatório. As análises feitas neste manuscrito são de natureza paliativa, uma vez que a doença, há mais de um ano, desafia os limites da ciência, que busca incansavelmente maneiras de atendimento e de intervenção eficazes no tratamento dos doentes, no entanto, ainda sem pleno sucesso.

A Vasculite por imunoglobulina A (IgAV) é conhecida por ser uma vasculite sistêmica de pequenos vasos. Apesar desta condição ser capaz de se estabelecer em qualquer faixa etária, o perfil epidemiológico desta doença afeta, majoritariamente, a população pediátrica situada entre 2 e 10 anos de idade. Nesse sentido, este artigo descritivo, tem como objetivo relatar o raro caso de uma paciente adulta que evoluiu com a IgAV, apresentação de forma cutânea, sendo tratada com corticosteroide. Para tanto, após consentimento livre e esclarecido da paciente foi aprovado pelo Comitê de Ética em Pesquisa da Universidade de Rio Verde (UniRV – GO), cujo Certificado de Apresentação para Apreciação Ética é 36621920.0.0000.507. Logo, descobriu-se que a paciente evoluiu com clínica compatível para IgAV de provável acometimento cutâneo pelas lesões em forma de púrpura e pelo envolvimento renal, apresentando boa resposta terapêutica com a corticoterapia em doses não imunossupressoras e após 1 ano e 3 meses de follow-up houve remissão do quadro sem novos episódios. Encontra-se na literatura alguns relatos sobre a boa resposta terapêutica desta forma clínica com a corticoterapia em doses não imunossupressoras, no entanto ensaios clínicos são necessários.

This study aimed to examine the prevalence rates of poor quality sleep and daytime sleepiness in health professionals and their association with socioeconomic, lifestyle, and anthropometric factors and psychosocial work conditions. This cross-sectional study was performed with health professionals from various public and private hospitals in Rio Verde, Goiás, Brazil. Daytime sleepiness and sleep quality were assessed using the Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index, respectively. The variables were analyzed using multiple hierarchical Poisson regression in the statistical package Stata version 13.0. A total of 244 health professionals participated in this study (women, 78.28%). The rates of abnormal daytime sleepiness and poor sleep quality were 50.41% (n = 123) and 55.74% (n = 136), respectively. Reduced physical activity was associated with poor sleep quality (prevalence ratio (PR) = 1.32; 95% confidence interval (CI) 1.02–1.70, p = 0.035). Age between 20 and 29 years (PR = 2.59; 95% CI 1.37–4.91, p = 0.021) and 30 and 49 years (PR = 2.09; 95% CI 1.12–3.91, p = 0.021), as well as excessive alcohol consumption (PR = 1.29; 95% CI 1.01–1.66, p = 0.048), were risk factors for daytime sleepiness. Conversely, adequate bodyweight (PR = 0.52; 95% CI 0.33–0.82, p = 0.005) was considered a protective factor. The present findings suggest high rates of abnormal daytime sleepiness and poor sleep quality among healthcare professionals. We emphasize the importance of physical activity, adequate weight, and healthy habits for better quality sleep and reduced daytime sleepiness.

To develop strategies of alternative public policies, it is necessary to know which plants and phytotherapics are most used, mainly by pregnant women, guaranteeing adequate use. The objective of the study is to identify the socio-demographic profile, to detect which medicinal plants and / or phytotherapics are most used and the possible risks for fetal morphology. A case-control study, conducted between July 2017 and October 2018. For the evaluation of clinical and epidemiological data, a questionnaire was applied in both groups, before ultrasonographic evaluation. Data were analyzed using a significance level of 5% (p ≤ 0.05), applying the Pearson's Chi-square test and Posthoc's test. Of the total of 282 pregnant women, 19.86% (56/282) reported use of medicinal plants. Of these, 62.5% (35/56) are pregnant women with malformations and 37.5% (21/56) are pregnant women with structurally normal fetuses. Statistical differences were obtained regarding the use of medicinal plants such as camomile (p = 0.02) and Passiflora (p = 0.03). The misuse of medicinal plants are risk factors for fetal morphology. Identifying the plants used in gestation can contribute to the planning of programs for enlightenment for pregnant women and continuing education for health professionals.