Mariana Costa Hoffmeister

The electronic cigarette: the new cigarette of the 21st century?

The electronic nicotine delivery system, also known as the electronic cigarette, is generating considerable controversy, not only in the general population but also among health professionals. Smokers the world over have been increasingly using electronic cigarettes as an aid to smoking cessation and as a substitute for conventional cigarettes. There are few available data regarding the safety of electronic cigarettes. There is as yet no evidence that electronic cigarettes are effective in treating nicotine addiction. Some smokers have reported using electronic cigarettes for over a year, often combined with conventional cigarettes, thus prolonging nicotine addiction. In addition, the increasing use of electronic cigarettes by adolescents is a cause for concern. The objective of this study was to describe electronic cigarettes and their components, as well as to review the literature regarding their safety; their impact on smoking initiation and smoking cessation; and regulatory issues related to their use.

Alternative diagnoses based on CT angiography of the chest in patients with suspected pulmonary thromboembolism.

Objective : To determine the prevalence of alternative diagnoses based on chest CT angiography (CTA) in patients with suspected pulmonary thromboembolism (PTE) who tested negative for PTE, as well as whether those alternative diagnoses had been considered prior to the CTA. Methods : This was a cross-sectional, retrospective study involving 191 adult patients undergoing CTA for suspected PTE between September of 2009 and May of 2012. Chest X-rays and CTAs were reviewed to determine whether the findings suggested an alternative diagnosis in the cases not diagnosed as PTE. Data on symptoms, risk factors, comorbidities, length of hospital stay, and mortality were collected. Results : On the basis of the CTA findings, PTE was diagnosed in 47 cases (24.6%). Among the 144 patients not diagnosed with PTE via CTA, the findings were abnormal in 120 (83.3%). Such findings were consistent with an alternative diagnosis that explained the symptoms in 75 patients (39.3%). Among those 75 cases, there were only 39 (20.4%) in which the same alterations had not been previously detected on chest X-rays. The most common alternative diagnosis, made solely on the basis of the CTA findings, was pneumonia (identified in 20 cases). Symptoms, risk factors, comorbidities, and the in-hospital mortality rate did not differ significantly between the patients with and without PTE. However, the median hospital stay was significantly longer in the patients with PTE than in those without (18.0 and 9.5 days, respectively; p = 0.001). Conclusions : Our results indicate that chest CTA is useful in cases of suspected PTE, because it can confirm the diagnosis and reveal findings consistent with an alternative diagnosis in a significant number of patients.

Perfil dos partos cesáreos em um hospital universitário

Introducao: A proporcao de partos cesarianos no Brasil esta muito alem da preconizada pela Organizacao Mundial da Saude, o mesmo ocorrendoem um Hospital Universitario de Porto Alegre, sul do Brasil. A taxa de cesareas e considerada um indicador poderoso na avaliacao da qualidade da assistencia perinatal. Nosso objetivo foi analisar o padrao dos partos cesarianos e normais em um hospital universitario no periodo de2004 a 2012 quanto a media de permanencia, faixa etaria da parturiente, taxa de infeccao relacionada ao parto, tipo de pagador e idade gestacional. Metodos: Estudo de coorte retrospectivo, observacional, com dados coletados no Sistema de Indicadores de Gestao (IG) de um Hospital Universitario, abrangendo o periodo de2004 a 2012. Resultados: A taxa de cesarea no hospital universitario nos anos analisados foi em media 33,21%. Em relacao as cesarianas realizadas nesta instituicao durante o periodo em estudo, observou-se que: ha uma maior prevalencia de cesareas em mulheres acima de 40 anos, ocorreu um crescimento de partos cesarianos pre-termo, a media de permanencia e taxa de infeccao foram superiores em relacao as mulheres submetidas ao parto vaginal, e houve predominio de cesarianas na saude suplementar quando comparada ao Sistema Unico de Saude. Conclusoes: As elevadas taxas de cesarea no hospital universitario, embora acima do recomendado pela OMS, sao justificadas por se tratar de um hospital terciario e estao em conformidade com o padrao observado no pais.