JOURNAL OF SURGICAL AND CLINICAL RESEARCH

Profile of the Dysphagic Patient treated at the dysphagia outpatient clinic of the Onofre Lopes University Hospital

Nícolas Conrado — 2024-07-08

Objective: Oropharyngeal dysphagia is a clinical condition with high prevalence and impact on the quality of life of the population, therefore, the present study aimed to elaborate the profile of this patient treated at the outpatient clinic of the Hospital Universitário Onofre Lopes. Methodology: The study evaluated fifty-nine patients through anamnesis and application of the Dysphagia Handicap Index (DHI), associated with video swallowing endoscopy (VED) in order to determine the degree of dysphagia in these individuals and classify them according to the criteria de Macedo e Filho, Yale scale for the presence of food residues, Souza parameter for posterior oral leakage and FOIS scale. Results: It was found that choking, coughing and choking were the signs and symptoms most present in the subjects. Posterior oral leakage, presence of residues in valleculae and pyriform recesses were the most frequent findings in VED. Most patients obtained FOIS classification 5, followed by FOIS 7. Furthermore, a correlation was observed between the total DHI value and the FOIS classification, so that the former is capable of predicting this in 16%. Finally, a difference was found in the total DHI averages for mild and severe dysphagia. Conclusion: For the studied population, we identified choking as the most frequent symptom, posterior oral leakage as the most observed VED finding and DHI prediction for FOIS in 16%.

Introduction: Video-assisted thoracic surgery is a well-known and established technique for the treatment of lung diseases. It is considered less invasive than conventional open thoracotomy and, as a result, provides less pain and less impairment of lung

Matheus Ribeiro — 2024-07-08

Introduction: Video-assisted thoracic surgery is a well-known and established technique for the treatment of lung diseases. It is considered less invasive than conventional open thoracotomy and, as a result, provides less pain and less impairment of lung function and the shoulder girdle. Objective: To evaluate the quality of post-anesthetic recovery of patients undergoing video-assisted thoracic lung resection surgery, who received analgesia through erector spinae block or intercostal nerve block, through the application of the Qor-15 questionnaire, 24 hours after anesthesia. Method: This is a pilot project of a randomized clinical trial developed with patients undergoing lung resection surgery at the Hospital Universitário Onofre Lopes (HUOL). In it, 18 patients were randomized into two groups: one (10 patients) received analgesia through intercostal block (INT) and the other (08 patients) underwent erector spinae plane block ESP block). As a primary outcome, we assessed the quality of post-anesthesia recovery between different blocks using the QoR-15 questionnaire, applied 24 hours after the end of anesthesia. As secondary outcomes, the consumption of morphine equivalents in mg/kg in the first 24 hours and the intensity of pain through EVN (0 for absence of pain and 10, worst pain imaginable) at times 1, 3, 6, were recorded. 12 and 24 hours after the end of anesthesia, at rest and after deep inspiration. Results: There was no difference in the anesthetic quality assessed through the application of the QoR-15 questionnaire between the ESP and INT groups. Furthermore, there was no significant discrepancy in the intraoperative dose of fentanyl, numerical visual scale (VNS) at rest and movement and consumption of morphine equivalent in the 24 hours after the surgical procedure. Discussion: The results of our study suggest similar results in relation to analgesia and post-anesthesia recovery in patients undergoing video-assisted thoracic lung resection surgery, showing that the erector spinae block can provide analgesia similar to the intercostal block. The choice of anesthetic method varies according to the anesthetist's personal preference. It should also be emphasized that this is a pilot study and was not designed or developed to provide clinical inference, serving as a guide and foundation for the basis of therapeutic plans and more assertive clinical practices during future research. Conclusion: It's evident the importance of nerve blocks for pain management in video-assisted thoracoscopic surgery (VATS) patients. However, the study's findings must be viewed considering its limitations, which prevents definitive conclusions about the superiority or inferiority of the techniques. There is a necessity for larger, multicenter studies to accurately assess the clinical and statistical significance of these findings.

LERMOYEZ SYNDROME: A LITERATURE REVIEW

Henrique Bedaque — 2024-07-08

INTRODUCTION: Lermoyez Syndrome is considered a rare pathology of unknown etiology, whose clinical picture includes hypoacusis, tinnitus and vertigo, similar to Ménière's Disease, differing from the latter due to the improvement in auditory acuity during the vertigo crisis. GOAL: To review the most up-to-date articles on Lermoyez Syndrome, given its relevance for a full understanding of otoneurological complaints. METHODS: Literature review of articles published in the last 30 years, in English, Portuguese and Spanish, using the keyword “Lermoyez syndrome” in the MEDLINE, PUBMED and Scielo databases. RESULTS: Four articles were screened for full analysis. Three inferred that, although similar, there are intrinsic aspects in these patients, which distinguish their pathophysiology from those with Ménière's Disease. Audiometric tests seem to overlap the vestibular ones in terms of positive predictive value, both being widely detailed in the studies, highlighting the finding of improvement in the auditory threshold, after the vertigo episode, at lower frequencies. CONCLUSION: Although the clinical picture and audiological and vestibular findings of Lermoyez Syndrome are well described, the scarcity of studies about this disease makes it difficult to fully understand this pathology as well as its proper management.

The Impact of Gut Microbiota on Long COVID: Insights and Challenges.

Irami Araujo-Filho — 2024-07-08

Long COVID-19, characterized by persistent symptoms following acute COVID-19 infection, presents a multifaceted challenge. Recent research has unveiled the potential role of gut microbiota in shaping the course of Long COVID, offering insights into its consequences and therapeutic avenues. Dysbiosis in the gut microbiota, marked by a reduction in beneficial commensal bacteria and an increase in pro-inflammatory taxa, appears to be a common feature in Long-term COVID patients. Notably, microbiota composition correlates with symptom severity and duration, suggesting a link between gut microbiome composition and Long COVID's clinical manifestations. Various interventions, such as antibiotics, probiotics, and dietary modulation, have been explored as potential strategies to mitigate gut dysbiosis and its effects on Long-term COVID-19. Parallels between Long-term COVID and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) have been drawn, indicating potential shared mechanisms, including gut microbiota involvement. Longitudinal studies highlight the persistence of gut microbiota alterations beyond the acute phase of COVID-19, emphasizing the need for long-term monitoring and interventions. While these findings offer promise, standardized and comprehensive research is essential to establish causality and elucidate the intricate mechanisms underlying the gut microbiota's influence on Long COVID. Understanding this relationship holds the potential to develop novel approaches for managing and improving Long COVID outcomes, addressing a pressing public health concern.

Post-Acute COVID-19 Syndrome and Stroke

Irami Araujo-Filho — 2024-07-08

This review explores the multifaceted strategies to mitigate the risk of cerebrovascular impairment in young adults recovering from COVID-19. The pandemic has illuminated an increased incidence of stroke in populations traditionally considered at lower risk, underscoring the need for targeted preventative measures. Given the complex interplay between SARS-CoV-2 infection and stroke risk, this article synthesizes current evidence and recommendations across lifestyle modifications, medical interventions, and proactive health monitoring. Key recommendations include adopting a heart-healthy diet, engaging in regular physical activity, and implementing stress reduction techniques. The management of existing cardiovascular risk factors, such as hypertension and diabetes, is emphasized as crucial for minimizing stroke risk post-COVID. Moreover, education on recognizing stroke symptoms is vital for ensuring timely medical response. The review also discusses the importance of avoiding smoking, limiting alcohol intake, and, for specific high-risk individuals, the judicious use of anticoagulants. Regular medical follow-ups for monitoring post-COVID symptoms and addressing any ongoing complications are advocated to identify and manage potential risks early. In conclusion, a comprehensive approach involving lifestyle changes, vigilant management of pre-existing conditions, education on stroke symptoms, and regular healthcare engagement is essential for reducing the risk of cerebrovascular events in young adults recovering from COVID-19. This review underscores the importance of continued research and public health advocacy in addressing the long-term effects of the pandemic on cerebrovascular health.

Nanotechnology and Immunetherapy: reduction of hepatotoxicity and anti-antineoplastic efficiency

Irami Araujo-Filho — 2024-07-08

The integration of nanotechnology and immune therapy presents a revolutionary approach to cancer treatment, merging the precision of nanoscale engineering with the power of the immune system to combat malignancies. This review article explores the synergy between nanotechnology and immune therapy, highlighting its potential to enhance antineoplastic efficiency and mitigate hepatotoxicity, with a particular focus on liver cancer treatments. Nanotechnology offers novel solutions for targeted drug delivery, controlled release, and the co-delivery of therapeutic agents, thus improving the bioavailability and efficacy of immune therapies. By overcoming the challenges posed by the immunosuppressive tumor microenvironment (TME), nanotechnology-enabled strategies can potentiate the antitumor immune response and transform "cold" tumors into "hot" ones, making them more amenable to immune-mediated destruction. Despite promising advancements, the field faces challenges such as optimizing nanoparticle formulations for maximal therapeutic efficacy and safety, identifying suitable targeting ligands for specific cancer types, and addressing the heterogeneity of the TME. Comprehensive preclinical and clinical studies are required to assess the biodistribution, metabolism, and potential toxicity of nanocarriers. This review underscores the transformative potential of combining nanotechnology with immune therapy, offering insights into future directions for more effective, targeted, and safer cancer treatments.

PRINCIPLES OF LAPAROSCOPIC SURGERY

thamires barreto sancho — 2024-07-08

A introdução da laparoscopia é um exemplo de inovação cirúrgica com rápida implementação em diversas áreas da cirurgia, começando pela cirurgia da vesícula biliar. Um grande número de estudos demonstrou que a cirurgia laparoscópica está associada aos mesmos benefícios que outros procedimentos minimamente invasivos, incluindo menos dor pós-operatória, recuperação mais precoce do trânsito intestinal e menor tempo de internação hospitalar, tanto em cirurgias de doenças benignas como malignas. Apesar das preocupações iniciais sobre a segurança oncológica, alguns ensaios demonstraram que os resultados oncológicos da laparoscopia e da cirurgia aberta são semelhantes. É preciso ter cuidado com o peumoperitônio prolongado com CO2, devido aos efeitos tóxicos do gás e outras variáveis. Apresentamos aqui uma revisão da história da cirurgia laparoscópica, equipamentos, instrumentos, vantagens e desvantagens, efeitos fisiológicos, complicações, fatos relacionados ao pneumoperitônio e conversão da cirurgia laparoscópica para cirurgia aberta. A prevenção de complicações e o manejo do sangramento completam a revisão.

Neoadjuvant Chemoradiotherapy and Postoperative Digestive Fistula

Irami Araujo-Filho — 2024-07-08

The pivotal role of neoadjuvant chemotherapy and radiotherapy in enhancing the management of gastrointestinal cancers is incontrovertible. However, their implications for surgical outcomes, particularly the risk of postoperative anastomotic fistulas, necessitate comprehensive analysis. This review examines the intricate relationship between neoadjuvant treatments and anastomotic fistula formation across a spectrum of gastrointestinal cancers, integrating findings from diverse clinical studies to elucidate risk factors and potential mitigation strategies. The timing and duration of neoadjuvant therapy emerge as critical considerations, with evidence suggesting that optimized intervals between therapy completion and surgical intervention may significantly influence fistula risk. Furthermore, patient-specific factors, including underlying health conditions and tumor characteristics, are highlighted as influential in determining fistula susceptibility. Through synthesizing current research, this review aims to guide clinical decision-making by providing insights into the balancing act of maximizing oncological efficacy while minimizing surgical complications. Future directions call for tailored treatment approaches, incorporating individual risk profiles and emerging therapeutic modalities to enhance patient outcomes in the neoadjuvant setting.

The Influence of Instagram on Medical Education in the age of Artificial Intelligence: A formal assessment of its utility in Health Education

Irami Araujo-Filho — 2024-07-08

This review article explores the intricate role of Instagram and artificial intelligence (AI) in medical education and health promotion. It scrutinizes the dual-edged nature of these technologies, highlighting their potential benefits in disseminating health information and the challenges they present, particularly regarding information accuracy and misinformation. The analysis underscores Instagram's unique capacity to reach broad audiences with visually engaging health education content, emphasizing its utility in public health campaigns and crisis communication. However, the platform's susceptibility to spreading inaccurate health information necessitates urgent and proactive strategies for mitigation. Integrating AI in content management and moderation on Instagram is a promising solution to address misinformation, with the effectiveness of such technologies hinging on continuous research, development, and ethical implementation. The review advocates for developing evidence-based content and engagement strategies by health professionals and educators to maximize benefits and minimize risks associated with Instagram use. It concludes that a collaborative, multidisciplinary approach involving health professionals, educators, researchers, technology developers, and regulators is essential to leverage Instagram and AI for global health improvement responsibly.

Neoadjuvant Immunotherapy and Intestinal Microbiota: Unraveling their roles in Anastomotic Leakage and Fistula after Colorectal Cancer Surgery

Irami Araujo-Filho — 2024-07-08

This comprehensive review explores the multifaceted relationship between neoadjuvant immunotherapy, intestinal microbiota alterations, and anastomotic leakage risk in patients undergoing colectomy for colon neoplasia. With the advent of immunotherapy, remarkably immune checkpoint inhibitors, there has been a significant shift in the treatment paradigms for various cancers, including colon neoplasia. These treatments, while effective, have been associated with changes in the intestinal microbiome, which, in turn, may influence wound healing and the integrity of anastomotic sites. The review delves into the complex interactions between the immune system and the gut microbiota, examining how immunotherapy-induced dysbiosis could disrupt the delicate balance necessary for optimal anastomotic healing. It discusses the role of specific bacterial species in modulating the immune response to cancer and their impact on the efficacy of immunotherapeutic agents. Moreover, the review highlights the potential mechanisms through which the microbiota-immune system interaction could affect surgical outcomes, focusing on the development of anastomotic leaks. The implications of these findings for clinical practice are discussed, including the need for targeted strategies to modulate the gut microbiota in patients undergoing immunotherapy and colectomy. Through this discussion, the review aims to provide insights into improving patient outcomes by integrating microbiome management into colon neoplasia patients' treatment and perioperative care.