Effect of adding hydrochlorothiazide to usual treatment of patients with acute decompensated heart failure: a randomized clinical trial.

Acute decompensated heart failure (ADHF) is the leading cause of hospitalization in patients aged 65 years or older, and most of them present with congestion. The use of hydrochlorothiazide (HCTZ) may increase the response to loop diuretics. To evaluate the effect of adding HCTZ to furosemide on congestion and symptoms in patients with ADHF. This randomized clinical trial compared HCTZ 50 mg versus placebo for 3 days in patients with ADHF and signs of congestion. The primary outcome of the study was daily weight reduction. Secondary outcomes were change in creatinine, need for vasoactive drugs, change in natriuretic peptides, congestion score, dyspnea, thirst, and length of stay. Fifty-one patients were randomized-26 to the HCTZ group and 25 to the placebo group. There was an increment of 0.73 kg/day towards additional weight reduction in the HCTZ group (HCTZ: - 1.78 ± 1.08 kg/day vs placebo: - 1.05 ± 1.51 kg/day; p = 0.062). In post hoc analysis, the HCTZ group demonstrated significant weight reduction for every 40 mg of intravenous furosemide (HCTZ: - 0.74 ± 0.47 kg/40 mg vs placebo: - 0.33 ± 0.80 kg/40 mg; p = 0.032). There was a trend to increase in creatinine in the HCTZ group (HCTZ: 0.50 ± 0.37 vs placebo: 0.27 ± 0.40; p = 0.05) but no significant difference in onset of acute renal failure (HCTZ: 58% vs placebo: 41%; p = 0.38). No differences were found in the remaining outcomes. Adding hydrochlorothiazide to usual treatment of patients with acute decompensated heart failure did not cause significant difference in daily body weight reduction compared to placebo. In analysis adjusted to the dose of intravenous furosemide, adding HCTZ 50 mg to furosemide resulted in a significant synergistic effect on weight loss.Trial registration: The Brazilian Clinical Trials Registry (ReBEC), a publically accessible primary register that participates in the World Health Organization International Clinical Trial Registry Platform; number RBR-5qkn8h. Registered in 23/07/2019 (retrospectively), http://www.ensaiosclinicos.gov.br/rg/RBR-5qkn8h/ .

Síndrome coronariana aguda como apresentação atípica do fenômeno de roubo subclávio / Acute coronary syndrome as an atypical presentation of the phenomenon of subclavian steal

Roubo coronariano da subclávia (RCS) é um fenômeno raro que ocorre em pacientes submetidos a cirurgia de revascularização miocárdica com enxerto de artéria torácica interna esquerda (ATIE) e que causa estenose da artéria subclávia ipsilateral e proximal à origem da ATIE. Relatamos o caso de um paciente masculino de 65 anos que apresentou quadro atípico de síndrome do RCS, manifestando-se como síndrome coronariana aguda no pós-operatório de cirurgia vascular (AU)

Coronary subclavian steal (CSS) is a rare phenomenon that occurs in patients undergoing coronary artery bypass graft surgery using the left internal thoracic artery (LITA) causing stenosis of the ipsilateral subclavian artery proximal to the origin of the LITA. We report the case of a 65-year-old male patient who presented with atypical CSS syndrome, manifesting as acute coronary syndrome after vascular surgery (AU)

Increasing teachers' knowledge about ADHD and learning disorders: an investigation on the role of a psychoeducational intervention.

OBJECTIVE: To investigate elementary school teachers' baseline knowledge about ADHD and learning disorders (LD) and the impact of a strategy to increase awareness of these disorders. METHOD: A total of 37 teachers were selected from four elementary schools in the catchment area of the University Hospital, in Porto Alegre, Brazil. To evaluate teachers' knowledge, two self-report questionnaires about ADHD and LD were applied before and after an awareness program on these disorders. RESULTS: The intervention significantly increased teachers' knowledge of both disorders, even after adjustment for confounding factors (p < .001). In the repeated measures ANCOVA, only teachers' previous knowledge of ADHD/LD (p < .001) was significant in predicting score change in knowledge before and after the intervention. CONCLUSION: Results suggest the efficacy of a brief psychoeducational intervention program for increasing teacher awareness and knowledge about ADHD and LD. Future studies are warranted to confirm the efficacy and evaluate the long-term impact of this intervention.