Hospital Universitário Pedro Ernesto

ABSTRACT Critically ill children admitted to pediatric intensive care units (PICUs) face significant neurological risks, but it remains unclear whether neurological assessments are adequately integrated into clinical routines. We aimed to evaluate the global scientific landscape regarding neurological examination in PICU, combining bibliometric analysis with clinical-guided critical analysis. A comprehensive search was conducted on the Web of Science Core Collection (WoS-CC) using terms related to pediatric critical care and neurological evaluation. Eligible publications were original research articles approaching neurological assessment during PICU stay. Bibliometric indicators, science mapping, and study design profiling were analyzed. In a separate, clinically guided interpretative layer, reporting patterns related to timing, tools, and strategies of neurological assessment were synthesized. From 359 records, 128 articles met inclusion criteria. The United States accounted for over half of the publications, while most studies employed retrospective designs and focused on traumatic brain injury or cardiac arrest. Despite the relevance of clinical neurological examination – especially using the Glasgow Coma Scale (GCS) and Pediatric Cerebral Performance Category (PCPC), advanced neuromonitoring tools, e.g., EEG, intracranial pressure monitoring, and biomarkers were inconsistently applied. Notably, neurological evaluations were often underreported at admission and discharge and rarely extended to non-neurological PICU conditions. Our findings reveal a critical gap between the neurological vulnerability of PICU patients, and the limited, inconsistent assessment strategies reported in the literature. Expanding structured neurological evaluation to all critically ill children, not only those with overt neurological diagnoses, seems essential to promote brain health and long-term recovery.

Neural damage, which could be characterized by demyelination and neuropathic pain, is a hallmark of leprosy, driven primarily by the interaction of Mycobacterium leprae with peripheral nerves, particularly Schwann cells. The role of indoleamine 2,3-dioxygenase (IDO) in neuroinflammation and neurodegeneration has been suggested; however, its precise contribution to leprosy-associated neuropathy remains poorly understood. This study aimed to determine whether variations in serum IDO activity, inferred from the kynurenine/tryptophan (Kyn/trp) ratio, could assist in distinguishing leprosy-associated neuropathy from other peripheral neuropathies. Additionally, we investigated the potential correlation between the increase in the Kyn/trp ratio and the extent of neural impairment. Based on clinical and electrophysiological evaluations, neural damage was classified into four severity types. Kyn/trp ratio was significantly higher in patients with leprosy neuropathy than in those with non-leprosy neuropathies. Moreover, we observed that patients exhibiting no sensory or motor responses have the highest IDO levels. Thus, the data presented here suggest that given the challenges in diagnosing leprosy neuropathy, IDO-1 activity may serve as a complementary diagnostic tool to help distinguish leprosy from other peripheral neuropathies.

PurposeThis anatomical study aimed to describe, quantify, and topographically correlate the insertions of the dorsal scapholunate complex (DSLC) components, specifically the dorsal scapholunate interosseous ligament (dSLIL), dorsal radiocarpal (DRC), dorsal intercarpal (DIC), and dorsal capsuloligamentous scapholunate septum (DCSS), with each other and in relation to lunate morphology (types I and II).MethodsTwenty-seven cadaveric wrists (23 formalin fixed and 4 fresh frozen) were systematically dissected. Measurements of width and thickness for dSLIL, DRC, DIC, and DCSS insertions were performed using a 0.05-mm precision caliper. Lunate morphology was classified (Viegas type I or II). Statistical analysis included descriptive statistics, independent samples t tests or Mann-Whitney U tests for intergroup comparisons, and paired-sample tests for dSLIL insertion site differences.ResultsDRC width at the lunate insertion was significantly greater in type II lunates compared to type I (P < .001, Cohen’s d = –1.647). No other DSLC component measurements differed significantly between lunate types. The dSLIL showed no notably difference in dimensions between its scaphoid and lunate insertions. Topographically, the scaphoid apex was identified as a consistent insertion site for dSLIL and DIC, with the DCSS located anterior and slightly ulnar to it.ConclusionsThis study provides a detailed morphological characterization of the DSLC components and their topographical relationships. Key findings include a more robust DRC at the lunate insertion in type II lunates and consistent insertion patterns of dSLIL and DIC at the scaphoid apex.Clinical relevanceThe observed robustness of the DRC in type II lunates suggests a potential protective effect against dorsal intercalated segment instability collapse. The precise anatomical data regarding DSLC component insertions offer crucial guidance for improving arthroscopic diagnostic accuracy and refining surgical reconstruction techniques for scapholunate instability.

Objetivo: avaliar custo minimização quanto a utilização de dispositivos intravenosos de cateter longo versus curto em punções venosas periféricas em pacientes internados em enfermarias clínicas num Hospital Universitário. Métodos: estudo descritivo, prospectivo e exploratório à luz da análise de custo e avaliação econômica em saúde. Resultados: o custo total associado ao uso do cateter periférico longo no horizonte temporal analisado foi de 2.381,02 reais. Já quanto ao uso do cateter periférico curto, teve o custo total médio de 5.510,08 reais. Assim, é observado o valor incremental de 3.129,06 reais comparando ambos os dispositivos. Conclusão: o cateter periférico longo ainda apresentou taxas de incidência maiores quanto ao evento obstrução, no entanto, taxas inferiores de eventos com custo de intervenção superior, como a flebite e a infiltração. Mesmo com custos maiores relacionado ao dispositivo com uso ao ultrassom, se torna um procedimento mais rentável pela redução de tentativas de punção.

More than one-third of inguinal hernias are asymptomatic, and performing surgery in the absence or presence of mild symptoms remains a point of concern for many surgeons. This study aims to evaluate whether watchful waiting (WW) is a viable management strategy for asymptomatic and mildly symptomatic inguinal hernias by comparing its outcomes to early surgical repair. To broaden the scope of existing evidence, we included both recent randomized controlled trials and observational studies. PubMed, Cochrane Central, and EMBASE were searched for studies comparing early repair and WW in patients with asymptomatic or mildly symptomatic inguinal hernias. The primary outcomes assessed were the rate of crossover from WW to surgery, reasons for crossover, and the presence of pain in both groups. Secondary outcomes included quality of life (QoL) and hernia recurrence. A Kaplan-Meier failure function curve was constructed to estimate time from study enrollment to crossover. Among 619 screened studies, 12 met the inclusion criteria, covering 1,755 patients (748 (42.6%) in early surgical intervention and 1,007 [57.4%] in the WW). Among WW patients, 477 (27.1%) eventually crossed over to surgery, with crossover rates ranging from 6.1% (Patti 2014) to 75.4% (Chung 2011). Approximately 50% of WW patients required surgery within five years. The most reported reason for crossover was pain (65%), followed by impaired quality of life (16%), bowel-related symptoms such as incarceration or strangulation (8.5%), hernia volume progression (3%), and other or unspecified causes (7.5%). Pain was the most consistent patient-specific predictor of crossover to surgery. WW appears to be a viable and safe approach with low complications rates for patients with asymptomatic inguinal hernias. However, long-term data show that approximately 50% of patients cross over to surgery within five years, and this proportion exceeds 96% by 12years. Ultimately, the decision between WW and early surgical intervention should be guided by shared decision-making, considering patient values, symptom burden, comorbidities, and life expectancy.

A síndrome ectrodactilia, displasia ectodérmica e fissura labiopalatina (EEC), é uma doença genética congênita rara com herança autossômica dominante. Este relato é o primeiro na literatura sob a perspectiva do anestesiologista em relação aos cuidados perioperatórios de uma criança com síndrome EEC, submetida a correções cirúrgicas em diferentes sítios, no mesmo tempo cirúrgico, o que torna desafiadora a condução da anestesia, que deve possibilitar o controle adequado da dor e das náuseas e vômitos pós operatórios, sem retardar a alta hospitalar. Nestes casos, o planejamento pré-operatório e a integração interdisciplinar são essenciais para antecipar etapas críticas, além de permitir uma abordagem individualizada e abrangente para atingir melhores resultados. O uso de anestesia venosa total, associada à anestesia regional, pode ser uma estratégia sistêmica poupadora de opioides, diminuindo o delírio de emergência e acelerando a recuperação pediátrica.

O estudo teve como objetivo identificar a estrutura das representações sociais de voduns entre adeptos do candomblé Jeje Mahi. Método: Trata-se de um estudo descritivo, de abordagem qualitativa, ancorado na abordagem estrutural da Teoria das Representações Sociais, com ênfase na Teoria do Núcleo Central. A pesquisa foi realizada em dois templos de candomblé Jeje Mahi localizados no Rio de Janeiro, com a participação de 99 adeptos. Para caracterização dos sujeitos, utilizou-se um questionário estruturado. Para obter os conteúdos semânticos das representações, aplicou-se a técnica de evocações livres de palavras com o termo indutor "vodum". Os dados das evocações foram tratados por meio de análise prototípica e apresentados graficamente através do quadro de quatro casas e da árvore máxima de similitude. Resultados e discussão: A análise prototípica indicou que os termos que possivelmente pertencem ao núcleo central são: amor, paz e fé. Esses termos foram evocados com maior frequência e de maneira mais imediata. Na análise da árvore máxima de similitude, observou-se que a conexão entre os termos "amor" e "fé" direciona a representação do vodum. O termo "amor" desempenha um papel central nesse contexto. Conclusão: o estudo revelou que a estrutura representacional do vodum para os sujeitos envolve dimensões afetivas e transcendentais, permeadas por sentimentos que conduzem a uma relação terna e mística com o vodum, proporcionando um estado de bem-estar. Palavras-chave: Representações Sociais; Espiritualidade; Vodum; Religiosidade; Candomblé Jeje Mahi.

Acute care surgery includes urgent non-trauma general surgical emergency, in which minimally invasive approaches, notably laparoscopic, are associated with reduced postoperative morbidity and hospital stay. Although robotic surgery has demonstrated advantages in elective procedures, its safety, feasibility, and applicability across a broad spectrum of acute care conditions remain undefined. We conducted a systematic review in accordance with PRISMA guidelines, searching PubMed/MEDLINE, EMBASE, Web of Science, and the Cochrane Library from inception to December 2024 for studies analyzing the safety profile of robotic approaches in adult care surgery. Primary outcomes included length of stay, postoperative complications, conversion to open surgery, operative time, 30-day readmission, and mortality. Our search yielded 3,740 results. After proper analysis, a total of eighteen studies were included (2016-2024; n = 4,439,317), in which robotic approaches showed shorter length of stay (0.7-28.46 vs. 1-38.26days), lower complication rates (2-25.62% vs. 3.7-46%), and fewer conversions (0-11.5% vs. 0-28.7%) compared to laparoscopy, though operative times were longer (67-323 vs. 46-294.5min). Procedure-specific trends emerged, particularly to robotic cholecystectomy, concerning fewer complications (0.5-25.62% vs. 8.23-21%) and conversions (0-1.9% vs. 1.9-8.57%). In this review, robotic surgery appears as a safe and feasible alternative in acute care settings, offering potential advantages in hospital stay, postoperative complications, and conversion rates-especially for cholecystectomy and colectomy-despite longer operative durations. Further randomized trials and cost-effectiveness analyses are warranted to define its optimal role. Level III, Systematic Review Study. A review protocol for this systematic review was registered at PROSPERO CRD420251025085.