Hospital Ernesto Dornelles

ABSTRACTThe lingering effects of COVID‐19 may impair survivors' long‐term health‐related quality of life (HRQoL). However, multicentre studies focusing on the Omicron variant, particularly in middle‐ and low‐income settings, are scarce. We conducted a prospective cohort study across 24 Brazilian hospitals between December 2021 and March 2024, when Omicron was the predominant variant. Adult COVID‐19 survivors were followed for 12 months via telephone interviews. The primary outcome was HRQoL at 12 months, assessed using the EuroQol five‐dimension three‐level questionnaire (EQ‐5D‐3L; range −0.17 to 1.0). All‐cause mortality was a secondary outcome. Among 649 participants (47.9% women; median age 71 years), the median EQ‐5D‐3L utility score at 12 months was 0.69 (IQR 0.41–0.80), and survival was 86.6%. Factors associated with lower HRQoL included female sex, age ≥ 60 years, Charlson comorbidity index ≥ 1, and need for respiratory support. Mortality was associated with age ≥ 60 years (HR 2.81), CCI ≥ 2 (HR 2.17), need for low‐flow oxygen therapy (HR 2.03), and BMI ≥ 25 kg/m² (HR 0.58). One year after hospitalization, Omicron survivors in Brazil showed impaired HRQoL and high mortality. Older age, comorbidities, and need for oxygen therapy were linked to worse outcomes. Long‐term support strategies are needed for these vulnerable populations.

ABSTRACTSurgical management in epithelial ovarian cancer (EOC) has a significant impact on overall survival (OS) and progression‐free survival (PFS). The Brazilian Society of Surgical Oncology (BSSO) supported an expert‐led task force for consensus: the best EOC surgery is provided by experienced and specialized trained surgeons in cancer centers. Laparoscopic or radiological staging can predict the possibility of complete cytoreduction (CC0) and help to reduce unnecessary laparotomies. Carcinomatosis and nodal extension should be evaluated at imaging. Multidisciplinary input is essential for determining the need for the selection of patients for surgery and adjuvant chemotherapy in patients with EOC. The BSSO proposes quality assurance criteria and the need for national consensus. Genetic counseling was deemed mandatory for all patients with EOC. This consensus states the final recommendations from BSSO for the management of EOC.

Parasagittal meningiomas commonly invade the superior sagittal sinus (SSS) and cortical veins. Reconstructing the veins can be challenging after radical meningioma removal, especially when major venous sinuses and veins are involved. The authors present a video showcasing the reconstruction of the rolandic vein during surgery for a large parasagittal meningioma. The video shows the surgical technique and motor evoked potential recovery after venous drainage returns to normal. A 59-year-old woman had been experiencing progressive weakness in her right lower limb over the past year. Magnetic resonance imaging revealed a consistent enhanced mass in the left parasagittal region over the motor area, indicating meningioma. Magnetic resonance venography showed a complete blockage of the SSS. The patient experienced the loss of motor evoked potentials after tumor removal and thrombosis of the rolandic vein. An open thrombectomy was performed, and the vein was reconnected to the SSS. The patient recovered her basal motor evoked potential. The video of a rolandic vein reconstruction emphasizes the significance of preserving and restoring venous blood flow in eloquent areas. Monitoring is crucial during meningioma surgery involving the SSS and cortical veins in the motor area to identify and reverse any motor and sensory deficits, ensuring optimal resection while maintaining the patient's quality of life. https://thejns.org/doi/10.3171/CASE24601.

BackgroundThis systematic review aims to identify predictors of intradialytic hypotension (IDH) in critically ill patients undergoing kidney replacement therapy (KRT) for acute kidney injury (AKI).MethodsA comprehensive search of PubMed was conducted from 2002 to April 2024. Studies included critically ill adults undergoing KRT for AKI, excluding pediatric patients, non-critically ill individuals, those with chronic kidney disease, and those not undergoing KRT. The primary outcome was identifying predictive tools for hypotensive episodes during KRT sessions.ResultsThe review analyzed data from 8 studies involving 2873 patients. Various machine learning models were assessed for their predictive accuracy. The Extreme Gradient Boosting Machine (XGB) model was the top performer with an area under the receiver operating characteristic curve (AUROC) of 0.828 (95% CI 0.796–0.861), closely followed by the deep neural network (DNN) with an AUROC of 0.822 (95% CI 0.789–0.856). All machine learning models outperformed other predictors. The SOCRATE score, which includes cardiovascular SOFA score, index capillary refill, and lactate level, had an AUROC of 0.79 (95% CI 0.69–0.89, p < 0.0001). Peripheral perfusion index (PPI) and heart rate variability (HRV) showed AUROCs of 0.721 (95% CI 0.547–0.857) and 0.761 (95% CI 0.59–0.887), respectively. Pulmonary vascular permeability index (PVPI) and mechanical ventilation also demonstrated significant diagnostic performance. A PVPI ≥ 1.6 at the onset of intermittent hemodialysis (IHD) sessions predicted IDH associated with preload dependence with a sensitivity of 91% (95% CI 59–100%) and specificity of 53% (95% CI 42–63%).ConclusionThis systematic review shows how combining predictive models with clinical indicators can forecast IDH in critically ill AKI patients undergoing KRT, with validation in diverse settings needed to improve accuracy and patient care strategies.

BackgroundCOVID-19 has been associated with cardiac troponin T (cTnT) elevations and changes in cardiac structure and function, but the link between cardiac dysfunction and high-sensitive cardiac troponin T (hs-cTnT) in the acute and convalescent phase is unclear.ObjectiveTo assess whether hs-cTnT concentrations are associated with cardiac dysfunction and structural abnormalities after hospitalization for COVID-19, and to evaluate the performance of hs-cTnT to rule out cardiac pathology.MethodsPatients hospitalized with COVID-19 had hs-cTnT measured during the index hospitalization and after 3-and 12 months, when they also underwent an echocardiographic study. A subset also underwent cardiovascular magnetic resonance imaging (CMR) after 6 months. Cardiac abnormalities were defined as left ventricular hypertrophy or dysfunction, right ventricular dysfunction, or CMR late gadolinium.ResultsWe included 189 patients with hs-cTnT concentrations measured during hospitalization for COVID-19, and after 3-and 12 months: Geometric mean (95%CI) 13 (11–15) ng/L, 7 (6–8) ng/L and 7 (6–8) ng/L, respectively. Cardiac abnormalities after 3 months were present in 45 (30%) and 3 (8%) of patients with hs-cTnT ≥ and < 5 ng/L at 3 months, respectively (negative predictive value 92.3% [95%CI 88.5–96.1%]). The performance was similar in patients with and without dyspnea. Hs-cTnT decreased from hospitalization to 3 months (more pronounced in intensive care unit-treated patients) and remained unchanged from 3 to 12 months, regardless of the presence of cardiac abnormalities.ConclusionHigher hs-cTnT concentrations in the convalescent phase of COVID-19 are associated with the presence of cardiac pathology and low concentrations (< 5 ng/L) may support in ruling out cardiac pathology following the infection.

ABSTRACT Introduction: Sclerosing Encapsulating Peritonitis (SEP) is a rare syndrome characterized by a chronic inflammatory process that leads to the formation of a thick fibrocollagenous membrane that surrounds and entraps intra-abdominal organs. As a result, although some cases may be asymptomatic, patients commonly develop symptoms of intestinal obstruction, and the diagnosis is often made incidentally during intra-abdominal surgeries. Case report: A 37-year-old male patient, a chronic alcoholic, was admitted with severe abdominal pain for seven days associated with abdominal distension, anorexia, and fever. Abdominal examination revealed signs of peritoneal irritation. Chest X-ray and abdominal computed tomography showed pneumoperitoneum and a large fluid collection, with signs of wall thickening extending through the pelvic cavity, parietocolic gutters, anterior abdominal cavity, and hepatodiaphragmatic space, causing compression of the hepatic parenchyma and displacement of intestinal loops. Due to these findings, the patient underwent an emergency exploratory laparotomy, in which a fibrocollagenous membrane, extensive bowel obstruction, and an abscess were identified. A total of 4.5 liters of purulent secretion were drained, the fibrous membrane was excised, the abdominal cavity was copiously washed, and a drain was placed in the upper right quadrant. He had a satisfactory resolution of the condition, without postoperative complications, and was discharged 11 days after the procedure. Conclusion: Initially, conservative management should be prioritized due to the technical difficulty of surgery and possible complications. However, in case of greater the level of peritoneal involvement and tissue adhesion, there is a higher chance of failure of conservative management, and surgical intervention may become necessary. Keywords: Peritonitis. Fibrosis Peritoneal. Intestinal Obstruction.