Epidemiological changes in invasive Streptococcus pyogenes infection during the UK alert period: A molecular comparative analysis from a tertiary Spanish hospital in 2023.

OBJECTIVES: To study the genomic epidemiology of Streptococcus pyogenes causing bloodstream infections (GAS-BSI) in a Spanish tertiary hospital during the United Kingdom invasive S. pyogenes outbreak alert. METHODS: Retrospective epidemiological analysis of GAS-BSI during the January-May 2017-2023 period. WGS was performed using Ion torrent GeneStudio™ S5 system for emm typing and identification of superantigen genes in S. pyogenes isolated during the 2022-2023 UK outbreak alert. RESULTS: During 2023, there were more cases of GAS-BSI compared to the same period of previous year with a non-significant increase in children. Fourteen isolates were sequenced. The emm1 (6/14, 42.9%) and emm12 (2/14, 14.3%) types predominated; 5 of 6 (75%) emm1 isolates were from the M1UK clone. The most detected superantigen genes were speG (12/14, 85.7%), speC (10/14, 71.4%), speJ (7/14, 50%), and speA (5/15, 33.3%). speA and speJ were predominant in M1UK clone. CONCLUSIONS: Our genomic epidemiology in 2023 is similar to the reported data from the UK outbreak alert in the same period and different from previous national S. pyogenes surveillance reports.

Percutaneous Intervention With GuideLiner Catheter in 4 Patients With Anomalous Coronary Artery Originating From Opposite Sinus of Valsalva.

Percutaneous intervention in anomalous coronary arteries originating from the opposite sinus of Valsalva is complicated by their unusual location and course, which makes selective cannulation difficult. The GuideLiner (Vascular Solutions, Inc.) is a monorail guide extension catheter designed to advance beyond the tip of a mother guide catheter to enable deep intubation of a coronary artery, provide extra support, and improve coaxial alignment. We describe the cases of 4 patients with an anomalous coronary artery originating from the opposite sinus of Valsalva-including 2 with acute myocardial infarction-who underwent successful percutaneous coronary intervention with use of a GuideLiner catheter.

Ensino da Língua Brasileira de Sinais durante a graduação em Medicina: a percepção dos futuros médicos / Teaching Brazilian Sign Language during medical students' training: the perception of future physicians

RESUMO Objetivo Avaliar a percepção dos estudantes de Medicina em relação à oferta da disciplina Língua Brasileira de Sinais (Libras) durante a sua formação acadêmica. Métodos Estudo transversal, descritivo e analítico, incluindo estudantes de Medicina da cidade de Salvador, Bahia, maiores de 18 anos. Aplicou-se um questionário virtual, semiestruturado, contendo aspectos sociodemográficos, acadêmicos e sobre a Libras (comunicação, aprendizado, importância na formação médica e oferta curricular). Resultados Dos 240 estudantes avaliados, 82,9% não sabe se comunicar através de Libras, entretanto 95,8% acreditam que a disciplina é necessária no currículo médico. Quanto à oferta curricular, os estudantes consideram que esta deveria ser obrigatória (55,2%) e na modalidade presencial (75,7%). Os principais motivos para não cursar a disciplina foram por esta ser optativa (41,7%) e por falta de tempo (33,3%). Identificou-se que as mulheres dão mais importância a esta formação (p=0,0013) e essa percepção independe de idade, natureza administrativa da instituição e ciclo acadêmico em curso. Conclusão Os estudantes de Medicina têm uma percepção favorável ao ensino de Libras na educação médica. Entretanto, a maioria desses estudantes não cursou a disciplina em seus percursos acadêmicos e acredita ser desafiador o atendimento a este público.

ABSTRACT Purpose To assess the perception of medical students regarding the discipline Brazilian Sign Language (Libras) during their academic training. Methods Cross-sectional, descriptive and analytical study, including medical students from the city of Salvador, Bahia, over 18 years old. A virtual, semi-structured questionnaire was applied, containing sociodemographic, academic and Libras (communication, learning, importance in medical training and curriculum offer) aspects. Results Of the 240 students evaluated, 82.9% do not know how to communicate through Libras, however 95.8% believe that the discipline is necessary in the medical curriculum. As for the curricular offer, students consider that it should be mandatory (55.2%) and in the face-to-face modality (75.7%). The main reasons for not taking the course were because it was optional (41.7%) and lack of time (33.3%). It was identified that women give more importance to this training (p=0.0013) and this perception is independent of age, administrative nature of the institution and ongoing academic cycle. Conclusion Medical students have a favorable perception of the teaching of Libras in medical education. However, most of these students did not attend the discipline in their academic careers and believe that serving this public is challenging.

A Educação Física na BNCC: desafios da escola republicana / Physical Education at BNCC: challenges of the republican school / Educación Física en BNCC: desafíos de la escuela republicana

Este estudo consiste em um ensaio teórico que apresenta reflexões acerca das possibilidades e dos desafios impostos pela Base Nacional Comum Curricular. Para tanto, propõe uma discussão sobre república e democracia, localizando a escola como uma instituição formativa necessária para o funcionamento da sociedade. Procura, por fim, analisar o processo de elaboração da base destacando que, embora a efetivação de um currículo comum seja importante para a legitimação da Educação Física como um componente curricular necessário para a escola republicana, o processo final da construção do documento ocorreu de modo pouco democrático, pondo em xeque sua legitimidade.

The present study consists of a theoretical essay that presents reflections on the possibilities and challenges imposed by the National Common Curricular Base. For this, it proposes a discussion on republic and democracy, locating the school as a training institution necessary for the functioning of society. Finally, we seek to analyze the process of preparing the base, highlighting that although the implementation of a common curriculum is important for the legitimation of Physical Education as a necessary curricular component for the republican school, the final process of the construction of the document occurred in an undemocratic way, challenging its legitimacy.

El presente estudio consiste en un ensayo teórico que presenta reflexiones sobre las posibilidades y desafíos que impone la Base Curricular Común Nacional. Para ello propone una discusión sobre república y democracia, ubicando a la escuela como una institución de formación necesaria para el funcionamiento de la sociedad. Finalmente, buscamos analizar el proceso de elaboración de la base, resaltando que, si bien la implementación de un currículo común es importante para la legitimación de la Educación Física como componente curricular necesario para la escuela republicana, se dio el proceso final de construcción del documento. de forma antidemocrática, desafiando su legitimidad.

Local Intracoronary Fibrinolysis in Acute Myocardial Infarction of Ectatic Coronary Arteries in the Post-Abciximab Era.

Percutaneous intervention in the context of coronary artery ectasia (CAE) is penalized with no-reflow phenomenon. The glycoprotein-IIb/IIIa-inhibitor abciximab was the most accepted method for pharmacology thrombus resolution in this scenario, nevertheless, this agent was recently withdrawn. We describe 5 patients treated with local intracoronary fibrinolysis administrated through predesigned catheters in the setting of AMI and CAE.

Transradial Secondary Approach During Transfemoral TAVI: Usefulness of Placing a Wire Before Femoral Puncture for Management and Treatment of Vascular Complications.

Vascular complications during transcatheter aortic valve implantation (TAVI) are relatively common, and some of them related to the transfemoral secondary access. The use of the transradial access (TRA) as an alternative vascular approach for transfemoral TAVI could reduce these complications, however, the treatment of potential vascular peripheral issues from this access has been scarcely described. The advance of a wire from the TRA to the primary transfemoral access at the beginning of the procedure could help the management of eventual vascular complications. A new TRA technique during transfemoral TAVI procedures is described, reporting the results in the first forty-two patients in one center.

Cardiologists and the Cardiology of the Future. Vision and proposals of the Spanish Society of Cardiology for the Cardiology of the 21st Century.

The Cardiology of the Future is a project of the Spanish Society of Cardiology (SEC) whose objectives are as follows: to define the action policies of the SEC; to analyze the trends and changes in the environment that will influence the practice of cardiology in Spain; to define the profile of the cardiologists needed in the future; to propose policies to achieve the objectives resulting from the identified needs; and to identify the role of the SEC in the development and implementation of these policies. This article describes the methodology and the most relevant findings of the final report of this project and the strategic lines to be developed by the SEC in the immediate future, resulting from the analysis performed.

Left Bundle Branch Block after Transcatheter Aortic Valve Implantation with Edwards Sapien 3 Valve: Influence of the Valve Depth Implantation.

OBJECTIVES: The aim of this study is to determine the relation between the valve depth implantation and the new-onset left bundle branch block (LBBB) in patients treated with transcatheter aortic valve implantation (TAVI) using Edwards Sapien 3 (S3) prosthesis. BACKGROUND: LBBB is the most common conduction disturbance after TAVI. The S3 has been associated with a higher incidence of LBBB. A deep valve implant could be related to new-onset LBBB with S3. METHODS: Seventy-six consecutive patients treated with transfemoral TAVI with S3 were included. Electrocardiogram (ECG) registries were recorded at baseline, after the procedure, and before discharge. Valve depth implantation was determined in 40 patients by off-line analysis of the two/three-dimensional transeophageal echocardiogram (TEE) images, with measure of the valve stent percentage under the aortic annulus. Previous and new conduction anomalies were documented; and patient, anatomic and procedural characteristics were retrospectively analyzed. RESULTS: Complete atrioventricular block (AVB) incidence was 2.9%. LBBB after TAVI appeared in 39% of patients, being transient in almost half of the cases (permanent LBBB rate 20%). Patients with new-onset LBBB after TAVI were older, with a higher STS Score and a wider basal QRS. A deep valve position was associated with new-onset LBBB, with a ROC curve establishing a cut-off point of 34% of depth implant as risk factor for new-onset LBBB (sensitivity and specificity 0.8). CONCLUSIONS: In transfemoral TAVI with S3 prosthesis, a higher valve implantation (<34% of valve stent introduced into the ventricle) may minimize the new-onset LBBB, especially in old and high-risk patients with a wide basal QRS.

Drug consumption, knowledge on the consequences of consumption and academic performance among college students in San Salvador, El Salvador / Uso de drogas, conhecimento das consequências do consumo e desempenho académico entre estudantes universitários em San Salvador, El Salvador / Consumo de drogas, conocimiento de las consecuencias del consumo y rendimiento académico entre estudiantes universitarios en San Salvador, El Salvador

ABSTRACT Objective: determine the relationship among drug consumption, knowledge on the consequences of consumption and academic performance, for alcohol cocaine and marijuana, among undergraduate students of social sciences and health of San Salvador, El Salvador. Method: the used method was a cross-sectional survey, with a convenience sample of 250 university students. A modified version of the combination of two instruments was applied evaluating the variables for the knowledge on the consequences, pursuing the knowledge of a student about the adverse effects of the biological, psychological and social categories related to consumption of the drugs under study. Drug consumption was evaluated by consulting the student whether or not they used drugs at any time or in the last 3 months. Academic performance was evaluated by consulting students on the average in which they are applied on a scale of 1 to 10. Results: the results showed that 88.1% of the survey participants have a broad knowledge on the consequences of consuming alcoholic beverages; 45.5% on the consequences of marijuana use and 55.7% know the consequences of cocaine consumption. While 28.4% have consumed alcohol in the last year, 6.5% have consumed marijuana and 1.7% cocaine. The relationship of alcohol consumption with the knowledge on each of the consequences reflected a very low influence, while the larger is the knowledge obtained from these consequences caused by the use of the drugs under study, the lower is the consumption. Conclusion: the use of alcohol, cocaine and marijuana is not related to academic performance, indicating very low positive and negative correlations according to each case.

RESUMO Objetivo: determinar a relação entre o uso de drogas, o conhecimento das consequências do consumo e o desempenho acadêmico, para o álcool, cocaína e maconha, entre estudantes de graduação em ciências sociais e em saúde de San Salvador, El Salvador. Método: foi utilizado questionário de modelo transversal, com amostra de conveniência de 250 estudantes universitários. Aplicou-se versão alterada da combinação de dois instrumentos, avaliando as variáveis do conhecimento das consequências, em busca do conhecimento do estudante em relação aos efeitos adversos das categorias biológicas, psicológicas e sociais do uso de drogas pesquisado; o consumo de drogas foi avaliado perguntando ao estudante se usou ou não drogas alguma vez nos últimos 3 meses; o desempenho acadêmico foi avaliado consultando os estudantes sobre a média na qual ele está, aplicando uma escala de 1 a 10. Resultados: os resultados evidenciaram que 88,1% dos participantes da pesquisa possui conhecimento amplo sobre as consequências do consumo de bebidas alcoólicas; 45,5% das consequências do uso de maconha e 55,7% conhecem as consequências do consumo de cocaína. Enquanto 28,4% têm consumido álcool no último ano, 6,5% consumiram maconha e 1,7% cocaína. A relação do consumo de álcool com o conhecimento de cada consequência refletiu uma influência muito baixa que quanto maior o conhecimento dessas consequências causadas pelo uso das drogas estudadas, menor será o consumo. Conclusão: o uso de álcool, cocaína e maconha não tem relação com o desempenho acadêmico, indicando correlações positivas e negativas muito baixas dependendo do caso.

RESUMEN Objetivo: determinar la relación entre el consumo de drogas, conocimiento de las consecuencias del consumo y el rendimiento académico, para el alcohol cocaína y marihuana, entre estudiantes de pregrado de ciencias sociales y de la salud de San Salvador, El Salvador. Método: el método utilizado fue una encuesta de diseño transversal, con una muestra de conveniencia de 250 estudiantes universitarios. Se aplicó una versión modificada de la combinación de dos instrumentos evaluando las variables del conocimiento de las consecuencias, persiguiendo el saber de un estudiante sobre los efectos adversos de las categorías biológicas, psicológicas y sociales del consumo de las drogas en estudio; el consumo de drogas fue evaluado consultando al estudiante si usaron o no drogas alguna vez o en los últimos 3 meses; el rendimiento académico fue evaluado consultando a los estudiantes el promedio en el que se encuentran aplicado en una escala del 1 al 10. Resultados: os resultados evidenciaron que el 88.1% de participantes de la encuesta posee un conocimiento amplio de las consecuencias del consumo de bebidas alcohólicas; el 45.5% de las consecuencias del consumo de marihuana y el 55.7% conoce las consecuencias del consumo de cocaína. Mientras que el 28.4% ha consumido alcohol en el último año, el 6.5% ha consumido marihuana y el 1.7% cocaína. La relación del consumo de alcohol con el conocimiento de cada una de las consecuencias reflejó una influencia muy baja de que a mayor conocimiento se tenga de estas consecuencias causadas por el uso de las drogas en estudio, menor será el consumo. Conclusión: el uso de alcohol, cocaína y marihuana no está relacionado con el rendimiento académico, indicando correlaciones positivas y negativas muy bajas según cada caso.

Outcomes of patients at estimated low surgical risk undergoing transcatheter aortic valve implantation with balloon-expandable prostheses.

INTRODUCTION AND OBJECTIVES: Transcatheter aortic-valve implantation (TAVI) is an accepted treatment for patients with severe aortic stenosis and high surgical risk. However, there is lack in data about TAVI in low-risk patients that are already being treated with this therapy in some clinical contexts. METHODS: A retrospective analysis of patients treated with transfemoral TAVI using Edwards Sapien prosthesis in one center was performed, classifying the patients into three groups according to the surgical risk (high/intermediate/low risk for STS score>8/4-8/<4). Clinical characteristics, procedure and follow-up outcomes were collected, comparing the results between low and high surgical risk groups. RESULTS: 89 TAVIs using Edwards balloon expandable prosthesis were performed (9 Sapien XT and 80 Sapien 3 valves were implanted). 40 patients (45%) presented a STS score<4, while 33 (37%) had a STS>8. Low-risk patients were significantly younger and had lower rates of coronary artery disease, peripheral vascular disease, pulmonary lung disease and atrial fibrillation. There were no significant differences in most of the technical variables of the procedure, apart from vascular complications and complete left bundle branch block after valve implant, which were higher in the group with STS>8. Patients of low risk presented shorter hospital stay (2,91±1,6, vs 4,8±3,9 days), with lower rates of mortality at mid- and long follow-up (death from any cause 15,2% vs 0%, p 0,04). CONCLUSIONS: TAVI in low-risk patients is safe and associated with better outcome at mid and long-term follow-up compared to high-risk patients.

Measurement and Modeling of Narrowband Channels for Ultrasonic Underwater Communications.

Underwater acoustic sensor networks are a promising technology that allow real-time data collection in seas and oceans for a wide variety of applications. Smaller size and weight sensors can be achieved with working frequencies shifted from audio to the ultrasonic band. At these frequencies, the fading phenomena has a significant presence in the channel behavior, and the design of a reliable communication link between the network sensors will require a precise characterization of it. Fading in underwater channels has been previously measured and modeled in the audio band. However, there have been few attempts to study it at ultrasonic frequencies. In this paper, a campaign of measurements of ultrasonic underwater acoustic channels in Mediterranean shallow waters conducted by the authors is presented. These measurements are used to determine the parameters of the so-called κ-µ shadowed distribution, a fading model with a direct connection to the underlying physical mechanisms. The model is then used to evaluate the capacity of the measured channels with a closed-form expression.

Enhanced cation recognition by a macrocyclic ionophore at the air-solution interface probed by mass spectrometry.

Interfacial environments have the potential to drive unexpected events of supramolecular recognition, leading to advances in the development of novel functional materials and molecular sensing techniques. We present experimental evidence for a noticeable enhancement of the cation binding specificity of a prototype calixarene macrocycle (cesium ionophore II) at the air-solution interface, in comparison to bulk solution and to isolated solvent-less conditions. A rationalization of this intriguing finding is outlined, with the support of quantum calculations, in terms of the 'half-solvation' conditions provided by the interface and of conformational effects posed by the backbone structure and the side chains of the macrocyclic ionophore. The investigation involves the introduction of a mass spectrometry method to determine the relative abundances of interfacial complexes that should be of general application in the field and guide future advances in analytical techniques based on molecular recognition.

Recomendações brasileiras de ventilação mecânica 2013. Parte 2 / Brazilian recommendations of mechanical ventilation 2013. Part 2

O suporte ventilatório artificial invasivo e não invasivo ao paciente grave tem evoluído e inúmeras evidências têm surgido, podendo ter impacto na melhora da sobrevida e da qualidade do atendimento oferecido nas unidades de terapia intensiva no Brasil. Isto posto, a Associação de Medicina Intensiva Brasileira (AMIB) e a Sociedade Brasileira de Pneumologia e Tisiologia (SBPT) - representadas por seu Comitê de Ventilação Mecânica e sua Comissão de Terapia Intensiva, respectivamente, decidiram revisar a literatura e preparar recomendações sobre ventilação mecânica, objetivando oferecer aos associados um documento orientador das melhores práticas da ventilação mecânica na beira do leito, com base nas evidências existentes, sobre os 29 subtemas selecionados como mais relevantes no assunto. O projeto envolveu etapas que visaram distribuir os subtemas relevantes ao assunto entre experts indicados por ambas as sociedades, que tivessem publicações recentes no assunto e/ou atividades relevantes em ensino e pesquisa no Brasil, na área de ventilação mecânica. Esses profissionais, divididos por subtemas em duplas, responsabilizaram-se por fazer uma extensa revisão da literatura mundial. Reuniram-se todos no Fórum de Ventilação Mecânica, na sede da AMIB, na cidade de São Paulo (SP), em 3 e 4 de agosto de 2013, para finalização conjunta do texto de cada subtema e apresentação, apreciação, discussão e aprovação em plenária pelos 58 participantes, permitindo a elaboração de um documento final.

Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document.