Early anticoagulation after aortic valve replacement with porcine bioprosthesis randomized control trial(ANTIPRO). 3 years follow-up.

BACKGROUND: Most evidence for anticoagulation in aortic bioprosthesis is centered on embolic events, bleeding and re-intervention risk. The effect of anticoagulation on hemodynamics has not been previously assessed. Our hypothesis was that patients with anticoagulation (AC) early after aortic valve replacement (AVR) with porcine bioprosthesis have better hemodynamics at 3 years of follow-up. METHODS: This is a follow-up evaluation of the ANTIPRO trial. All patients undergoing AVR with porcine bioprosthesis were consecutively recruited. The AC group received warfarin+aspirin and the non-AC(control) only aspirin. The primary outcome was mean gradient after 3 years of AVR and change in New York Heart Association (NYHA) class. Secondary outcomes were major and minor bleeding and embolic events. RESULTS: Of 140 participants in the study, 71 were assigned to the AC group and 69 to the control group. Mean age of the overall population was 72.4(SD: 7.1) years. Global euroSCORE was 7.65(SD: 5.73). At 3 years the mean gradient was similar between both groups (19.4(SD: 9.6 mmHg) and 18.6(SD: 8.2 mmHg) in the control and AC group respectively, p = 0.7). No differences in functional class at 3 years were found among groups. No differences were found among groups in the secondary outcomes. CONCLUSIONS: The addition of 3 months of oral anticoagulation to anti-aggregation treatment did not affect bioprosthetic hemodynamics nor functional class at years after AVR.

Warfarin use is associated with higher aortic bioprosthetic 18F-fluoride PET uptake.

BACKGROUND: Prevalence of bioprosthetic valve degeneration (BVD) is rising as the use of bioprosthetic aortic valves increases. Detecting early signs of BVD remains a challenge, with conventional imaging methods often failing to identify early deterioration stages. 18F-fuoride positron emission tomography (PET-CT) is an emerging technique that offers promising prospects to detect subclinical BVD. This study aimed to compare early PET parameters of fluoride uptake with echocardiographic hemodynamic parameters and compare outcomes according to anticoagulation in patients who received bioprosthetic valves. METHODS: This is a sub-study of the ANTIPRO clinical trial, which involved patients undergoing surgical aortic valve replacement (SAVR) with a porcine bioprosthesis and randomized them into anticoagulated and non-anticoagulated groups. Hemodynamic changes were assessed by transthoracic echocardiography (TTE), while 18F-fluoride PET-CT quantified fluoride uptake and divided the patients in two groups: high-uptake and low-uptake. Mean and maximum gradients by TTE at three years were compared between the two uptake groups. Fluoride uptake was also compared between the anticoagulated and control groups. RESULTS: We found no significant differences in transprosthetic gradients between high-uptake(21.4 ± 8.6 mmHg) and low-uptake(17.3 ± 11.2 mmHg.p = 0.244) PET-defined groups in this specific timeframe. Notably, anticoagulated patients exhibited significantly risk of higher fluoride uptake(OR = 4.34;95%CI:1.04-18.21.p = 0.045). CONCLUSIONS: No association was found between fluoride uptake and hemodynamic evaluation. Anticoagulation was associated with higher fluoride uptake. These findings highlight the emerging role of PET-CT in studying bioprosthetic aortic valves and emphasize the need for extended follow-up to evaluate the impact of anticoagulation on valve degeneration.

Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery Associated with Right Coronary Giant Aneurysm.

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital malformation, usually diagnosed in the infant period due to myocardial ischemia and heart failure, with the need for emergency surgery. Less commonly, it can be asymptomatic until adulthood. Coronary artery aneurysms are also rare anatomical anomalies with symptoms of acute or chronic angina or even remain completely asymptomatic. We present an unusual case of ALCAPA, associated with a giant aneurysm of the right coronary artery. Meeting presentation: American Association for Thoracic Surgery 102nd annual meeting, Boston MA, USA, May 16, 2022.

Analysis of notified drug poisoning among children in Santa Catarina state, 2016-2020.

OBJECTIVE: The aim of this study was to analyze the incidence of drug poisoning in children registered in the Santa Catarina Information and Toxicological Assistance Center between 2016 and 2020. METHODS: This observational epidemiological study, with a historical cohort design, was carried out from reported cases of drug poisoning in children aged 0-12 years. Census sampling was used to collect data. RESULTS: There were 4839 reported cases of drug poisoning among children in the State of Santa Catarina in the surveyed period, with an average annual incidence rate of 6 cases/1000 live births. The median age was 3 years. Most cases of poisoning occurred among girls aged 0-3 years by accidental ingestion of drugs at home. There was a predominance of signs and symptoms affecting the nervous system; only a small portion required hospitalization. Most cases were considered mild poisoning with a favorable outcome. No deaths were recorded. There was a tendency of increasing cases over time, however not significant. There is a predominance of incident cases in the Great West of the state, followed by the Midwest and Serra Catarinense regions. CONCLUSIONS: Drug poisoning in children is predominant in early childhood, mainly caused by accidental ingestion of drugs at home. These findings highlight the importance of preventive and educational measures among family members and caregivers.

Cross-cultural adaptation and validation of the Iowa Satisfaction with Anesthesia Scale for use in Brazil: a cross-sectional study.

BACKGROUND: The Iowa Satisfaction with Anesthesia Scale (ISAS) was developed to assess the satisfaction of patients undergoing sedation with monitored anesthesia care. This study aimed to cross-culturally adapt the ISAS instrument and evaluate the acceptability, validity, and reliability of the proposed Brazilian version (ISAS-Br). METHODS: The cross-cultural adaptation process involved translation, synthesis, back-translation, expert committee review, pre-testing, and final review of the ISAS-Br. A cross-sectional study was conducted, involving 127 adult individuals undergoing ambulatory surgeries with moderate/deep sedation. The acceptability, reliability, and construct validity of the scale were assessed. RESULTS: The cross-cultural adaptation process did not require significant changes to the final version of the scale. The ISAS-Br demonstrated excellent acceptability, with a completion rate of 99% and an average completion time of 4.6 minutes. Exploratory factor analysis revealed three factors: emotional well-being, physical comfort, and anxiety relief, with respective composite reliability coefficient values of 0.874, 0.580, and 0.428. The test-retest reliability of the ISAS-Br, measured by the intraclass correlation coefficient, was 0.67 (95% confidence interval [95% CI] 0.42 to 0.83), and the Bland-Altman plot showed satisfactory agreement between the measurements. CONCLUSION: The proposed Brazilian version of the ISAS underwent successful cross-cultural adaptation according to international standards. It demonstrated good acceptability and reliability, regarding the assessment of temporal stability. However, the ISAS-Br exhibited low internal consistency for some factors, indicating that this instrument lacks sensitivity to assess the satisfaction of deeply sedated patients. Further studies are necessary to explore the hypotheses raised based on the knowledge of its psychometric properties.

The Large-Scale Implementation of a Health Information System in Brazilian University Hospitals: Process and Outcomes.

Governments around the globe are paving the way for healthcare services that can have a profound impact on the overall well-being and development of their nations. However, government programs to implement health information technologies on a large-scale are challenging, especially in developing countries. In this article, the process and outcomes of the large-scale implementation of a hospital information system for the management of Brazilian university hospitals are analyzed. Based on a qualitative approach, this research involved 21 hospitals and comprised a documentary search, interviews with 24 hospital managers and two system user focus groups, and a questionnaire of 736 respondents. Generally, we observed that aspects relating to the wider context of system implementation (macro level), the managerial structure, cultural nuances, and political dynamics within each hospital (meso level), as well as the technology, work activities, and individuals themselves (micro level) acted as facilitators and/or obstacles to the implementation process. The dynamics and complex interactions established between these aspects had repercussions on the process, including the extended time necessary to implement the national program and the somewhat mixed outcomes obtained by hospitals in the national network. Mostly positive, these outcomes were linked to the eight emerging dimensions of practices and work processes; planning, control, and decision making; transparency and accountability; optimization in the use of resources; productivity of professionals; patient information security; safety and quality of care; and improvement in teaching and research. We argued here that to maximize the potential of information technology in healthcare on a large-scale, an integrative and cooperative vision is required, along with a high capacity for change management, considering the different regional, local, and institutional contexts.

Early anticoagulation after aortic valve replacement with porcine bioprosthesis randomized control trial (ANTIPRO).

OBJECTIVES: Most evidence for anticoagulation (AC) in aortic bioprosthesis is centred on embolic events, bleeding and reintervention risk. The effect of AC on haemodynamics has not been previously assessed. Our hypothesis was that patients with early AC after aortic valve replacement (AVR) with porcine bioprosthesis have better haemodynamics at 1 year of follow-up. METHODS: Prospective, randomized, open-label trial conducted at 2 cardiac surgery centres. All patients undergoing AVR with porcine bioprosthesis were consecutively recruited. The anticoagulated group received warfarin + aspirin and the non-anticoagulated (control) only aspirin. The primary outcome was mean gradient after 1 year of AVR and change in New York Heart Association class. Secondary outcomes were major and minor bleeding, embolic events and prosthetic leak. RESULTS: Of 140 participants in the study, 71 were assigned to the anticoagulated group and 69 to the control group. The mean age of the overall population was 72.4 (SD: 7.1) years. Global EuroSCORE was 7.65 (SD: 5.73). At 1 year, the mean gradient was similar between both groups [18.6 (SD: 1.1 mmHg) and 18.1 (SD: 1.0 mmHg) in the control and anticoagulated groups, respectively, P = 0.701]. No differences in functional class at 3 months or 1 year were found among groups. No differences were found among groups in the secondary outcomes. CONCLUSIONS: The addition of 3 months of oral AC to anti-aggregation treatment was not detected to affect bioprosthetic haemodynamics nor functional class at 1 year after AVR. Likewise, AC does not lead to the higher incidence of complications.

Trastuzumab-induced cardiotoxicity in early breast cancer over a 10-year period in Uruguay.

This srudy aimed to estimate the prevalence of trastuzumab-induced cardiotoxicity in Uruguayan women diagnosed with human epidermal growth factor receptor 2 (HER2)-positive breast cancer over a 10-year period, who were treated under the financial coverage of the National Resources Fund (Fondo Nacional de Recursos). This was an observational, descriptive study based on the analysis of an anonymized database of Uruguayan women diagnosed with HER2-positive breast cancer who received adjuvant trastuzumab treatment from to 2006 to 2016, provided by the Fondo Nacional de Recursos. Statistical analysis was performed using SPSS Statistics version 25, and variables were assessed using measures of central tendency, dispersion, contingency tables, and proportions. The chi-square test was used to analyze the association between the different variables. The study included 1401 patients diagnosed with stage I to III HER2-positive breast cancer. The mean age at diagnosis was 52 years. The prevalence of cardiotoxicity was 20.3%. Most patients who discontinued treatment owing to cardiotoxicity eventually resumed treatment (92.6%). Moreover, the prevalence of cardiotoxicity was similar among patients who received regimens with and without anthracyclines. No association was observed between prior cardiovascular events or trastuzumab administration (concurrent vs sequential) and the development of cardiotoxicity. In the present study, the prevalence of cardiotoxicity was similar to that reported nationally and internationally. Most patients did not develop cardiotoxicity, while the ones who developed it remained asymptomatic and cardiotoxicity was reversible.

Temporal trend and spatial distribution of cases of mother-to-child transmission of HIV in the state of Santa Catarina, Brazil, 2007-2017: an ecological study. / Tendência temporal e distribuição espacial dos casos de transmissão vertical do HIV em Santa Catarina, 2007-2017: um estudo ecológico.

OBJECTIVE: To analyze the temporal trend and spatial distribution of mother-to-child HIV transmission in Santa Catarina between 2007 and 2017. METHODS: This was a mixed ecological study with data from the Notifiable Health Conditions Information System. Linear regression was performed for time series analysis and the mean rates in the period and mean annual percentage changes in the rates of HIV-infected pregnant women were calculated, children exposed to HIV during pregnancy, and seroconversion of children exposed to HIV/AIDS during pregnancy, in addition to data geoprocessing. RESULTS: There were 5,554 records of HIV-infected pregnant women, with a rate of 5.6 pregnant women per 1,000 live births. The mean seroconversion rate was 13.5/100,000 live births (95%CI 6.8;20.1) and it showed a falling trend (APC = -99.4%; 95%CI -99.9;-93.1). The seroconversion rate was more expressive in small towns. CONCLUSION: The rate of HIV-infected pregnant women was stable in the period, whereas the number of children infected with HIV through mother-to-child transmission decreased.

Contribution of plasma, placental, inflammatory and pro-resolving mediators in labor induction.

INTRODUCTION: The onset of labor is regulated by endocrine, nervous and immunological factors. This study was designed to determine the inflammatory and pro-resolving mediator levels in plasma and placenta of women undergoing labor induction in late-term pregnancy. METHOD: Healthy pregnant women admitted for delivery or labor induction were included. TNF, IL-1ß, IL-6, IL-8, and IL-10 were quantified by ELISA in plasmatic and placental samples and Annexin A1 (ANXA1) in the placenta by Western Blotting, and immunofluorescence to CD15+ antibody. The data were analyzed using the Wilcoxon test and Spearman correlation. The p-value was significant when <0.05. RESULTS: There was a higher concentration of IL-8 was found in the amniotic plaque (p = 0.042) and IL-10 (p < 0.001) in the trophoblast of patients with spontaneous labor. Greater ANXA1 density in the trophoblast was also observed in those with induction failure. There was a positive correlation of ANXA1 density in trophoblast induction duration with (r = 0.580) and with the IL-6 level in amniotic plaque (r = 0.517), and a positive correlation between labor duration and density of ANXA1 was identified in the trophoblast (r = 0.419). An increase was identified in CD15+ cell immunocapturing among the groups with spontaneous labor compared to the group with induction failure (p < 0.001). DISCUSSION: The inflammatory process in labor involves both maternal and fetal participation. Induction failure is associated with higher levels of ANXA1 in the trophoblast.

Bio-packaging based on cellulose acetate from banana pseudostem and containing Butia catarinensis extracts.

Banana (Musa acuminata) pseudostem cellulose was extracted and acetylated (CA) to prepare membranes with potential use as bio-packages. The CA membrane was embedded by Butia seed (CA-BS) or Butia pulp (CA-BP) extracts obtained from Butia catarinenses (Butia). The produced CA, CA-BS, and CA-BP membranes were evaluated for their physical-chemical, mechanical, thermal, and antibacterial properties. The process for obtaining the cellulose yielded a material with about 92.17% cellulose (DS = 2.85). The purity, cellulose degree acetylation, and the incorporation of Butia extracts into the membranes were confirmed by FTIR. The CA-BS and CA-BP membranes showed a smaller contact angle and higher swelling ratio than the CA membrane. Furthermore, Butia seed or pulp extracts reduced the elastic modulus and deformation at break compared to the CA membrane. The DSC analysis suggested the compatibility between sections and the CA matrix, whereas the TGA analysis confirmed the thermal stability of the membranes. Moreover, less than 1% of the Butia seed and pulp extracts were put into a food simulant media from the membrane. Finally, the CA-BS and CA-BP membranes could inhibit the growth of Staphylococcus aureus and Escherichia coli on their surface, confirming the potential use of these membranes as bio-packaging for food preservation.

Epidemiology of COVID-19 Among Indigenous Populations in Brazil.

BACKGROUND: Due to social and geographical isolation, indigenous people are more vulnerable to adverse conditions; however, there is a lack of data on the epidemics' impact on these populations. Thus, this article's objective was to describe the epidemiological situation of COVID-19 in indigenous communities in Brazil. METHODS: This descriptive observational study was carried out in indigenous communities in the municipality of Amaturá (Amazonas, Brazil). Individuals from the Alto Rio Solimões Special Indigenous Sanitary District (DSEI) who met the Sars-Cov-2 infection case definitions during the period between January and August 2020 were included. For case notification, the definitions adopted by the Ministry of Health of Brazil and by the Special Secretariat for Indigenous Health were considered. RESULTS: Out of the entire population served by the Alto Rio Solimões DSEI (n = 2890), 109 indigenous people were suspected of having been infected with Sars-Cov-R during the study period; a total of 89 cases were actually confirmed (rate: 3.08 cases/100,000 inhabitants). Most patients diagnosed with COVID-19 were female (56.2%), with a mean age of 32.4 (± 23.6) years. Predominant symptoms were fever (76.4%), dry cough (64%), and headache (60.7%). Complications occurred in 7.9% of the patients; no deaths were reported. CONCLUSION: These results enhance the observation that indigenous populations, even if relatively isolated, are exposed to COVID-19. The disease cases assessed showed a favorable evolution, which does not mean reducing the need for caring of this population.

Transcultural adaptation of Patient-Reported Outcomes in Obesity (PROS) questionnaire for Brazil. / Adaptação transcultural do questionário Patient-Reported Outcomes in Obesity (PROS) para utilização no Brasil.

OBJECTIVE: To perform a cross-cultural adaptation and validation in the Brazilian cultural context of questionnaire Patient-Reported Outcomes in Obesity (PROS). METHODS: The cross-cultural adaptation process involved the translation from original English language into Brazilian Portuguese by two qualified and independent translators. The back-translation was performed by two English language teachers who were native speakers, without any medical knowledge of the original scale. An expert committee was created with researchers to assess semantic, idiomatic, experiential and conceptual equivalence. The pre-test of the Brazilian version, named PROS-Br, was carried out with ten adults with obesity. To assess the psychometric properties of the instrument, a cross-sectional epidemiological study was carried out. The population consisted of 120 Brazilian adults with obesity who went to the appointment at a school-clinic. The Item Response Theory and Factor Analysis with Principal Component Extraction was used for the psychometrics analysis. To measure reliability, the α-Cronbach indicator was used. RESULTS: In the reliability analysis, α-Cronbach was 0.82. Two factors explained 58.3% of the total variance in the principal component analysis, involving behavioral and physical aspects. Item Response Theory curves showed that all questions have discriminatory characteristics, pointing to the adequacy of the proposed version. CONCLUSION: The Brazilian version was proven valid and reliable to measure the quality of life of individuals with obesity, allowing one to develop intervention strategies, plan and execute actions at services and for public health policies.

OBJETIVO: Realizar a adaptação transcultural e a validação, no contexto cultural brasileiro, do instrumento de impacto da obesidade Patient-Reported Outcomes in Obesity (PROS). MÉTODOS: O processo de adaptação transcultural contou com a tradução do idioma original, inglês, para o português, executada por dois tradutores qualificados e independentes. A retrotradução foi realizada por dois professores de inglês, nativos, sem qualquer conhecimento médico nem da escala original. Um comitê de especialistas foi composto de pesquisadores para avaliar as equivalências semântica, idiomática, experiencial e conceitual. O pré-teste da versão brasileira, denominada PROS-Br, foi realizado com dez indivíduos adultos com obesidade. Para a avaliação das propriedades psicométricas, foi realizado um estudo epidemiológico de delineamento transversal. A população foi composta de 120 indivíduos adultos com obesidade, brasileiros, presentes para consulta médica em ambulatório-escola. Para análises psicométricas, foram utilizadas a Teoria de Resposta ao Item e análise fatorial com extração de componentes principais. Para aferição da confiabilidade foi utilizado o indicador α-Cronbach. RESULTADOS: Na análise de confiabilidade, o PROS-Br apresentou α-Cronbach de 0,82. Dois fatores explicaram 58,3% da variância total na análise de componentes principais, envolvendo aspectos comportamentais e físicos. As curvas da Teoria de Resposta ao Item mostraram que todas as perguntas apresentam características discriminatórias, apontando para a adequação da versão brasileira proposta. CONCLUSÃO: A versão brasileira mostrou-se válida e confiável para aferir a qualidade de vida de indivíduos com obesidade, possibilitando desenvolver estratégias de intervenção, planejamento e execução de ações nos serviços e na política pública de saúde.

Congenital anomalies in Santa Catarina: case distribution and trends in 2010-2018.

OBJECTIVE: To evaluate the distribution of cases of congenital anomalies in the state of Santa Catarina by health macro-region, to determine the frequency according to maternal and neonatal variables, to estimate the related mortality, and the trends in the period 2010-2018. METHODS: An ecological time-series study with secondary data on congenital anomalies and the sociodemographic and health variables of mothers and newborns living in Santa Catarina, from 2010 to 2018. For temporal trend analysis, generalized linear regression was performed using the Prais-Winsten method with robust variance. RESULTS: The average prevalence of congenital anomalies in the period was 8.9 cases per 1,000 live births, being 9.4 cases by 1,000 live births in 2010 and, in 2018, 8.2/1,000. The trend remained stable in the analyzed period. The major malformations were musculoskeletal, hip, and foot malformations, with a proportion ≥30%. There was a higher prevalence of congenital anomalies in low birthweight, preterm, male livebirths with Apgar≤7, born by cesarean section, mothers of older age (≥40 years), and less educated (less than eight years of study). Infant mortality due to congenital malformations was 2.6 deaths/1,000 live births, representing about 25.8% of the total infant deaths in the period. CONCLUSIONS: The frequency of congenital anomalies and the mortality with anomalies was stable in the studied period in Santa Catarina. The presence of anomalies was associated with low birth weight, prematurity, and low Apgar score. The highest proportion of congenital anomalies was in the musculoskeletal system.

Internal construct validity of the Brazilian version of a tool for assessing the population's knowledge of human papillomavirus.

OBJECTIVE: To verify the internal construct validity of the Brazilian Portuguese version of a tool for measuring the general population's knowledge of human papillomavirus (HPV). MATERIALS AND METHODS: A cross-culturally adapted Brazilian Portuguese version of a measurement tool originally designed for English speaking populations was administered to 330 adults in Tubarão, Santa Catarina, Southern Brazil. After examining the overall suitability of the method, we performed investigations based on the item response theory and exploratory factor analysis. RESULTS: Ten of the 29 items presented a low contribution to the construct and were excluded from subsequent analysis. The factor analysis yielded three factors, which explained approximately 51% of the variance variability. A different arrangement from the original measurement tool was found: general HPV knowledge, with six items; HPV vaccination knowledge, with five items; HPV transmission and testing knowledge, with eight items. CONCLUSION: The Brazilian Portuguese version under study presented a different behavior from the original measurement tool, but proved to be a reliable and valid instrument in assessing the Brazilian population's knowledge about HPV.

Predictors of dropout from a multidisciplinary heart failure program: a nested case study.

BACKGROUND: Chronic heart failure is a growing public health issue that is reaching epidemic proportions. In the last few years, multidisciplinary management programs have been developed to improve its management. Yet, some patients take advantage of these programs, whereas others do not. METHODS: Several demographic, medical, and social variables were evaluated as contributors to dropout after enrollment into a multidisciplinary heart failure program using a nested case-control design. A total of 14 patients and 42 controls were interviewed using a standardized questionnaire. Possible associations were explored by means of chi Mantel-Haenszel test and a binary logistic regression model. RESULTS: The only significant factor associated with dropout was social isolation. Patients who lived alone, without family support, had a significantly greater dropout risk (odds ratio, 12.5; 95% confidence interval, 1.35-11.6). CONCLUSIONS: For patients who live alone, an individualized approach may be better than a multidisciplinary management program, but this hypothesis should be investigated in future studies.

Cardiac output measured by transthoracic echocardiography and Swan-Ganz catheter. A comparative study in mechanically ventilated patients with high positive end-expiratory pressure. / Monitorizacion del gasto cardiaco con ecocardiografia transtoracica y cateter de Swan Ganz. Estudio comparativo en pacientes en ventilacion mecanica con presión positiva espiratoria final elevada.

OBJECTIVE: To compare cardiac output measurements by transthoracic echocardiography and a pulmonary artery catheter in mechanically ventilated patients with high positive end-expiratory pressure. To evaluate the effect of tricuspid regurgitation. METHODS: Sixteen mechanically ventilated patients were studied. Cardiac output was measured by pulmonary artery catheterization and transthoracic echocardiography. Measurements were performed at different levels of positive end-expiratory pressure (10cmH2O, 15cmH2O, and 20cmH2O). The effect of tricuspid regurgitation on cardiac output measurement was evaluated. The intraclass correlation coefficient was studied; the mean error and limits of agreement were studied with the Bland-Altman plot. The error rate was calculated. RESULTS: Forty-four pairs of cardiac output measurements were obtained. An intraclass correlation coefficient of 0.908 was found (p < 0.001). The mean error was 0.44L/min for cardiac output values between 5 and 13L/min. The limits of agreement were 3.25L/min and -2.37L/min. With tricuspid insufficiency, the intraclass correlation coefficient was 0.791, and without tricuspid insufficiency, 0.935. Tricuspid insufficiency increased the error rate from 32% to 52%. CONCLUSIONS: In patients with high positive end-expiratory pressure, cardiac output measurement by transthoracic echocardiography is comparable to that with a pulmonary artery catheter. Tricuspid regurgitation influences the intraclass correlation coefficient. In patients with high positive end-expiratory pressure, the use of transthoracic echocardiography to measure cardiac output is comparable to invasive measures.

OBJETIVO: Comparar las medidas de gasto cardiaco por ecocardiografía transtorácica y por catéter arterial pulmonar en pacientes en ventilación mecánica con presión positiva al final de la espiración elevada. Evaluar el efecto de la insuficiencia tricúspide. MÉTODOS: Se estudiaron 16 pacientes en ventilación mecánica. El gasto cardiaco se midió con el catéter arterial pulmonar y por ecocardiografía transtorácica. Las medidas se realizaron en diferentes niveles de presión positiva al final de la espiración (10cmH2O, 15cmH2O, y 20cmH2O). Se evalúo el efecto de la insuficiencia tricúspide sobre la medida de gasto cardiaco. Se estudió el coeficiente de correlación intraclase; el error medio y los límites de concordancia se estudiaron con el diagrama de Bland-Altman. Se calculó el porcentaje de error. RESULTADOS: Se obtuvieron 44 pares de medidas de gasto cardiaco. Se obtuvo un coeficiente de correlación intraclase de 0,908, p < 0,001; el error medio fue 0,44L/min para valores de gasto cardíaco entre 5 a 13L/min. Los límites de concordancia se encontraron entre 3,25L/min y -2,37L/min. Con insuficiencia tricúspide el coeficiente de correlación intraclase fue 0,791, sin insuficiencia tricúspide el coeficiente de correlación intraclase fue 0,935. La presencia de insuficiencia tricúspide aumentó el porcentaje de error de 32 % a 52%. CONCLUSIONES: En pacientes con presión positiva al final de la espiración elevada la medida de gasto cardiaco por ecocardiografía transtorácica es comparable con catéter arterial pulmonar. La presencia de insuficiencia tricúspide influye en el coeficiente de correlación intraclase. En pacientes con presión positiva al final de la espiración elevada, el uso de ecocardiografía transtorácica para medir gasto cardiaco es comparable con las medidas invasivas.

Psychometric properties of a medium version of the Copenhagen Psychosocial Questionnaire (COPSOQ II) for southern Brazil.

BACKGROUND: The emerging frequency of Behavioural Mental Health Disorders among Brazilian workers and the recent legal demand for analysis of psychosocial risks in the workplace highlight the importance of standardizing measures to assess these risks as a way to allow identification and proper comparison among different populations. OBJECTIVE: To assess the psychometric properties of the COPSOQ II questionnaire medium version for southern Brazil, based on the Spanish medium-length version of COPSOQ-ISTAS21 II. METHODS: A sample of 426 workers from a university in southern Brazil answered the model under study online. Content validity and internal consistency were analyzed through Confirmatory Factor Analysis (AFC) and Exploratory Factor Analysis (AFE) and Cronbach's α coefficient. RESULTS: The study model presented a response rate of 48.46%. The analyses indicated the possibility of the instrument to present reliability and validity of content. From the AFE, the final model consisted of 13 dimensions and 70 items, and presented a Cronbach's alpha of 0.82, which is considered a good internal consistency. CONCLUSIONS: The results showed that the final model of this study presents acceptable levels of reliability and internal validity for the application in Brazil, along with the groups of workers that resemble the participants of the research, to assess psychosocial risks in the workplace.

Cross-cultural adaptation and validation of the Iowa Satisfaction with Anesthesia Scale for use in Brazil: a cross-sectional study

Abstract Background: The Iowa Satisfaction with Anesthesia Scale (ISAS) was developed to assess the satisfaction of patients undergoing sedation with monitored anesthesia care. This study aimed to cross-culturally adapt the ISAS instrument and evaluate the acceptability, validity, and reliability of the proposed Brazilian version (ISAS-Br). Methods: The cross-cultural adaptation process involved translation, synthesis, back-translation, expert committee review, pre-testing, and final review of the ISAS-Br. A cross-sectional study was conducted, involving 127 adult individuals undergoing ambulatory surgeries with moderate/deep sedation. The acceptability, reliability, and construct validity of the scale were assessed. Results: The cross-cultural adaptation process did not require significant changes to the final version of the scale. The ISAS-Br demonstrated excellent acceptability, with a completion rate of 99% and an average completion time of 4.6 minutes. Exploratory factor analysis revealed three factors: emotional well-being, physical comfort, and anxiety relief, with respective composite reliability coefficient values of 0.874, 0.580, and 0.428. The test-retest reliability of the ISAS-Br, measured by the intraclass correlation coefficient, was 0.67 (95% confidence interval [95% CI] 0.42 to 0.83), and the Bland-Altman plot showed satisfactory agreement between the measurements. Conclusion: The proposed Brazilian version of the ISAS underwent successful cross-cultural adaptation according to international standards. It demonstrated good acceptability and reliability, regarding the assessment of temporal stability. However, the ISAS-Br exhibited low internal consistency for some factors, indicating that this instrument lacks sensitivity to assess the satisfaction of deeply sedated patients. Further studies are necessary to explore the hypotheses raised based on the knowledge of its psychometric properties.

Aortopathy and regurgitation in bicuspid valve patients increase the risk of aortopathy in relatives.

BACKGROUND: Bicuspid aortic valve (BAV) is the most frequent cardiac congenital valvular disease. Although the BAV risk of first degree relatives (FDR) has been assessed (7-9%), there is little information as to the heritable risk for aortopathy. OBJECTIVE: Identify the specific risk for regional aortopathy in FDR with tricuspid aortic valve (TAV) of BAV patients according to their aortic phenotype and aortic regurgitation (AR). METHODS: Using an international consortium, BAV probands were assessed for aortopathy of the root, ascending aorta and for AR. Aortopathy was defined by the presence of segmental dilatation. The presence of segmental aortopathy and AR in BAV probands was evaluated as predictor for aortopathy in FDR with TAV. RESULTS: We identified 74 FDR related to 49 probands with aortopathy and 66 FDR related to 31 probands without aortopathy. Demographic variables were similar between proband groups. Among FDR, 16 individuals had BAV (11.4%). TAV-FDR of probands with ascending aortopathy had higher incidence of root aortopathy (18.8% vs. 3.6% p < 0.05) while TAV-FDR of probands with root aortopathy had higher incidence of aortopathy at all aortic segments (55%vs25%, 55%vs21%, and 4%vs29% at annulus, root and ascending respectively, p < 0.05 for all). Independent predictors for root aortopathy in TAV-FDR were: ascending (OR = 6.23;95%CI:1.27-30.5) and root aortopathy (OR = 9.00;95%CI:1.58-51.1) in probands; and for ascending aortopathy: root aortopathy (OR = 4.04;95%CI:1.33-12.3) and AR in probands (OR = 4.84; 95%CI:1.75-13.4). CONCLUSION: Root and ascending aortopathy in BAV probands are strong predictors of aortopathy in their TAV-FDR. AR in BAV patients has an independent effect on the risk for ascending aortopathy in TAV-FDR.