Validation of a Measurement Model to Identify Socio-emotional Difficulties in Preschool Children: The Preschool Pediatric Symptom Checklist-Chilean Version.

Identifying issues in early childhood enables timely interventions, potentially mitigating future mental health risks. In this context, this study seeks to validate the model of Preschool Pediatric Symptom Checklist for detecting social and emotional challenges among Chilean preschoolers, as reported by their caregivers. In the first stage, 36 cognitive interviews using the published Spanish version of the PPSC were conducted with caregivers, parents and/or teachers of preschool aged children, so that they could review the questions and be sure that they understood them. In stage 2, 12 experts checked the questions for coherence and consistency. As a result, only one item was slightly modified. Then, 1009 preschool caregivers answered the preliminary version of the Chilean-adapted scale (PPSC-CL). Taking into account the minor changes incorporated in the scale, and using latent variable analysis techniques, it was possible to obtain evidence of validity for the four-factor structure of the PPSC-CL. Additionally, by using the questions about children's difficulties, a robust bifactor model was established, highlighting the presence of a general factor whose items have a specific component that sustain the existence of latent dimensions for internalizing, externalizing, and attentional problems. Thanks to this advancement, it will now be possible to identify and report the occurrence of global mental health challenges in preschool-aged children.

Comparative study of video recordings of non-medical devices in laparoscopic surgery: a cross-sectional study.

INTRODUCTION: Laparoscopic surgery is the approach of choice for multiple procedures, being laparoscopic cholecystectomy one of the most frequently performed surgeries. Likewise, video recording of these surgeries has become widespread. Currently, the market offers medical recording devices (MRD) with an approximate cost of 2000 USD, and alternative non-medical recording devices (NMRD) with a cost ranging from 120 to 200 USD. To our knowledge, no comparative studies between the available recording devices have been done. We aim to compare the perception of the quality of videos recorded by MRD and NMRD in a group of surgeons and surgical residents. METHODS: A cross-sectional study was conducted using an online survey to compare recordings from three NMRDs (Elgato 30 fps, AverMedia 60 fps, Hauppauge 30 fps) and one MRD (MediCap 20 fps) during a laparoscopic cholecystectomy. The survey assessed: definition of anatomical structures (DA), fluidity of movements (FM), similarity with the operating room screen (ORsim), and overall quality (OQ). Descriptive and nonparametric analytical statistics tests were applied. Results were analyzed using JMP-15 software. RESULTS: Forty surveys were collected (80% surgeons, 20% residents). NMRDs scored significantly higher than MRD in DA (p = 0.003), FM (p < 0.001), ORsim (p < 0.001), and OQ (p < 0.001). One NMRD was chosen as the highest quality device (70%), and MRD as the poorest (78%). No significant differences were found when analyzing by surgical experience. CONCLUSIONS: In terms of recording laparoscopic procedures, non-medical video recording devices (NMRDs) outperformed medical-grade recording device (MRD) with a higher overall score. This suggests that NMRDs could serve as a cost-effective alternative with superior video quality for recording laparoscopic surgeries.

Implementation and Outcomes of a National School-Based Mental Health Program for Middle School Students in Chile.

Background: Chile's national school-based mental health program, Skills for Life (SFL), has demonstrated effectiveness in improving behavioral and academic outcomes in first- through third-grade students. The current study assessed the feasibility and outcomes of SFL's program for sixth- through eighth-grade students. Methods: We assessed the percentage of students who participated in the program and longitudinal changes on teacher-reported Teacher Observation of Classroom Adaptation Re-Revised (TOCA-RR) scores, youth-reported Pediatric Symptom Checklist-Chile (PSC-Y-CL) scores, grade-point average, and school attendance from sixth to eighth grade (2016-2018) for SFL's workshop intervention. Linear mixed effects models analyzed the association between outcome variables and workshop attendance. Results: Of the 30,649 sixth graders who attended the 754 participating schools in 2016, 28,204 (92.0%) were screened with the TOCA-RR. Of the 1829 students who screened at risk, 1344 had available workshop data for seventh grade, with 86.9% of them participating in most (≥ 7) workshop sessions. Workshop attendance was significantly associated with improvements in school attendance and peer relationships (a TOCA-RR subscale) in eighth grade. Conclusions: With high rates of behavioral health screening and workshop attendance, this study demonstrated the feasibility of implementing SFL's middle school program on a national scale. Higher workshop attendance by at-risk students was associated with better school attendance and peer relationships in eighth grade, as well as better but not significantly different outcomes on other measures (e.g., teacher-rated school performance and aggressive behavior in the classroom). Overall, these findings provide preliminary evidence of the feasibility and benefits of SFL's middle school program.

Earthquake exposure, adverse childhood experiences, and psychosocial functioning in Chilean children: A longitudinal study.

The impact of an 8.8 magnitude Chilean earthquake on elementary school students' psychosocial functioning was assessed along with exposure to adverse childhood experiences (ACEs). Skills for Life, a national school-based mental health program in Chile, routinely assesses first- and third-grade students' psychosocial functioning and classroom adaptation. Students (N = 19,627) were screened before (2009) and after (2011) the 2010 earthquake with parent- and teacher-report measures and with a parent-report of four ACEs (family psychopathology, child chronic illness, family social isolation, father absence). Earthquake exposure was categorized as mild, moderate, or severe for Chile's 15 regions. Multilevel models analyzed the unadjusted and adjusted impacts of earthquake exposure and ACEs on functioning while clustering for school- and district-level effects. In covariate-adjusted models, earthquake exposure and three ACEs were significantly associated with worsened psychosocial functioning; earthquake exposure and all four ACEs were significantly associated with worsened classroom adaptation. New family psychopathology, B = 1.90, p < .001; chronic illness, B = 2.25, p < .001; and severe earthquake impact, B = 1.29, p < .001, held the strongest negative effects on psychosocial well-being. Moderate, B = 3.04, p = .011, and severe earthquake exposure, B = 2.53, p = .047, and new family psychopathology, B = 1.99, p < .001, were associated with the worst classroom functioning 1-year postdisaster. Findings suggest that both exogenous and home-based stressors can have significant consequences for children's psychosocial functioning and classroom adaptation, and routine screening helps quantify how individual students are affected by chronic versus acute stressors.

Ángulo de fase como indicador de riesgo cardiovascular en estudiantes universitarios / Phase angle as an indicator of cardiovascular risk in university students

Resumen Introducción El ángulo de fase se utiliza actualmente como indicador del estado nutricional de los adultos y marcador pronóstico de presencia y progresión de enfermedades crónicas, como las cardiovasculares. Objetivo Determinar la asociación entre el ángulo de fase y los indicadores de riesgo cardiovascular en estudiantes universitarios. Método: Estudio correlacional de corte transversal, en el que se evalúo a 30 estudiantes universitarios (edad 22.1 ± 2 años, peso 65.6 ± 10,3 kg) a través de IPAQ (versión corta), glucometría basal, composición corporal mediante bioimpedancia eléctrica con el instrumento Inbody® de referencia 770, fuerza prensil, batería de Bosco (Optogait®) y consumo de oxígeno indirecto (test de Leger). Resultados Se encontró una media de ángulo de fase de 6.4 ± 0.66, y se halló correlación moderada entre masa magra en tronco (0.68; p = 0.05), tasa metabólica basal (0.64; p = 0.009), nivel de fitness (0.71; p = 0.003), Counter Movement Jump (0.56; p = 0.028) y ángulo de fase. Las mujeres presentan correlación entre relación de cintura y cadera (r = 0.74; p = 0.034). Conclusiones El ángulo demostró ser un indicador predictor de riesgo cardiovascular en población adulta joven; además, permitió una visión más exacta de la predisposición y la potencialidad para padecer enfermedad cardiovascular.

Abstract Introduction The phase angle is currently used as an indicator of the nutritional status of adults and a prognostic marker of the presence and progression of chronic diseases such as cardiovascular diseases. Objective To determine the association between phase angle and cardiovascular risk indicators in university students. Method Correlational cross-sectional study. Thirty university students (age 22.1 ± 2 years, weight 65.6 ± 10.3 kg) were evaluated through IPAQ (short version), baseline glucometry, body composition using electrical bioimpedance with the Inbody® reference instrument 770, prehensile force, Bosco battery (Optogait®), indirect oxygen consumption (Leger test). Results A mean phase angle 6.4 ± 0.66 was found, with a moderate correlation between lean trunk mass (0.68; p =0.05), basal metabolic rate (0.64; p = 0.009), fitness level (0.71; p = 0.003), Counter Movement Jump (0.56; p = 0.028) and phase angle. Women have a correlation between waist and hip ratio (r = 0.74; p = 0.034). Conclusions The angle proved to be a predictive indicator of cardiovascular risk in young adult population, also allowed a more accurate view of the predisposition and potential for cardiovascular disease.

Correlación y comparación entre el nivel de actividad física y flexibilidad en niños y niñas de 10 a 11 años de edad de un colegio de Concepción. Chile / Correlation and comparison between the level of physical activity and flexibility in boys and girls from 10 to 11 years of age from a school in Concepción. Chile

RESUMEN. El estudio se centró en determinar los niveles de actividad física que presentan los escolares de 10 a 11 años que asisten a un Colegio de la Ciudad de Concepción, relacionarlo y compararlo con la flexibilidad. La metodología utilizada corresponde a un estudio cuantitativo, transversal, descriptivo-correlacional; con muestreo intencionado, se evaluó a 49 escolares, para medir el nivel de actividad física se utilizó la encuesta INTA y para medir la flexibilidad se utilizó el test de V-Sit And Reach. Se utilizó la prueba de Shapiro Wilk arrojando la normalidad de los datos, la prueba Z score para establecer medias, la prueba t de Student para el nivel de significancia entre grupo, y, por último, en la relación de las variables se empleó la correlación de Pearson. Los resultados muestran que las niñas tienen un nivel de flexibilidad mayor a los niños siendo estadísticamente significativa, en cambio en el nivel de actividad física se obtiene un nivel regular no existiendo diferencias significativas. No existe correlación entre las variables estudiadas.

ABSTRACT. The study focuses on determining levels of physical activity presented by children between the ages 10 and 11, attending a school in the City of Concepción, relating it and comparing it with flexibility. The methodology used corresponds to a quantitative, cross-sectional, descriptive-correlational study; with intentional sampling, 49 students were evaluated, the INTA survey was used to assess the level of physical activity, and the V-Sit And Reach test were used to measure flexibility. The Shapiro-Wilk test was used, yielding the normality of the data, the Z score test to establish means, the Student's T test for the level of significance between the groups, and, finally, for the relationship of the variables, Pearson's correlation was used. The results show that girls have a higher level of flexibility than boys, being statistically significant, while in the level of physical activity a regular level is obtained, without significant differences. There is no correlation between the variables studied.

Nematicidal potential of hydrolates from the semi industrial vapor-pressure extraction of Spanish aromatic plants.

The nematicidal activity of hydrolate by-products from the semi industrial vapor-pressure essential oil extraction of selected aromatic plant species (commercial: Lavandula × intermedia Emeric ex Loisel. var. super, Thymus vulgaris L., T. zygis Loefl ex L. and experimentally pre-domesticated: L. luisieri (Rozeira) Rivas-Martínez) was investigated against the root-knot nematode Meloidogyne javanica by in vitro and in vivo bioassays. Liquid-liquid extraction of hydrolates yielded the corresponding aqueous and organic fractions which were biological and chemically studied. Hydrolates from L. × intermedia var. super, L. luisieri, T. vulgaris, and T. zygis showed strong in vitro nematicidal effects against M. javanica (J2 mortality and suppression of egg hatching). In the case of the Thymus species, the active components were found in the organic fraction, characterized by thymol as major component. Conversely, the nematicidal activity of L. × intermedia var. super and L. luisieri remained in the corresponding aqueous fractions. In vivo tests on tomato seedlings at sublethal doses of the hydrolates/organic fractions induced a significant reduction of nematode infectivity. In pot experiments, all hydrolates tested on tomato plants significantly affect the infection frequency and reproduction rate of the nematode population. This study demonstrates that L. × intermedia var. super, L. luisieri, T. vulgaris, and T. zygis hydrolates could be an exploitable source of potential waste protection products on root-knot nematodes.

Diabetes and cardiovascular events in high-risk patients: Insights from a multicenter registry in a middle-income country.

AIMS: The aim of this study was to determine the rate of major clinical events and its determinants in patients with previous cardiovascular event or not, and with or without diabetes from a middle-income country. METHODS: REACT study is a multicenter registry conducted between July 2010 and May 2013 in Brazil. Patients were eligible if they were over 45years old and high cardiovascular risk. Patients were followed for 12months; data were collected regarding adherence to evidence-based therapies and occurrence of clinical events (all-cause mortality, non-fatal cardiac arrest, myocardial infarction, or stroke). RESULTS: A total of 5006 subjects was included and analyzed in four groups: No diabetes and no previous cardiovascular event, n=430; diabetes and no previous cardiovascular event, n=1138; no diabetes and previous cardiovascular event, n=1747; and diabetes and previous cardiovascular event, n=1691. Major clinical events in one-year follow-up occurred in 332 patients. A previous cardiovascular event was associated with a higher risk of having another event in the follow-up (HR 2.31 95% CI 1.74-3.05, p<0.001), as did the presence of diabetes (HR 1.28 95% CI 1.10-1.73, p=0.005). In patients with diabetes,failure to reach HbA1c targetswas related topoorer event-free survival compared to patients with good metabolic control (HR 1.70 95% CI 1.01-2.84, p=0.044). CONCLUSIONS: In Brazil, diabetes confers high risk for major clinical events, but this condition is not equivalent to having a previous cardiovascular event. Moreover, not so strict targets for HbA1c in patients with diabetes and previous cardiovascular events might be considered.

Heart Rate Variability Correlates to Functional Aerobic Impairment in Hemodialysis Patients.

BACKGROUND: Autonomic dysfunction (AD) is highly prevalent in hemodialysis (HD) patients and has been implicated in their increased risk of cardiovascular mortality. OBJECTIVE: To correlate heart rate variability (HRV) during exercise treadmill test (ETT) with the values obtained when measuring functional aerobic impairment (FAI) in HD patients and controls. METHODS: Cross-sectional study involving HD patients and a control group. Clinical examination, blood sampling, transthoracic echocardiogram, 24-hour Holter, and ETT were performed. A symptom-limited ramp treadmill protocol with active recovery was employed. Heart rate variability was evaluated in time domain at exercise and recovery periods. RESULTS: Forty-one HD patients and 41 controls concluded the study. HD patients had higher FAI and lower HRV than controls (p<0.001 for both). A correlation was found between exercise HRV (SDNN) and FAI in both groups. This association was independent of age, sex, smoking, body mass index, diabetes, and clonidine or beta-blocker use, but not of hemoglobin levels. CONCLUSION: No association was found between FAI and HRV on 24-hour Holter or at the recovery period of ETT. Of note, exercise HRV was inversely correlated with FAI in HD patients and controls.

Detection of autonomic dysfunction in hemodialysis patients using the exercise treadmill test: the role of the chronotropic index, heart rate recovery, and R-R variability.

OBJECTIVE: To evaluate the ability of different parameters of exercise treadmill test to detect autonomic dysfunction in hemodialysis patients. METHODS: Cross-sectional study involving hemodialysis patients and a control group. Clinical examination, blood sampling, echocardiogram, 24-hour Holter, and exercise treadmill test were performed. A ramp treadmill protocol symptom-limited with active recovery was employed. RESULTS: Forty-one hemodialysis patients and 41 controls concluded the study. There was significant difference between hemodialysis patients and controls in autonomic function parameters in 24h-Holter and exercise treadmill test. Probability of having autonomic dysfunction in hemodialysis patients compared to controls was 29.7 at the exercise treadmill test and 13.0 in the 24-hour Holter. Chronotropic index, heart rate recovery at the 1st min, and SDNN at exercise were used to develop an autonomic dysfunction score to grade autonomic dysfunction, in which, 83% of hemodialysis patients reached a scoring ≥2 in contrast to 20% of controls. Hemodialysis was independently associated with either altered chronotropic index or autonomic dysfunction scoring ≥2 in every tested model (OR=50.1, P=0.003; and OR=270.9, P=0.002, respectively, model 5). CONCLUSION: The exercise treadmill test was feasible and useful to diagnose of the autonomic dysfunction in hemodialysis patients. Chronotropic index and autonomic dysfunction scoring ≥2 were the most effective parameters to differentiate between hemodialysis patients and controls suggesting that these variables portrays the best ability to detect autonomic dysfunction in this setting.

Heart Rate Variability Correlates to Functional Aerobic Impairment in Hemodialysis Patients / Variabilidade RR ao Esforço Correlaciona-se com Déficit Funcional Aeróbico em Pacientes em Hemodiálise

Background: Autonomic dysfunction (AD) is highly prevalent in hemodialysis (HD) patients and has been implicated in their increased risk of cardiovascular mortality. Objective: To correlate heart rate variability (HRV) during exercise treadmill test (ETT) with the values obtained when measuring functional aerobic impairment (FAI) in HD patients and controls. Methods: Cross-sectional study involving HD patients and a control group. Clinical examination, blood sampling, transthoracic echocardiogram, 24-hour Holter, and ETT were performed. A symptom-limited ramp treadmill protocol with active recovery was employed. Heart rate variability was evaluated in time domain at exercise and recovery periods. Results: Forty-one HD patients and 41 controls concluded the study. HD patients had higher FAI and lower HRV than controls (p<0.001 for both). A correlation was found between exercise HRV (SDNN) and FAI in both groups. This association was independent of age, sex, smoking, body mass index, diabetes, and clonidine or beta-blocker use, but not of hemoglobin levels. Conclusion: No association was found between FAI and HRV on 24-hour Holter or at the recovery period of ETT. Of note, exercise HRV was inversely correlated with FAI in HD patients and controls. (Arq Bras Cardiol. 2015; [online]. ahead print, PP.0-0) .

Fundamento: A disfunção autonômica (DA) é altamente prevalente em pacientes em hemodiálise (HD) e tem sido implicada no risco aumentado de mortalidade cardiovascular. Objetivo: Correlacionar a variabilidade RR (VRR) durante o teste ergométrico (TE) com o déficit funcional aeróbico (FAI) em pacientes em HD e em um grupo controle. Métodos: Trata-se de um estudo transversal no qual as variáveis analisadas foram obtidas através de exame clínico, coleta de sangue, ecocardiograma transtorácico, Holter de 24 horas e TE. Foi realizado TE em esteira pelo protocolo de rampa, limitado por sintomas, com recuperação ativa. A VRR foi avaliada no domínio do tempo no exercício e na recuperação separadamente. Resultados: Quarenta e um pacientes em HD e 41 controles concluíram o estudo. Pacientes em HD tinham maior FAI e menor VRR do que os controles (p <0,001 para ambos). Houve correlação entre FAI e VRR no exercício (SDNN) em ambos os grupos. Esta associação foi independente de idade, sexo, tabagismo, índice de massa corporal, diabetes, clonidina, betabloqueador, mas não dos níveis de hemoglobina. Conclusão: A VRR no exercício foi inversamente correlacionada com o FAI em pacientes em HD e controles. Não foram observadas associações do FAI com VRR no Holter ou no período de recuperação do TE. .

ß-adrenergic receptor polymorphisms in susceptibility, response to treatment and prognosis in heart failure: implication of ethnicity.

Common functional polymorphisms in ß-adrenergic receptor (ßAR) genes have been associated with heart failure (HF) phenotypes and pharmacogenetic interactions with ßAR blockers. This study evaluated the association between ßAR polymorphisms and carvedilol drug response and prognosis in patients with HF. In this prospective cohort controlled study, 326 volunteers were enrolled [146 HF patients (ejection fraction (EF)<50% by Simpson) and 180 healthy controls]. Drug response was evaluated by echocardiography and outcomes were mortality and hospitalization. DNA was extracted from peripheral blood leukocytes, fragments were amplified by the polymerase reaction and genotyped by restriction fragment length polymorphism (RFLP) for Ser49Gly and Arg389Gly ßAR-1 polymorphisms and Gln27Glu and Arg16Gly ßAR-2 polymorphisms. The study population was in Hardy­Weinberg equilibrium. The survival rate was adjusted using the Kaplan-Meier method. HF patients showed the following characteristics: EF 35±9%, 69.9% male, age 59±13 years, 50.7% self-identified as black, 46% had ischemic etiology. The mean follow-up of 23 months showed 18 mortalities and 46 hospitalizations. The genotypes Glu27Glu (24.7 vs. 6.1%, p=0.0004) and Arg16Arg (72.6 vs. 22.8, p<0.0001) of ßAR2 polymorphisms and Gly49Gly (33.6 vs. 4.3%, p<0.0001) of the ßAR1 polymorphism were higher in HF patients compared with controls. Patients with hospital admission showed a significantly higher Gly389 allelic frequency (54.9 vs. 42.1%, p=0.039), and the trend prevailed among patients who succumbed to the disease (61.1%, p=0.047). Black patients with the Ser49Ser genotype showed a reduced survival compared with the Gly49Gly or Ser49Gly genotypes (p=0.028). There was no association between improved LVEF >20% and ßAR polymorphisms. HF patients with ß-blocker therapy and the Gly389 allele have reduced event-free survival compared to those carrying the Arg389 allele. Additionally, systolic HF outpatients undergoing ß-blocker therapy, self­identified as black and homozygous for Ser49Ser may have reduced event-free survival, while Glu27Glu, Arg16Arg and Gly49Gly genotypes may be associated with risk for HF.

Prevalência e influência da hiperglicemia de estresse no prognóstico em uma coorte de pacientes com síndrome coronariana aguda / Influence on prognosis and prevalence of stress hyperglycemia in a cohort of patients with acute coronary syndrome

OBJETIVO: Demonstrar a prevalência da hiperglicemia de estresse em coorte de pacientes com síndrome coronariana aguda e a correlação com óbito, insuficiência cardíaca e/ou disfunção ventricular esquerda sistólica, na fase intra-hospitalar. MÉTODOS: Estudo de coorte prospectiva inicial constituída por pacientes internados com síndrome coronariana aguda, com ou sem supradesnivelamento do segmento ST. Foram comparados os grupos para demonstrar a correlação entre hiperglicemia de estresse e eventos cardiovasculares. Na comparação entre os grupos com e sem hiperglicemia de estresse, foram usados o teste do qui-quadrado ou exato de Fisher, e o teste t de student. As variáveis com valor de p<0,20 na análise univariada foram submetidas à regressão logística variáveis. RESULTADOS: Foram estudados 363 pacientes com média etária de 62,06±12,45 anos, com predomínio do gênero masculino (64,2%). O total de 96 pacientes (26,4%) apresentou hiperglicemia de estresse. Não houve diferenças entre os grupos com ou sem hiperglicemia de estresse. A área sobre a curva ROC foi de 0,67 para relação entre a hiperglicemia de estresse e o desfecho composto insuficiência cardíaca, disfunção sistólica de ventrículo esquerdo ou óbito ao fim da internação. A curva ROC mostrou ser a hiperglicemia de estresse fator preditivo do desfecho composto (óbito, insuficiência cardíaca e/ou disfunção ventricular). A análise multivariada não apontou fator de risco a idade, hiperglicemia de estresse ou frequência cardíaca de admissão. CONCLUSÃO: A hiperglicemia de estresse na amostra estudada foi frequente. Sua presença associou-se, na análise univariada, com eventos como óbito, insuficiência cardíaca e/ou disfunção ventricular na fase intra-hospitalar, em pacientes com síndrome coronariana aguda.

OBJECTIVE: To demonstrate the prevalence of stress hyperglycemia in a cohort of patients with acute coronary syndrome and to determine the correlation of stress hyperglycemia with death, heart failure and/or left ventricular systolic dysfunction during the intrahospital phase. METHODS: A prospective initial cohort study of hospitalized patients with acute coronary syndrome with or without ST segment elevation. The groups were compared to demonstrate the correlation between stress hyperglycemia and cardiovascular events. The chi-square test or Fisher's exact test and student's t-test were used to compare the groups with and without stress hyperglycemia. The variables with p<0.20 in the univariate analysis were submitted to logistic regression. RESULTS: In total, 363 patients with an average age of 12.45 ± 62.06 were studied. There was a predominance of males (64.2%). In total, 96 patients (26.4%) presented with stress hyperglycemia. There were no differences between the groups with or without stress hyperglycemia. The area under the ROC curve was 0.67 for the relationship between stress hyperglycemia and the composite outcome heart failure, left ventricular systolic dysfunction or death at the end of the hospital admission. The ROC curve proved that stress hyperglycemia was the predictor of the composite outcome (death, heart failure and/or ventricular dysfunction). The multivariate analysis did not indicate age, stress hyperglycemia or admission heart rate as risk factors. CONCLUSION: Stress hyperglycemia was common in the studied sample. In the univariate analysis, the presence of stress hyperglycemia was associated with such events as death, heart failure and/or intrahospital ventricular dysfunction in patients with acute coronary syndrome.

Múltiplos aneurismas coronarianos em pacientes com síndrome coronariana aguda / Multiple coronary artery aneurysms in a patient with acute coronary syndrome

Paciente do sexo masculino, 49 anos, foi admitido no Serviço de Emergência com quadro de taquicardia ventricular após síndrome coronariana aguda. A estratificação não invasiva foi realizada, inicialmente, com ecocardiograma transtorácico que evidenciou aneurisma ventricular esquerdo e disfunção sistólica moderada. Na análise segmentar observou-se acinesia anteroapical. Evidenciou-se ainda regurgitação mitral moderada e regurgitação aórtica leve. O paciente foi submetido, a seguir, à cineangiocoronariografia que evidenciou oclusão de artéria descendente anterior, aneurisma em coronária direita, circunflexa, diagonal e trombo organizado em ponta de ventrículo esquerdo. Decidiu-se pelo tratamento clínico.

Male patient, 49 years, was admitted to the ER with signs of ventricular tachycardia after acute coronary syndrome. Non-invasive stratification performed initially with a transthoracic echocardiogram showed a left ventricular aneurysm and moderate systolic dysfunction. The segment analysis showed anteroapical akinesis, as well as moderate mitral regurgitation and mild aortic regurgitation. The patient then underwent coronary angiography that indicated occlusion of the anterior descending artery, aneurysm in the right coronary artery,circumflex, diagonal, and organized thrombus in the left ventricle. Clinical treatment was selected.

Influence on prognosis and prevalence of stress hyperglycemia in a cohort of patients with acute coronary syndrome.

OBJECTIVE: To demonstrate the prevalence of stress hyperglycemia in a cohort of patients with acute coronary syndrome and to determine the correlation of stress hyperglycemia with death, heart failure and/or left ventricular systolic dysfunction during the intrahospital phase. METHODS: A prospective initial cohort study of hospitalized patients with acute coronary syndrome with or without ST segment elevation. The groups were compared to demonstrate the correlation between stress hyperglycemia and cardiovascular events. The chi-square test or Fisher's exact test and student's t-test were used to compare the groups with and without stress hyperglycemia. The variables with p<0.20 in the univariate analysis were submitted to logistic regression. RESULTS: In total, 363 patients with an average age of 12.45 ± 62.06 were studied. There was a predominance of males (64.2%). In total, 96 patients (26.4%) presented with stress hyperglycemia. There were no differences between the groups with or without stress hyperglycemia. The area under the ROC curve was 0.67 for the relationship between stress hyperglycemia and the composite outcome heart failure, left ventricular systolic dysfunction or death at the end of the hospital admission. The ROC curve proved that stress hyperglycemia was the predictor of the composite outcome (death, heart failure and/or ventricular dysfunction). The multivariate analysis did not indicate age, stress hyperglycemia or admission heart rate as risk factors. CONCLUSION: Stress hyperglycemia was common in the studied sample. In the univariate analysis, the presence of stress hyperglycemia was associated with such events as death, heart failure and/or intrahospital ventricular dysfunction in patients with acute coronary syndrome.

Anormalidades no descenso da frequência cardíaca ao teste ergométrico em diabéticos / Heart rate decline anomalies during treadmil tests for diabetics

Fundamentos: Estudos demonstraram que a disfunção autonômica cardiovascular, medida através da variabilidade da frequência cardíaca, está associada a aumento do risco cardiovascular. Objetivos: Comparar a presença de disautonomia em diabéticos e não diabéticos através do teste ergométrico e determinar as variáveis preditoras de disautonomia em diabéticos. Métodos: Estudo retrospectivo, com pacientes que realizaram o teste ergométrico em caráter eletivo sob protocolo individualizado de rampa. Os pacientes foram estratificados em dois grupos: diabéticos (G1) e não diabéticos (G2). Foram definidos como disautonômicos os pacientes que obtiveram uma redução da FC no primeiro minuto da recuperação <12bpm. Os grupos G1 e G2 foram comparados. As variáveis com valores de p≤0,10 foram submetidas à análise de regressão logística. Resultados: Foram avaliados 1433 pacientes submetidos ao TE. A idade média foi 52,65±13,06 anos e variou entre 18-92 anos. Observaram-se, no G1, indivíduos mais velhos, obesos e dislipidêmicos. No teste ergométrico houve diferenças na FCR no primeiro minuto, FC do picodo esforço, número de METs e déficit cronotrópico. Submetidas as variáveis da população amostral, diabéticos e não diabéticos, à regressão logística, encontrou-se um único preditor de disautonomia: o número de METs (IC95% 0,083/0,031; p<0,0001); nos diabéticos, o único preditor independente da presença de disautonomia foi o índice de massa corporal (IC95%0,002-0,025; p=0,02). Conclusão: Indivídos diabéticos apresentam recuperação mais lenta da FC no pós-esforço que não diabéticos, evidenciando maior disautonomia e menor capacidade física; os diabéticos com excesso de peso têm maior comprometimento do sistema autonômico.

Insuficiência cardíaca e depressão: uma associação com desfechos negativos / Depression and heart failure: an association with negative outcomes / Insuficiencia cardíaca y depresión: una asociación con resultados negativos

Este trabalho trata da relação entre depressão e doença cardiovascular (DCV), a qual tem relevância na piora clínica de pacientes portadores de insuficiência cardíaca (IC), bem como no aumento da taxa de hospitalizações e morbimortalidade. A depressão é mais prevalente em pacientes com IC que na população em geral, devido a hipóteses sobre o aumento da estimulação neuro-hormonal e das citocinas, mesmo em presença de menor comprometimento cardíaco. Os desfechos clínicos negativos oriundos desta associação levam ao ônus público e social. Esta revisão abordará os mecanismos psicossociais e fisiopatológicos determinantes desta associação, bem como o tratamento, o diagnóstico e prevenção da depressão em pacientes com insuficiência cardíaca. Espera-se suscitar reflexões sobre o cuidado clínico dos portadores de IC, considerando seus estressores psicossociais de adaptação para melhor monitoramento, logo, detecção precoce desta associação.

This paper deals with the relationship between depression and cardiovascular disease, which has relevance to clinical worsening in patients with heart failure (HF), as well as increased rate of hospitalizations and mortality. Depression is more prevalent in patients with HF in the general population, due to assumptions about the increased neurohormonal stimulation and cytokines, even in the presence of minor cardiac involvement. Outcomes from this negative association lead to public and social burden. This review will discuss the pathophysiological mechanisms and psychosocial determinants of this association, as well as treatment, diagnosis and prevention of depression in patients with heart failure. Expected to generate reflections on the clinical care of patients with HF, considering its adaptation to psychosocial stressors better monitoring, so early detection of this association.

El presente trabajo trata sobre la relación entre depresión y enfermedad cardiovascular, la cual tiene relevancia en el empeoramiento clínico de pacientes con insuficiencia cardíaca, así como en el aumento de la tasa de hospitalización y mortalidad. La depresión tiene mayor prevalencia en pacientes con insuficiencia cardíaca que en la población general, debido a las diversas hipótesis sobre el aumento de la estimulación neurohormonal y de las citoquinas, incluso en presencia de compromiso cardíaco menor. Los resultados clínicos de esta asociación negativa suponen una carga pública y social. En esta revisión se abordarán los mecanismos psicosociales y los determinantes fisiopatológicos de esta asociación, así como el diagnóstico, tratamiento y prevención de la depresión en pacientes con insuficiencia cardíaca. Se espera generar algunas reflexiones sobre la atención clínica de los pacientes portadores de insuficiencia cardíaca, considerando los factores de estrés psicosociales de adaptación para un mejor seguimiento, y por ende, la detección precoz de esta asociación.

Diagnóstico angiográfico da ruptura de parede livre do ventrículo esquerdo noinfarto agudo do miocárdio / Angiographic diagnosis of ruptured left ventricular free wall in acute myocardial infarction

Paciente do sexo masculino com precordialgia típica foi admitido com delta T de 8 horas e diagnóstico de infarto do miocárdio com supradesnivelamento do ST dep a rede a n t e r i o r. F o i e n caminhado paracineangiocoronariografia para realização de angioplastia primária e observou-se oclusão total da descendente anterior e de 90% na coronária direita, sem sucesso. Durante o procedimento piora do quadro clínico com sinais de tamponamento cardíaco e a ventriculografia demonstrou ruptura de parede de ventrículo esquerdo.Realizada punção pericárdica com alívio dos sintomas. Foi indicado o tratamento cirúrgico que evoluiu sem sucesso e o paciente foi a óbito.

Aplicação de escore de marcadores de baixo custo no prognóstico de pacientes com insuficiência cardíaca crônica / Application of low cost biomarkers score in prognosis analysis of patients with chronic heart failure / Aplicación de score de marcadores biológicos de bajo costo en el pronóstico de los pacientes con insuficiencia cardíaca crónica

Objetivo. Demonstrar que escore baseado em marcadores laboratoriais de baixo custo pode determinar prognóstico de pacientes ambulatoriais portadores de insuficiência cardíaca (IC). Introdução: A IC é uma doença que reconhecidamente evolui com alta morbimortalidade. Os biomarcadores estão emergindo como importante auxiliar na avaliação clínica padrão de uma variedade de desordens cardiovasculares, incluindo a IC. Métodos. Consiste em coorte prospectiva de pacientes ambulatoriais portadores de IC, foram selecionados os marcadores: sódio, high density lipoprotein (HDL), creatinina, clearance de creatinina, ácido úrico e hemoglobina. Foi conferido um ponto para alterações em cada marcador e definido como baixo risco: 0 a 2 pontos, moderado risco: 3 a 4 pontos e alto risco: 5 a 6 pontos. O desfecho primário foi óbitos de origem cardiovascular, e o secundário foi óbitos de causa cardiovascular associado a internações de causas cardiovasculares. Os métodos estatísticos utilizados foram qui-quadrado, teste t de Student, regressão de Cox e utilizado método de Kaplan Meier para análise de curva de eventos. Resultados. Foram estudados 146 pacientes com média etária de 58±13.04, 44 pacientes (30,2%) do sexo masculino e 102 (69,8%) do sexo feminino. Os desfechos foram o primário: 15 (10,2%) óbitos e secundário: 54 (37%) eventos compostos. O número de indivíduos segundo o estágio de risco: baixo: 68, intermediário: 63 e alto: 15. A taxa de eventos no baixo, intermediário e alto risco foram 8 (11,7%), 34 (54%) e 12 (80%), respectivamente. Segundo a estratificação de risco, o hazard ratio para baixo risco (HR=0,14; p=0,0001), moderado (HR=1,69; p=0,01) e alto (HR=2,46;p=0,001). Conclusão. O escore multimarcadores baseado em marcadores de baixo custo permite a estratificação prognóstica dos pacientes, permitindo prever óbitos e internações hospitalares e também criar uma estratégia terapêutica de seguimento dos pacientes de acordo a estratificação de risco.

Purpose. To demonstrate that score based on low cost laboratory markers can determine prognosis of ambulatory patients with heart failure (HF). Introduction. HF is a disease known for her evolving with high mortality. Biomarkers are emerging as an important aid in the standard clinical evaluation of a variety of cardiovascular disorders, including HF. Methods. This study consists on a prospective cohort of outpatients with HF, the markers selected were: sodium, high density lipoprotein (HDL), creatinine, creatinine clearance, uric acid and hemoglobin. One point for changes in each marker was given and defined as low risk: 0-2 points, moderate risk: 3-4 points, and high risk: 5-6 points. The primary outcome was death from cardiovascular causes and secondary deaths from cardiovascular causes associated with hospitalizations for cardiovascular causes. The statistical methods used were chi-square, Student t test, Cox regression and it was used the Kaplan Meier curve analysis of events. Results. We studied 146 patients with mean age 58±13.04, 44 male patients (30.2%) and 102 female ones (69.8%). The primary outcomes were: 15 (10.2%) deaths and secondary: 54 (37%) compound events. The number of individuals according to the stage of risk: low: 68, intermediate: 63 and higher: 15. The rate of events in low, intermediate and high risk were eight (11.7%), 34 (54%) and 12 (80%), respectively. According to the risk stratification, the hazard ratio for low risk (HR=0.14, p=0.0001), moderate (HR=1.69, p=0.01) and high (HR=2.46, p=0.001). Conclusion. The multi-markers score based on markers of low cost admits prognostic stratification of patients, allowing predicting deaths and hospital admissions, and also creating a therapeutic strategy for follow-up of patients according to risk stratification.

Objetivo. Demostrar que un score basado en marcadores de laboratorio de bajo costo puede determinar el pronóstico de pacientes ambulatorios con insuficiencia cardíaca (IC). Introducción. La IC es una enfermedad que reconocidamente evoluciona con alta mortalidad. Los biomarcadores están emergiendo como una ayuda importante en la evaluación clínica estándar de una variedad de enfermedades cardiovasculares, incluyendo la IC. Métodos. Consiste en una cohorte prospectiva de pacientes ambulatorios portadores de IC. Los marcadores seleccionados fueron sodio, lipoproteína de alta densidad (HDL), creatinina, clearance de creatinina, ácido úrico y hemoglobina. Se otorgó un punto por alteración en cada marcador, y se definió como riesgo bajo: 0-2 puntos, riesgo moderado: 3-4 puntos y riesgo alto: 5-6 puntos. El resultado primario fue muerte por causas cardiovasculares, y el secundario: muerte por causas cardiovasculares asociada a internaciones por causas cardiovasculares. Los métodos estadísticos utilizados fueron Chi-cuadrado, test T de Student, regresión de Cox y el método de Kaplan-Meier para el análisis de curvas de eventos. Resultados. Fueron estudiados 146 pacientes con una edad media de 58±13,04; 44 pacientes eran hombres (30,2%) y 102 eran mujeres (69,8%). Los resultados primarios fueron 15 (10,2%) muertes, y los secundarios, 54 (37%) eventos compuestos. El número de individuos de acuerdo al estadio de riesgo fue: bajo 68, moderado 63 y alto 15. La tasa de eventos en los estadios bajo, moderado y alto fue de 8 (11,7%), 34 (54%) y 12 (80%), respectivamente. De acuerdo a la estratificación de riesgo, hubo un hazard ratio para riesgo bajo (HR=0,14; p=0,0001), moderado (HR=1,69; p=0,01) y alto (HR=2,46; p=0,001). Conclusión. El score de multimarcadores basado en marcadores de bajo costo, permite la estratificación pronóstica de los pacientes, posibilitando la predicción de muertes y hospitalizaciones. También crea una estrategia terapéutica para el seguimiento de los pacientes, de acuerdo a la estratificación de riesgo.

Síndrome de Kearns-Sayre: Relato de caso / Síndrome de Kearns-Sayre: Reporte de un caso / Kearns-Sayre syndrome: Case report

A síndrome de Kearns-Sayre é uma mitocondriopatia caracterizada por disfunções multiorgânicas que classicamente se desenvolve antes dos vinte anos de idade. Os critérios diagnósticos mais aceitos na literatura são a tríade: oftalmoplegia externa progressiva, retinopatia pigmentar e distúrbio de condução cardíaco. O prognóstico da SKS está relacionado ao número de tecidos acometidos, bem como a gravidade das alterações. Neste artigo relata-se caso de um paciente de 18 anos que apresentou características clínicas compatíveis com a síndrome de Kearns-Sayre.

Kearns-Sayre syndrome The Kearns-Sayre syndrome (KSS) is a mitochondriopathies characterized by multiorgan dysfunction that typically develops before the age of twenty. The diagnostic criteria most widely accepted in the literature are a triad: progressive external ophthalmoplegia, pigmentary retinopathy and disorders of cardiac conduction. KSS prognosis is related to the number of tissues affected and the severity of the alterations. In this article we report on a patient who presented 18 clinical features consistent with the Kearns-Sayre syndrome.

Síndrome de Kearns-Sayre El síndrome de Kearns-Sayre (SKS) es una mitocondriopatía caracterizada por disfunciones multiorgánicas que clásicamente se desarrolla antes de los veinte años de edad. Los criterios de diagnóstico más ampliamente aceptados en la literatura son una tríada: oftalmoplejía externa progresiva, retinopatía pigmentaria y trastornos de la conducción cardíaca. El pronóstico del SKS está relacionado con el número de los tejidos afectados y la severidad de las alteraciones. En este artículo, se presenta un caso de un joven de 18 años que presentaba características clínicas compatibles con el síndrome de Kearns-Sayre.