Hospital São Vicente

Reference values for cardiac chamber quantification are essential for clinical decision-making. Brazil is a continental country with marked racial diversity and substantial regional socioeconomic and anthropometric variability, which may not be adequately represented in international echocardiographic standards. To establish reference echocardiographic measurements for healthy Brazilian adults and to investigate geographic and sex-related differences across Brazil's major regions. In this prospective, multicenter study, transthoracic echocardiograms were performed in 496 healthy volunteers (mean age 41 ± 15 years; 55% women) from five Brazilian regions. Left ventricular (LV) and left atrial (LA) dimensions, volumes, mass, ejection fraction, and global longitudinal strain (GLS) were analyzed in accordance with current guidelines. Comparisons were conducted by sex (Student's t test or Mann-Whitney U test) and by region (analysis of variance). Cardiac chamber dimensions and LV mass were greater in men, even after indexing for body surface area. LA volumes were also higher in men, although these differences were attenuated after indexing. Absolute LVGLS and right ventricle (RV) GLS (RVGLS) values were higher in women, whereas LA strain reservoir (LASr) was similar between sexes. Regionally, the Center-West exhibited significantly smaller LV volumes, a difference primarily driven by women, along with lower LVGLS and RVGLS (p < 0.001). In contrast, LA volumes were smaller in the Northeast region. No significant associations were observed between self-reported race and echocardiographic parameters, except for RVGLS and LASr, which were lower in White participants. This study establishes echocardiographic reference values in a nationally representative Brazilian cohort, confirms expected sex-related differences, and identifies previously unrecognized regional variations in cardiac chamber dimensions. These findings underscore the need for population-specific standards to ensure accurate cardiac quantification.

This study aims to assess the rate of histopathologic diagnostic discordances between the local reviewer in each country of the Sarcoma European and Latin-American Network (SELNET) consortium and expert soft tissue and bone pathologists present in the SELNET network and to evaluate the causes of discrepancies. Histologic diagnosis at the local center of each country from the SELNET consortium and its relative agreement with the revised diagnosis of expert pathologists from the SELNET pathologist network were evaluated in 347 cases of bone or soft tissue tumors over 3 years. Diagnostic concordance was observed in 296 cases (85.3% with a Cohen's κ = 0.84, P < .001), whereas in the remaining 51 cases (14.7%), diagnostic discordance was observed. In 19 of 51 cases, the discordance was considered major because it was related to a significant change in clinical management. Minor histologic discordances were observed in the remaining 32 cases. The most frequent reason for diagnostic discordances was incorrect morphologic interpretation and/or the unavailability of key diagnostic immunohistochemical markers (41.2%), or the unavailability of molecular testing to confirm morphologic and immunohistochemical data (21.6%). Incorrect interpretations of morphologic features alone occurred in 37.2% of cases. A diagnostic agreement of 85.3% was obtained between the original diagnosis in each country of the SELNET consortium and the expert pathologist of the network. Morphologic assessment of tumors, the use of newer immunohistochemical markers, and molecular analysis on a limited number of cases were found to be useful in correcting discrepancies.

Polyangiitis with granulomatosis, previously known as Wegener's granulomatosis, is a necrotizing vasculitis of small and medium-sized vessels characterized by the formation of necrotizing granulomas that primarily affect the upper respiratory tract, lungs, and kidneys. Clinically, it presents with symptoms such as chronic sinusitis, hemoptysis, dyspnea, rapidly progressive glomerulonephritis, and systemic manifestations such as fever, weight loss, and asthenia. Diagnosis is based on detecting anti-neutrophil cytoplasmic antibodies (ANCA) type PR3 and histopathological studies. Treatment includes immunosuppressants, such as corticosteroids and cyclophosphamide or rituximab, to induce remission. Two clinical cases with diagnoses of polyangiitis with granulomatosis are reported. One was a 58-year-old man with orbital involvement, saddle nose, recurrent epistaxis, chronic rhinosinusitis, and bilateral pulmonary cavitary involvement. A second case is a 44-year-old man with chronic rhinosinusitis, recurrent epistaxis, hearing loss, and bilateral tracheobronchial stenosis and chondritis. Both cases have been positive for C-ANCA; the first involved a lung biopsy that revealed necrotizing vasculitis, and the second involved a positive skin biopsy for necrotizing vasculitis. In both cases, induction treatment started with an excellent response and is currently being maintained.

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.

ObjectiveDescribe the prevalence of preoperative malnutrition in individuals undergoing primary TKA and to assess its association with age, sex, body mass index (BMI), and comorbidities, as well as the risk of prolonged postsurgical hospitalization, early prosthetic joint infection (PJI), or readmission.MethodsWe conducted a cohort study of TKAs performed between 2014 and 2016. Preoperative malnutrition was defined as a total lymphocyte count < 1,500 cells/mm3, a serum albumin concentration < 3.5 g/dL, or a transferrin concentration < 200 mg/dL within the six months before surgery.ResultsOut of the 2080 TKAs performed, 1099 had valid lymphometry, albumin, and transferrin data and were included in the analysis. The prevalence of malnutrition was 17.7%. Independent factors associated with a higher prevalence of malnutrition were age (OR = 1.03; 95% CI = (1.01–1.05)), anemia (1.55 (1.05–2.28)), low weight (3.13 (1.50–6.50)), and normal weight (1.85 (1.21–2.82)). Diabetes mellitus was inversely associated with malnutrition (0.60 (0.38–0.96)). Early PJI was diagnosed in 18 (1.6%) participants. There was no statistically significant and independent association between malnutrition and postsurgical complications.ConclusionAltered lymphocyte count, serum albumin, and transferrin levels is common among individuals undergoing TKA, particularly in older patients, those with anemia, and individuals with normal or low weight. Future studies with larger sample sizes are needed to better assess the relationship between malnutrition and adverse outcomes following TKA.

Este estudo aborda o papel do enfermeiro obstetra no contexto do parto natural humanizado, destacando a relevância da humanização na assistência ao parto e os desafios enfrentados em instituições hospitalares de ensino. A pesquisa discute práticas baseadas em evidências, como o respeito à autonomia da mulher, o estímulo ao vínculo mãe-bebê e a redução de intervenções desnecessárias, além de enfatizar o enfrentamento da violência obstétrica. Os resultados reforçam a importância da atuação do enfermeiro como mediador no cuidado centrado na mulher, promovendo segurança, acolhimento e bem-estar durante o processo de parto.

A Estratégia Saúde da Família (ESF) representa uma evolução significativa na atenção básica no Brasil, integrando equipes multiprofissionais para ampliar o acesso à saúde e promover um cuidado contínuo, especialmente em comunidades vulneráveis, como quilombolas, ribeirinhas e indígenas. Este estudo analisou o papel central dos enfermeiros na ESF, destacando suas atividades assistenciais, educativas e gerenciais. Esses profissionais desempenham funções estratégicas, incluindo visitas domiciliares, triagens e a criação de vínculos com as comunidades, essenciais para garantir a adesão ao cuidado.Os resultados apontaram que as Doenças Crônicas Não Transmissíveis (DCNTs) e as Doenças Tropicais Negligenciadas (DTNs) representam os principais desafios de saúde nessas populações, dadas as condições de vulnerabilidade socioeconômica e cultural. A atuação dos enfermeiros, ao integrar saberes tradicionais e científicos, demonstrou-se crucial para a prevenção, manejo e redução da prevalência dessas condições. A educação em saúde foi identificada como um pilar indispensável para fomentar hábitos saudáveis e aumentar a eficácia das intervenções. No entanto, limitações estruturais, como infraestrutura precária, alta rotatividade de profissionais e invisibilidade política, dificultam a continuidade e eficiência das ações. Esses fatores destacam a necessidade de políticas públicas robustas, investimentos em formação cultural para profissionais e estratégias integrativas que considerem as especificidades dessas comunidades. Conclui-se que os enfermeiros desempenham um papel transformador na ESF, contribuindo para a redução das desigualdades em saúde e a promoção de cuidados inclusivos e sustentáveis. O fortalecimento dessas práticas e a superação das barreiras estruturais são essenciais para consolidar a ESF como um modelo de equidade e eficiência na atenção primária no Brasil.

O estudo analisa a evolução temporal na taxa e nos anos potenciais de vida perdidos (APVP) por homicídios ocorridos no estado de Roraima de 2000 a 2020, sendo um estudo ecológico e de tendência temporal. A população compreendeu o total de óbitos por agressão obtidos do Sistema de Informação sobre Mortalidade. As taxas de homicídios e os APVP (variáveis dependentes) foram analisadas em função do ano (variável independente), usando modelos de regressão estimados por Mínimos Quadrados Generalizados (GLS). O modelo foi considerado significativo, com p≤0,05. Foi identificada a presença de tendência nas séries como crescente ou decrescente, conforme o sentido da reta. O valor do coeficiente de determinação foi utilizado como medida de ajuste. As taxas de homicídios total, do sexo masculino, das faixas etárias de 10 a 19 anos, 20 a 29 anos, de 30 a 59 anos, os APVP total e os APVP do sexo masculino apresentaram a tendência temporal de redução entre os anos de 2000 e 2010 e aumento entre os anos de 2011 e 2020. As taxas de homicídios do sexo feminino, da faixa etária de 0 a 9 anos, e dos APVP do sexo feminino apresentaram tendência temporal crescente linear. A faixa etária de 60 anos e mais não apresentou evidência de tendência temporal estatisticamente significativa. Além disso, as taxas de homicídios total são muito superiores ao nível epidêmico da Organização Mundial da Saúde de 10 homicídios por 100 mil habitantes. O homicídio é um importante problema de segurança e de saúde pública, além de histórico e cultural no estado de Roraima. Todas as taxas de homicídios encontram-se em aumento na última década, estão acima da média nacional, são consideradas epidêmicas, e os APVP mostraram que muitas vidas foram perdidas precocemente.

BackgroundThis study aimed at describing the demographic and clinical characteristics, treatment patterns and overall survival of patients with MM in Brazil to identify gaps in the disease diagnosis and treatment. MethodsMMyBRAve (NCT03506386) was a multicenter, observational study of patients diagnosed with MM in Brazil between January 2008 and December 2016, with data collection between August 2018 and September 2019 at 17 participating centers. ResultsOf 943 patients included, 914 had complete data for overall survival (OS) analysis. The most used frontline regimens were cyclophosphamide, thalidomide and dexamethasone; bortezomib, cyclophosphamide and dexamethasone; and thalidomide and dexamethasone. After a median follow-up of 63 months, the median OS from diagnosis was 70 months. These results indicate continuous improvements in comparison with previous observational studies from Brazil. The median OS in transplantation-ineligible (N = 491) and eligible (N = 452) patients were 49 and 93 months, respectively (hazard ratio [HR] = 0.52; 95% confidence interval [CI], 0.43 to 0.63; P < .001). The median OS also differed between patients with and without known prognostic factors. ConclusionDespite the improvements, our results suggest that access to novel agents and transplantation continue to hinder further progress in patient outcomes in Brazil and countries with similar health-care constraints.