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Search Results: 1 - 10 of 192836 matches for " Michel Pompeu Barros de Oliveira;Figueira "
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Validation of MagedanzSCORE as a predictor of mediastinitis after coronary artery bypass graft surgery
, Michel Pompeu Barros de Oliveira;Figueira, Evelyn Soares;Santos, Cecília Andrade;Figueiredo, Omar Jacobina;Lima, Renato Oliveira Albuquerque;Rueda, Fábio Gon?alves de;Escobar, Rodrigo Renda de;Soares, Alexandre Magno Macário Nunes;Lima, Ricardo de Carvalho;
Revista Brasileira de Cirurgia Cardiovascular , 2011, DOI: 10.5935/1678-9741.20110013
Abstract: objective: the aim of this study is to evaluate the applicability of a new score for predicting mediastinitis - magedanzscore - in patients undergoing coronary artery bypass graft (cabg) surgery in the division of cardiovascular surgery of pronto socorro cardiológico de pernambuco - procape. methods: retrospective study involving 500 patients operated between may/2007 and april/2010. the registers contained all the information used to calculate the magedanzscore. the outcome of interest was mediastinitis. we calculated sensitivity, specificity, positive predictive value, negative predictive value, concordance and accuracy. the accuracy of the model was evaluated by roc (receiver operating characteristic) curve. results: the incidence of mediastinitis was 5.6%, with a lethality rate of 32.1%. in univariate analysis, the five variables of the magedanzscore were predictors of postoperative mediastinitis: chronic obstructive pulmonary disease (or 6.42; 95.0% ci 2.76-14.96; p<0.001), obesity (or 3.06; 95.0% ci 1.32-7.09; p=0.009), surgical reintervention (or 82.40; 95.0% ci 30.40-223.30; p<0.001), multiple transfusion (or 3.33; 95.0% ci 1.52-7.29; p=0.003) and stable angina class iv or unstable (or 2.59; 95.0% ci 1.19-7.64; p=0.016) according to canadian cardiovascular society. the score had a sensitivity of 96.4%, specificity of 90.0%, positive predictive value of 36.5%, negative predictive value of 99.8% and 90.4% concordance. the accuracy measured by the area under the roc curve was 96.2% (95.0% ci 94.5%-97.9%). conclusions: the magedanzscore proved to be a simple and objective index, revealing a satisfactory predictor of development of postoperative mediastinitis in patients undergoing cabg surgery at our institution
Predictors of transfusion of packed red blood cells in coronary artery bypass grafting surgery
, Michel Pompeu Barros de Oliveira;Soares, Evelyn Figueira;Santos, Cecília Andrade;Figueiredo, Omar Jacobina;Lima, Renato Oliveira Albuquerque;Rueda, Fábio Gon?alves de;Escobar, Rodrigo Renda de;Soares, Alexandre Magno Macário Nunes;Lima, Ricardo de Carvalho;
Revista Brasileira de Cirurgia Cardiovascular , 2011, DOI: 10.5935/1678-9741.20110044
Abstract: objectives: finding predictors of blood transfusion may facilitate the most efficient approach for the use of blood bank services in coronary artery bypass grafting procedures. the aim of this retrospective study is to identify preoperative and intraoperative patient characteristics predicting the need for blood transfusion during or after cabg in our local cardiac surgical service. methods: 435 patients undergoing isolated first-time cabg were reviewed for their preoperative and intraoperative variables and analyzed postoperative data. patients were 255 males and 180 females, with mean age 62.01 ± 10.13 years. regression logistic analysis was used for identifying the strongest perioperative predictors of blood transfusion. results: blood transfusion was used in 263 patients (60.5%). the mean number of transfused blood products units per patient was 2.27 ± 3.07 (0-23) units. the total number of transfused units of blood products was 983. univariate analysis identified age >65 years, weight <70 kg, body mass index <25 kg/m2, hemoglobin <13mg/dl, hematocrit < 40% and ejection fraction <50%, use of cardiopulmonary bypass (cpb), not using an internal thoracic artery as a bypass, and multiple bypasses as significant predictors. the strongest predictors using multivariate analysis were hematocrit < 40% (or 2.58; ci 1.62-4.15; p<0.001), cpb use (or 2.00; ci 1.27-3.17; p=0.003) and multiple bypasses (or 2.31; ci 1.31-4.08; p=0.036). conclusions: the identification of these risk factors leads to better identification of patients with a grater probability of using blood, allocation blood bank resources and cost-effectiveness use of blood products.
Risk factors for mediastinitis after coronary artery bypass grafting surgery
, Michel Pompeu Barros de Oliveira;Soares, Evelyn Figueira;Santos, Cecília Andrade;Figueiredo, Omar Jacobina;Lima, Renato Oliveira Albuquerque;Escobar, Rodrigo Renda;Rueda, Fábio Gon?alves de;Lima, Ricardo de Carvalho;
Revista Brasileira de Cirurgia Cardiovascular , 2011, DOI: 10.1590/S0102-76382011000100008
Abstract: objective: mediastinitis is a serious complication of median sternotomy and is associated to significant morbidity and mortality. the aim of this study is to identify risk factors for mediastinitis in patients undergoing coronary artery bypass grafting (cabg), without the use of bilateral internal thoracic artery (ita), at the division of cardiovascular surgery of pronto socorro cardiológico de pernambuco - procape. methods: a retrospective study of 500 consecutive patients operated on between may 2007 and april 2010. ten preoperative variables, seven intraoperative variables and seven postoperative variables possibly involved in the development of postoperative mediastinitis were evaluated. univariate and multivariate logistic regression analyses were performed. results: the incidence of mediastinitis was 5.6% (n=28), with a lethality rate of 32.1% (n=9). in multivariate analysis using logistic regression, five variables remained as independent risk factors: obesity (or 2.60, 95% ci 1.11 to 6.68), diabetes (or 2.71, 95% ci 1.18 to 6.65), smoking (or 2.10, 95% ci 1.12 to 4.67), use of pedicled internal thoracic artery (or 5.17, 95% ci 1.45 to 18.42) and on-pump cabg (or 2.26, 95% ci 1.14 to 5.85). conclusion: this study identified the following independent risk factors for mediastinitis after cabg: obesity, diabetes, smoking, use of pedicled ita and on-pump cabg.
Mortalidade perioperatória em diabéticos submetidos à cirurgia de revasculariza??o miocárdica
, Michel Pompeu Barros de Oliveira;Soares, Evelyn Figueira;Santos, Cecília Andrade;Figueiredo, Omar Jacobina;Lima, Renato Oliveira Albuquerque;Escobar, Rodrigo Renda;Rueda, Fábio Gon?alves de;Lima, Ricardo de Carvalho;
Revista do Colégio Brasileiro de Cirurgi?es , 2012, DOI: 10.1590/S0100-69912012000100006
Abstract: objective: to investigate the risk factors for in-hospital death in diabetic patients undergoing isolated coronary artery bypass grafting (cabg). methods: we conducted a retrospective study with 305 consecutive diabetic patients undergoing cabg in the division of cardiovascular surgery of our institution from april 2004 to april 2010. univariate analysis for categorical variables was performed with the chi-square or fisher's exact test, as appropriate. potential risk factors with p <0.05 in the univariate analysis were included in the multivariate analysis, which was performed by backward logistic regression. values of p <0.05 were considered statistically significant. results: the study population had a mean age of 61.44 years (± 9.81) and 65.6% (n=200) were male. the in-hospital mortality rate was 11.8% (n=36). the following independent risk factors for death were identified: on-pump cabg (or 6.15, 95% ci 1.57 to 24.03, p=0.009) and low cardiac output in the postoperative period (or 34.17, 95% ci 10.46 to 111.62, p <0.001). the use of internal thoracic artery (ita) was an independent protective factor for death (or 0.27, 95% ci 0.08 to 0.093, p=0.038). conclusion: this study identified the following independent risk factors for death after cabg: on-pump cabg and low cardiac output syndrome. the use of ita was an independent protective factor.
Skeletonized left internal thoracic artery is associated with lower rates of mediastinitis in diabetic patients
, Michel Pompeu Barros de Oliveira;Soares, Evelyn Figueira;Santos, Cecília Andrade;Figueiredo, Omar Jacobina;Lima, Renato Oliveira Albuquerque;Escobar, Rodrigo Renda;Rueda, Fábio Gon?alves de;Ferraz, Paulo Ernando;Lima, Ricardo Carvalho;
Revista Brasileira de Cirurgia Cardiovascular , 2011, DOI: 10.1590/S0102-76382011000200007
Abstract: background: mediastinitis is a serious complication of median sternotomy and is associated to significant morbidity and mortality. diabetes is a feared risk factor for mediastinitis and viewed with caution by cardiovascular surgeons. objective: to identify risk factors for mediastinitis in diabetics undergoing cabg surgery with use of unilateral ita in the division of cardiovascular surgery of pronto socorro cardiológico de pernambuco - procape. methods: retrospective study of 157 diabetics operated between may 2007 and april 2010. nine preoperative variables, five intraoperative variables and seven postoperative variables possibly involved in the development of postoperative mediastinitis were evaluated. univariate and multivariate logistic regression analyses were applied. results: the incidence of mediastinitis was 7% (n=11), with a lethality rate of 36.1% (n=4). variables associated with increased risk of mediastinitis were: use of pedicled ita (or 8.25, 95% ci 2.03 to 66.10, p=0.016), postoperative renal complications (or 5.10, 95% ci 1.03 to 25.62, p=0.049) and re-operation (or 7.45, 95% ci 1.24 to 42.17, p=0.023). in multivariate analysis using backward logistic regression, only one variable remained as independent risk factor: use of pedicled ita (or 7.64, 95% ci 1.95 to 61.6, p=0.048), in comparison to skeletonized ita. conclusions: we suggest that diabetics should be considered for strategies to minimize risk of infection. in diabetics that undergo unilateral ita, the problem seems to be related to how ita is harvested. diabetics should always be considered for use of skeletonized ita.
EuroSCORE e mortalidade em cirurgia de revasculariza??o miocárdica no Pronto Socorro Cardiológico de Pernambuco
, Michel Pompeu Barros de Oliveira;Soares, Evelyn Figueira;Santos, Cecília Andrade;Figueredo, Omar Jacobina;Lima, Renato Oliveira Albuquerque;Escobar, Rodrigo Renda;Silva, Frederico Pires Vasconcelos;Lima, Ricardo de Carvalho;
Revista Brasileira de Cirurgia Cardiovascular , 2010, DOI: 10.1590/S0102-76382010000400010
Abstract: objective: the aim of this study is to evaluate the applicability of euroscore in patients undergoing coronary artery bypass graft (cabg) surgery at the division of cardiovascular surgery of pernambuco cardiologic emergency medical services - procape. methods: a retrospective study involving 500 patients operated between may 2007 and april 2010. the registers contained all the information used to calculate the euroscore. the outcome of interest was death. univariate analysis and multivariate analysis by backward logistic regression were applied to assess the association between each variable in the euroscore and deaths. the following parameters were calculated: sensitivity, specificity, positive predictive value, and negative predictive value. the power of concordance between the predicted mortality by the euroscore and the observed mortality was measured using the kappa coefficient. the accuracy of the model was evaluated by the roc (receiver operating characteristic) curve. results: the incidence of death was 13%. in multivariate analysis, nine variables remained independent predictors of death: chronic obstructive pulmonary disease, creatinine >2,3mg/dl, active endocarditis, preoperative critical state, unstable angina, ejection fraction 30% to 50%, acute myocardial infarction < 90 days, emergency surgery and additional surgery. the score had a sensitivity of 88.4%, specificity of 79.3%, positive predictive value of 40.7%, negative predictive value of 97.7% and 80.6% concordance. the accuracy measured by the area under the roc curve was 0.892 (95% ci 0.862-0.922). conclusions: the euroscore proved to be a simple and objective index, revealing a satisfactory discriminator of postoperative evolution in patients undergoing cabg surgery at our institution.
Automedica??o em idosos na cidade de Salgueiro-PE
, Mirivaldo Barros e;Barros, José Augusto Cabral de;Sá, Michel Pompeu Barros de Oliveira;
Revista Brasileira de Epidemiologia , 2007, DOI: 10.1590/S1415-790X2007000100009
Abstract: objectives: to identify the determinants associated with the practice of self-medication in the 60-year-old or older population in the city of salgueiro/pernambuco/brazil. methods: a cross-sectional study was carried out in the urban zone in the city of salgueiro - pe; questionnaires were handed out between may/01/2004 and june/06/2004 in a sample population of 355 persons aged 60 years or more. data were processed and analyzed using epiinfo 6.04 software after a double entry and validated. results: the sample was comprised of 44.9% (159/355) 60-70-year olds, 69.8% (247/355) of which were female, 53.1% (188/355) illiterate, 40.7% (145/355) without having finished high school, and 77.7% (276/355) retired. in the group that used medicines without medical prescription, the drugs used most often were analgesics (30%) and antipyretics (29%). of the reasons presented to justify the use of self-prescribed medicines, pain was the most frequent one (38.3%), followed by fever (24.4%), diarrhea (8.0%), hypertension (8.0%) and cough (5.2%). there was association between the lack of exercise and self-medication (x2 =14.44 p=0.001). conclusions: there is a high prevalence of self-medication in this group; analgesics and antipyretics are the drugs used most often; pain is the symptom that most leads to self-medication; and sedentary individuals use more self-medication than those who exercise.
Educa??o Permanente em SBV e SAVC: impacto no conhecimento dos profissionais de enfermagem
Lima, Sandro Gon?alves de;Macedo, Larissa Araripe de;Vidal, Marcela de Lima;Sá, Michel Pompeu Barros de Oliveira;
Arquivos Brasileiros de Cardiologia , 2009, DOI: 10.1590/S0066-782X2009001200012
Abstract: background: the theoretical knowledge and practical skills of the basic life support (bls) and the advanced life support (als) are among the most important determining factors of the cardiopulmonary reanimation success rates. objective: assess the impact of a permanent training program in bls and als on the knowledge of nursing professionals. method: cross-sectional study. population was made of nursing professionals of a tertiary level hospital. assessments were carried out before and after training. the critical points of the international liaison committee on resuscitation (ilcor) analysis were addressed. results: 213 professionals were assessed (76 nurses, 35.7%; 38 assistants, 17.8%; and 99 technicians, 46.7%). pre-course assessment average grades were statistically different (p<0.001) among assistants (3.25), technicians (3.96) and nurses (4.69). single professional without kids showed performance significantly superior to married professional with kids (p=0.02 and 0.004 respectively). pre-training level of knowledge was inversely proportional to the time elapsed since the completion of undergraduate course or technical course. main deficiencies were related to the initial approach of airways, to post-resuscitation cares and to the external cardiac massage technique. the post-course general average grade was 7.26. assistants achieved a performance of 131.2%, technicians, of 78.9% and the nurses, of 85%, with no significant statistic difference (p=0.43). conclusion: the permanent training program in bls and als resulted in important increment in the level of knowledge of nursing professionals.
GuaragnaSCORE satisfactorily predicts outcomes in heart valve surgery in a Brazilian hospital
, Michel Pompeu Barros de Oliveira;Sá, Marcus Villander Barros de Oliveira;Albuquerque, Ana Carla Lopes de;Silva, Belisa Barreto Gomes da;Siqueira, José Williams Muniz de;Brito, Phabllo Rodrigo Santos de;Vasconcelos, Frederico Pires;Lima, Ricardo de Carvalho;
Revista Brasileira de Cirurgia Cardiovascular , 2012, DOI: 10.5935/1678-9741.20120003
Abstract: objective: the aim of this study is to evaluate the applicability of guaragnascore for predicting mortality in patients undergoing heart valve surgery in the division of cardiovascular surgery of pronto socorro cardiológico de pernambuco - procape, recife, pe, brazil. methods: retrospective study involving 491 consecutive patients operated between may/2007 and december/2010. the registers contained all the information used to calculate the score. the outcome of interest was death. association of model factors with death (univariate analysis and multivariate logistic regression analysis), association of risk score classes with death and accuracy of the model by the area under the roc (receiver operating characteristic) curve were calculated. results: the incidence of death was 15.1%. the nine variables of the score were predictive of perioperative death in both univariate and multivariate analysis. we observed that the higher the risk class of the patient (low, medium, high, very high, extremely high), the greater is the incidence of postoperative af (0%; 7.2%; 25.5%; 38.5%; 52.4%), showing that the model seems to be a good predictor of risk of postoperative death, in a statistically significant association (p <0.001). the score presented a good accuracy, since the discrimination power of the model in this study according to the roc curve was 78.1%. conclusions: the brazilian score proved to be a simple and objective index, revealing a satisfactory predictor of perioperative mortality in patients undergoing heart valve surgery at our institution.
Perfil clínico-cirúrgico de pacientes operados por ruptura do septo interventricular pós-infarto do miocárdio
, Michel Pompeu Barros de Oliveira;Sá, Marcus Villander Barros de Oliveira;Barbosa, Caio Henrique;Silva, Niedjon Peixoto de Carvalho;Escobar, Rodrigo Renda de;Rueda, Fábio Gon?alves de;Silva, Frederico Pires Vasconcelos;Lima, Ricardo de Carvalho;
Revista Brasileira de Cirurgia Cardiovascular , 2010, DOI: 10.1590/S0102-76382010000300010
Abstract: objectives: to study clinical features, complications and in-hospital outcomes of patients operated for postinfarction ventricular septal rupture. methods: a retrospective study involving 21 patients between january/1996 and june/2009. all operations were performed at the division of cardiovascular surgery of complexo hospitalar huoc/procape. results: mean age of patients was 62.81 years (± 8.21), 61.9% (n = 13) were male. rupture occurred on average 4.8 days after infarction. cardiogenic shock was observed in 57.1% (n = 12), being risk factor for death (100% with shock vs. 22.2% without shock; p<0.001). survivors had a higher mean ejection fraction compared to deaths (66.29% ± 4.61% versus 42.71% ± 4.79%, p <0.001). all were classified as high risk by the euroscore, and the survivors had lower average score compared to deaths (6.57 ± 0.53 versus 10.93 ± 2.23; p <0.001). the majority (76.2%, n = 16) of the patients needed to use vasoactive drugs and 57.1% (n = 12) considered hemodynamically unstable. need for vasoactive drugs was a risk factor for death (81.3% with vasoactive drugs versus 20% without vasoactive drugs, p = 0.025). hemodynamic instability was also a risk factor for death (100% in the unstable group versus 22.2% in the stable group; p <0.001). the rate of in-hospital mortality was 66.7% (n = 14). conclusions: the need for vasoactive drugs, hemodynamic instability and cardiogenic shock were associated with higher rates of mortality. patients who had adverse outcomes had less ventricular function and higher score in the euroscore. mortality remains high
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