Sublithospheric diamond ages and the supercontinent cycle.

Subduction related to the ancient supercontinent cycle is poorly constrained by mantle samples. Sublithospheric diamond crystallization records the release of melts from subducting oceanic lithosphere at 300-700 km depths1,2 and is especially suited to tracking the timing and effects of deep mantle processes on supercontinents. Here we show that four isotope systems (Rb-Sr, Sm-Nd, U-Pb and Re-Os) applied to Fe-sulfide and CaSiO3 inclusions within 13 sublithospheric diamonds from Juína (Brazil) and Kankan (Guinea) give broadly overlapping crystallization ages from around 450 to 650 million years ago. The intracratonic location of the diamond deposits on Gondwana and the ages, initial isotopic ratios, and trace element content of the inclusions indicate formation from a peri-Gondwanan subduction system. Preservation of these Neoproterozoic-Palaeozoic sublithospheric diamonds beneath Gondwana until its Cretaceous breakup, coupled with majorite geobarometry3,4, suggests that they accreted to and were retained in the lithospheric keel for more than 300 Myr during supercontinent migration. We propose that this process of lithosphere growth-with diamonds attached to the supercontinent keel by the diapiric uprise of depleted buoyant material and pieces of slab crust-could have enhanced supercontinent stability.

Evaluation of New Potential Inflammatory Markers in Patients with Nonvalvular Atrial Fibrillation.

Atrial fibrillation (AF), the most common arrhythmia in clinical practice, is associated with an increase in mortality and morbidity due to its high potential to cause stroke and systemic thromboembolism. Inflammatory mechanisms may play a role in the pathogenesis of AF and its maintenance. We aimed to evaluate a range of inflammatory markers as potentially involved in the pathophysiology of individuals with nonvalvular AF (NVAF). A total of 105 subjects were enrolled and divided into two groups: patients with NVAF (n = 55, mean age 72 ± 8 years) and a control group of individuals in sinus rhythm (n = 50, mean age 71 ± 8 years). Inflammatory-related mediators were quantified in plasma samples by using Cytometric Bead Array and Multiplex immunoassay. Subjects with NVAF presented significantly elevated values of interleukin (IL)-2, IL-4, IL-6, IL-10, tumor necrosis factor (TNF), interferon-gamma, growth differentiation factor-15, myeloperoxidase, as well as IL-4, interferon-gamma-induced protein (IP-10), monokine induced by interferon-gamma, neutrophil gelatinase-associated lipocalin, and serum amyloid A in comparison with controls. However, after multivariate regression analysis adjusting for confounding factors, only IL-6, IL-10, TNF, and IP-10 remained significantly associated with AF. We provided a basis for the study of inflammatory markers whose association with AF has not been addressed before, such as IP-10, in addition to supporting evidence about molecules that had previously been associated with the disease. We expect to contribute to the discovery of markers that can be implemented in clinical practice hereafter.

Evaluation of serum haptoglobin levels and Hp1-Hp2 polymorphism in the haptoglobin gene in patients with atrial fibrillation.

BACKGROUND: Atrial fibrillation (AF) is an arrhythmia that involves structural and electrophysiological abnormalities. Many of the AF-related clinical conditions are associated with an increase in inflammatory and oxidative factors. Haptoglobin (Hp) is an acute phase protein whose biological role is to promote clearance of free hemoglobin (Hb). In addition, for being considered an inflammatory marker, Hp represents a protective mechanism against the oxidative effects of Hb. The Hp1-Hp2 polymorphism at Hp locus can lead to three phenotypes related to structural and functional differences in the protein. The objective of this study were to evaluate Hp levels and Hp1-Hp2 polymorphism at Hp locus in patients with AF compared to a control group. METHODS AND RESULTS: This study included 65 patients with AF and 54 individuals without the arrhythmia. Biochemical parameters were determined using Vitros system, plasma levels of Hp were measured in serum samples by using ELISA method and polymorphisms were verified by PCR technique. Plasma Hp levels, as well as allelic and genotypic frequency, were not associated with AF. The levels of Hp also did not differ among the genotypes according to the applied models. CONCLUSIONS: The results suggest that Hp levels and Hp1-Hp2 polymorphism are not associated to AF.

Use of Blumensaat's line for assessment of cranial tibial subluxation in dogs with cranial cruciate ligament deficiency.

BACKGROUND: This study aimed to determine whether Blumensaat's line, a consistently present radiographic feature delineating the peak of the femoral intercondylar fossa, could be used to assess for cranial tibial subluxation in canine stifles with cranial cruciate ligament disease. METHODS: Thirty sequential, neutrally positioned, standing-angle stifle radiographs were taken from dogs presenting to a specialist referral centre for treatment of cruciate ligament disease. Thirty similarly positioned radiographs of healthy canine stifles were used as a control group. The radiographs were anonymised and submitted to blinded observers for measurement of the tibial plateau angle, patella tendon angle, Blumensaat's line length and the length of Blumensaat's line cranial to the tibial mechanical axis. RESULTS: Finding that the tibial mechanical axis intersects Blumensaat's line cranial to its midpoint, as a marker of cranial tibial subluxation, had a positive predictive value of 76% for subsequent surgical identification of cruciate ligament disease. CONCLUSIONS: Tibial cranial subluxation is detectable and quantifiable radiographically using the intersection of the tibial mechanical axis and Blumensaat's line. Once quantified, this measurement could be used both as a radiographic marker of cruciate ligament disease and to adjust tibial osteotomy procedures to minimise the risk of under advancement of the tibial tuberosity resulting in a persistently unstable stifle.

Atrial Fibrillation and Use of Rivaroxaban: Performance of the Prothrombin Time / INR as a Function of Time After Blood Collection

Abstract Background Traditionally, the most effective therapy in the prevention of stroke in patients with atrial fibrillation (AF) has been oral anticoagulation with vitamin K inhibitors, particularly warfarin, whose disadvantages and adverse effects have led to their replacement by "direct oral anticoagulants", as factor X inhibitor. Objectives This study aimed to conduct a brief approach on atrial fibrillation (AF) and use of Rivaroxaban, and to comparatively evaluate the prothrombin time / International Normalized Ratio (PT/INR) in patients with AF in use of this oral anticoagulant, depending on the time elapsed between the last administration of the drug and the time of blood sample venipuncture. Methods We evaluated 34 patients with AF in use of Rivaroxaban by using PT / INR, distributed into a subgroup with blood collection time ≤ 12 hours (n = 7) and > 12 hours after the last drug intake (n = 27). Mann-Whitney test was used to compare the groups and p < 0.05 was considered significant. Results An analysis as a function of time between the Rivaroxaban intake and blood collection, revealed that PT / INR suffers the greatest effect up to 12 hours after ingestion of the drug, dropping to levels close to normal in subsequent hours before the next dose. Conclusion We concluded that, in contrast to warfarin, the knowledge of the time interval between drug intake and blood collection from patients taking Rivaroxaban is essential to properly interpret a laboratory test to assess hemostasis, particularly PT and its derivatives. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

Thrombin Generation and other hemostatic parameters in patients with atrial fibrillation in use of warfarin or rivaroxaban.

Patients with atrial fibrillation (AF) present hyperactivation of both platelets and coagulation leading to a hypercoagulable state which contributes to an increased risk of thromboembolism. Therefore, one of the main strategies for treatment of AF is prevention of these events through the use of oral anticoagulants (OAC). The aim of this study was to evaluate hemostasis as a whole in patients with non-valvular AF undergoing warfarin or rivaroxaban by thrombin generation test (TGT), in addition to monocyte-platelet aggregates (MPA), glycoprotein IIb/IIIa (GPIIb/IIIa), and platelet (PMP) and endothelium (EMP) microparticles, compared to age and sex matched controls. PT/INR for OAC use was also determined. In patients taking OAC, compared to control group, a decrease in TGT (p = 0.000 for all parameters) were observed. Patients taking warfarin showed to be more hypocoagulable, presenting lower levels of ETP (p = 0.000) and peak (p = 0.002) than patients using rivaroxaban. Patients on warfarin use with INR > 3 had also lower levels of ETP (p = 0.01) and peak (p = 0.006). A decrease in ETP (p = 0.03) and peak (p = 0.02) values was also observed in patients using rivaroxaban with PT > 21.4 s. Patients using warfarin (p = 0.000) and rivaroxaban (p = 0.000) presented lower levels of MPA in relation to control group. It was also observed in patients using warfarin, lower GPIIb/IIIa levels in relation to control group (p = 0.011). Patients taking rivaroxaban (p = 0.003) and warfarin (p = 0.001) had higher PMP levels compared to control group. There was no difference in levels of EMP between the groups (p = 0.0536). The present study reinforces the usefulness of OAC in AF, which decisively contribute to a better management of the disease preventing possible complications.

Outcome following surgical stabilization of distal diaphyseal and supracondylar femoral fractures in dogs.

Signalment, clinical features, fixation techniques, complications, and outcome for dogs presenting with distal diaphyseal and supracondylar femoral fractures were retrospectively reviewed. A total of 45 dogs with unilateral femoral fractures were included. Supracondylar femoral plates were the most popular method of fixation. However, various fixation techniques resulted in favorable outcomes in most dogs with 19/45 cases achieving full function and 22/45 achieving acceptable function. Degree of fracture comminution did not appear to affect complication rate or be a surrogate for worse clinical outcome.

Résultats de stabilisation chirurgicale de fractures fémorales diaphysaires distales et supracondylaires chez le chien. Une étude rétrospective portant sur le signalement, la présentation clinique, les techniques de réduction de fracture, les complications et les résultats de chiens atteints de fractures fémorales supracondyliennes et diaphysaires distales a été réalisée. Quarante-cinq chiens présentant une fracture fémorale unilatérale ont été inclus au total. Les plaques fémorales supracondyliennes représentaient la méthode d'ostéosynthèse la plus courante. Diverses techniques de fixation ont abouti à des résultats favorables dans la majorité des cas, avec 19/45 cas récupérant une fonction complète et 22/45 une fonction considérée acceptable. Le degré de comminution de la fracture n'apparaissait pas comme étant un facteur de risque de complication ou étant associé à des résultats défavorables.(Traduit par Emilie Fauchon et Emilie Hanot).

Comparison of Inflammatory Mediators in Patients With Atrial Fibrillation Using Warfarin or Rivaroxaban.

Background: Atrial fibrillation (AF) is the most common arrhythmia associated with high risk of venous thromboembolism. Inflammatory mechanisms may be involved in the pathophysiology of AF and in the AF-related thrombogenesis, and patients with AF might benefit from the use of anticoagulants with anti-inflammatory properties. However, the evidence is still scarce, and it points out the need of trials seeking to investigate the levels of inflammatory mediators in patients with AF under different anticoagulant therapies. Therefore, this study was designed to define whether patients with AF treated either with an activated coagulation factor X (FXa) inhibitor (rivaroxaban) or with a vitamin K inhibitor (warfarin) present changes in peripheral levels of inflammatory mediators, mainly cytokines and chemokines. Methods: A total of 127 subjects were included in this study, divided into three groups: patients with non-valvular atrial fibrillation (NVAF) using warfarin (N = 42), patients with NVAF using rivaroxaban (N = 29), and controls (N = 56). Plasma levels of inflammatory mediators were quantified by immunoassays. Results: Patients with AF (both warfarin and rivaroxaban groups) presented increased levels of inflammatory cytokines in comparison with controls. The use of rivaroxaban was associated with decreased levels of inflammatory cytokines in comparison with warfarin. On the other hand, patients with AF using rivaroxaban presented increased levels of the chemokines (MCP-1 in comparison with warfarin users; MIG and IP-10 in comparison with controls). Conclusions: AF is associated with an inflammatory profile that was less pronounced in patients on rivaroxaban in comparison with warfarin users. Further studies are necessary to assess the clinical implications of our results and whether patients with AF would benefit from rivaroxaban anti-inflammatory effects.

Evidence of validity of a modern homonegativity measure against gays and lesbians / Evidências de validade de uma medida de homonegatividade moderna frente a gays e lésbicas / Evidencias de validez de una medida de homonegatividad moderna frente a los gays y lesbianas

The goal of this research was to adapt and obtain validity evidence of the Modern Homonegativity Scale (MHS), which is set by two parallel forms with 12 items, one of them referring to gays (MHS-G) and the other referring to lesbians (MHS-L). In the first study 418 heterosexuals between 18 and 58 years old (M = 24,9; SD = 7,23), mostly women (66,3%) living at João Pessoa-PB (50,5%) answered. Both scales have shown as unidimensional and containing a high degree of internal consistency. The second study had the participation of 273 heterosexuals between 18 and 55 years old (M = 23,7; SD = 6,33), mostly women (69%). The confirmatory factor analysis showed satisfactory adjustment indexes for the proposed model and the Item Response Theory (IRT) demonstrated a good degree of discrimination and variation of the difficulty parameters. Therefore, we may conclude MHS is psychometrically valid, easily applicable and can be used in research contexts. (AU)

O objetivo desta pesquisa foi adaptar e obter evidências de validade da Modern Homonegativity Scale (MHS) composta por duas formas paralelas com 12 itens, sendo uma versão referente aos gays (MHS-G) e outra às lésbicas (MHS-L). No Estudo 1, participaram 418 heterossexuais entre 18 e 58 anos (M = 24,8; DP = 7,23), a maioria mulheres (66,3%) e residentes em João Pessoa-PB (50,5%). As escalas apresentaram-se unidimensionais e com bons níveis de consistência interna (α = 0,92). O Estudo 2, contou com 273 heterossexuais entre 18 e 55 anos (M = 23,7; DP = 6,33), a maioria mulheres (69%). A análise fatorial confirmatória mostrou satisfatórios índices de ajuste para o modelo proposto e a análise da Teoria de Resposta ao Item (TRI) demostrou uma boa discriminação e variação dos parâmetros de dificuldade. Conclui-se que a MHS é psicometricamente válida e de fácil aplicação, podendo ser usada em contextos de pesquisa. (AU)

El objetivo de esta investigación fue adaptar y obtener evidencia de validez de la Escala de Homonegatividad Moderna (MHS), compuesta por dos formas paralelas con 12 ítems, siendo, una versión referente a gays (MHS-G) y otra a lesbianas (MHS-L). En el estudio 1 participaron 418 heterosexuales entre 18 y 58 años (M = 24,8; DP = 7,23), la mayoría mujeres (66,3%) residentes en la ciudad de João Pessoa-PB (50,5%). Las escalas se presentan em forma unidimensional y con buen nivel de consistencia interna (α = 0,92). En el estudio 2 participaron 273 heterosexuales entre 18 y 55 años (M = 23,7; DP = 6,33), la mayoría también mujeres (69%). El análisis factorial confirmatorio mostró índices satisfactorios de ajuste para el modelo propuesto, y el análisis de Teoría de Respuesta al Ítem (TRI) demostró una buena discriminación y variación de los parámetros de dificultad. Se concluye que la MHS es psicométricamente válida y de fácil aplicación, pudiendo ser usada en contextos de investigación. (AU)

Health Behaviours in Scaffold Use Risk Assessment Model - SURAM.

INTRODUCTION: Problems concerning occupational safety and health are commonly found in the construction industry, including falling materials, tools or people from a height, stepping on objects, and injuries caused by hand tools. An important factor in occupational safety in the construction industry is the use of scaffolds. All scaffolds used in construction, renovation, repair (including isolating, painting and decorating) and demolition, should be erected, maintained and dismantledin accordance with safety procedures. Therefore, it is crucial to deal with the safety of scaffolds and risk assessment in the construction industry; thus, the way of undertaking the assessment and the liability of assessment seems to be essential for professionals. However, it has been found that those professionals are prone to rely heavily on their own experience and knowledge in decision-making regarding risk assessment. MATERIAL AND METHODS: The Scaffold Use Risk Assessment Model (SURAM) has been developed for assessing risk levels at various stages of the construction process in various work trades. The SURAM is the result of a research project carried out at 60 construction sites in Poland and Portugal where 504 observations have been completed including both harmful physical and chemical factors, stress level, workers' habits, as well as a hundreds ex-post reconstruction of construction accidents scenarios. RESULTS: It was found that the workers' Health Behaviour Index (HBI) seems to be a more direct predictor for development of the unsafe chain of events leading to an accident than the workload, and concentration of harmful factors at the workplace. CONCLUSIONS: The developed HBI module of SURAM seems to be beneficial for predicting high-risk construction activities, and thus preventing the occurrence of accidents, based on a set of historical accident data.

Conhecimento dos pais sobre o processo de aleitamento materno em mães de uma maternidade pública em Belo Horizonte, MG / Fatherly knowledge of breastfeeding process in a public maternity in Belo Horizonte, MG

OBJETIVO: Analisar os graus de conhecimento e de participação dos pais acerca do processo de aleitamento materno. MÉTODOS: Estudo do tipo observacional e transversal realizado com 351 casais entrevistados na Maternidade Odete Valadares, em Belo Horizonte, com base em questionários semiestruturados. A coleta de dados foi feita com as entrevistas divididas em duas partes, primeiro respondida pela mãe e em seguida pelo pai. A análise dos dados foi feita por meio do software Epi-Info, versão 7.1.2.0. RESULTADOS: A maioria dos pais (92,02%) relatou não ter recebido dos profissionais de saúde qualquer informação sobre a amamentação. Apenas 4,27% dos pais souberam informar o período de aleitamento materno recomendado pela Organização Mundial da Saúde e o Ministério da Saúde do Brasil. Quando questionados se, em algum momento, conversaram com a mãe sobre alimentação infantil, 56,98% responderam que "não". CONCLUSÃO: O pai, apesar de reconhecer a importância do aleitamento materno, muitas vezes não conversa sobre esse assunto com a mãe. Um pai bem informado e participativo em relação à prática da amamentação poderá ser um elemento ativo de apoio para diminuir o desmame precoce. A assistência educativa sobre o aleitamento materno, por profissionais de saúde deve incluir e motivar o papel do pai a participar ativamente da amamentação.(AU)

Objectives: Analyse the degrees of involvement and knowledge of fathers on breastfeeding. Methods: Observational and transversal study undertaken with 351 interviewed couples at Odete Valadares Maternity Hospital, in Belo Horizonte, based on semi-structured questionnaires . Data was collected through a two-part interview, first answered by the mother and later by the father. Data analysis was run throughout the software Epi-Info, version 7.1.2.0. Results: Majority (92.0%) of fathers reported that they did not receive any information from health professionals about breastfeeding. Only 4.27% of fathers reported the correct breastfeeding timeline recommended by World Health Organisation and the Brazilian Ministry of Health. When argued if they, at any time, if they have spoken with the mother about the child's nurture, 56.98% answered "no". Conclusions: Despite the fact the father recognises the importance of breastfeeding, majority of the time do not talk with the mother about this subject. A well informed and engaged father on a child's nurture might be an active element in supporting precocious abclatation diminution. Educative assistance on breastfeeding undertaken by health professionals should include and motivate the role of the father to actively participate for breastfeeding. (AU)

Breaking bad news: doctors' skills in communicating with patients / Dando más notícias: a habilidade dos médicos em se comunicar com os pacientes

ABSTRACT CONTEXT AND OBJECTIVE: Breaking bad news is one of doctors' duties and it requires them to have some skills, given that this situation is difficult and distressful for patients and their families. Moreover, it is also an uncomfortable condition for doctors. The aim of this study was to evaluate doctors' capacity to break bad news, ascertain which specialties are best prepared for doing this and assess the importance of including this topic within undergraduate courses. DESIGN AND SETTING: Observational cross-sectional quantitative study conducted at a university hospital in Belo Horizonte (MG), Brazil. METHODS: This study used a questionnaire based on the SPIKES protocol, which was answered by 121 doctors at this university hospital. This questionnaire investigated their attitudes, posture, behavior and fears relating to breaking bad news. RESULTS: The majority of the doctors did not have problems regarding the concept of bad news. Nevertheless, their abilities diverged depending on the stage of the protocol and on their specialty and length of time since graduation. Generally, doctors who had graduated more than ten years before this survey felt more comfortable and confident, and thus transmitted the bad news in a better conducted manner. CONCLUSION: Much needs to be improved regarding this technique. Therefore, inclusion of this topic in undergraduate courses is necessary and proposals should be put forward and verified.

RESUMO CONTEXTO E OBJETIVO: Dar más notícias, além de dever do médico, requer certas habilidades de sua parte, por se tratar de situação difícil e angustiante para o paciente e seus familiares, assim como desconfortável para os profissionais da saúde. O objetivo deste estudo é avaliar a capacidade dos médicos em dar más notícias, assim como as especialidades mais preparadas e a importância da inclusão do tema para a graduação. TIPO DE ESTUDO E LOCAL: Estudo observacional, transversal, quantitativo, realizado em hospital universitário de Belo Horizonte, Minas Gerais, Brasil. MÉTODOS: Este estudo utilizou de questionário baseado no protocolo SPIKES que foi respondido por 121 médicos deste hospital universitário. O questionário investigou suas atitudes, posturas, modos e medos em relação a dar más notícias. RESULTADOS: A maioria dos médicos não teve problemas quanto ao conceito de más notícias, contudo, as habilidades divergiram dependendo da etapa do protocolo, assim como quanto a especialidade e tempo de formado. De modo geral, os médicos formados há mais de 10 anos se sentem mais confortáveis e confiantes, e transmitem tal informação de maneira mais bem conduzida. CONCLUSÃO: Muito se tem a aprimorar em relação a essa técnica. Desse modo, a inclusão do tema durante a graduação é necessária e propostas devem ser sugeridas e averiguadas.

Breaking bad news: doctors' skills in communicating with patients.

CONTEXT AND OBJECTIVE:: Breaking bad news is one of doctors' duties and it requires them to have some skills, given that this situation is difficult and distressful for patients and their families. Moreover, it is also an uncomfortable condition for doctors. The aim of this study was to evaluate doctors' capacity to break bad news, ascertain which specialties are best prepared for doing this and assess the importance of including this topic within undergraduate courses. DESIGN AND SETTING:: Observational cross-sectional quantitative study conducted at a university hospital in Belo Horizonte (MG), Brazil. METHODS:: This study used a questionnaire based on the SPIKES protocol, which was answered by 121 doctors at this university hospital. This questionnaire investigated their attitudes, posture, behavior and fears relating to breaking bad news. RESULTS:: The majority of the doctors did not have problems regarding the concept of bad news. Nevertheless, their abilities diverged depending on the stage of the protocol and on their specialty and length of time since graduation. Generally, doctors who had graduated more than ten years before this survey felt more comfortable and confident, and thus transmitted the bad news in a better conducted manner. CONCLUSION:: Much needs to be improved regarding this technique. Therefore, inclusion of this topic in undergraduate courses is necessary and proposals should be put forward and verified.

Evaluation of the use of intra-operative radiology for open placement of lag screws for the stabilization of sacroiliac luxation in cats.

OBJECTIVES: To assess the effect of intra-operative radiology on the quality of lag screw insertion for the management of sacroiliac joint luxations in cats. METHODS: In this retrospective single-centre study, the surgical, anaesthetic and imaging records of 40 screws (32 cats) placed with lag effect for management of sacroiliac luxation were reviewed. Postoperative radiographs were assessed for sacroiliac joint reduction, screw position, and sacral width purchased by each screw. Cases were divided into two groups according to the use of (IOR) or the absence of intra-operative radiology (NIOR). RESULTS: A total of 23 lag screws were placed with the aid of intra-operative radiology and 17 without. Three of the 23 screws placed in the IOR group exited the sacrum as opposed to eight of 17 screws in the NIOR group (p = 0.03). Mean sacral width purchased by the screws in the IOR group (70.8%) was also significantly higher (p = 0.002) than in the NIOR group (54.6%). Mean general anaesthetic times for unilateral and bilateral screw placement for the IOR group and NIOR group were not significantly different. CLINICAL SIGNIFICANCE: The use of intra-operative radiology can significantly improve the quality of lag screw insertion for the stabilization of sacroiliac luxations in cats, which should lead to a reduced incidence of postoperative screw loosening.

Estudo epidemiológico da evolução de neonatos com hipertireotropinemia no Estado de Minas Gerais: Brasil / Epidemiologic study of the newborns evolution with hyperthyrotropinemia in the State of Minas Gerais: Brazil

Introdução: no exame sérico os valores de TSH acima de 10 ?Ul/mL e de T4 livre (T4L) baixo confirmam o diagnóstico do hipotireoidismo congênito, e as crianças deverão ser tratadas. Contudo, se houver elevação discreta do TSH (5,6 a 10 µUI/mL) e T4L normal, o recém-nascido (RN) apresenta quadro de hipertireotropinemia (HT) neonatal, que pode ser transitório ou permanente, e deve permanecer em acompanhamento clínico rigoroso. Objetivos: verificar a evolução de crianças triadas pelo Programa de Triagem Neonatal de Minas Gerais (PTN-MG) com HT. Métodos: estudo do tipo coorte retrospectivo. Analisaram-se os dados obtidos pelo ?teste do pezinho?, disponibilizados pelo banco de dados do Núcleo deAções e Pesquisa em Apoio Diagnóstico (NUPAD). Resultados: no período de 2000 a 2010,125 RNs apresentaram HT. Desses, 48% normalizaram os níveis de TSH no período médio de 20 meses. Já os outros 52% não normalizaram o TSH no período estudado e por isso foram mantidos em acompanhamento. Conclusões: mesmo que os níveis de TSH tenham se normalizado em 48% dos casos, concedendo alta a esses RNs, o tempo para esse desfecho foi significativo (cerca de 20 meses). Nesse período, pode haver alterações nos exames, muitas vezes com necessidade de tratamento com reposição hormonal, sendo, portanto, fundamentalo seguimento por meio de consultas e dosagens hormonais periódicas.

Introduction: in the serum exam TSH values above 10 ?Ul / mL and free T4 (FT4) low confirm the diagnosis of congenital hypothyroidism, and children should be treated. However, if mild elevation of TSH (5.6 to 10 ?UI / mL), normal FT4, the newborn (NB) has a hyperthyrotropinemia (HT) frame neonatal, which can be temporary or permanent, and should remain in rigorous clinical monitoring. Objects: to check the progress of children screened by the Newborn Screening Program of Minas Gerais (LWA-MG) withHT. Methods: this is a retrospective cohort study. We analyzed the data obtained by ? heel prick test ? provided by the Core Database Action and Research in Support Diagnostics (NUPAD). Results: from 2000 to 2010, 125 newborns had HT. Of these, 48% had a normal TSH levels in an average period of 20 months. As for the other 52% did not normalizeTSH during the study period and were therefore kept in accompaniment. Conclusions: Even though TSH levels have become normal in 48% of cases providing high for these RNs, this time to endpoint was significantly (about 20 months). During this period there may be changes in the exams, often requiring treatment with hormone replacement, and is therefore essential to follow through periodic consultations and hormone levels.

Prevalência de sobrepeso e obesidade em crianças de quatro escolas estaduais de Belo Horizonte, Minas Gerais / Prevalence of overweight and obesity in children of four State schools in Belo Horizonte, Minas Gerais

Introdução: a obesidade é um distúrbio do estado nutricional, de difícil tratamento, relacionado ao aumento do tecido adiposo, com consequente elevação do peso corporal. A população vem apresentando alta prevalência de excesso de peso e entre as causas para explicar esse aumento estão as mudanças no estilo de vida e nos hábitos alimentares. Objetivos: avaliar a prevalência de sobrepeso e obesidade em crianças dequatro escolas estaduais de Belo Horizonte, Minas Gerais. Métodos: estudo transversal e observacional, constituído por uma amostra de 194 estudantes, com idade entre sete e nove anos, de quatro escolas estaduais de Belo Horizonte. Foram obtidos os dados antropométricos (peso e altura) e alguns dados de hábitos de vida. Como referencial para a análise dos dados foram utilizados os indicadores propostos pela Organização Mundial da Saúde (OMS), a fim de se obter as prevalências de sobrepeso e obesidade. Resultados: houve certa homogeneidade na distribuição entre as faixas etárias e predominância do sexo feminino sobre o masculino. Das crianças analisadas, 20,1% estão na faixa de sobrepeso, sendo que 13,9% são meninas e 6,2% são meninos. Enquantoisso, 16,0% das crianças foram considerados obesos, sendo que 10,8% são meninas e 5,2% meninos. Conclusão: o número de crianças acima do peso é significativo e preocupante, o que indica a necessidade de ações direcionadas para a prevenção e tratamento desse importante problema de saúde pública.

Introduction: obesity is a disorder of nutritional status that is difficult to treat and related to increasing in adipose tissue with consequent elevation of body weight. The population has shown a high prevalence of overweight and among the causes to explain this weight increase are changes in lifestyle and eating habits. Objectives: to evaluate the prevalence of overweight and obesity in children of four State schools in Belo Horizonte, Minas Gerais. Methods: this was a cross-sectional and observational study consisting of 194 students, aged between seven and nine years, attending four State schools in Belo Horizonte. Anthropometric (height and weight) and some life habits data were obtained. Indicators proposed by the World Health Organization (WHO) were used as a reference for the data analysis to obtain the prevalence of overweight and obesity. Results: there was certain homogeneity in the distribution between age groups and female predominance over males. Out of the examined children, 20.1% are in the overweight range, 13.9% are girls and 6.2% are boys. Meanwhile,16.0% of children were considered obese; 10.8% are girls, and 5.2% are boys. Conclusion: the number of overweight children is significant and troubling, which indicates the need for targeted actions to prevent and treat this important public health problem.

Miocardite fulminante / Fulminant myocarditis

A miocardite constitui-se em um dos diagnósticos mais desafiadores em Cardiologia, pois raramente é reconhecida clinicamente. Além disso, não existe um exame que seja padrão-ouro para o diagnóstico e o tratamento atual permanece controverso. O objetivo deste relato de caso é descrever a importância do diagnóstico precoce de miocardite aguda fulminante, na avaliação de paciente com dor torácica e história clínica sugestiva que, após tratamento adequado, apresentou evolução favorável.

The myocarditis constitutes one of the most challenging diagnoses in cardiology because it is rarely recognized clinically. In addition, there is no gold standard exam for the diagnosis and current treatment remains controversial. The objective of this case report is to describe the importance of early diagnosis of acute fulminant myocarditis in the evaluation of patients with chest pain and clinical history that is suggestive that after appropriate treatment, presented favorable evolution.

Bloqueio atrioventricular avançado: uma manifestação incomum da endomiocardiofibrose / Advanced atrioventricular block: an unusual manifestation od endomyocardial fibrosis

A endomiocardiofibrose é uma causa importante de cardiopatia restritiva na zona tropical, ocasionalmente verificada no Brasil. Caracteriza-se pelo espessamento fibroso do endocárdio e do miocárdio subjacente, com progressão tardia para insuficiência cardíaca grave e prognóstico reservado. Relata-se aqui uma apresentação infrequente da doença: a insuficiência cardíaca de baixo débito, secundária a bloqueio atrioventricular avançado. O paciente foi tratado com sucesso por meio de implante de marcapasso DDD/R e encontra-se em classe funcional I (NYHA) há dois anos.

Endomyocardial fibrosis is an important cause of restrictive cardiomyopathy observed in tropical areas and has been occasionally found in Brazil. It is characterized by fibrous thickening of the endocardium and underlying myocardium with late progression to severe heart failure and poor prognosis. We report an unusual presentation of the disease: low output heart failure secondary to advanced atrioventricular block. The patient was successfully treated by implanting a DDD/R pacemaker and has been in functional class I (NYHA) for 2 years.

Analysis of EGF+61A>G polymorphism and EGF serum levels in Brazilian glioma patients treated with perillyl alcohol-based therapy.

PURPOSE: Malignant gliomas are associated with alteration in EGF/EGFR signaling. Functional EGF+61A>G polymorphism is implicated with risk, recurrence, and progression of glioma. This study aimed to establish a putative association of EGF+61A>G with risk of glioma development, production of angiogenic growth factor EGF, and the response to perillyl alcohol administered by intranasal route. METHODS: The study included 83 patients with recurrent glioma enrolled in Phase I/II trial for intranasal perillyl alcohol therapy and subjects without cancer (n = 196) as control group. DNA was extracted from blood samples, EGF genotype performed with PCR-RFLP assay, and EGF circulating levels by enzyme immunoassay. Adequate statistical tests were performed to verify associations between polymorphism and glioma risk, and genotype correlation with EGF circulating levels. The log-rank test was also used to evaluate differences on patient survival. RESULTS: Patients with primary glioblastoma had high frequency of AA genotype (p = 0.037) and A allele (p = 0.037). Increased EGF circulating levels were observed in glioma patients with AA (p = 0.042), AG (p = 0.006), and AA + AG (p = 0.008) genotypes compared with GG. Patients with GG genotype showed increased but not significant (p > 0.05) survival rate, and EGF levels lower than 250 pg/mL was consistently (p = 0.0374) associated with increased survival. CONCLUSION: Presence of EGF+61A>G polymorphism in Brazilian subjects was associated with glioma risk and increased circulating EGF levels. Better response to perillyl alcohol-based therapy was observed in a group of adult Brazilian subjects with lower EGF levels.

Predictors of hospital mortality in hemodynamically stable patients with pulmonary embolism.

BACKGROUND: Pulmonary embolism is associated with high mortality in patients with hypotension or circulatory shock. However, the association between some clinical variables and mortality is still unclear in hemodynamically stable patients. OBJECTIVES: To derive an in-hospital mortality risk stratification model in hemodynamically stable patients with pulmonary embolism. METHODS: This is a prospective multicenter cohort study of 582 consecutive patients admitted in emergency units or intensive care units with clinically suspected pulmonary embolism and whose diagnosis was confirmed by one or more of the following tests: pulmonary arteriography, spiral CT angiography, magnetic resonance angiography, Doppler echocardiography, pulmonary scintigraphy, or venous duplex scan. Data on demographics, comorbidities and clinical manifestations were collected and included in a logistic regression analysis so as to build the prediction model. RESULTS: Overall mortality was 14.1%. The following parameters were identified as independent death risk variables: age > 65 years, bed rest > 72h, chronic cor pulmonale, sinus tachycardia, and tachypnea. After risk stratification, mortalities of 5.4%, 17.8%, and 31.3% were found in the low, moderate and high-risk subgroups, respectively. The model showed 65.5% sensitivity and 80% specificity, with a 0.77 area under the curve. CONCLUSION: In hemodynamically stable patients with pulmonary embolism, age > 65 years, bed rest > 72h, chronic cor pulmonale, sinus tachycardia and tachypnea were independent predictors of in-hospital mortality. However, further validation of the prediction model in other populations is required so that it can be incorporated into the clinical practice.