Einstein-Sao Paulo最新文献

{"title":"Impact evaluation of technical notes issued by NATJUS on healthcare judicialization.","authors":"Lucas Reis Correia, Luís Gustavo Nascimento de Paula, Julio Trecenti, Bruno Daleffi da Silva","doi":"10.31744/einstein_journal/2025GS0766","DOIUrl":"10.31744/einstein_journal/2025GS0766","url":null,"abstract":"<p><strong>Introduction: </strong>Technical Support Centers of the Judiciary (NATJUST), provide health technology assessments to judges in health-related litigations against both public and private healthcare systems. These centers provide technical notes, that can assist Brazilian Courts in making provisional rulings and determining patient access to health services during legal proceedings.</p><p><strong>Objective: </strong>This study aimed to evaluate the impact of NATJUS technical notes on preliminary injunctions in lawsuits against the Brazilian Unified Health System. Specifically, we analyzed the alignment between judicial decisions and technical notes recommendations, assessed lawsuit costs, and examined NATJUS-generated savings for Brazilian Unified Health System. Furthermore, we examined the technical notes issued by Hospital Israelita Albert Einstein, which manages the national NATJUS.</p><p><strong>Methods: </strong>We constructed a database of lawsuits with and without NATJUS technical notes. Using random forest models, we predicted the potential outcomes of preliminary injunctions where technical notes were available. Savings were estimated by examining the relationship between preliminary injunctions and case values, then compared with potential injunctions incorporating technical notes recommendations.</p><p><strong>Results: </strong>The technical notes recommendations and judges' decisions were aligned in 76% of the cases, with median savings from lawsuits amounting to BRL10,120. The estimated impact of NATJUS technical notes for Brazilian Unified Health System indicated median savings of BRL1,312.74 per case per year. Between 2020 and 2022, NATJUS resulted in total savings of BRL111.4 million. Focusing on Hospital Israelita Albert Einstein NATJUS, the cost savings for Brazilian Unified Health System amounted to BRL27 million, which indicates a return on investment of BRL1.66 per BRL1 invested in the project.</p><p><strong>Conclusion: </strong>Our findings indicate the economic importance of technical notes in shaping preliminary injunctions, not only elevating decision quality but also fostering evidence-based judicial processes.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eGS0766"},"PeriodicalIF":1.1,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mucocutaneous disease: a child with extrapulmonary manifestation of mycoplasma infection.","authors":"Kelly Regina Pereira da Silva, Rafaela Sardini Covello Giaccio, Bárbara Martins de Aquino, Marina Abellan Van Moorsel, Fernanda Mazziero Pires, Carolina Maria Hélène, Selma Maria Furman Hélène","doi":"10.31744/einstein_journal/2025RC1138","DOIUrl":"10.31744/einstein_journal/2025RC1138","url":null,"abstract":"<p><p>Mycoplasma-induced rash and mucositis is a distinctive subset of reactive infectious mucocutaneous eruption identified in 2015 to differentiate it from other mucocutaneous disorders such as Stevens-Johnson syndrome, erythema multiforme major, and toxic epidermal necrolysis. Although its pathophysiology is not completely understood, Mycoplasma-induced rash and mucositis is characterized by polyclonal B cell proliferation, production of antibodies against Mycoplasma pneumoniae, subsequent immune complex deposition, and keratinocyte apoptosis. Clinical manifestations include scattered cutaneous lesions and severe mucositis, which predominantly affect children and young males. In this report, we present the case of a 4-year-old boy with characteristic Mycoplasma-induced rash and mucositis symptoms, including erythematous annular lesions, mucosal involvement, and positive serologies for Mycoplasma pneumoniae and herpes simplex. The diagnostic challenges, treatment modalities, and differential diagnosis of erythema multiforme major are discussed. Our case underscores the importance of recognizing Mycoplasma-induced rash and mucositis as a distinct entity, facilitating accurate diagnosis and tailoring management strategies to optimize patient outcomes.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eRC1138"},"PeriodicalIF":1.1,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predatory Journals.","authors":"Jacyr Pasternak","doi":"10.31744/einstein_journal/2025ED1663","DOIUrl":"10.31744/einstein_journal/2025ED1663","url":null,"abstract":"","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eED01663"},"PeriodicalIF":1.1,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A pilot study on feasibility and hypothesis exploration: reducing on-scene length of stay of the emergency teams via ambulance dispatch teleconsultation for prehospital examination.","authors":"Tarso Augusto Duenhas Accorsi, João Carlos Barbosa, Ricardo Galesso Cardoso, José Leão de Souza Junior, Karine De Amicis, Renata Albaladejo Morbeck, José Paulo Ladeira, Eduardo Cordioli, Carlos Henrique Sartorato Pedrotti","doi":"10.31744/einstein_journal/2025AO1469","DOIUrl":"10.31744/einstein_journal/2025AO1469","url":null,"abstract":"<p><strong>Background: </strong>This pilot study showed that teleconsultation during ambulance dispatch considerably reduced the emergency team's on-scene evaluation time, underscoring the potential of telemedicine in prehospital care. ■ Teleconsultation reduced on-scene time from 36.8 to 20.6 min (p=0.019). ■ Video-based prearrival anamnesis improved team efficiency. ■ Interventions and clinical profiles were similar across the groups. ■ Study supports broader telemedicine adoption in emergency care.</p><p><strong>Objective: </strong>Ambulance transport time is an important metric in prehospital care. Limited studies have explored strategies to decrease on-scene time. We examined the effect of collecting telemedicine-based medical data during ambulance dispatch on the on-scene evaluation time of the prehospital team.</p><p><strong>Methods: </strong>This randomized, single-center, open-label study included individuals aged >18 years who independently sought hospital emergency services and requested on-site emergency care. Individuals with primary trauma emergencies occurring outside the home, cardiac arrest cases, and situations in which video communication was unfeasible were excluded.</p><p><strong>Results: </strong>Twenty patients were randomized to receive telemedicine assessment during ambulance dispatch or standard care with physician phone support. Both groups were comparable in age (53.2 ± 26.1 versus 63.4 ± 24.2 years, p=0.380), sex (50% versus 70% female, p=0.360), initial vital signs, and medical history. The main reasons for patients calls were falls from standing height (30%), followed by cardiovascular symptoms (20%), and acute neurological events (15%). Teleconsultation via a mobile application was successfully conducted in all cases. Furthermore, in situ interventions, including venous access, oxygen therapy, orthopedic immobilization, hypotension stabilization, and symptomatic treatment, were similar between the groups. The Telemedicine Group demonstrated a significantly shorter on-scene evaluation time (20.45 ± 6 min) than the Standard Group (36.80 ± 20.4 min, p = 0.019).</p><p><strong>Conclusion: </strong>Conducting checklist-based anamnesis teleconsultation during ambulance dispatch considerably decreased the on-scene evaluation time of the emergency team. Further research with larger cohorts and different settings is required to better examine telemedicine's potential in this context.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAO1469"},"PeriodicalIF":1.1,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12094677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of extubation failure on the duration of mechanical ventilation in the pediatric population.","authors":"Thamires de Carvalho Silvério, Cristiane do Prado, Milena Siciliano Nascimento","doi":"10.31744/einstein_journal/2025AO0705","DOIUrl":"10.31744/einstein_journal/2025AO0705","url":null,"abstract":"<p><strong>Background: </strong>The study demonstrated that extubation failure prolonged the total duration of mechanical ventilation to twice that observed in patients with successful extubation. These findings emphasize the critical need for daily patient assessment guided by well-defined clinical criteria to ensure mechanical ventilation is discontinued precisely when the patient is clinically prepared-neither prematurely nor unnecessarily delayed. ■ In patients who experienced extubation failure, the total ventilation time was twice as long as that of patients with successful extubation. ■ The incidence of extubation failure was 5.2%, which is relatively low compared to other studies. ■ The study revealed no significant association between the presence of pre-existing illnesses and extubation outcomes. ■ Results indicated that the primary cause of extubation failure was upper airway obstruction, accounting for 67% of cases requiring reintubation.</p><p><strong>Objective: </strong>To compare the epidemiological profiles of patients who experienced extubation failure with those who achieved success and to evaluate the impact of extubation failure on total mechanical ventilation duration.</p><p><strong>Methods: </strong>An observational study with both retrospective and prospective components was conducted on patients admitted to the Pediatric Intensive Care Unit of a private hospital. This study included patients who underwent mechanical ventilation and were extubated between January 2017 and December 2022. Patients were classified into extubation Success or Failure Groups, with failure defined as requiring a return to invasive mechanical ventilation within 48hs post-extubation. Epidemiological factors, including age, pre-existing illnesses, and time on invasive mechanical ventilation, were analyzed.</p><p><strong>Results: </strong>A total of 173 patients were included, of which 9 (5.2%) required reintubation within 48hs. The total duration of mechanical ventilation differed significantly between the Success Group (3 days [1.8; 6.6]) and the Failure Group (6.5 days [5.6; 9.3]), p=0.004. Upper airway obstruction was identified as the primary cause of extubation failure.</p><p><strong>Conclusion: </strong>This study demonstrated that extubation failure doubled the total duration of mechanical ventilation compared to successful extubation. These findings highlight the importance of daily patient assessment with clearly defined clinical criteria to ensure mechanical ventilation is discontinued precisely when the patient is ready-neither prematurely nor excessively delayed.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAO0705"},"PeriodicalIF":1.1,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12094675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mild and moderate manifestations of SARS-CoV-2 infection, including hospitalization, in children and adolescents with cystic fibrosis.","authors":"Fábia Regina Dos Santos, Daniela Gois Meneses, Ricardo Queiroz Gurgel, Tatiana Rodrigues de Moura, Camilla Natália Oliveira Santos, Lucas Sousa Magalhães, Alexia Ferreira Rodrigues, Maria Luiza Doria Almeida, Allan Valadão de Oliveira Britto, Angela Maria Silva","doi":"10.31744/einstein_journal/2025AO1312","DOIUrl":"10.31744/einstein_journal/2025AO1312","url":null,"abstract":"<p><strong>Background: </strong>Santos et al. analyzed the clinical characteristics and pulmonary function of children with cystic fibrosis infected with SARS-CoV-2. Infected children showed higher rates of dyspnea, coughing, hospitalization, and pulmonary exacerbations. Despite a temporary decline in pulmonary function, the recovery rates matched those of the uninfected children during follow-up. ■ SARS-CoV-2 infection leads to mild-to-moderate disease in children with cystic fibrosis. ■ No worsening of cystic fibrosis was observed months after infection.</p><p><strong>Objective: </strong>This study aimed to evaluate the clinical manifestations of SARS-CoV-2 in children and adolescents with cystic fibrosis.</p><p><strong>Methods: </strong>This was a case-control analysis of clinical variables and pulmonary function test results in 43 children with cystic fibrosis, 17 (39.5%) of whom tested positive for SARS-CoV-2.</p><p><strong>Results: </strong>The infected children exhibited a higher frequency of dyspnea and cough and a greater need for hospitalization. One infected child died. Pulmonary exacerbations were more frequent among the infected children. Additional data indicated a subsequent reduction in pulmonary function in the infected children, although this was not significantly different from that in the uninfected children.</p><p><strong>Conclusion: </strong>Children with cystic fibrosis who contracted SARS-CoV-2 experienced mild to moderate symptoms and required hospitalization but generally had high recovery rates.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAO1312"},"PeriodicalIF":1.1,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12094674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Multiple Mini Interviews in medical school admissions: assessment using The Big Five Personality framework.","authors":"João Sampaio Góes, Stefano Ivani de Paula, Durval Aníbal Daniel-Filho, Elda Maria Stafuzza Gonçalves Pires, Ângela Tavares Paes, Eduardo Juan Troster","doi":"10.31744/einstein_journal/2025AO1352","DOIUrl":"10.31744/einstein_journal/2025AO1352","url":null,"abstract":"<p><strong>Background: </strong>This study highlights how the Multiple Mini Interviews can be an effective format to evaluate the socio-emotional competencies of candidates seeking admission to medical school. Candidates with higher levels of conscientiousness, revealing traits of competence and self-discipline, achieved superior performance. These traits are linked to future professional success. ■ Multiple Mini Interviews assess medical school candidates' non-cognitive skills effectively. ■ Conscientiousness is found to strongly correlate with higher Multiple Mini Interviews performance. ■ Multiple Mini Interviews ensure diversity without bias toward irrelevant personality traits. ■ Structured interview formats predict academic success and professional readiness.</p><p><strong>Objective: </strong>To evaluate the effectiveness of Multiple Mini Interviews as a selection method for medical school admissions at the Faculdade Israelita de Ciências da Saúde Albert Einstein by evaluating the relationship between the Big Five personality traits and the performance of candidates in the Multiple Mini Interviews.</p><p><strong>Methods: </strong>All candidates who had completed the NEO PI-R personality test and the socio-demographic questionnaire were the participants of the study. The personality profiles of candidates who participated in the Multiple Mini Interviews process of this cross-sectional descriptive study were analyzed by crossing data to identify significant correlations.</p><p><strong>Results: </strong>Of the 225 candidates, 63% were female and the mean age of the sample was 21 years. Only the domain of Conscientiousness showed significant correlations with higher Multiple Mini Interviews scores (p=0.004). Specifically, traits of Conscientiousness such as Competence (p=0.046), Dutifulness (p=0.043), Achievement-Oriented (p=0.050) and Self-Discipline (p=0.028) were associated with better Multiple Mini Interviews performance. Other domains, like Neuroticism, Extraversion, Openness, and Agreeableness, showed no significant correlation. Additionally, socio-demographic factors had no significant impact on performance.</p><p><strong>Conclusion: </strong>The findings validate the Multiple Mini Interviews as an effective method for medical school selection, as they correlate with high-value personality traits such as Conscientiousness, while not favoring irrelevant individualities. These results orient the enhancement of selection methods, ensuring a diverse and competent student body and, overall, improving medical education. The findings thus support the use of structured interviews in admission processes, highlighting their role in identifying candidates with essential qualities for success in medical education and practice, and offer valuable insights for similar educational institutions aiming to refine their selection methods.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAO1352"},"PeriodicalIF":1.1,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12094676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Omission of dexamethasone in prophylaxis for highly emetogenic chemotherapy in patients with breast cancer.","authors":"Camilla Vieira de Rebouças, Rafaela de Brito Alves, Alayne Magalhães Trindade Domingues Yamada, Auro Del Giglio, Felipe José Silva Melo Cruz","doi":"10.31744/einstein_journal/2025AO1124","DOIUrl":"10.31744/einstein_journal/2025AO1124","url":null,"abstract":"<p><strong>Background: </strong>A phase II study evaluated a corticosteroid-free regimen (olanzapine, netupitant, and palonosetron) for the treatment of chemotherapy-induced nausea and vomiting. The results showed control rates comparable to those of standard protocols, demonstrating its feasibility without dexamethasone. ■ Evaluation of a corticosteroid-free antiemetic regimen. ■ Primary endpoint: 46% nausea control. ■ Secondary endpoint: 68% emesis control. ■ Comparable to standard four-drug protocols.</p><p><strong>Objective: </strong>Chemotherapy-induced nausea and vomiting are highly prevalent adverse events that can lead to poor treatment adherence and a decreased quality of life. To the best of our knowledge, the complete omission of dexamethasone from any regimen for preventing nausea and vomiting has not yet been evaluated. This study aimed to evaluate the efficacy of a three-drug protocol without corticosteroids for preventing nausea and vomiting.</p><p><strong>Methods: </strong>This prospective, single-arm, phase II study was designed to evaluate the efficacy of olanzapine, netupitant, and palonosetron in controlling nausea and vomiting induced by emetogenic chemotherapy. Patients were assigned to receive olanzapine on days 1-5 and netupitant and palonosetron on day 1. No corticosteroids were administered. The primary endpoint was complete nausea control during the first 5 days after chemotherapy. Secondary endpoints included complete emesis control (no emesis and no use of rescue medication) and overall complete control (no emesis, no rescue medication, and no nausea).</p><p><strong>Results: </strong>The complete nausea control rate was 46% (95% confidence interval [95%CI] 0.32-0.59). The emesis control rate was 68% (95%CI= 0.55-0.80), and the overall control rate was 46% (95%CI= 0.32-0.59).</p><p><strong>Conclusion: </strong>These findings suggest that omitting dexamethasone in highly emetogenic chemotherapy is feasible and results in nausea and vomiting control rates similar to those of the standard four-drug protocol. However, randomized controlled trials are required to confirm this hypothesis.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAO1124"},"PeriodicalIF":1.1,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12094673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality assessment of clinical practice in neuro-oncology.","authors":"Renata Carolina Acri Nunes Miranda, Suzana Maria Fleury Malheiros, André Felix Gentil, Gisele Sampaio Silva, Fabiana de Campos Cordeiro Hirata, Sérgio Eduardo Alonso Araujo, Luís Otávio Sales Caboclo","doi":"10.31744/einstein_journal/2025AO1343","DOIUrl":"10.31744/einstein_journal/2025AO1343","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In this study, we aimed to improve patient care for central nervous system conditions based on the 2021 National Institute for Health and Care Excellence guidelines. Performance measures were used to enhance team accountability and address challenges due to limited evaluate to health insurance and variations in clinical staff decision-making. Rehabilitation and observed variability in surgical costs were not measured in this study. Similar studies were also referenced, and improvements in real-time glioma management were suggested. Performance measures and standardizing practices were recommended to improve cost predictability despite the observed cost variability caused by individualized care. ■ The molecular test according to the WHO classification of CNS tumors (gliomas) was performed in 100% (172) of patients. ■ Education on chemotherapy and informed consent for patients with brain tumors was carried out for 100% (130) of the patients who had an indication for chemotherapy treatment. ■ Approximately 87% of the patients with gliomas underwent postoperative cranial MRI. ■ A multidisciplinary approach, including molecular testing, was used for 35% of patients with glioma. ■ Thromboembolic events after resection of the primary brain tumor occurred in only 0.84% (3) patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the quality indicators proposed by the American Academy of Neurology and Neuro-oncology Society in patients with primary intracranial central nervous system tumors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study is a retrospective level I analysis that used electronic medical records from the CERNER system and GDOC-SAME at the tertiary hospital. It was approved by the Research Ethics Committee and followed the Declaration of Helsinki. Data was collected and analyzed confidentially via REDCap. The research focused on patients 18 or older with primary central nervous system tumors who had surgery from August 2015 to August 2021. It excluded surgeries performed elsewhere, reoperations, secondary (metastatic) tumors, and primary central nervous system tumors outside the cranium.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The results showed that 48% of the patients had gliomas, whereas 30 and 21.6% had meningiomas and other types of tumors. Quality measures showed that 35% of the patients with grade 2-4 tumors had multidisciplinary care plan discussions. All patients with gliomas underwent molecular testing and those eligible who underwent chemotherapy were educated and provided informed consent. Postoperative magnetic resonance imaging within 72h was performed in 87% of gliomas. The length of hospital stay, postoperative complications, Eastern Cooperative Oncology Group status at discharge, and 30-day status were also potential quality measures. However, for meningioma cases, readmissions were associated with patients in the American Society of Anesthesiologists II (58.33%) and American Society of Anesthesiologists II","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAO1343"},"PeriodicalIF":1.1,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12094678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative management of adult patients undergoing coronary artery bypass grafting and valve surgery: a literature review.","authors":"Nair Naiara Barros de Vasconcelos, Veronica Neves Fialho Queiroz, Guilherme Martins de Souza, Sandrigo Mangini, Fernando Morita Fernandes Silva, Luiz Guilherme Villares da Costa, Pedro Paulo Zanella do Amaral Campos, Samuel Padovani Steffen, Flávio Takaoka, Ary Serpa Neto, Adriano José Pereira, Carmen Silvia Valente Barbas, Thiago Domingos Corrêa, Renato Carneiro de Freitas Chaves","doi":"10.31744/einstein_journal/2025RW1353","DOIUrl":"https://doi.org/10.31744/einstein_journal/2025RW1353","url":null,"abstract":"<p><strong>Purpose of review: </strong>Coronary artery bypass grafting, revascularization by percutaneous coronary intervention, and heart valve surgery are crucial therapeutic interventions for patients with various cardiovascular diseases. The objective of this literature review was to present the main evidence and practical aspects of the perioperative management of patients undergoing coronary artery bypass grafting and heart valve surgery.</p><p><strong>Recent findings: </strong>Despite advancements in surgical and anesthetic techniques, coronary artery bypass grafting and heart valve surgery present significant risks for perioperative complications and death. These complications increase morbidity, mortality, and length of hospital stay. Coronary artery bypass grafting is indicated for patients with significant left main or advanced coronary artery disease. Most patients undergoing coronary artery bypass grafting with a reasonable life expectancy are advised to adopt a multiple-arterial graft strategy using two or three arterial grafts. Revascularization by percutaneous coronary intervention is frequently performed to alleviate symptoms in patients with stable angina and coronary artery stenoses causing moderate or severe ischemia. Intraoperative coagulation management should include tranexamic acid after the induction of anesthesia and protamine immediately after the termination of extracorporeal circulation. The prophylactic use of fresh-frozen plasma, desmopressin, recombinant activated factor VII, or fibrinogen to reduce bleeding is not recommended. Inhaled anesthetics have recognized cardioprotective properties; however, it is unclear whether anesthesia with a volatile agent can reduce mortality in patients undergoing elective surgery. Echocardiography plays an important role in the perioperative management of patients by defining myocardial structure, assessing intracardiac blood flow, aiding preoperative evaluation, facilitating intraoperative monitoring, and providing real-time guidance for intervention. The perioperative management of patients undergoing coronary artery bypass grafting, percutaneous coronary intervention, and heart valve surgery is highly complex and involves numerous specific conditions. Effective management requires dedicated multidisciplinary teams skilled in timely recognition, prevention, and treatment to ensure appropriate care.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eRW1353"},"PeriodicalIF":1.1,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}