Publications by authors named "Thiago Mamoru Sakae"

20 Publications

  • Page 1 of 1

Ultrasound-guided erector spinae plane block for open inguinal hernia repair: a randomized controlled trial.

Braz J Anesthesiol 2021 Jun 9. Epub 2021 Jun 9.

SIANEST/Hospital Florianópolis, Unidade de Anestesiologia, Florianópolis, SC, Brazil; Universidade do Sul de Santa Catarina (UNISUL), Florianópolis, SC, Brazil; TSA, Sociedade Brasileira de Anestesiologia, Brazil.

Introduction And Objectives: Inguinal hernia repair is associated with significant postoperative pain. We assessed the analgesia efficacy of unilateral Erector Spinae Plane block (ESP) performed under ultrasound guidance in patients submitted to open unilateral inguinal hernia repair, comparing ESP to spinal anesthesia administered with or without opioid.

Method: Forty-five patients with ages ranging from 27 to 83 years were randomly allocated into three groups: control group receiving spinal anesthesia (n = 14), ESP group receiving ESP block combined with spinal anesthesia (n = 16), and spinal morphine group receiving spinal anesthesia with morphine 1 mcg.kg as adjuvant drug (n = 15). ESP was performed at the T8 level using 0.5% ropivacaine, 20 mL. We assessed the pain intensity in the initial 24 hours after surgery using the Visual Analogue Scale - VAS and rescue opioid requirement.

Results: The ESP group showed four times higher consumption of rescue opioids than the spinal morphine group, or 26.7% vs. 6.2%, respectively (RR = 4.01; 95% CI: 0.82 to 19.42; p = 0.048). The spinal morphine group showed higher incidence of adverse effects than the ESP group, 37.5% vs. 6.7%, respectively (p = 0.039). There were no statistically significant differences among groups for the mean values of VAS score at 24 hours after surgery (p = 0.304).

Conclusion: At the doses used in this study, the ESP block was an ineffective technique for providing postoperative analgesia in unilateral open inguinal hernioplasty and was associated with higher consumption of rescue opioids when compared to spinal anesthesia with or without opioid.
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http://dx.doi.org/10.1016/j.bjane.2021.04.032DOI Listing
June 2021

Melatonin can be, more effective than N-acetylcysteine, protecting acute lung injury induced by intestinal ischemia-reperfusion in rat model.

Clinics (Sao Paulo) 2021 5;76:e2513. Epub 2021 May 5.

Departamento de Cirurgia, Disciplina de Anestesiologia, Dor e Medicina Intensiva, Universidade Federal de Sao Paulo, Sao Paulo, SP, BR.

Objectives: The current study compared the impact of pretreatment with melatonin and N-acetylcysteine (NAC) on the prevention of rat lung damage following intestinal ischemia-reperfusion (iIR).

Methods: Twenty-eight Wistar rats were subjected to intestinal ischemia induced by a 60 min occlusion of the superior mesenteric artery, followed by reperfusion for 120 min. Animals were divided into the following groups (n=7 per group): sham, only abdominal incision; SS+iIR, pretreated with saline solution and iIR; NAC+iIR, pretreated with NAC (20 mg/kg) and iIR; MEL+iIR, pretreated with melatonin (20 mg/kg) and iIR. Oxidative stress and inflammatory mediators were measured and histological analyses were performed in the lung tissues.

Results: Data showed a reduction in malondialdehyde (MDA), myeloperoxidase (MPO), and TNF-alpha in the animals pretreated with NAC or MEL when compared to those treated with SS+iIR (p<0.05). An increase in superoxide dismutase (SOD) levels in the NAC- and MEL-pretreated animals as compared to the SS+iIR group (34±8 U/g of tissue; p<0.05) was also observed. TNF-α levels were lower in the MEL+iIR group (91±5 pg/mL) than in the NAC+iIR group (101±6 pg/mL). Histological analysis demonstrated a higher lung lesion score in the SS+iIR group than in the pretreated groups.

Conclusion: Both agents individually provided tissue protective effect against intestinal IR-induced lung injury, but melatonin was more effective in ameliorating the parameters analyzed in this study.
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http://dx.doi.org/10.6061/clinics/2021/e2513DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8075110PMC
May 2021

Impact of topical airway anesthesia on immediate postoperative cough/bucking: a systematic review and meta-analysis.

Braz J Anesthesiol 2021 Apr 22. Epub 2021 Apr 22.

Postdoctoral Research Fellow, Harvard Medical School, Boston, United States; Sociedade Brasileira de Anestesiologia, Brazil.

Background: Postoperative cough may occur after tracheal intubation, but it is indistinct which drug is best at diminishing these events. Additionally, airway reflexes are commonly accompanied by severe hemodynamics responses during emergence.

Objectives: To evaluate the role of topical airway anesthesia on immediate post-extubation cough/bucking and extubation time.

Methods: Randomized clinical trials from MEDLINE, EMBASE, CENTRAL, and LILACS published until December 23, 2020 were included. Our primary outcome was postoperative cough/bucking incidence which was compared between local anesthetics and controls. Extubation times were likewise considered. Predisposition appraisal and subgroup, affectability investigations were likewise performed.

Results: The pooled analysis found a 45% reduction in cough incidence after treatment with topical airway local anesthetic (RR = 0.55; 95% CI: 0.42 to 0.72; p < 0.001). The number needed to treat (NNT) was 4.61. The intervention showed no differences in reduction of the extubation time (mean difference = -0.07; 95% CI: -0.14 to 0.28; p = 0.49).

Conclusion: Topical airway anesthesia demonstrated better than placebo or no medication in reducing immediate post-extubation cough/bucking. Further studies could have this objective to combine the different ways to perform better outcomes for patients.
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http://dx.doi.org/10.1016/j.bjane.2021.03.016DOI Listing
April 2021

[Comparison between subarachnoid morphine and femoral nerve block for analgesia after knee ligament reconstruction: a randomized clinical trial].

Braz J Anesthesiol 2020 Nov-Dec;70(6):613-619. Epub 2020 Oct 5.

Universidade Federal do Paraná (UFPR), Programa de Pós-Graduação em Clínica Cirúrgica, Curitiba, Paraná, Brasil; Sociedade Brasileira de Anestesiologia, Rio de Janeiro, RJ, Brasil.

Background And Objectives: There is no consensus of the ideal technique to provide analgesia in knee ligament reconstructions. The aim of this study was to compare the intensity of postoperative pain in these patients under different modalities of analgesia.

Method: Randomized and controlled clinical trial of patients undergoing reconstruction of the anterior cruciate ligament (ACL) with flexor tendons between December 2013 and 2014. All patients underwent spinal anesthesia and rescue analgesia with tramadol. The Groups C, M, R0,375 and R0,25 were compared with only the previously described technique, subarachnoid morphine (100 μg) or femoral nerve block with 25 mL of 0.375% ropivacaine and 0.25%, respectively. Pain intensity at 6, 12 and 24hours, age, sex, rescue analgesia, adverse reactions and satisfaction were evaluated.

Results: Among the 83 eligible patients, a predominance of males (85.7%) was observed, between 28 and 31 years. The Group C requested more opioid (27.3%) than the other groups, without significance when compared. There were no significant differences in pain intensity at 6, 12 and 24hours. There was a higher incidence of urinary retention in the Group M (23.8%) than in the R0,375 (0%) and prolonged quadriceps motor block in the R0,375 Group (30%) than in the M and C Groups (0%), with statistical significance (p < 0.05).

Conclusion: There was no difference in the intensity of postoperative pain in patients submitted to anterior cruciate ligament reconstruction with flexor tendons under the analgesic modalities evaluated, despite the predominance of urinary retention in the M Group and motor block in the R0,375 Group.
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http://dx.doi.org/10.1016/j.bjan.2019.08.006DOI Listing
October 2020

[Comparison between erector spinal plane block and epidural block techniques for postoperative analgesia in open cholecystectomies: a randomized clinical trial].

Braz J Anesthesiol 2020 Jan - Feb;70(1):22-27. Epub 2020 Feb 27.

Serviço de Anestesiologia SIANEST, Florianópolis, SC, Brasil; Universidade do Sul de Santa Catarina (UNISUL), Florianópolis, SC, Brazil; Hospital Florianópolis, Florianópolis, SC, Brasil; TSA Sociedade Brasileira de Anestesiologia (SBA), Rio de Janeiro, RJ, Brasil.

Introduction And Objectives: Blockade of the Erector Spinal Muscle (ESP block) is a relatively new block, initially described for chronic thoracic pain analgesia, but it has already been described for anesthesia and analgesia in thoracic surgical procedures and, more recently, for high abdominal surgeries. The aim of the study was to compare two techniques, ESP Block and Epidural block with morphine and local anesthetic for postoperative analgesia of open cholecystectomy surgeries.

Methods: Controlled single-blind randomized clinical trial with 31 patients (ESP block, n = 15; Epidural, n = 16), of both genders, ages between 27 and 77 years. The ESP block was performed at the T8 level with injection of 20 mL of 0.5% ropivacaine bilaterally. The epidural block was performed at the T8-T9 space with 20 mL of 0.5% ropivacaine and 1 mg of morphine.

Results: The ESP block group presented higher mean Numeric Pain Scale (NPS) values for pain in the up to 2 hour (p = 0.001) and in the 24 hour (p = 0.001) assessments. The ESP block group had a three-fold increased risk (43.7% vs. 13.3%) of rescue opioid use in the 24 postoperative hours when compared to the epidural group (RR = 3.72, 95% CI: 0.91 to 15.31, p = 0.046).

Conclusion: ESP block did not prove to be an effective technique for postoperative analgesia of open cholecystectomy, at the doses performed in this study, having required more use of rescue opioid, and without differences in NPS. More comprehensive studies are required to assess the efficacy of ESP block for the visceral and abdominal somatic component, considering the specific blockade level.
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http://dx.doi.org/10.1016/j.bjan.2019.12.009DOI Listing
May 2021

Effects of sertraline in the prevention of low blood pressure in patients undergoing hemodialysis.

J Bras Nefrol 2019 Oct-Dec;41(4):492-500

Universidade do Sul de Santa Catarina, Tubarão, SC, Brasil.

Introduction: Intradialytic hypotension (IDH) is a major complication of hemodialysis, with a prevalence of about 25% during hemodialysis sessions, causing increased morbidity and mortality.

Objective: To study the effects of sertraline to prevent IDH in hemodialysis patients.

Methods: This was a double-blind, crossover clinical trial comparing the use of sertraline versus placebo to reduce intradialytic hypotension.

Results: Sixteen patients completed the two phases of the study during a 12-week period. The IDH prevalence was 32%. A comparison between intradialytic interventions, intradialytic symptoms, and IDH episodes revealed no statistical difference in the reduction of IDH episodes (p = 0.207) between the two intervention groups. However, the risk of IDH interventions was 60% higher in the placebo group compared to the sertraline group, and the risk of IDH symptoms was 40% higher in the placebo group compared to the sertraline group. Survival analysis using Kaplan-Meier estimator supported the results of this study. Sertraline presented a number needed to treat (NNT) of 16.3 patients to prevent an episode from IDH intervention and 14.2 patients to prevent an episode from intradialytic symptoms.

Conclusion: This study suggests that the use of sertraline may be beneficial to reduce the number of symptoms and ID interventions, although there was no statistically significant difference in the blood pressure levels.
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http://dx.doi.org/10.1590/2175-8239-JBN-2018-0189DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6979582PMC
May 2020

Prevalence and factors associated with work accidents in a metal-mechanic company.

Rev Bras Med Trab 2018 1;16(1):26-35. Epub 2018 Mar 1.

Universidade do Sul de Santa Catarina (Unisul) - Tubarão (SC), Brazil.

Background: Work accidents affect more than 700,000 workers in Brazil each year. Among the three economic sectors, industry is the one that contributes with most work accidents in the country. Metallurgical and metal-mechanic companies stand out within this sector as a function of the frequency of leaves resulting from work-related accidents and illnesses.

Objective: To analyze the occupational profile and hazards associated with work accidents at a metal-mechanic company for the period from 2007 to 2015.

Methods: Cross-sectional study that analyzed data available in work accident report forms issued by the employer.

Results: Thesociodemographic and occupational profile predominantly associated with work accidents at the investigated company included: male gender, age 18 to 29 years old, white people, married or in stable union, with incomplete higher education, welders/assemblers and less than 5years of work at the company. The most frequent types of injuries caused by accidents were fractures, dislocations, strains, contusions, excoriations, cuts and amputations. The most common causative agents were metal parts. The highest accident rates corresponded to 2008 and 2012, in which years economic recession hit the metal-mechanic segment.

Conclusion: In addition to pointing to an economic sector with a high-risk work accident profile, the analyzed work accidents - the predominant consequence of which was leave for more than 15 days - might express a selective strategy from the company, which chose not to record less serious accidents.
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http://dx.doi.org/10.5327/Z1679443520180086DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7104819PMC
March 2018

Dexamethasone as a ropivacaine adjuvant for ultrasound-guided interscalene brachial plexus block: A randomized, double-blinded clinical trial.

J Clin Anesth 2017 May 16;38:133-136. Epub 2017 Feb 16.

Clinical Research Center, Hospital Nossa Senhora da Conceição, Brazil; Postgraduate Program in Health Sciences, University of Southern Santa Catarina - Unisul, Brazil. Electronic address:

Study Objective: The purpose of this study was to evaluate the effect of intravenous or perineural dexamethasone added to ropivacaine on the duration of ultrasound-guided interscalene brachial plexus blocks (BPB).

Design: Randomized clinical trial.

Setting, Patients And Interventions: Sixty ASA physical status I-II patients with elective shoulder arthroscopic surgeries under interscalene brachial plexus blocks were randomly allocated to receive 20ml of 0.75% ropivacaine with 1ml of isotonic saline (C group, n=20), 20ml of 0.75% ropivacaine with 1ml (4mg) of perineural dexamethasone (Dpn group, n=20), or 20ml of 0.75% ropivacaine with 1ml of isotonic saline and intravenous 4mg dexamethasone (IV) (Div group, n=20). A nerve stimulation technique with ultrasound was used in all patients.

Measurements: The onset time and duration of sensory blocks were assessed. Secondary outcomes were pain scores (VAS) and postoperative vomiting and nausea (PONV).

Main Results: The duration of the motor and sensory block was extended in group Dpn compared with group Div and group C (P<0.05). In addition, within 24h, group Dpn presented lower levels of VAS and lower incidence of PONV as compared with the other groups. Moreover, there was a significant reduction on onset time between group Dpn and the other groups.

Conclusions: Perineural 4mg dexamethasone was more effective than intravenous in extending the duration of ropivacaine in ultrasound-guided interscalene BPB. Moreover, Dpn has significant effects on onset time, PONV, and VAS.
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http://dx.doi.org/10.1016/j.jclinane.2017.02.004DOI Listing
May 2017

Ethical and legal duty of anesthesiologists regarding Jehovah's Witness patient: care protocol.

Braz J Anesthesiol 2016 Nov - Dec;66(6):637-641. Epub 2016 Sep 12.

CET Sianest SBA, Florianópolis, SC, Brazil; Hospital Florianópolis, Florianópolis, SC, Brazil.

Background And Objectives: Jehovah's Witnesses patients refuse blood transfusions for religious reasons. Anesthesiologists must master specific legal knowledge to provide care to these patients. Understanding how the Law and the Federal Council of Medicine treat this issue is critical to know how to act in this context. The aim of this paper was to establish a treatment protocol for the Jehovah's Witness patient with emphasis on ethical and legal duty of the anesthesiologist.

Content: The article analyzes the Constitution, Criminal Code, resolutions of the Federal Council of Medicine, opinions, and jurisprudence to understand the limits of the conflict between the autonomy of will of Jehovah's Witnesses to refuse transfusion and the physician's duty to provide the transfusion. Based on this evidence, a care protocol is suggested.

Conclusions: The Federal Council of Medicine resolution 1021/1980, the penal code Article 135, which classifies denial of care as a crime and the Supreme Court decision on the HC 268,459/SP process imposes on the physician the obligation of blood transfusion when life is threatened. The patient's or guardian's consent is not necessary, as the autonomy of will manifestation of the Jehovah's Witness patient refusing blood transfusion for himself and relatives, even in emergencies, is no not forbidden.
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http://dx.doi.org/10.1016/j.bjane.2015.03.012DOI Listing
April 2017

[Ethical and legal duty of anesthesiologists regarding Jehovah's Witness patient: care protocol].

Rev Bras Anestesiol 2016 Nov - Dec;66(6):637-641. Epub 2016 Mar 23.

CET Sianest SBA, Florianópolis, SC, Brasil; Hospital Florianópolis, Florianópolis, SC, Brasil.

Background And Objectives: Jehovah's Witnesses patients refuse blood transfusions for religious reasons. Anesthesiologists must master specific legal knowledge to provide care to these patients. Understanding how the Law and the Federal Council of Medicine treat this issue is critical to know how to act in this context. The aim of this paper was to establish a treatment protocol for the Jehovah's Witness patient with emphasis on ethical and legal duty of the anesthesiologist.

Content: The article analyzes the Constitution, Criminal Code, resolutions of the Federal Council of Medicine (FCM), opinions, and jurisprudence to understand the limits of the conflict between the autonomy of will of Jehovah's Witnesses to refuse transfusion and the physician's duty to provide the transfusion. Based on this evidence, a care protocol is suggested.

Conclusions: The FCM resolution 1021/1980, the penal code Article 135, which classifies denial of care as a crime and the Supreme Court decision on the HC 268,459/SP process imposes on the physician the obligation of blood transfusion when life is threatened. The patient's or guardian's consent is not necessary, as the autonomy of will manifestation of the Jehovah's Witness patient refusing blood transfusion for himself and relatives, even in emergencies, is no not forbidden.
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http://dx.doi.org/10.1016/j.bjan.2015.03.008DOI Listing
March 2016

Relative luminosity in the plus maze upon the exploratory behaviour of female Wistar rats.

Arq Neuropsiquiatr 2015 Jul;73(7):601-6

Departamento de Ciências Fisiológicas, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil.

Objective: This study evaluated the provision of two configuration of the Elevated Pluz-Maze (EPM) by analizing the exploratory behaviour of female Wistar rats in different phases of the estrous cycle in EPMs with different gradients of luminosity between the open and enclosed arms (O/E∆Lux).

Methods: Female Wistar rats were treated with Midazolam (MDZ, 1.0 mg.kg-1) and were tested for their exploratory behaviour in either the EPM 10 O/E∆Lux or EPM 96 O/E∆Lux.

Results: A multiple regression analysis indicated that the O/E∆Lux is negatively associated with the %Open arm entries and %Open arm time, suggesting that as O/E∆Lux increases, the open arm exploration decreases. The estrous cycle phase did not influence the open-arm exploration in either EPM. MDZ- induced anxiolysis was detected in 96 O/E∆Lux EPM in all phases of the EC.

Discussion: Results of this study suggest the importance of the O/E∆Lux to establish the arm preference in the EPM, and to preserve the predictive validity of the EPM.
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http://dx.doi.org/10.1590/0004-282X20150088DOI Listing
July 2015

The use of neurovascular ultrasound versus digital subtraction angiography in acute ischemic stroke.

Arq Neuropsiquiatr 2015 Mar;73(3):218-22

Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil.

Unlabelled: Cervical and intracranial arterial evaluation is an important issue for acute ischemic stroke (IS).

Objective: Compare the use of the neurovascular ultrasound examination (NVUE) to digital subtraction angiography (DSA) in acute IS patients for diagnosing significant extracranial and intracranial arteriopathy.

Method: Nonconsecutive patients with IS or transient ischemic attack admitted within 12 hours of the onset of symptoms were evaluated retrospectively. Standardized NVUE and DSA were done in all patients within the first 120 hours of hospital admission.

Results: Twenty-four patients were included in the study. Compared to DSA, the NVUE demonstrated 94.7% sensitivity and 100% specificity for identifying symptomatic extracranial and/or intracranial arteriopathy.

Conclusion: The standardized NVUE technique demonstrated high sensitivity and specificity compared to DSA for diagnosing arterial abnormalities in acute IS patients.
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http://dx.doi.org/10.1590/0004-282X20140231DOI Listing
March 2015

Effects of prednisone on eosinophilic bronchitis in asthma: a systematic review and meta-analysis.

J Bras Pneumol 2014 Oct;40(5):552-63

Federal University of Santa Catarina, Florianópolis, Brazil.

Objective: To evaluate the effect size of oral corticosteroid treatment on eosinophilic bronchitis in asthma, through systematic review and meta-analysis.

Methods: We systematically reviewed articles in the Medline, Cochrane Controlled Trials Register, EMBASE, and LILACS databases. We selected studies meeting the following criteria: comparing at least two groups or time points (prednisone vs. control, prednisone vs. another drug, or pre- vs. post-treatment with prednisone); and evaluating parameters before and after prednisone use, including values for sputum eosinophils, sputum eosinophil cationic protein (ECP), and sputum IL-5-with or without values for post-bronchodilator FEV1-with corresponding 95% CIs or with sufficient data for calculation. The independent variables were the use, dose, and duration of prednisone treatment. The outcomes evaluated were sputum eosinophils, IL-5, and ECP, as well as post-bronchodilator FEV1.

Results: The pooled analysis of the pre- vs. post-treatment data revealed a significant mean reduction in sputum eosinophils (↓8.18%; 95% CI: 7.69-8.67; p < 0.001), sputum IL-5 (↓83.64 pg/mL; 95% CI: 52.45-114.83; p < 0.001), and sputum ECP (↓267.60 µg/L; 95% CI: 244.57-290.63; p < 0.0001), as well as a significant mean increase in post-bronchodilator FEV1 (↑8.09%; 95% CI: 5.35-10.83; p < 0.001).

Conclusions: In patients with moderate-to-severe eosinophilic bronchitis, treatment with prednisone caused a significant reduction in sputum eosinophil counts, as well as in the sputum levels of IL-5 and ECP. This reduction in the inflammatory response was accompanied by a significant increase in post-bronchodilator FEV1.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263337PMC
http://dx.doi.org/10.1590/s1806-37132014000500012DOI Listing
October 2014

Nosocomial infections in a neonatal intensive care unit in South Brazil.

Rev Bras Ter Intensiva 2012 Dec;24(4):381-5

Objective: The aim of this study was to describe the incidence and epidemiology of nosocomial infection in newborns who were admitted to a neonatal intensive care unit in a hospital in south Santa Catarina, Brazil.

Methods: A prospective cohort study was conducted for 1 year among 239 neonates who remained as in-patients 48 hours after admission. The criteria that were used to diagnose infection were in accordance with the Centers for Disease Control and Prevention and the National Health Surveillance Agency.

Results: The incidence of nosocomial infection was 45.8%. The primary reasons for admission were primary bloodstream infection (80.7%) and pneumonia (6.7%). Coagulase-negative Staphylococcus was the most commonly identified agent in the blood cultures and in the hospital unit. Prematurity was the most prevalent reason for admission. The general mortality rate was 12.1%, and mortality from nosocomial infection was 33.8%.

Conclusions: The incidence of nosocomial infection in the hospital unit was higher than rates that have been reported in other national studies. The major types of nosocomial infection were primary bloodstream infection and pneumonia.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4031819PMC
http://dx.doi.org/10.1590/s0103-507x2012000400015DOI Listing
December 2012

Exacerbations of COPD and symptoms of gastroesophageal reflux: a systematic review and meta-analysis.

J Bras Pneumol 2013 May-Jun;39(3):259-71

Graduate Program in Medical Sciences, Federal University of Santa Catarina, Florianópolis, Brazil.

Objective: To examine the relationship between gastroesophageal reflux (GER) and COPD exacerbations.

Methods: We conducted a systematic search of various electronic databases for articles published up through December of 2012. Studies considered eligible for inclusion were those dealing with COPD, COPD exacerbations, and GER; comparing at least two groups (COPD vs. controls or GER vs. controls); and describing relative risks (RRs) and prevalence ratios-or ORs and their respective 95% CIs (or presenting enough data to allow further calculations) for the association between GER and COPD-as well as exacerbation rates. Using a standardized form, we extracted data related to the study design; criteria for GER diagnosis; age, gender, and number of participants; randomization method; severity scores; methods of evaluating GER symptoms; criteria for defining exacerbations; exacerbation rates (hospitalizations, ER visits, unscheduled clinic visits, prednisone use, and antibiotic use); GER symptoms in COPD group vs. controls; mean number of COPD exacerbations (with symptoms vs. without symptoms); annual frequency of exacerbations; GER treatment; and severity of airflow obstruction.

Results: Overall, GER was clearly identified as a risk factor for COPD exacerbations (RR = 7.57; 95% CI: 3.84-14.94), with an increased mean number of exacerbations per year (mean difference: 0.79; 95% CI: 0.22-1.36). The prevalence of GER was significantly higher in patients with COPD than in those without (RR = 13.06; 95% CI: 3.64-46.87; p < 0.001).

Conclusions: GER is a risk factor for COPD exacerbations. The role of GER in COPD management should be studied in greater detail.
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http://dx.doi.org/10.1590/S1806-37132013000300002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4075854PMC
May 2014

[Questionnaire of Diabetes Self-Care Activities: translation, cross-cultural adaptation and evaluation of psychometric properties].

Arq Bras Endocrinol Metabol 2010 Oct;54(7):644-51

Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil.

Objectives: To translate into Portuguese, perform cross-cultural adaptation and to evaluate the psychometric properties of the Summary of Diabetes Self-Care Activities Questionnaire - SDSCA.

Materials And Methods: The process followed the international guidelines for the adaptation and evaluation of psychometric properties. The Cronbach's alpha (α) was determined to evaluate the internal consistency (inter-itens correlation) and the reliability (test-retest and inter-evaluator correlation).

Results: The inter-itens correlation showed values of α = 0.09 to α = 0.86. In the test-retest evaluation, the lowest correlation was obtained for the item "eat sweets" (α = 0.15) and the highest correlation was obtained for the items concerning smoking (α = 1.00). The inter-evaluator correlations varied from α = 0.29 to α = 1.00.

Conclusions: The adapted questionnaire showed psychometric properties similar to those of the SDSCA. Its Brazilian version provides a reliable and valid questionnaire to evaluate diabetic patient adherence to self-care in our community.
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http://dx.doi.org/10.1590/s0004-27302010000700009DOI Listing
October 2010

TIMI risk score for acute myocardial infarction according to prognostic stratification.

Arq Bras Cardiol 2009 Aug;93(2):105-12

Universidade do Sul de Santa Catarina, SC - Brasil.

Background: The TIMI (Thrombolysis in Myocardial Infarction) risk score is derived from clinical trial involving patients who are eligible for fibrinolysis. As the risk profiles of these cases differ from those found in non-selected populations, it is important to review the applicability of the score in usual clinical conditions.

Objectives: To evaluate the management and clinical evolution of hospital inpatients with acute myocardial infarction, according to risk stratification by the TIMI score.

Methods: We evaluated, retrospectively, 103 cases of acute myocardial infarction with ST-segment elevation admitted to the Hospital Nossa Senhora da Conceição - Tubarão, in 2004 and 2005. The cases were analyzed in three risk groups according to the TIMI score.

Results: The hospital mortality after infarction was 17.5%. In the low-risk group there was no death. The mortality was 8.1% in the medium risk group and 55.6% in the high-risk group. The risk of death in cases of high risk was 14.1 times higher than in the cases of medium and low risk (95% CI = 4.4 to 44.1 and p <0.001). The chance of receiving fibrinolytic was 50% lower in the high-risk group in relation to the low risk group (95% CI = 0.27 to 0.85, p = 0.004).

Conclusion: There was a progressive increase in mortality and incidence of in-hospital complications according to the stratification by the TIMI score. High risk patients received thrombolytic less frequently than the patients at low risk.
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http://dx.doi.org/10.1590/s0066-782x2009000800007DOI Listing
August 2009

[Prevalence of burnout syndrome in nursing staff in a large hospital in south of Brazil].

Cad Saude Publica 2009 Jul;25(7):1559-68

Faculdade de Medicina, Universidade do Sul de Santa Catarina, Tubarão, Brasil.

Burnout syndrome is a chronic adaptive disorder that affects workers and is characterized by three forms of psychological distress: emotional exhaustion, depersonalization, and a sense of low personal fulfillment. A cross-sectional quantitative design was used to apply questionnaires including socio-cultural data and the Maslach Burnout Inventory in 151 nurses and nurse technicians, representing 54.1% of this professional category in a large general hospital in Tubarão, Santa Catarina State, Brazil. Mean scores were: emotional exhaustion (17), depersonalization (7.79), and low personal fulfillment (36.6). According to the criterion proposed by Ramirez et al., no cases of burnout were diagnosed. According to the criteria by Grunfeld et al., 35.7% of the interviewees displayed burnout. The standard profile of workers with burnout identified in the study was: nurse technicians, female gender, age 26-35 years, married, with no children, and with five or more years in the profession. Hospital wards or areas with the highest proportion of nursing staff with burnout were the grouped hospital sectors (42.6%), ICU (25.9%), and neonatal ICU (18.5%). There was no statistically significant association between ward or hospital area and burnout.
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http://dx.doi.org/10.1590/s0102-311x2009000700014DOI Listing
July 2009

[Factors associated with cesarean section rates in a university hospital].

Rev Saude Publica 2009 Jun;43(3):472-80

Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil.

Objective: To assess factors associated to cesarean section.

Methods: A cross-sectional study was conducted in a university hospital in Florianópolis, Southern Brazil, from 2001 to 2005. Socioeconomic, reproductive, obstetric and institutional information were collected. Data from 7,249 deliveries was obtained from medical records and admission, delivery and post-delivery records. Cox regression was used in the analysis to estimate cesarean prevalence ratios in the categories of variables studied.

Results: Cesarean rates increased from 27.5% to 36.5% during the period studied and they were higher than those associated with medical indications. After adjustment for confounders cesarean rates were positively associated with previous cesarean section (PR=2.65, 95% CI: 2.31;3.05), non-cephalic presentation (PR=2.23, 95%CI: 1.69;2.95), oxytocin use (PR=1.77, 95%CI: 1.43;2.19), dilatation at admission (PR=2.74, 95%CI: 2.18;3.44), and obstetrician profile (>35% of cesarean sections) (PR=1.82, 95%CI: 1.36;2.42).

Conclusions: The factors associated with cesarean section indicate the need of interventions focusing on women and their reproductive experience and changes in obstetrician practice as well.
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http://dx.doi.org/10.1590/s0034-89102009000300011DOI Listing
June 2009

[Medical and non-medical factors associated with cesarean section rates in a university hospital in southern Brazil].

Cad Saude Publica 2008 May;24(5):1051-61

Departamento de Saúde Pública, Universidade Federal de Santa Catarina, Beco da Lua 232, Florianópolis, Brazil.

The objective of this study was to describe factors associated with the increase in cesarean rates in a university hospital in 2002 and 2004, exploring medical and non-medical factors. A cross-sectional study investigated 2,905 deliveries: 1,441 in 2002 and 1,464 in 2004. Differences in adjusted prevalence rates using Poisson regression and attributable risk percent were estimated for the associations between cesarean section and demographic, clinical, reproductive, institutional, obstetric, and delivery-related factors. The cesarean rate increased from 28.4% in 2002 to 36.7% in 2004. Higher maternal schooling, time of day at delivery, illness during pregnancy, and number of prenatal visits were associated with the excess rate in 2004 compared to 2002. The increased cesarean rate can be attributed at least partially to an increase in relative clinical indications and non-medical factors.
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http://dx.doi.org/10.1590/s0102-311x2008000500012DOI Listing
May 2008