Fondaparinux versus Enoxaparin in the Treatment of Obese Patients with Acute Coronary Syndrome. / Fondaparinux versus Enoxaparina no Tratamento de Pacientes Obesos com Síndrome Coronariana Aguda.

BACKGROUND: Fondaparinux is an effective and safe anticoagulant in the treatment of acute coronary syndromes (ACS). However, due to the low representation of obese individuals in clinical trials, the effects of applying the results of this drug to this population remain uncertain. OBJECTIVES: To compare Fondaparinux to Enoxaparin in the treatment of obese patients with ACS. METHODS: This is a retrospective cohort study, including obese individuals (BMI ≥ 30 Kg/m2) admitted with non-ST-segment elevation myocardial infarction (NSTEMI) or unstable angina (UA) and treated with Fondaparinux or Enoxaparin between 2010 and 2020. The Fondaparinux and Enoxaparin groups were compared for their clinical and laboratory characteristics using chi-square and Mann-Whitney tests, as appropriate. The incidence of primary outcomes (death, reinfarction, stroke, major bleeding) was compared between groups. P-value < 0.05 was considered significant for all analyses. RESULTS: A total of 367 obese patients with NSTEMI or UA were included, of whom 258 used Fondaparinux and 109 used Enoxaparin. Mean age was 64 ± 12 years, and 52.9% were male. The prevalence of diabetes, hypertension, dyslipidemia, prior coronary artery disease, prior stroke, and implementation of invasive strategy was similar between groups. The incidence of the primary outcome was 4.7% in the Fondaparinux group and 5.5% in the Enoxaparin group (p = 0.729). There was no difference between groups when analyzing the components of the primary outcome separately. CONCLUSION: In a sample of obese patients with NSTEMI or UA, there was no difference in the occurrence of the composite outcome (death, stroke, reinfarction, major bleeding) between patients who used Fondaparinux or Enoxaparin.

FUNDAMENTO: O fondaparinux é um anticoagulante eficaz e seguro usado no tratamento de síndromes coronarianas agudas (SCAs). No entanto, devido à baixa representatividade de indivíduos obesos em ensaios clínicos, os efeitos de se aplicar os resultados desse medicamento nesta população continuam incertos. OBJETIVOS: Comparar o fondaparinux à enoxaparina no tratamento de obesos com SCA. MÉTODOS: Este é um estudo do tipo coorte retrospectivo, incluindo indivíduos obesos (IMC ≥ 30 Kg/m2) internados com Infarto do Miocárdio sem Elevação do Segmento ST (IAMSSST) ou Angina Instável (AI) e tratados com fondaparinux ou enoxaparina entre 2010 e 2020. Os grupos que receberam fondaparinux e enoxaparina foram comparados quanto suas características clínicas e laboratoriais usando o teste do qui-quadrado e o teste de Mann-Whitney, conforme apropriado. A incidência dos desfechos primários (morte, reinfarto, acidente vascular cerebral, sangramento maior) foi comparada entre os grupos. Um p<0,05 foi considerado estatisticamente significativo em todas as análises. RESULTADOS: Um total de 367 pacientes obesos com IAMSSST ou AI foi incluído, dos quais 258 usaram fondaparinux e 109 usaram enoxaparina. A idade média foi 64 ± 12 anos, 52,9% eram do sexo masculino. A prevalência e diabetes, hipertensão, dislipidemia, doença arterial coronariana prévia, acidente vascular cerebral prévio, e implementação de estratégia invasiva foi similar entre os grupos. A incidência do desfecho primário foi 4,7% no grupo fondaparinux e 5,5% no grupo enoxaparina (p = 0,729). Não houve diferença entre os grupos quando os componentes do desfecho primário foram analisados separadamente. CONCLUSÃO: Em uma amostra de pacientes obesos com IAMSSST ou AI, não houve diferença na ocorrência do desfecho composto (morte, acidente vascular cerebral, reinfarto, sangramento maior) entre os pacientes que utilizaram fondaparinux ou enoxaparina.

Clinical trajectories of critically ill patients discharged directly from a critical unit to a postacute care facility: retrospective cohort.

OBJECTIVE: To describe the clinical trajectories of patients discharged directly from a critical unit to a postacute care facility. METHODS: This was a retrospective cohort study of patients who were transferred from an intensive care unit or intermediate care unit to a postacute care facility between July 2017 and April 2023. Functional status was measured by the Functional Independence Measure score. RESULTS: A total of 847 patients were included in the study, and the mean age was 71 years. A total of 692 (82%) patients were admitted for rehabilitation, while 155 (18%) were admitted for palliative care. The mean length of stay in the postacute care facility was 36 days; 389 (45.9%) patients were discharged home, 173 (20.4%) were transferred to an acute hospital, and 285 (33.6%) died during hospitalization, of whom 263 (92%) had a do-not-resuscitate order. Of the patients admitted for rehabilitation purposes, 61 (9.4%) had a worsened functional status, 179 (27.6%) had no change in functional status, and 469 (63%) had an improved functional status during hospitalization. Moreover, 234 (33.8%) patients modified their care goals to palliative care, most of whom were in the group that did not improve functional status. Patients whose functional status improved during hospitalization were younger, had fewer comorbidities, had fewer previous hospitalizations, had lower rates of enteral feeding and tracheostomy, had higher Functional Independence Measure scores at admission to the postacute care facility and were more likely to be discharged home with less complex health care assistance. CONCLUSION: Postacute care facilities may play a role in the care of patients after discharge from intensive care units, both for those receiving rehabilitation and palliative care, especially for those with more severe illnesses who may not be discharged directly home.

Fondaparinux versus Enoxaparina no Tratamento de Pacientes Obesos com Síndrome Coronariana Aguda / Fondaparinux versus Enoxaparin in the Treatment of Obese Patients with Acute Coronary Syndrome

Resumo Fundamento: O fondaparinux é um anticoagulante eficaz e seguro usado no tratamento de síndromes coronarianas agudas (SCAs). No entanto, devido à baixa representatividade de indivíduos obesos em ensaios clínicos, os efeitos de se aplicar os resultados desse medicamento nesta população continuam incertos. Objetivos: Comparar o fondaparinux à enoxaparina no tratamento de obesos com SCA. Métodos: Este é um estudo do tipo coorte retrospectivo, incluindo indivíduos obesos (IMC ≥ 30 Kg/m2) internados com Infarto do Miocárdio sem Elevação do Segmento ST (IAMSSST) ou Angina Instável (AI) e tratados com fondaparinux ou enoxaparina entre 2010 e 2020. Os grupos que receberam fondaparinux e enoxaparina foram comparados quanto suas características clínicas e laboratoriais usando o teste do qui-quadrado e o teste de Mann-Whitney, conforme apropriado. A incidência dos desfechos primários (morte, reinfarto, acidente vascular cerebral, sangramento maior) foi comparada entre os grupos. Um p<0,05 foi considerado estatisticamente significativo em todas as análises. Resultados: Um total de 367 pacientes obesos com IAMSSST ou AI foi incluído, dos quais 258 usaram fondaparinux e 109 usaram enoxaparina. A idade média foi 64 ± 12 anos, 52,9% eram do sexo masculino. A prevalência e diabetes, hipertensão, dislipidemia, doença arterial coronariana prévia, acidente vascular cerebral prévio, e implementação de estratégia invasiva foi similar entre os grupos. A incidência do desfecho primário foi 4,7% no grupo fondaparinux e 5,5% no grupo enoxaparina (p = 0,729). Não houve diferença entre os grupos quando os componentes do desfecho primário foram analisados separadamente. Conclusão: Em uma amostra de pacientes obesos com IAMSSST ou AI, não houve diferença na ocorrência do desfecho composto (morte, acidente vascular cerebral, reinfarto, sangramento maior) entre os pacientes que utilizaram fondaparinux ou enoxaparina.

Abstract Background: Fondaparinux is an effective and safe anticoagulant in the treatment of acute coronary syndromes (ACS). However, due to the low representation of obese individuals in clinical trials, the effects of applying the results of this drug to this population remain uncertain. Objectives: To compare Fondaparinux to Enoxaparin in the treatment of obese patients with ACS. Methods: This is a retrospective cohort study, including obese individuals (BMI ≥ 30 Kg/m2) admitted with non-ST-segment elevation myocardial infarction (NSTEMI) or unstable angina (UA) and treated with Fondaparinux or Enoxaparin between 2010 and 2020. The Fondaparinux and Enoxaparin groups were compared for their clinical and laboratory characteristics using chi-square and Mann-Whitney tests, as appropriate. The incidence of primary outcomes (death, reinfarction, stroke, major bleeding) was compared between groups. P-value < 0.05 was considered significant for all analyses. Results: A total of 367 obese patients with NSTEMI or UA were included, of whom 258 used Fondaparinux and 109 used Enoxaparin. Mean age was 64 ± 12 years, and 52.9% were male. The prevalence of diabetes, hypertension, dyslipidemia, prior coronary artery disease, prior stroke, and implementation of invasive strategy was similar between groups. The incidence of the primary outcome was 4.7% in the Fondaparinux group and 5.5% in the Enoxaparin group (p = 0.729). There was no difference between groups when analyzing the components of the primary outcome separately. Conclusion: In a sample of obese patients with NSTEMI or UA, there was no difference in the occurrence of the composite outcome (death, stroke, reinfarction, major bleeding) between patients who used Fondaparinux or Enoxaparin.

Evaluation of internal markers in digestibility estimation for sheep and goats.

The objective of this study was to compare the indirect methods of obtaining digestibility with the direct method of total fecal collection to estimate the apparent digestibility of nutrients in sheep and goats supplemented with non-protein nitrogen. Five goats and five sheep with no defined racial pattern were used, distributed in two 5 × 5 Latin squares, with split plots, considering the diets as plots and the apparent digestibility determination methodologies as subplots. The diets were composed of buffelgrass hay and the addition, via ruminal infusion, of increasing amounts of nitrogen supplementation in order to gradually raise the CP level of the basal diet in intervals of 2% points, that is, + 2, +4, + 6 and + 8%. Samples of the feeds offered, and the leftovers were collected daily during the five days of collection to determine the nutrient intake, as well as the total collection of feces to determine the apparent digestibility of the nutrients. The amount of fecal dry matter excreted was estimated by the concentration of Indigestible Acid Detergent Fiber (ADFi), Indigestible Neutral Detergent Fiber (NDFi), Indigestible Dry Matter at 244 h (DMi 244 h) and Indigestible Dry Matter at 264 h (DMi 264 h). Among the evaluated markers, DMi 264 h had the lowest accuracy in estimating fecal excretion and nutrient digestibility. For the goat species, the markers ADFi and DMi 244 h proved to be able to adequately predict fecal excretion and digestibility indices, while NDFi stood out for both species. Among the evaluated markers, NDFi is the one that most accurately estimates the nutrient digestibility of the diet for goats and sheep.

Long-term outcomes for epidemic viral pneumonia survivors after discharge from the intensive care unit: a systematic review.

OBJECTIVE: To review the long-term outcomes (functional status and psychological sequelae) of survivors of critical illnesses due to epidemic viral pneumonia before the COVID-19 pandemic and to establish a benchmark for comparison of the COVID-19 long-term outcomes. METHODS: This systematic review of clinical studies reported the long-term outcomes in adults admitted to intensive care units who were diagnosed with viral epidemic pneumonia. An electronic search was performed using databases: MEDLINE®, Web of Science™, LILACS/IBECS, and EMBASE. Additionally, complementary searches were conducted on the reference lists of eligible studies. The quality of the studies was assessed using the Newcastle-Ottawa Scale. The results were grouped into tables and textual descriptions. RESULTS: The final analysis included 15 studies from a total of 243 studies. This review included 771 patients with Influenza A, Middle East Respiratory Syndrome, and Severe Acute Respiratory Syndrome. It analyzed the quality of life, functionality, lung function, mortality, rate of return to work, rehospitalization, and psychiatric symptoms. The follow-up periods ranged from 1 to 144 months. We found that the quality of life, functional capacity, and pulmonary function were below expected standards. CONCLUSION: This review revealed great heterogeneity between studies attributed to different scales, follow-up time points, and methodologies. However, this systematic review identified negative long-term effects on patient outcomes. Given the possibility of future pandemics, it is essential to identify the long-term effects of viral pneumonia outbreaks. This review was not funded. Prospero database registration: (www.crd.york.ac.uk/prospero) under registration ID CRD42021190296.

Comparative Study of the Influence of Heat Treatment on Fracture Resistance of Different Ceramic Materials Used for CAD/CAM Systems.

The aim of this study was to compare the influence of heat treatment on fracture resistance (FR) of different ceramic materials used for CAD/CAM systems. METHODS: Eighty monolithic restorations were designed using the same parameters and milled with a CAD/CAM system (CEREC SW 5.0, PrimeMill, Dentsply-Sirona™, Bensheim, Germany), forming five study groups: Group 1 (n = 10), CEREC Tessera (Dentsply-Sirona™, Bensheim, Germany) crystallized (CCT), Group 2 (n = 10), CEREC Tessera uncrystallized (UCT), Group 3 (n = 20), Emax-CAD (Ivoclar Vivadent, Schaan, Liechtenstein) (CEC), Group 4 (n = 20), Vita Suprinity (Vita Zahnfabrik, Bad Säckingen, Germany) (CVS), and Group 5 (n = 20) Cameo (Aidite, Qinhuangdao, China) (CC). RESULTS: The average FR was similar for CCT, CC, and CEC at above 400 N, while CVS and UCT had the lowest values at 389,677 N and 343,212 N, respectively. CONCLUSION: Among the three ceramic materials that exhibited an FR above 400 N, CCT was considered the first recommended choice for CAD/CAM systems. This material not only demonstrated the highest FR but also exhibited outstanding consistency in the related measurements without the presence of outliers. Although the CC material showed high FR, its high dispersion revealed inconsistencies in the repetitions, suggesting caution in its use.

Correlation of Diagnostic Components of Metabolic Syndrome with Electrocardiographic and Echocardiographic Alterations in Patients with Obesity

Abstract Introduction: Metabolic syndrome (MS) and obesity are risk factors for cardiovascular diseases (CVD). However, the development of cardiovascular pathologies in obese individuals without MS is being investigated. Objective: To investigate whether there are similar electrocardiographic (ECG) and echocardiographic changes in individuals with obesity with and without MS. Methodology: A retrospective, descriptive cross-sectional study was carried out with obese patients at a university hospital in Belém, Pará, Brazil. Anthropometric, laboratory, ECG and echocardiographic data were evaluated in both populations. The chi-square test was used to describe the relationship between variables among groups; hypothesis tests with p < 0.05 were considered statistically significant values. Results: The study evaluated 100 individuals with obesity, 60 of whom had MS. The average age was 54 years, and the female sex was prevalent. Systolic blood pressure, HDL, and waist circumference were altered in both groups. Systemic arterial hypertension and low HDL demonstrated 4.27 times and 3.32 times greater likelihood of presenting changes in the ECG and echocardiogram for both groups. On the ECG, diffuse changes in ventricular repolarization were observed in both groups. On echocardiography, left ventricular diastolic dysfunction and left ventricular hypertrophy were present in both populations studied. Conclusion: Obese individuals without MS present a similar risk, requiring adequate attention to their cardiac health.

Long-term outcomes for epidemic viral pneumonia survivors after discharge from the intensive care unit: a systematic review

ABSTRACT Objective To review the long-term outcomes (functional status and psychological sequelae) of survivors of critical illnesses due to epidemic viral pneumonia before the COVID-19 pandemic and to establish a benchmark for comparison of the COVID-19 long-term outcomes. Methods This systematic review of clinical studies reported the long-term outcomes in adults admitted to intensive care units who were diagnosed with viral epidemic pneumonia. An electronic search was performed using databases: MEDLINE®, Web of Science™, LILACS/IBECS, and EMBASE. Additionally, complementary searches were conducted on the reference lists of eligible studies. The quality of the studies was assessed using the Newcastle-Ottawa Scale. The results were grouped into tables and textual descriptions. Results The final analysis included 15 studies from a total of 243 studies. This review included 771 patients with Influenza A, Middle East Respiratory Syndrome, and Severe Acute Respiratory Syndrome. It analyzed the quality of life, functionality, lung function, mortality, rate of return to work, rehospitalization, and psychiatric symptoms. The follow-up periods ranged from 1 to 144 months. We found that the quality of life, functional capacity, and pulmonary function were below expected standards. Conclusion This review revealed great heterogeneity between studies attributed to different scales, follow-up time points, and methodologies. However, this systematic review identified negative long-term effects on patient outcomes. Given the possibility of future pandemics, it is essential to identify the long-term effects of viral pneumonia outbreaks. This review was not funded. Prospero database registration: (www.crd.york.ac.uk/prospero) under registration ID CRD42021190296.

An overview on neurobiology and therapeutics of attention-deficit/hyperactivity disorder.

Attention-Deficit/Hyperactivity Disorder (ADHD) is a prevalent psychiatric condition characterized by developmentally inappropriate symptoms of inattention and/or hyperactivity/impulsivity, which leads to impairments in the social, academic, and professional contexts. ADHD diagnosis relies solely on clinical assessment based on symptom evaluation and is sometimes challenging due to the substantial heterogeneity of the disorder in terms of clinical and pathophysiological aspects. Despite the difficulties imposed by the high complexity of ADHD etiology, the growing body of research and technological advances provide good perspectives for understanding the neurobiology of the disorder. Such knowledge is essential to refining diagnosis and identifying new therapeutic options to optimize treatment outcomes and associated impairments, leading to improvements in all domains of patient care. This review is intended to be an updated outline that addresses the etiological and neurobiological aspects of ADHD and its treatment, considering the impact of the "omics" era on disentangling the multifactorial architecture of ADHD.

Caracterização dos espaços de participação social na Atenção Primária à Saúde em João Pessoa, Paraíba(Brasil) / Characterization of spaces of social participation in Primary Health Care in João Pessoa, Paraíba(Brasil)

A participação social na esfera local encontra dificuldades de se estabelecer como norteadora da construção de políticas públicas. Com base nessa assertiva, este artigo tem como objetivo caracterizar os espaços de participação social em uma capital brasileira. Para tanto, foram realizadas entrevistas estruturadas escritas com 12 gerentes de Unidades de Saúde da Família do Distrito Sanitário II de João Pessoa, as quais foram posteriormente analisadas pela aproximação de ideias semelhantes. A seguir, procedeu-se às etapas de interpretação dos resultados por meio de discussão, intuição e crítica, utilizando-se a metodologia da análise de conteúdo, conforme Bardin. Constatou-se predominância da prática de grupos de linhas de cuidado, além de um público composto principalmente de mulheres e idosos. A maioria dos espaços foi criada entre 2017 e 2018. Grande parte dos temas falava sobre bem-estar individual, mas pouco foi abordado sobre a construção de políticas públicas, a fiscalização de obras e investimentos ou aluta por direitos

Social participation in the local sphere encounters difficulties in establishing itself as a guideline for the construction of public policies. Based on this assertion, we produced this article with the objective of characterizing the spaces for social participation in a Brazilian capital. For that, written structured interviews were carried out with 12 managers ofFamily Health Units of the Sanitary District II of João Pessoa, which were later analyzed by approximating similar ideas. The next step was the interpretation of the results throughdiscussion, intuition and criticism, using the content analysis methodology, according to Bardin. It was found a predominance of the practice of groups of lines of care, in addition to an audience composed mainly of women and the elderly. Most of the spaces were created between 2017 and 2018. Most of the themes talked about individual well-being, but little was addressed about the construction of public policies, the monitoring of works and investments, or the fight for rights.

Espaços Formativos e de Sensibilização Quanto às Práticas Integrativas e Complementares em uma Unidade de Saúde da Família: Potencialidades e Desafios

Diante do contexto do Sistema Único de Saúde e das Diretrizes Curriculares Nacionais para os Cursos de Medicina, o Módulo Horizontal A-2 traz uma proposta de conectar os aprendizados teóricos e a prática na rede de saúde. Com objetivos de construção de conhecimentos em práticas educativas em saúde, foram realizados dois cursos de Práticas Integrativas centrados em princípios da educação popular e em uma construção horizontal do conhecimento. Esses cursos foram realizados na Unidade de Saúde da Família - Vila Saúde e a sua construção deu-se em conjunto com a equipe e usuários da mesma. Os participantes entraram em contato com diversas práticas como a fitoterapia, terapia floral, biodança e vivências teatrais. Nesse contexto, foi possível identificar muitas potencialidades e dificuldades no desenvolvimento desses cursos, como a importância do interesse dos participantes e os problemas de infraestrutura na Unidade. Durante os cursos, o conhecimento construído permitiu um contato maior dos participantes com as práticas integrativas e uma visão ampliada sobre o cuidado. Além disso, os profissionais puderam se capacitar e conhecer novas práticas, o que possibilita uma melhoria no atendimento realizado. Para os estudantes, o curso trouxe uma visão ampla do sistema e da importância da educação em saúde no Sistema Único de Saúde.

Índice de massa corporal, nutrição e atividade física em crianças e adolescentes com síndrome de Down / Body-mass index, nutrition and physical activity in children and adolescents with Down syndrome

Objetivo: Descrever e comparar hábito nutricional, prática de atividade física e índice de massa corporal (IMC) de crianças e adolescentes com síndrome de Down acompanhados em ambulatório especializado de um hospital terciário no sul do Brasil. Método: Estudo transversal realizado a partir da análise de prontuário de pacientes com síndrome de Down em idade escolar e adolescentes acompanhados em ambulatório especializado do Complexo Hospital de Clínicas da Universidade Federal do Paraná. A alimentação foi considerada adequada se consistisse em alimentos de todos os grupos nas três refeições principais e um ou dois lanches e água nos intervalos. Sedentarismo foi definido como tempo de atividade física inferior a 300 minutos por semana. O estado nutricional foi avaliado usando as curvas de IMC da Organização Mundial da Saúde, 2007.Resultados: O estudo incluiu 755 pacientes, sendo 236 (31,3%) crianças e 519 (68,7%) adolescentes. Sobrepeso e obesidade foram observados em 10,7% e 14,8% da população, respectivamente, sem diferença significativa entre os gêneros. Alimentação inadequada foi observada em 34,6% e sedentarismo em 23,7% dos pacientes. IMC elevado foi observado em 20,3% das crianças e 27,9% dos adolescentes (p=0,026). Observou-se sedentarismo em 29,5% dos adolescentes e 11% das crianças (p<0,001). Alimentação inadequada também foi mais prevalente em adolescentes, porém sem diferença estatística. Pacientes com IMC elevado, em comparação com eutróficos, tiveram maior prevalência de alimentação inadequada e sedentarismo, com significância estatística. Nesse subgrupo, o sedentarismo foi observado em 25% das crianças e 57,2% dos adolescentes (p<0,001). Conclusão: Adolescentes com síndrome de Down apresentam maiores taxas de IMC elevado e sedentarismo comparados com crianças. Estudos específicos em educação em saúde para essa população são necessários com o objetivo de promover hábitos de vida saudáveis e prevenir a obesidade com efetividade. [au]

Objective: To describe and compare the nutritional habits, physical activity, and body mass index (BMI) of children and adolescents with Down syndrome followed up in the specialized outpatient clinic of a tertiary hospital in southern Brazil. Method: Cross-sectional study conducted from the analysis of medical records of patients with Down syndrome at school age and adolescents followed up at the Complexo Hospital de Clínicas of the Universidade Federal do Paraná. The diet was considered adequate if it consisted of foods from all groups in the three main meals and one or two snacks and water in the intervals. A sedentary lifestyle was defined as physical activity time of fewer than 300 minutes per week. Nutritional status was assessed using BMI curves from the World Health Organization, 2007. Results: The study included 755 patients, of whom 236 (31.3%) were children and 519 (68.7%) were adolescents. Overweight and obesity were observed in 10.7% and 14.8% of the population, respectively, without significant gender differences. Inadequate diet was observed in 34.6% and sedentarism in 23.7% of the patients. High BMI was observed in 20.3% of children and 27.9% of adolescents (p=0.026). Sedentarism was observed in 29.5% of adolescents and 11% of children (p<0.001). Inadequate diet was also more prevalent in adolescents but without statistical difference. Patients with high BMI, compared to eutrophic patients, had a higher prevalence of inadequate diet and sedentarism, with statistical significance. In this subgroup, sedentarism was observed in 25% of children and 57.2% of adolescents (p<0.001). Conclusion: Adolescents with Down syndrome have higher rates of high BMI and sedentarism compared to children. Specific studies in health education for this population are necessary to promote healthy lifestyle habits and effectively prevent obesity. [au]

Prognostic analysis of lymph node ratio of patients with disease recurrence previously submitted to cervical dissection surgery for head and neck cancer.

INTRODUCTION: the variable lymph node ratio has recently been studied as a possible influencer in the survival of patients diagnosed with head and neck cancer. OBJECTIVE: to analyze the correlation between lymph node density and survival of recurred disease patients previously submitted to cervical dissection surgery due to head and neck squamous cell carcinoma. METHOD: we retrospectively analyzed 71 medical records of patients treated at the Head and Neck Surgery Service of the Pontifícia Universidade Católica de Campinas who had undergone cervical dissection surgery and presented tumor recurrence between 2006 and 2019. Patient and tumor data such as age, gender, skin color, smoking, alcohol consumption, location of the primary tumor, anatomopathological characteristics and lymph node status were correlated with the survival time. RESULTS: we found a predominance of males and the mean age was 59.5 years. The most frequent primary site was the oral cavity followed by the larynx and oropharynx. The mortality rate was 53.52% and the mean lymph node ratio 0.28. We found influence on survival with statistical significance for the parameters: lymph node ratio, number of dissected and affected lymph nodes, T and N staging, type of treatment proposed (palliative or surgical), presence of compromited margins in the primary tumor and lymph node extravasation. CONCLUSION: the calculation of lymph node density in patients with recurred disease after cervical dissection surgery by head and neck squamous cell carcinoma should be taken into account during therapeutic planning and prognostic evaluation due to its direct influence on the survival.

Baixa Concordância entre a Classificação da NYHA e as Variáveis do Teste de Exercício Cardiopulmonar em Pacientes com Insuficiência Cardíaca e Fração de Ejeção Reduzida / Low Concordance between NYHA Classification and Cardiopulmonary Exercise Test Variables in Patients with Heart Failure and Reduced Ejection Fraction

Resumo Fundamento A classificação funcional da New York Heart Association (NYHA) é o sistema de classificação mais utilizado para a insuficiência cardíaca (IC), enquanto o teste de exercício cardiopulmonar (TECP) é o padrão ouro para a avaliação do estado funcional na IC. Objetivo Analisar a correlação e a concordância entre as classes da NYHA e as variáveis do TECP. Métodos Foram selecionados pacientes com IC com indicação clínica para TECP e fração de ejeção (FE) < 50%. A correlação (coeficiente de Spearman) e a concordância (kappa) entre a classificação da NYHA e as classificações baseadas no TECP foram analisadas. Um valor de p < 0,05 foi considerado significativo. Resultados No total, foram incluídos 244 pacientes no estudo. A idade média foi de 56±14 anos, e a FE média foi de 35,5%±10%. A distribuição de pacientes de acordo com a classificação da NYHA foi a seguinte: classe I (31,2%), classe II (48,3%), classe III (19,2%) e classe IV (1,3%). A correlação (r) entre as classes da NYHA e de Weber foi de 0,489 (p < 0,001), e a concordância foi de 0,231 (p < 0,001). A correlação (r) entre as classes da NYHA e ventilatórias (inclinação da ventilação minuto/produção de dióxido de carbono [VE/VCO2]) foi de 0,218 (p < 0,001), e a concordância foi de 0,002 (p = 0,959). A correlação de Spearman entre as classes da NYHA e do escore TECP foi de 0,223 (p = 0,004), e a concordância kappa foi de 0,027 (p = 0,606). Conclusão Foi identificada uma associação moderada entre as classes da NYHA e de Webber, embora a concordância tenha sido baixa. As classes ventilatórias (inclinação VE/VCO2) e do escore TECP apresentaram uma associação fraca e uma baixa concordância com as classes da NYHA.

Abstract Background The New York Heart Association (NYHA) functional classification is the most commonly used classification system for heart failure (HF), whereas cardiopulmonary exercise testing (CPET) is the gold standard for functional status evaluation in HF. Objective This study aimed to analyze correlation and concordance between NYHA classes and CPET variables. Methods HF patients with clinical indication for CPET and ejection fraction (EF) < 50% were selected. Correlation (Spearman coefficient) and concordance (kappa) between NYHA classification and CPET-based classifications were analyzed. A p < 0.05 was accepted as significant. Results In total, 244 patients were included. Mean age was 56 ± 14 years, and mean EF was 35.5% ± 10%. Distribution of patients according to NYHA classification was 31.2%% class I, 48.3% class II, 19.2% class III, and 1.3% class IV. Correlation (r) between NYHA and Weber classes was 0.489 (p < 0.001), and concordance was 0.231 (p < 0.001). Correlation (r) between NYHA and ventilatory classes (minute ventilation/carbon dioxide production [VE/VCO2] slope) was 0.218 (p < 0.001), and concordance was 0.002 (p = 0.959). Spearman correlation between NYHA and CPET score classes was 0.223 (p = 0.004), and kappa concordance was 0.027 (p = 0.606). Conclusion There was a moderate association between NYHA and Weber classes, although concordance was low. Ventilatory (VE/VCO2slope) and CPET score classes had a weak association and a low concordance with NYHA classes.

Fracture Resistance of Sintered Monolithic Zirconia Dioxide in Different Thermal Units.

The purpose of this study was to compare the fracture strength of monolithic zirconium dioxide subjected to a sintering process in two different furnaces: InFire HTC Speed and CEREC SpeedFire. METHODS: Forty restorations were designed and machined using a computer aided design / computer aidded machine (CAD/CAM) system. The restorations were randomly assigned to two groups of 20 samples each, Group 1 for the SpeedFire furnace (fast sintering) and Group 2 for the InFire furnace (slow sintering). Each of the crowns was subjected to a maximum compression load recorded in Newtons (N) and a displacement control with a speed of 1 mm/min. RESULTS: Group 1 presented an average of 1222.8 N and a standard deviation of 136.91 N. Group 2 obtained a mean of 1068.5 N and a standard deviation of 316.39 N. CONCLUSIONS: There were no significant differences between the two groups, and the mechanical strength of the material was not affected, which would imply a saving of clinical and laboratory time when performing rapid sintering on monolithic translucent zirconium dioxide restorations. However, rapidly sintered restorations have limited reliability.

Low Concordance between NYHA Classification and Cardiopulmonary Exercise Test Variables in Patients with Heart Failure and Reduced Ejection Fraction. / Baixa Concordância entre a Classificação da NYHA e as Variáveis do Teste de Exercício Cardiopulmonar em Pacientes com Insuficiência Cardíaca e Fração de Ejeção Reduzida.

BACKGROUND: The New York Heart Association (NYHA) functional classification is the most commonly used classification system for heart failure (HF), whereas cardiopulmonary exercise testing (CPET) is the gold standard for functional status evaluation in HF. OBJECTIVE: This study aimed to analyze correlation and concordance between NYHA classes and CPET variables. METHODS: HF patients with clinical indication for CPET and ejection fraction (EF) < 50% were selected. Correlation (Spearman coefficient) and concordance (kappa) between NYHA classification and CPET-based classifications were analyzed. A p < 0.05 was accepted as significant. RESULTS: In total, 244 patients were included. Mean age was 56 ± 14 years, and mean EF was 35.5% ± 10%. Distribution of patients according to NYHA classification was 31.2%% class I, 48.3% class II, 19.2% class III, and 1.3% class IV. Correlation (r) between NYHA and Weber classes was 0.489 (p < 0.001), and concordance was 0.231 (p < 0.001). Correlation (r) between NYHA and ventilatory classes (minute ventilation/carbon dioxide production [VE/VCO2] slope) was 0.218 (p < 0.001), and concordance was 0.002 (p = 0.959). Spearman correlation between NYHA and CPET score classes was 0.223 (p = 0.004), and kappa concordance was 0.027 (p = 0.606). CONCLUSION: There was a moderate association between NYHA and Weber classes, although concordance was low. Ventilatory (VE/VCO2slope) and CPET score classes had a weak association and a low concordance with NYHA classes.

FUNDAMENTO: A classificação funcional da New York Heart Association (NYHA) é o sistema de classificação mais utilizado para a insuficiência cardíaca (IC), enquanto o teste de exercício cardiopulmonar (TECP) é o padrão ouro para a avaliação do estado funcional na IC. OBJETIVO: Analisar a correlação e a concordância entre as classes da NYHA e as variáveis do TECP. MÉTODOS: Foram selecionados pacientes com IC com indicação clínica para TECP e fração de ejeção (FE) < 50%. A correlação (coeficiente de Spearman) e a concordância (kappa) entre a classificação da NYHA e as classificações baseadas no TECP foram analisadas. Um valor de p < 0,05 foi considerado significativo. RESULTADOS: No total, foram incluídos 244 pacientes no estudo. A idade média foi de 56±14 anos, e a FE média foi de 35,5%±10%. A distribuição de pacientes de acordo com a classificação da NYHA foi a seguinte: classe I (31,2%), classe II (48,3%), classe III (19,2%) e classe IV (1,3%). A correlação (r) entre as classes da NYHA e de Weber foi de 0,489 (p < 0,001), e a concordância foi de 0,231 (p < 0,001). A correlação (r) entre as classes da NYHA e ventilatórias (inclinação da ventilação minuto/produção de dióxido de carbono [VE/VCO2]) foi de 0,218 (p < 0,001), e a concordância foi de 0,002 (p = 0,959). A correlação de Spearman entre as classes da NYHA e do escore TECP foi de 0,223 (p = 0,004), e a concordância kappa foi de 0,027 (p = 0,606). CONCLUSÃO: Foi identificada uma associação moderada entre as classes da NYHA e de Webber, embora a concordância tenha sido baixa. As classes ventilatórias (inclinação VE/VCO2) e do escore TECP apresentaram uma associação fraca e uma baixa concordância com as classes da NYHA.

Global DNA methylation changes in adults with attention deficit-hyperactivity disorder and its comorbidity with bipolar disorder: links with polygenic scores.

Genetic and environmental factors contribute to the etiology of Attention Deficit-Hyperactivity Disorder (ADHD). In this sense, the study of epigenetic mechanisms could contribute to the understanding of the disorder's neurobiology. Global DNA methylation (GMe) evaluated through 5-methylcytosine levels could be a promising epigenetic biomarker to capture long-lasting biological effects in response to environmental and hormonal changes. We conducted the first assessment of GMe levels in subjects with ADHD (n = 394) and its main comorbidities in comparison to populational controls (n = 390). Furthermore, given the high genetic contribution to ADHD (heritability of 80%), polygenic risk scores (PRS) were calculated to verify the genetic contribution to GMe levels in ADHD and the comorbidities associated with GMe levels. The GMe levels observed in patients were lower than controls (P = 1.1e-8), with women being significantly less globally methylated than men (P = 0.002). Regarding comorbidities, the presence of bipolar disorder (BD) among patients with ADHD was associated with higher methylation levels compared to patients with ADHD without BD (P = 0.031). The results did not change when pharmacological treatment was accounted for in the analyses. The ADHD and BD most predictive PRSs were negatively (P = 0.0064) and positively (P = 0.0042) correlated with GMe, respectively. This study is the first to report an association between GMe, ADHD, and its comorbidity with BD and associations between PRSs for specific psychiatric disorders and GMe. Our findings add to previous evidence that GMe may be a relevant piece in the psychiatric disorders' etiological landscape.