Atrioventricular block secondary to transient causes and long-term recurrence after an index event.

BACKGROUND: Atrioventricular block (AVB) secondary to transient causes can recover with its correction. However, studies assessing predictors of recovery and long-term recurrence are lacking. METHODS: Patients with advanced or complete AVB who had a reversible cause admitted in a single expert center were retrospectively studied. Patients with AVB secondary to acute coronary syndromes were excluded from analysis. RESULTS: In a population of 162 patients, the main factors associated with recovery of rhythm without a permanent pacemaker (PPM) implantation were the presence of chronic kidney disease (CKD) on dialysis (OR 7.6; CI 95% 1.2-47.5 (p = .03)); greater serum potassium levels (OR 2.3; CI 95% 1.28-4.0 (p < .01)), higher dosage of bradycardic drugs (OR 2.2; CI 95% 1.13-4.4 (p = .02)), the association between different bradycardic drugs (OR 9.0; CI 95% 2.02-40.3 (p < .01)) and between drug therapy and hyperkaliemia (OR 5.2; CI 95% 1.8-15.1 (p < .01)). There was an overall high burden of conductions abnormalities which did not correlate with recovery of rhythm (OR 0.5; CI 95% 0.19-1.5 (p = .23)). In 29 patients (17.9%) there was a correction of the AVB. During a maximum follow-up of 130 months, 24 patients (82.8%) had a recurrence which warranted a PPM. In the overall cohort only five patients (3%) had sustained recovery of rhythm. CONCLUSIONS: Recovery of AVB was mainly observed with higher doses of drug therapy, higher serum potassium levels or a combination of factors and regardless of baseline conduction abnormalities. The high rate of recurrence during follow-up warrants a close follow-up or PPM implantation at index admission.

Optimization of Biodiesel Production Process Using MoO3 Catalysts and Residual Oil: A Comprehensive Experimental 23 Study.

The study aimed to utilize MoO3 catalysts, produced on a pilot scale via combustion reaction, to produce biodiesel from residual oil. Optimization of the process was conducted using a 23 experimental design. Structural characterization of the catalysts was performed through X-ray diffraction, fluorescence, Raman spectroscopy, and particle size distribution analyses. At the same time, thermal properties were examined via thermogravimetry and differential thermal analysis. Catalytic performance was assessed following process optimization. α-MoO3 exhibited a monophasic structure with orthorhombic phase, whereas α/h-MoO3 showed a biphasic structure. α-MoO3 had a larger crystallite size and higher crystallinity, with thermal stability observed up to certain temperatures. X-ray fluorescence confirmed molybdenum oxide predominance in the catalysts, with traces of iron oxide. Particle size distribution analyses revealed polymodal distributions attributed to structural differences. Both catalysts demonstrated activity under all conditions tested, with ester conversions ranging from 93% to 99%. The single-phase catalyst had a long life cycle and was reusable for six biodiesel production cycles. The experimental design proved to be predictive and significant, with the type of catalyst being the most influential variable. Optimal conditions included α-MoO3 catalyst, oil/alcohol ratio of 1/15, and a reaction time of 60 min, resulting in high biodiesel conversion rates and showcasing the viability of MoO3 catalysts in residual oil biodiesel production.

The challenging approach of a young patient with a primary intimal sarcoma of the heart: a case report.

Background: Primary intimal sarcomas of the heart are extremely rare and have a dismal prognosis. Their management represents a complex clinical challenge since complete surgical resection is the only reliable possibility of cure but is only possible in 50% of patients. In non-resectable disease, anthracycline-based therapy is the most effective treatment, but pazopanib may be used in patients unfit to receive anthracyclines. Case summary: A 38-year-old man presented with acute right heart failure symptoms due to a primary intimal sarcoma of the heart. A definite diagnosis was made after cardiac surgery. Multi-modality cardiac imaging showed early recurrence of disease with mitral valve and pulmonary veins' invasion, and the patient was deemed inoperable. Due to chronic kidney disease and previous heart failure symptoms, he was started on first-line pazopanib palliative treatment. After 11 months of chemotherapy, there was good clinical tolerance and no evidence of disease progression, which occurred after 13 months. Discussion: This case highlights the value of a multi-modality imaging approach for cardiac masses. Most importantly, it reports the successful treatment of a young patient with a primary intimal sarcoma of the heart who was started on palliative pazopanib, with a significantly higher progression-free survival than is reported in the literature. This finding may support pazopanib as a good alternative as first-line treatment when there is contraindication for anthracycline-based chemotherapy.

A Three-Year Study on the Nutritional Composition and Occurrence of Mycotoxins of Corn Varieties with Different Transgenic Events Focusing on Poultry Nutrition.

Corn is one of the most produced cereals in the world and plays a major role in poultry nutrition. As there is limited scientific information regarding the impact of transgenic technology on the quality and nutrient composition of the grains, this study investigated the effect of three major transgenic corn varieties-VT PRO3®, PowerCore® ULTRA, and Agrisure® Viptera 3-on the field traits, nutrient composition, and mycotoxin contamination of corn grains cultivated in southern Brazil during three consecutive harvests. VT PRO3®, while demonstrating superior crop yield, showed susceptibility to mycotoxins, particularly fumonisins. In contrast, PowerCore® ULTRA, with the lowest yield, consistently exhibited lower levels of fumonisins. VT PRO3® had higher AMEn than the other varieties, while PowerCore® ULTRA had the highest total and digestible amino acid contents over the three years. The study's comprehensive analysis reveals the distinct impact of transgenic corn technologies on both productivity and nutritional levels. Balancing the crops yield, mycotoxin resistance, and nutritional content of corn is crucial to meet the demands of the poultry feed industry. Such insights are essential for decision-making, ensuring sustainability and efficiency in agricultural production as well as meeting the demands of the poultry industry.

Primary diffuse large B-cell lymphoma of the heart: A rare case of heart failure.

A 65-year-old man with previous history of smoking, controlled HIV infection, treated hepatitis B infection, and type III cryoglobulinemia, was admitted due to right heart failure symptoms and significant weight loss. Despite being haemodynamically stable, he had periods of 1:1 conduction atrial flutter and presented with respiratory alkalosis and metabolic acidosis, as well as acute kidney and hepatic dysfunction, elevated D-dimer and cardiac markers. He underwent imaging with chest computed tomography and echocardiogram that confirmed pulmonary embolism and most notably revealed a significant sized cardiac mass causing almost complete obstruction of the right chambers, with no cleavage plane with the myocardial walls and tricuspid valve. Cardiac magnetic resonance was highly suggestive of malignancy. Cardiac surgery for mass excision and endomyocardial biopsy for diagnosis were considered, but the patient died with obstructive shock unresponsive to medical treatment. The autopsy revealed a primary unspecified diffuse large B-cell lymphoma.

Training and attitudes concerning cardiac rehabilitation in Portugal: A national survey of physician members of the Portuguese Society of Cardiology.

INTRODUCTION AND OBJECTIVES: Cardiac rehabilitation (CR) is a central component in the management of cardiovascular disease. While its potential benefits have been extensively explored and confirmed, its implementation is still suboptimal, due to various possible barriers. This study aimed to assess training and attitudes concerning CR among physicians in a Portuguese setting. METHODS: An online questionnaire structured in three parts (participant characteristics, training and attitudes concerning CR, and a brief general knowledge assessment) was developed and sent to members of the Portuguese Society of Cardiology. The study population encompassed physicians with a medical specialty or residents from the third year onward of a specialty program. RESULTS: A total of 97 individuals (57.7% male, 61.9% aged ≤50 years) presented valid answers. CR was available at the workplace of 54.6% of participants. Most of them considered that the time allocated to CR training during residency was inadequate, and thought that more time was needed for this purpose. Most had not dedicated (or intended to dedicate) time for CR training, with lack of time being the most frequently attributed reason. In terms of referral, a substantial proportion of subjects did not refer patients, with lack of CR centers and human resources being the most frequent reasons. CONCLUSIONS: This survey provides contemporary data on CR training and attitudes, highlighting areas of potential improvement, such as time allocated to training in this area. These results could provide a useful pragmatic framework for optimization of training and awareness in this pivotal field of cardiovascular medicine.

Progression of partial to complete ruptures of the Achilles tendon during rehabilitation: A study using a finite element model.

Substantial research on complete Achilles tendon ruptures is available, but guidance on partial ruptures is comparatively sparse. Conservative management is considered acceptable in partial tendon ruptures affecting less than 50% of the tendon's width, but supporting experimental evidence is currently lacking. Using a previously validated finite element model of the Achilles tendon, this study aimed to assess whether loading conditions simulating an early functional rehabilitation protocol could elicit progression to a complete rupture in partial ruptures of varying severity. In silico tendon rupture simulations were performed to locate the most likely rupture site for least, moderate, and extreme subtendon twist configurations. These three models were split at the corresponding rupture site and two sets of partial ruptures were created for each, starting from the medial and lateral sides, and ranging from 10% to 50% loss of continuity. Simulations were conducted with material parameters from healthy and tendinopathic tendons. Partial ruptures were considered to progress if the volume of elements showing a maximum principal strain above 10% exceeded 3 mm3. To assess whether the tendinopathic tendons typical geometric characteristics could compensate for the inferior material properties found in tendinopathy, an additional model with increased cross-sectional area in the free tendon region was developed. Progression to complete ruptures occurred even with less than a 50% loss of continuity, regardless of subtendon twisting, and material parameters. The tendinopathic tendon model with increased cross-sectional area showed similar results. These findings suggest the current criteria for surgical treatment of partial ruptures should be reconsidered. Statement of clinical significance: The clinical significance and most appropriate treatment of partial ruptures of the Achilles tendon is unclear. Despite the widespread use of the "50% rule" in treatment decisions of partial tendon ruptures, experimental evidence supporting it is missing. The present study provides new data, from a validated aponeurotic and free Achilles tendon finite element model, showing that partial ruptures may progress to complete ruptures under loading conditions elicited from functional rehabilitation protocols, even for partial ruptures affecting less than 50% of the tendon's width. Under these novel findings, the current criteria for surgical treatment of partial ruptures should be reconsidered.

World Heart Federation Cholesterol Roadmap: The Portuguese case.

Atherosclerotic cardiovascular disease (ASCVD) remains the major cause of premature death and disability; effective cardiovascular (CV) risk prevention is fundamental. The World Heart Federation (WHF) Cholesterol Roadmap provides a framework for national policy development and aims to achieve ASCVD prevention. At the invitation of the WHF, a group of experts from the Portuguese Society of Cardiology (SPC), addressed the cholesterol burden at nationally and discussed possible strategies to include in a Portuguese cholesterol roadmap. The literature review showed that the cholesterol burden in Portugal is high and especially uncontrolled in those with the highest CV risk. An infographic scorecard was built to include in the WHF collection, for a clear idea about CV risk and cholesterol burden in Portugal, which would also be useful for health policy advocacy. The expert discussion and preventive strategies proposal followed the five pillars of the WHF document: awareness improvement; population-based approaches for CV risk and cholesterol; risk assessment/population screening; system-level approaches; surveillance of cholesterol and ASCVD outcomes. These strategies were debated by all the expert participants, with the goal of creating a national cholesterol roadmap to be used for advocacy and as a guide for CV prevention. Several key recommendations were outlined: include all stakeholders in a multidisciplinary national program; create a structured activities plan to increase awareness in the population; improve the quality of continuous CV health education; increase the interaction between different health professionals and non-health professionals; increment the referral of patients to cardiac rehabilitation; screen cholesterol levels in the general population, especially high-risk groups; promote patient self-care, engage with patients' associations; use specific social networks to spread information widely; create a national database of cholesterol levels with systematic registry of CV events; redefine strategies based on the evaluation of results; create and involve more patients' associations - invert the pyramid order. In conclusion, ASCVD and the cholesterol burden remain a strong global issue in Portugal, requiring the involvement of multiple stakeholders in prevention. The Portuguese cholesterol roadmap can provide some solutions to help urgently mitigate the problem. Population-based approaches to improve awareness and CV risk assessment and surveillance of cholesterol and ASCVD outcomes are key factors in this change. A call to action is clearly needed to fight hypercholesterolemia and ASCVD burden.

Association between intraoperative ketamine and the incidence of emergence delirium in laparoscopic surgeries: an observational study

Abstract Background: Emergence Delirium (ED) is an essential condition in the immediate postoperative period. Systematic review and meta-analysis of randomized controlled trials have concluded that the effect of ketamine on postoperative delirium remains unclear. The present study sought to evaluate if the intraoperative use of ketamine for postoperative analgesia is associated with postoperative ED in laparoscopic surgeries. Methods: A prospective observational study was performed in the PostAnesthetic Care Unit (PACU) to evaluate patients who had undergone laparoscopic surgery under a rigid intraoperative anesthesia protocol from July 2018 to January 2019. Patients submitted to laparoscopic surgery for cholecystectomy, oophorectomy, or salpingectomy with a score ≥1 on the Richmond Assessment Sedation Scale (RASS) or ≥2 on the Nursing Delirium Screening Scale (Nu-DESC) were considered to have ED. t-test, Chi-Square test or Fisher's exact tests were used for comparison. Results: One hundred and fifteen patients were studied after laparoscopic surgery. Seventeen patients (14.8%) developed ED, and the incidence of ED in patients who received ketamine was not different from that of other patients (18.3% vs. 10.6%, p = 0.262). Patients with ED had more postoperative pain and morphine requirement at the PACU (p = 0.005 and p = 0.025, respectively). Type of surgery (general surgery, OR = 6.4, 95% CI 1.2‒35.2) and postoperative pain (OR = 3.7, 95% CI 1.2‒11.4) were risk factors for ED. Conclusion: In this study, no association was found between ED and intraoperative administration of ketamine in laparoscopic surgeries. Type of surgery and postoperative pain were risk factors for ED.

Dialogando com lacan para uma compreensão da estrutura das psicoses / A dialogue with lacan to understand the structure of psychoses

O trabalho realizado e que vai aqui apresentado consiste em uma apresentação do percurso empreendido por Jacques Lacan ([1955-56] 1988) no Seminário sobre As Psicoses. A proposta de chamar o nosso percurso de "diálogos" baseia-se na leitura de outros textos e notícias que reportam ao tema, ajudando-nos a melhor compreendê-lo. Não é um percurso simples e tampouco óbvio. A escrita de Lacan, ou mesmo a estrutura psicótica, abre continuamente outras portas pelas quais pode o observador perscrutar, embora não lhe seja permitido adentrar com suas ansiosas pretensões interpretativas, plenas de significantes simbólicos. Contente-se, pois, o clínico, com a função de secretário do delírio, compreendendo-o não simplesmente como uma defesa, mas como uma outra forma de se organizar diante de um outro ­ imagem de si e que rejeita habitar o complexo mundo da linguagem.

The work carried out and which will be presented here consists of a presentation of the journey undertaken by Jacques Lacan ([1955-56] 1988) at the Seminar on The Psychoses. The proposal to call our journey "dialogues" is based on reading other texts and news that report on the topic, helping us to better understand it. It is not a simple or obvious route. Lacan's writing, or even the psychotic structure, continually opens other doors through which the observer can peer, although he is not allowed to enter with his anxious interpretative pretensions, full of symbolic signifiers. Therefore, the clinician is content, with the role of secretary of the delusion, understanding it not simply as a defense, but as another way of organizing himself in front of another - an image of himself that rejects inhabiting the complex world of language.

Ultrassonografia intravascular para guiar a intervenção coronária percutânea: resultados do registro nacional português / Intravascular ultrasound in percutaneous coronary intervention guidance: results from Portuguese registry

Introdução: As diretrizes atuais recomendam o uso da ultrassonografia intravascular de coronárias como ferramenta adjuvante em situações difíceis. Objetivo: Caracterizar a utilização da ultrassonografia intravascular em Portugal e comparar os desfechos após intervenção coronária percutânea no tronco da coronária esquerda, guiada ou não por ultrassonografia intravascular. Métodos: Estudo observacional retrospectivo multicêntrico, que analisou pacientes submetidos à intervenção coronária percutânea entre janeiro de 2012 e dezembro de 2018, incluídos no Portuguese Registry on Interventional Cardiology da Sociedade Portuguesa de Cardiologia. Valor de p bicaudal <0,05 foi considerado estatisticamente significativo. Resultados: Este estudo demonstrou variação significativa na utilização da ultrassonografia intravascular em Portugal (valor de p qui-quadrado para tendência <0,001). O ano com maior utilização foi 2016 (2,4%). Houve aumento progressivo, nos últimos 7 anos, na utilização da ultrassonografia intravascular na intervenção coronária percutânea do tronco da coronária esquerda (valor de p qui-quadrado para tendência <0,001), com importantes diferenças regionais. A população submetida à intervenção coronária percutânea do tronco da coronária esquerda guiada por ultrassonografia intravascular era mais jovem, mas tinha maior prevalência de fatores de risco cardiovascular, disfunção sistólica ventricular e lesões coronárias complexas. Além disso, esse grupo de pacientes teve menor prevalência do desfecho primário intra-hospitalar (1,4% versus 3,9%; p=0,024). Porém, após análise multivariada ajustada para fatores de confusão, este estudo não demonstrou impacto significativo da utilização da ultrassonografia intravascular no desfecho intra-hospitalar. Conclusão: A utilização da ultrassonografia intravascular na intervenção coronária percutânea do tronco da coronária esquerda vem aumentando lentamente nos últimos 7 anos em Portugal. Neste estudo, a utilização desse método não teve impacto estatístico nos desfechos intra-hospitalares.

Background: Current guidelines recommend the use of coronary intravascular ultrasound as an adjunctive tool in challenging situations. Objective: To characterize the use of intravascular ultrasound in Portugal and compare outcomes after left main percutaneous coronary intervention, with or without intravascular ultrasound. Methods: A retrospective multicentric observational study analyzed patients who underwent percutaneous coronary intervention between January 2012 and December 2018 and were included in the Portuguese Registry on Interventional Cardiology of the Sociedade Portuguesa de Cardiologia. A two-sided p-value<0.05 was considered statistically significant. Results: This study revealed significant variation of intravascular ultrasound usage in Portugal over time (p-value Chi-squared for trend <0.001). The year with maximum use was 2016 (2.4%). Regarding left main percutaneous coronary intervention, there was a progressive increase in use of intravascular ultrasound (p-value Chi-squared for trend<0.001) in the last 7 years, with important regional differences. The population submitted to left main percutaneous coronary intervention with intravascular ultrasound was younger, but had a higher prevalence of some cardiovascular risk factors, ventricular systolic dysfunction, and complex coronary lesions. Moreover, this group of patients had lower prevalence of intrahospital primary endpoint (1.4% versus 3.9%; p=0.024). However, after multivariate analysis adjusted to confounding factors, this study did not demonstrate a significant impact of intravascular ultrasound on intrahospital endpoint. Conclusion: The overall use of intravascular ultrasound in left main percutaneous coronary intervention has been slowly increasing in the last seven years, in Portugal. In this study, the use of this method had no statistical impact in intrahospital endpoints.

A atuação do empresário no executivo municipal apresenta melhores resultados? / ¿El emprendedor en el Poder Ejecutivo Municipal tiene mejores resultados? / Is a business owner a better mayor?

Resumo O objetivo deste artigo é levantar as características demográficas dos prefeitos eleitos, enfatizando os candidatos que se declaram empresários, e analisar se esse perfil tem melhores resultados quanto ao desempenho, medidos com base na situação fiscal e no Índice de Educação Básica (IDEB) do município. Para tanto, o trabalho foi dividido em duas partes. Na primeira, por meio de regressão logística, buscou-se encontrar o perfil do candidato eleito, centrando-se no fato de ele ser empresário. Na segunda seção do artigo, com o emprego da metodologia de regressão multinível, foi analisado se tal perfil escolhido pelos eleitores era responsável por um desempenho superior. Com relação aos resultados, apesar de os empresários constituírem a maioria entre os candidatos, essa característica não foi significativa para o sucesso eleitoral. Na segunda parte da pesquisa, de modo geral os resultados não encontraram correlação entre o perfil dos eleitos e o desempenho da gestão municipal. Somente a idade do prefeito foi significativa na questão fiscal dos municípios. Dessa forma, os empresários não apresentam resultados diferentes da média, o que permite pressupor que esse grupo não tem melhores habilidades e julgamentos.

Resumen El objetivo de este artículo es sondear las características demográficas de los alcaldes electos elegidos, con énfasis en los candidatos que se declaran emprendedores, y analizar si este perfil tiene mejores resultados de desempeño, medido por la situación fiscal del municipio y el puntaje del IDEB (Índice de Desarrollo de la Educación Básica). Para ello, el trabajo se dividió en dos partes. En la primera, mediante regresión logística, se buscó encontrar el perfil del candidato elegido. En la segunda parte del artículo se analizó si el perfil elegido por los votantes era responsable de un desempeño superior. La metodología utilizada fue la de regresión multinivel. En cuanto a los resultados, a pesar de que los empresarios fueron mayoría entre los candidatos, esta característica no fue significativa para explicar el éxito electoral. En general, en la segunda parte de la investigación, los resultados no demostraron correlación entre el perfil de los elegidos y el desempeño de la gestión municipal. Solo la edad del alcalde fue significativa para explicar el tema fiscal de los municipios. De esta forma, los emprendedores no presentan resultados diferentes a la media, lo que nos permite concluir que este grupo no tiene mejores habilidades y juicios. Entre las limitaciones de este trabajo, está la cuestión de que la variable "emprendedor" haya sido declarada libremente por los candidatos.

Abstract This study analyzes the demographic characteristics of elected mayors in Brazil, emphasizing those who are business owners. The research observes whether mayors with a background as business owners obtain better performance in office, which is evaluated through the municipality's fiscal situation and the IDEB (basic education development index) score. The research was conducted in two parts. The first part used logistic regression and sought to identify the profile of elected mayors. The second part analyzed whether mayors who were business owners obtained a superior performance using the multilevel regression model. The study observed that the majority of mayors had a background as business owners, but this characteristic was not significant to explain electoral success. The results of the second part did not find a correlation between mayors who are business owners and their performance. The only demographic characteristic relevant to explain differences in municipalities' fiscal results was the mayor's age. Therefore, mayors who were business owners did not present results different from those who have other backgrounds, which allows us to assume that this group does not have better skills and judgments. One of the limitations of this study is that the characteristic of being a business owner was obtained by self-declaration.

Health promotion at work: assessment of lifestyles of administrative assistants in a hospital / Promoción de la salud en el trabajo: evaluación de los estilos de vida de auxiliares administrativos en un hospital / Promoção da saúde no trabalho: avaliação dos estilos de vida de assistentes administrativos de um hospital

ABSTRACT Objective: To characterize the lifestyles of administrative assistants in a hospital, in order to define health promotion strategies in the workplace. Method: A quantitative, descriptive, cross-sectional study, carried out with administrative assistants (N = 167) of a medium-sized Portuguese hospital. The data were collected through a questionnaire (QEV&PS-SO) for sociodemographic characterization and analysis of health determinants related to lifestyles. Results: It was observed that 54% of the sample did not practice physical exercise, 52% had four or fewer meals a day, 29% were smokers, 51% had insomnia, and 45% had no health surveillance, as well as 51.5% were overweight or obese and 63% had an increased or very increased risk of developing metabolic complications. No significant differences were identified in relation to weight, physical exercise or stress according to sex or age. Conclusion: The results support the need to develop intervention programs with strategies aimed at promoting healthy lifestyles among workers in health institutions, to be comprehensively integrated within the scope of occupational health.

RESUMEN Objetivo: Caracterizar los estilos de vida de los auxiliares administrativos de un hospital, para definir estrategias de promoción de la salud en el trabajo. Método: Estudio cuantitativo, descriptivo, transversal, realizado con auxiliares administrativos (N = 167) de un hospital portugués de tamaño medio. Los datos fueron recolectados a través de un cuestionario (QEV&PS-SO), para la caracterización sociodemográfica y el análisis de los determinantes de la salud relacionados con los estilos de vida. Resultados: Se observó que el 54% de la muestra no practicaba ejercicio físico, el 52% hacía cuatro o menos comidas al día, el 29% era fumador, el 51% tenía insomnio, el 45% no tenía vigilancia de salud, así como el 51,5% tenía sobrepeso u obesidad y el 63% tenía un riesgo aumentado o muy aumentado de desarrollar complicaciones metabólicas. No se identificaron diferencias significativas en relación con el peso, el ejercicio físico o el estrés según el sexo o la edad. Conclusión: Los resultados respaldan la necesidad de desarrollar programas de intervención con estrategias dirigidas a la promoción de estilos de vida saludable entre los trabajadores de las instituciones de salud, para ser integradas integralmente en el ámbito de la salud ocupacional.

RESUMO Objetivo: Caracterizar os estilos de vida dos assistentes administrativos de um hospital, para definição de estratégias de promoção de saúde no local de trabalho. Método: Estudo quantitativo, descritivo, de caráter transversal, realizado junto a assistentes administrativos (N = 167) de um hospital português de média dimensão. Os dados foram coletados através de um questionário (QEV&PS-SO), para caracterização sociodemográfica e análise dos determinantes de saúde relacionados com estilos de vida. Resultados: Observou-se que 54% da amostra não praticava exercício físico, 52% fazia quatro ou menos refeições por dia, 29% apresentava hábitos tabágicos, 51% tinha insônia e 45% não fazia vigilância de saúde, assim como 51,5% apresentava excesso de peso ou obesidade e 63% apresentava risco aumentado ou muito aumentado para desenvolvimento de complicações metabólicas. Não se identificaram diferenças significativas em relação ao peso, prática de exercício físico ou estresse em função do sexo ou idade. Conclusão: Os resultados sustentam a necessidade do desenvolvimento de programas de intervenção com estratégias dirigidas à promoção de estilos de vida saudáveis junto aos trabalhadores das instituições de saúde, a serem integradas, de forma compreensiva, no âmbito da saúde ocupacional.

Lingual tonsil hypertrophy: about a case of unpredictable difficult airway / Hipertrofia de la amígdala lingual: a propósito de un caso de vía aérea difícil imprevisible

Abstract: Eleven years old children, proposed for resection of pylocitic astrocytoma of cerebellum, presented with lingual tonsil hypertrophy causing a unpredictable difficult airway approach. The presence of a lingual tonsil hypertrophied isn't diagnosed most of the times, with their occurrence being associated with previous tonsillectomy in more than half of the cases. Its occurrence, and non-identification, can originate scenarios of difficult airway approach, with a higher morbility association.

Resumen: Niño con 11 años, propuesto para exéresis de recidiva de astrocitoma pilocítico del cerebelo con hipertrofia de las amígdalas linguales a condicionar vía aérea difícil no previsible. La hipertrofia de las amígdalas linguales es subdiagnosticada y se suele asociar a amigdalectomía previa en más de la mitad de los casos. Su ocurrencia y no reconocimiento, puede originar situaciones de vía aérea difícil, con alta morbilidad asociada.

Estratégias de Revascularização em Doentes com Infarto Agudo do Miocárdio em Choque Cardiogênico - Resultados do Registo Português de Síndromes Coronárias Agudas / Revascularization Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock: Results from the Portuguese Registry on Acute Coronary Syndromes

Resumo Fundamento: Em doentes com infarto agudo do miocárdio (IAM), choque cardiogênico (CC) e doença multivaso (DMV) persistem dúvidas sobre a intervenção nas artérias não responsáveis. Objetivos: 1) caracterizar a amostra de doentes com IAM, CC e DMV incluídos no Registo Nacional Português de Síndromes Coronárias Agudas (RNSCA); 2) comparar os eventos associados a diferentes estratégias de revascularização; e 3) identificar preditores de mortalidade intra-hospitalar nesta amostra. Métodos: Estudo observacional retrospetivo de doentes com IAM, CC e DMV incluídos no RNSCA entre 2010 e 2018. Compararam-se duas estratégias de revascularização: completa durante o procedimento índice (grupo 1); e completa diferida ou incompleta durante o internamento (grupo 2-3). O endpoint primário foi a ocorrência de reinfarto ou morte intra-hospitalar. A significância estatística foi definida por um valor p < 0,05. Resultados: Identificaram-se 127 doentes com IAM, CC e DMV (18,1% no grupo 1 e 81,9% no grupo 2-3), com idade média de 70 ± 12 anos e 92,9% com IAM com supradesnivelamento do segmento ST. O endpoint primário ocorreu em 47,8% dos doentes do grupo 1 e em 37,5% do grupo 2-3 (p = 0,359). As taxas de mortalidade intra-hospitalar, reinfarto, acidente vascular cerebral e hemorragia major foram também semelhantes nos dois grupos. Os preditores de mortalidade intra-hospitalar nesta amostra foram a presença na admissão de disfunção ventricular esquerda (OR 16,8), bloqueio completo de ramo direito (OR 7,6) e anemia (OR 5,2), (p ≤ 0,02). Conclusões: Entre os doentes com IAM, CC e DMV, incluídos no RNSCA, não se verificou diferença significativa entre revascularização completa no evento índex e completa diferida ou incompleta durante o internamento, relativamente à ocorrência de morte intra-hospitalar ou reinfarto. (Arq Bras Cardiol. 2021; 116(5):867-876)

Abstract Background: In patients with acute myocardial infarction (MI), cardiogenic shock (CS), and multivessel disease (MVD) questions remain unanswered when it comes to intervention on non-culprit arteries. Objective: This article aims to 1) characterize patients with MI, CS and MVD included in the Portuguese Registry on Acute Coronary Syndromes (ProACS); 2) compare different revascularization strategies in the sample; 3) identify predictors of in-hospital mortality among these patients. Methods: Observational retrospective study of patients with MI, CS and MVD included in the ProACS between 2010 and 2018. Two revascularization strategies were compared: complete during the index procedure (group 1); and complete or incomplete during the index hospitalization (groups 2-3). The primary endpoint was a composite of in-hospital death or MI. Statistical significance was defined by a p-value <0.05. Results: We identified 127 patients with MI, CS, and MVD (18.1% in group 1, and 81.9% in groups 2-3), with a mean age of 7012 years, and 92.9% of the sample being diagnosed with ST-segment elevation MI (STEMI). The primary endpoint occurred in 47.8% of the patients in group 1 and 37.5% in group 2-3 (p = 0.359). The rates of in-hospital death, recurrent MI, stroke, and major bleeding were also similar. The predictors of in-hospital death in this sample were the presence of left ventricle systolic dysfunction on admission (OR 16.8), right bundle branch block (OR 7.6), and anemia (OR 5.2) (p ≤ 0.02 for both). Conclusions: Among patients with MI, CS, and MVD included in the ProACS, there was no significant difference between complete and incomplete revascularization during the index hospitalization regarding the occurrence of in-hospital death or MI. (Arq Bras Cardiol. 2021; 116(5):867-876)

Complicações Neurológicas em Pacientes com Endocardite Infecciosa: Perspectivas de um Centro Terciário / Neurological Complications in Patients with Infective Endocarditis: Insights from a Tertiary Centre

Resumo Fundamento: Complicações neurológicas são comuns em pacientes com endocardite infecciosa (EI). Dados recentes sugerem que os eventos neurológicos são os principais determinantes do prognóstico e que a cirurgia é crítica para melhorar o resultado. Objetivo: Caracterizar pacientes com EI e complicações neurológicas e determinar preditores de embolização para o sistema nervoso central (SNC) e mortalidade. Métodos: Análise retrospectiva de pacientes internados em centro terciário com diagnóstico de EI no período de 2006 a 2016. Significância estatística foi definida por um valor de p <0,05. Resultados: Identificamos 148 episódios de EI, 20% dos quais tinham evidências de embolização do SNC. Em pacientes com embolização do SNC, 76% apresentaram acidente vascular cerebral isquêmico. Durante o seguimento, 35% foram submetidos à cirurgia e a mortalidade hospitalar e em um ano foi de 39%. Esses pacientes tiveram hospitalizações mais longas, mas não houve diferenças significativas em relação à mortalidade em pacientes com e sem embolização do SNC. Os preditores independentes de complicações neurológicas foram diabetes (p = 0,005) e ausência de febre na apresentação (p = 0,049). A cirurgia foi associada a menor mortalidade (0 vs. 58%; p = 0,003), enquanto os pacientes com choque séptico tiveram pior prognóstico (75 vs. 25%; p = 0,014). Na regressão multivariada de Cox, a infecção pelo vírus da imunodeficiência humana (HIV) foi o único preditor independente de mortalidade hospitalar e de 1 ano (p = 0,011 em ambos). Conclusões: Nessa população, a embolização para o SNC foi comum, mais frequentemente apresentada como acidente vascular cerebral isquêmico, e esteve associada a maior tempo de internação, embora sem diferenças significativas na mortalidade. Nos pacientes com embolização do SNC, os submetidos à cirurgia tiveram boa evolução clínica, enquanto os pacientes com choque séptico e infecção pelo HIV tiveram pior evolução. Esses resultados devem ser interpretados com cautela, levando em consideração que os pacientes com complicações mais graves ou mais frágeis foram provavelmente menos considerados para a cirurgia, resultando em viés de seleção.

Background: Neurological complications are common in patients with infective endocarditis (IE). Recent data suggest that neurologic events are a major determinant of prognosis, and that surgery is critical in improving the outcome. Objective: To characterize patients with IE and neurological complications and to determine predictors of embolization to the central nervous system (CNS) and mortality. Methods: Retrospective analysis of patients admitted to a tertiary center with the diagnosis of IE from 2006 to 2016. Statistical significance was defined by a p-value < 0.05. Results: We identified 148 episodes of IE, 20% of which had evidence of CNS embolization. In patients with CNS embolization, 76% presented with ischemic stroke. During follow-up, 35% were submitted to surgery and both in-hospital and one-year mortality were 39%. These patients had longer hospitalizations, but there were no significant differences regarding mortality in patients with and without CNS embolization. The independent predictors of neurological complications were diabetes (p=0.005) and the absence of fever at presentation (p=0.049). Surgery was associated with lower mortality (0 vs. 58%; p=0.003), while patients with septic shock had a poorer prognosis (75 vs. 25%; p=0.014). In multivariate Cox regression, human immunodeficiency virus (HIV) infection was the only independent predictor of in-hospital and 1-year mortality (p=0.011 in both). Conclusions: In this population, embolization to the CNS was common, more often presented as ischemic stroke, and was associated with longer hospitalization, although without significant differences in mortality. In patients with CNS embolization, those submitted to surgery had a good clinical evolution, while patients with septic shock and HIV infection had a worse outcome. These results should be interpreted with caution, taking into consideration that patients with more severe complications or more fragile were probably less often considered for surgery, resulting in selection bias.

Risk Factors for In-Hospital Mortality in Infective Endocarditis / Fatores de Risco para Mortalidade Hospitalar na Endocardite Infecciosa

Abstract Background: Infective endocarditis (IE) is associated with severe complications and high mortality. The assessment of mortality rates and predictors for fatal events is important to identify modifiable factors related to the pattern of treatment, in order to improve outcomes. Objectives: We sought to evaluate clinical outcomes of patients with IE and to determine predictors of in-hospital mortality. Methods: Retrospective single-center study including patients with IE admitted during a 10-year period (2006-2015). Data on comorbidities, clinical presentation, microbiology and clinical outcomes during hospitalization were evaluated. Risk factors of in-hospital death were analyzed. A p-value < 0.05 was considered significant. Results: A total of 134 cases were included (73% males, mean age of 61 ± 16 years-old). Half of them had previous valvular heart disease. Healthcare-associated IE and negative blood-cultures occurred in 22% and prosthetic IE in 25%. The aortic valve was the one most often affected by infection. Staphylococcus aureus was the most commonly isolated microorganism. Forty-four (32.8%) patients underwent cardiac surgery. The in-hospital mortality rate was 31.3% (42 patients). The identified risk factors for in-hospital mortality were Staphylococcus aureus etiology (OR 6.47; 95% CI: 1.07-39.01; p = 0.042), negative blood-cultures (OR 9.14; 95% CI: 1.42-58.77; p = 0.02), evidence of valve obstruction in echocardiography (OR 8.57; 95% CI: 1.11-66.25; p = 0.039), clinical evolution with heart failure (OR 4.98; 95%CI: 1.31-18.92; p = 0.018) or septic shock (OR 20.26; 95% CI: 4.04-101.74; p < 0.001). Cardiac surgery was a protective factor of mortality (OR 0.14; 95% CI 0.03-0.65; p = 0.012). Conclusion: The risk factors for in-hospital mortality were clinical (heart failure, septic shock), evidence of valve obstruction in echocardiography, Staphylococcus aureus etiology or negative blood cultures. Invasive treatment by surgery significantly decreased the mortality risk.

Resumo Fundamento: A endocardite infecciosa (EI) está associada a complicações graves e alta mortalidade. A avaliação das taxas de mortalidade e preditores de eventos fatais é importante para identificar fatores modificáveis relacionados ao padrão de tratamento, com o objetivo de melhorar os desfechos. Objetivos: Avaliar os desfechos clínicos de pacientes com EI e determinar preditores de mortalidade hospitalar. Métodos: Estudo retrospectivo de centro único, incluindo pacientes com EI admitidos durante um período de 10 anos (2006-2015). Foram avaliados dados de comorbidades, apresentação clínica, microbiologia e desfechos clínicos durante a internação. Foram analisados os fatores de risco de morte hospitalar. Um valor de p < 0,05 foi considerado significativo. Resultados: Foram incluídos 134 casos (73% do sexo masculino, média de idade de 61 ± 16 anos). Metade dos casos apresentava cardiopatia valvar prévia. A EI associada a cuidados de saúde e hemoculturas negativas ocorreram em 22%, e a EI associada a prótese em 25%. A válvula aórtica foi a mais frequentemente afetada por infecção. Staphylococcus aureus foi o microrganismo mais comumente isolado. Quarenta e quatro (32,8%) pacientes foram submetidos à cirurgia cardíaca. A taxa de mortalidade hospitalar foi de 31,3% (42 pacientes). Os fatores de risco identificados para mortalidade hospitalar foram etiologia do Staphylococcus aureus (OR 6,47; IC 95%: 1,07-39,01; p = 0,042), hemoculturas negativas (OR 9,14; IC 95%: 1,42-58,77; p = 0,02), evidência de obstrução valvar na ecocardiografia (OR 8,57; IC 95%: 1,11-66,25; p = 0,039), evolução clínica com insuficiência cardíaca (OR 4,98; IC 95%: 1,31-18,92; p = 0,018) ou choque séptico (OR 20,26; IC 95%: 4,04-101,74; p < 0,001). A cirurgia cardíaca foi um fator protetor de mortalidade (OR 0,14; IC95%: 0,03-0,65; p = 0,012). Conclusão: Os fatores de risco para mortalidade hospitalar foram clínicos (insuficiência cardíaca, choque séptico), evidência de obstrução valvar no ecocardiograma, etiologia do Staphylococcus aureus ou hemoculturas negativas. O tratamento invasivo por cirurgia diminuiu significativamente o risco de mortalidade.

Creolin® administered by different pathways in rats experimentally poisoned with Bothrops jararaca venom / Creolina ® administrada por diferentes vias em ratos envenenados experimentalmente com veneno de Bothrops jararaca

ABSTRACT: This study aimed to evaluate the effects of Creolin® when administered by different pathways in rats experimentally poisoned with Bothrops jararaca venom. In female Wistar rats, the Bothropic venom was inoculated intramuscularly, and then the rats were either treated with Creolin® (administered orally, topically, or intramuscularly), or with amixture of venom + Creolin® intramuscularly. Animals that received Creolin®, apart from the venom, by oral, topical, or intramuscular routes developed local symptoms and showed laboratory findings similar to those animals that received only the venom. Conversely, animals inoculated with the venom incubated with Creolin® showed no signs of local venom toxicity (necrosis or hemorrhage) and displayed hematological parameters within the normal range for the species. These results suggest that Creolin® exhibited an antiophidian effect only when it is mixed with the venom and administered intramuscularly.

RESUMO: Esse estudo objetivou avaliar os efeitos da Creolina® quando administrada por diferentes vias de acesso em ratos experimentalmente envenenados pela peçonha de Bothrops jararaca. Em ratas Wistar fêmeas foi inoculada a peçonha botrópica por via intramuscular, e em seguida as ratas foram tratadas com Creolina® (administrada oralmente, topicamente e intramuscularmente) ou a mistura de veneno + Creolina®. Os animais que receberam a Creolina®, além do veneno, por via oral, tópica e muscular desenvolveram a sintomatologia local e achados laboratoriais semelhantes ao grupo que recebeu apenas o veneno. De forma controversa, os animais inoculados com o veneno misturado a Creolina® não apresentaram sinais característicos da ação local do veneno (necrose, hemorragia) e apresentaram parâmetros hematológicos dentro da normalidade para espécie. Esses resultados sugerem que a Creolina® apresentou efeito antiofídico apenas quando misturada ao veneno e administrada intramuscularmente.