Pharmaceutical care reducing the impact of the COVID-19 pandemic on the cardiovascular health of hypertensive and diabetic patients / O cuidado farmacêutico na redução do impacto da pandemia de COVID-19 na saúde cardiovascular de pacientes hipertensos e diabéticos

Introduction: The COVID-19 pandemic has impacted the provision of health services to patients with chronic dis-eases, and the Medication Therapy Management, an integral part of pharmaceutical care can lead to an improvement in clinical parameters impacted by the pandemic. The objective of this study was to assess the clinical impact of MTM-PC on systemic arterial hypertension and diabetes mellitus (DM) in comparison with the changes imposed by the COVID-19 pandemic in the primary healthcare scope. Methods: This is a quasi-experimental, single-arm, be-fore-and-after study, with data collection from July 1, 2019 to October 31, 2022. Data from patients at the pharmaceutical services, of the teaching-Pharmacy of UFJF, were included in the study and were divided into pre-pandemic and pandemic period, considering baseline data and the data related to the reintroduction of face-to-face care in the office as an endpoint.. Data were collected on blood pressure, lipidic profile, glycemia, use of statins and acetylsalicylic acid, cardiovascular risk, and psychosocial data, consequences of social isolation on mental health, medication prescription and life habits. Data were analyzed using the MINITAB v19 software, considering a significance level of 5%. Results: During the pandemic without MTM-PC it was found that blood pressure and HDL increased comparing the pre-pandemic with the pandemic without MTM-PC, respectively, SBP 117.5±8.86 and 134.75±12.43; DBP 71.25±3.54 and 83.25±11.65; HDL 45.25±7.80 and 52.38±12.52. Comparatively, it was verified that the blood pressure values were maintained and, the MTM-PC changed parameters like HbA1c 7.890±1.798, [p=0.028] and 7.325±1.30; HDL48.00±6.00 and 59.00±10.56, [p=0.020]. There was a change in both mean of cardiovascular risk, the global scale 13.69±8.08 to 22.38±7.28 and the optimized scale 8.35±6.71 to 16.10±5.83, [p=0.38], with a break in the trend of increased risk with the MTM-PC. The therapeutic load of drugs used for hypertension and diabetes remained below the limit value of 75%. Conclusion: There was evidence that the pandemic changed parameters such as blood pressure and cardiovascular risk. Additionally, the MTM-PC may be able to reduce the impact of the pandemic on glycated hemoglobin, improve HDL cholesterol levels and break a trend of increased cardiovascular risk (AU).

Introdução: A pandemia de COVID-19 impactou na prestação de serviços à saúde aos pacientes portadores de doenças crônicas e o Medication Therapy Management (MTM-PC), parte integrante do cuidado farmacêutico, pode acarretar melhora dos parâmetros clínicos impactados pela pandemia. O objetivo deste estudo foi avaliar o impacto clínico do cuidado farmacêutico na hipertensão arterial sistêmica (HAS) e diabetes mellitus (DM) diante às mudanças impostas pela pandemia de COVID-19 no âmbito da atenção primária à saúde. Métodos: Trata-se de um estudo quase-experimental, single arm, do tipo antes e depois, com a coleta de dados de 01 julho de 2019 a 31 de outubro de 2022. Foram incluídos no estudo dados de pacientes do consultório farmacêutico da Farmácia Uni-versitária - UFJF que foram divididos em pré-pandemia e pandemia, considerando o baseline e os dados relativos à reintrodução do atendimento presencial no consultório como endpoint. Foram coletados dados de pressão arterial, perfil lipídico, glicemia capilar, uso de estatinas e ácido acetilsalicílico, risco cardiovascular e dados psicossociais, consequências do isolamento social na saúde mental, prescrição de medicamentos e hábitos de vida. Os dados foram analisados no software MINITAB v19, considerando o nível de significância de 5%. Resultados: Durante a pan-demia sem o MTM-PC verificou-se que a pressão arterial e o HDL aumentaram, PAS 117,5±8,86 e 134,75±12,43; PAD 71,25±3,54 e 83,25±11,65; HDL 45,25± 7,80 e 52,38±12,52. Comparativamente, verificou-se que os valores de pressão arterial se mantiveram e os parâmetros de hemoglobina glicada e HDL melhoraram com o MTM-PC, HbA1c 7,890±1,798, [p=0,028] e 7,325±1,30; HDL 48,00±6,00 e 59,00±10,56, [p=0,020]. Consequentemente, refletiu-se no aumento do risco cardiovascular pela pandemia, tanto na escala global 13,69±8,08 para 22,38±7,28, quanto otimizada, 8,35± 6,71 para 16,10±5,83, [p=0,38], havendo a quebra de tendência no aumento do risco com o MTM-PC. A carga terapêutica dos medicamentos utilizados para hipertensão e diabetes se manteve abaixo do valor limite de 75%. Conclusão: Evidenciou-se que a pandemia modificou parâmetros como pressão arterial e risco cardiovascular. E que o MTM-PC foi capaz de reduzir o impacto da pandemia na hemoglobina glicada, melhorar os níveis de colesterol HDL e quebrar uma tendência do aumento do risco cardiovascular (AU).

Development and validation of a health information system for assistance and research in gestational trophoblast disease.

BACKGROUND: Gestational Trophoblastic Disease (GTD) comprises pathological forms of placental trophoblastic tissue proliferation. When benign, they present with hydatidiform moles, and when malignant, they are called Gestational Trophoblastic Neoplasia. With the growth of the practice of digital health, allied to updated therapeutic approaches, the Outpatient Clinic for Gestational Trophoblastic Disease has built a Health Information System (HIS), contributing to the teaching-learning binomial, as well as to self-care. METHODS: This is a cross-sectional and blind technological assessment research for developing SIS-Mola (Website for the medical team and the Application "MolaApp" aimed at patients with GTD). We used the Praxis management approach to manage the application creation project. In the tasks involving real-time chat, a WebSocket layer was created and hosted together with the project's web services, which use the Arch Linux operating system. For the evaluations, we provided questionnaires developed based on the System Usability Scale (SUS), to determine the degree of user satisfaction, with objective questions on the Likert scale. We invited 28 participants for the evaluations, among ABDTG specialist physicians, doctors from the DTG Outpatient Clinic team, and the patients. The study was systematized according to the rules of treatment and follow-up in treating the disease. RESULTS: The tests were conducted from November 2021 to February 2022. The responses obtained on a Likert scale indicated reliability and credibility to the HIS, since the total usability score, measured by the ten questions of the SUS instrument, had a mean of 81.1 (clinicians), 80 (patients) and median of 77.5 for both groups. The sample was characterized according to the variables: age, gender, education, computer knowledge, and profession. CONCLUSION: Developing a HIS in the GTD Outpatient Clinic met the objectives regarding the rules of treatment and follow-up of patients. With these digital tools, it is possible to obtain data about the patient's health, sending information through exams performed and appropriate treatments. The connectivity capacity allows agile care, saving time, costs and solving the displacement problem. The TICs generate natural efficiency for the organization in the flow of service and the formation of a database, improving the quality of the assistance.

Occupational nursing in portugal: context and perspectives / Enfermería del trabajo en portugal: contexto y perspectivas / Enfermagem do trabalho em portugal: contexto e perspetivas

Objective: to know the perception of nurses at work regarding the areas of knowledge and intervention. Method: quantitative, descriptive and cross-sectional study. It involved a sample of 472 occupational nurses. A questionnaire was used as a data collection instrument, which took place between May and September 2017, based on the core areas of knowledge and competencies of the occupational nurse and on the scale of perception of the areas of knowledge and intervention of the occupational nurse. Results: Occupational Nursing was understood by the majority as a transitory professional activity, because it was exercised as a financial complement to the main activity or because they could not be placed in the area of professional practice of their preference. Conclusion: the professional practice in the areas of knowledge and intervention was devalued or not recognized and seen by the majority of nurses as transitory, because almost half aspire to work in the future in this area, but only on a part-time basis.

Objetivo: conocer la percepción de las enfermeras en el trabajo con respecto a las áreas de conocimiento e intervención. Método: estudio cuantitativo, descriptivo y transversal. Involucró una muestra de 472 enfermeras de trabajo. Se utilizó un cuestionario como instrumento de recolección de datos, que tuvo lugar entre mayo y septiembre de 2017, basado en las áreas nucleares de conocimiento y competencias de la enfermera de trabajo y en la escala de percepción de las áreas de conocimiento e intervención de la enfermera de trabajo. Resultados: la Enfermería Ocupacional fue entendida por la mayoría como una actividad profesional transitoria, porque se ejercía como complemento económico de la actividad principal o porque no podían ubicarse en el área de práctica profesional de su preferencia. Conclusión: la práctica profesional en las áreas de conocimiento e intervención fue devaluada o no reconocida y vista por la mayoría de las enfermeras como transitoria, porque casi la mitad aspira a trabajar en el futuro en esta área, pero solo a tiempo parcial.

Objetivo: conhecer a perceção dos enfermeiros do trabalho no que respeita às áreas de conhecimento e intervenção. Método: estudo quantitativo, descritivo e transversal. Envolveu amostra de 472 enfermeiros do trabalho. Utilizou-se como instrumento de recolha de dados, que decorreu entre maio e setembro de 2017, questionário, alicerçado nas áreas nucleares de conhecimentos e competências do enfermeiro do trabalho e na escala de perceção das áreas de conhecimento e intervenção do enfermeiro do trabalho. Resultados: a Enfermagem do Trabalho foi entendida pela maioria como atividade profissional transitória, pelo facto de ser exercida como complemento financeiro à atividade principal ou porque não conseguiram colocação na área de exercício profissional da sua preferência. Conclusão: o exercício profissional nas áreas de conhecimento e intervenção foi desvalorizado ou não reconhecido e encarado pela maioria dos enfermeiros como transitório, pelo facto de quase metade ambicionar trabalhar no futuro nessa área, mas apenas em regime de tempo parcial.

Association between tracking of extracurricular sports practice and weight status during childhood: a prospective cohort study

ABSTRACT BACKGROUND: Overweight and obesity have reached epidemic prevalences. Obesity control involves many factors and needs to begin early in childhood. OBJECTIVES: To ascertain the association between tracked extracurricular sports practice and weight status; and to analyze tracking of overweight and obesity among school-aged children. DESIGN AND SETTING: Prospective cohort study conducted in 13 public schools in Cianorte, Paraná, in 2012-2016. METHODS: The sample comprised 2459 schoolchildren in Cianorte, of mean age 6.3 years at baseline and 9.4 years at follow-up. Body mass index was calculated from body mass and height measurements. The children were grouped as normal weight, overweight or obese. Information on extracurricular sports practice was collected through the dichotomous question "Do you participate in any extracurricular sports?" ("yes" or "no"). RESULTS: Tracking of weight status showed that 75.5% maintained this, with kappa of 0.530. Tracking of extracurricular sports practice showed that 80.9% maintained this, with low concordance (kappa of 0.054). Weight status correlation between baseline and follow-up showed that overweight or obese individuals were 4.65 times (CI: 4.05-5.34) more likely to maintain the same classification or move from overweight to obese at follow-up. Correlation of extracurricular sports practice with overweight or obesity at follow-up was not significant. CONCLUSIONS: These results demonstrated that overweight or obese children were at higher risk of gaining weight than were normal-weight children. In addition, the proportion of these children who maintained extracurricular sports practices over the years was low. Maintenance of this variable was not associated with weight status.

Association between tracking of extracurricular sports practice and weight status during childhood: a prospective cohort study.

BACKGROUND: Overweight and obesity have reached epidemic prevalences. Obesity control involves many factors and needs to begin early in childhood. OBJECTIVES: To ascertain the association between tracked extracurricular sports practice and weight status; and to analyze tracking of overweight and obesity among school-aged children. DESIGN AND SETTING: Prospective cohort study conducted in 13 public schools in Cianorte, Paraná, in 2012-2016. METHODS: The sample comprised 2459 schoolchildren in Cianorte, of mean age 6.3 years at baseline and 9.4 years at follow-up. Body mass index was calculated from body mass and height measurements. The children were grouped as normal weight, overweight or obese. Information on extracurricular sports practice was collected through the dichotomous question "Do you participate in any extracurricular sports?" ("yes" or "no"). RESULTS: Tracking of weight status showed that 75.5% maintained this, with kappa of 0.530. Tracking of extracurricular sports practice showed that 80.9% maintained this, with low concordance (kappa of 0.054). Weight status correlation between baseline and follow-up showed that overweight or obese individuals were 4.65 times (CI: 4.05-5.34) more likely to maintain the same classification or move from overweight to obese at follow-up. Correlation of extracurricular sports practice with overweight or obesity at follow-up was not significant. CONCLUSIONS: These results demonstrated that overweight or obese children were at higher risk of gaining weight than were normal-weight children. In addition, the proportion of these children who maintained extracurricular sports practices over the years was low. Maintenance of this variable was not associated with weight status.

Biophysical and Dynamic Characterization of Fine-Tuned Binding of the Human Respiratory Syncytial Virus M2-1 Core Domain to Long RNAs.

The human respiratory syncytial virus (hRSV) M2-1 protein functions as a processivity and antitermination factor of the viral polymerase complex. Here, the first evidence that the hRSV M2-1 core domain (cdM2-1) alone has an unfolding activity for long RNAs is presented and the biophysical and dynamic characterization of the cdM2-1/RNA complex is provided. The main contact region of cdM2-1 with RNA was the α1-α2-α5-α6 helix bundle, which suffered local conformational changes and promoted the RNA unfolding activity. This activity may be triggered by base-pairing recognition. RNA molecules wrap around the whole cdM2-1, protruding their termini over the domain. The α2-α3 and α3-α4 loops of cdM2-1 were marked by an increase in picosecond internal motions upon RNA binding, even though they are not directly involved in the interaction. The results revealed that the cdM2-1/RNA complex originates from a fine-tuned binding, contributing to the unraveling interaction aspects necessary for M2-1 activity.IMPORTANCE The main outcome is the molecular description of the fine-tuned binding of the cdM2-1/RNA complex and the provision of evidence that the domain alone has unfolding activity for long RNAs. This binding mode is essential in the understanding of the function in the full-length protein. Human respiratory syncytial virus (hRSV), an orthopneumovirus, stands out for the unique role of its M2-1 protein as a transcriptional antitermination factor able to increase RNA polymerase processivity.

Oficina "MemorIdade": impactos na cognição e queixa de memória em idosos de um Centro de Convivência / Cognitive stimulation "MemorIdade": impacts on cognition and subjective memory complaint in the elderly of a Senior Center / Taller "MemorIdade": impactos en las quejas de cognición y memoria en personas mayores en un Centro Comunitario

Objetivou-se avaliar os efeitos promovidos por uma oficina de memória na cognição e queixa subjetiva de memória, em idosos de um Centro de Convivência. Dez idosos participaram da oficina, que constou de nove encontros semanais que abordaram diversos aspectos, com foco na memória episódica, operacional, e na linguagem. Foi observada melhora significativa nos domínios cognitivos memória e linguagem após a oficina, bem como aumento das queixas subjetivas de memória.

The purpose of this study was to evaluate the effects promoted by a cognitive stimulation program on cognition and subjective memory complaint in elderly people of a Senior Center. Ten elderly people participated in the program, which consisted of nine weekly meetings that addressed several aspects, focusing on episodic and operational memory, and language. Significant improvement in memory and language cognitive domains after the workshop was observed, as well as increased subjective complaints of memory.

El objetivo de este estudio fue evaluar los efectos promovidos por un taller de memoria sobre cognición y quejas de memoria subjetiva en personas mayores en un Centro Comunitario. Diez personas mayores participaron en el taller, que consistió en nueve reuniones semanales que abordaron diversos aspectos, centrándose en la memoria episódica, operativa y del lenguaje. Se observó una mejora significativa en los dominios cognitivos de memoria y lenguaje después del taller, así como un aumento en las quejas de memoria subjetiva.

Biophysical and flavonoid-binding studies of the G protein ectodomain of group A human respiratory syncytial virus.

The human Respiratory Syncytial Virus (hRSV) is the major causative agent of lower respiratory tract diseases in infants, young children and elderly. The membrane protein G is embedded in the viral lipid envelope and plays an adhesion function of the virus to host cells. The present study reports the production of the group A hRSV recombinant G protein ectodomain (edG) and its characterization of secondary structure and thermal unfolding by circular dichroism (CD), as well as the binding investigation of flavonoids quercetin and morin to this protein by fluorescent quenching. CD data reveal that edG is composed mostly of ß-structure and its melting temperature is of 325 K. Fluorescence quenching experiments of hRSV edG show that the dissociation constants for the flavonoids binding are micromolar and the binding affinity for the edG/quercetin complex is inversely dependent on rising temperature while is directly dependent for the edG/morin interaction. The thermodynamic parameters suggest that hydrophobic contacts are important for the edG/morin association while van der Waals forces and hydrogen bonds contribute to the stabilization of the edG/quercetin complex. Thus, data reported herein may contribute to the development of new treatment strategies that prevent the viral infection by hRSV.

Codon Context Optimization in Synthetic Gene Design.

Advances in de novo synthesis of DNA and computational gene design methods make possible the customization of genes by direct manipulation of features such as codon bias and mRNA secondary structure. Codon context is another feature significantly affecting mRNA translational efficiency, but existing methods and tools for evaluating and designing novel optimized protein coding sequences utilize untested heuristics and do not provide quantifiable guarantees on design quality. In this study we examine statistical properties of codon context measures in an effort to better understand the phenomenon. We analyze the computational complexity of codon context optimization and design exact and efficient heuristic gene recoding algorithms under reasonable constraint models. We also present a web-based tool for evaluating codon context bias in the appropriate context.

Brachiaria physiological parameters in agroforestry systems / Parâmetros fisiológicos da braquiária em diferentes arranjos do sistema agrossilvipastoril

ABSTRACT: This study aimed to assess the effects of Eucalyptus and maize shading on characteristics related to water use by Brachiaria in agroforestry systems. Treatments were arranged in a split-split-plot design, with plots consisting of different spacing between Eucalyptus plants (12.0×2.0m and 12.0×4.0m), split-plots of different distances between Brachiaria and Eucalyptus (6.0, 4.0, and 2.0m), and split-split-plots of Brachiaria sowing sites (maize row and inter-row). One treatment with Brachiaria under full sunlight was included. Bread grass intercropping in maize inter-rows associated with the densest Eucalyptus spacing and bread grass proximity to Eucalyptus tree crowns adversely affected the stomatal conductance, internal carbon, and transpiration rate of bread grass. Water use efficiency of bread grass intercropped in maize rows decreased, regardless of the Eucalyptus plot design and distance between forages and trees.

RESUMO: O objetivo desta pesquisa foi avaliar os efeitos do sombreamento ocasionado por plantas de eucalipto e milho nas características relacionadas ao uso da água da braquiária em sistema agrossilvipastoril. O experimento foi realizado no delineamento em blocos casualizados, com quatro repetições. Os tratamentos foram arranjados em esquema de parcelas subsubdivididas, comas parcelas representadas constituídas pelos espaçamentos de plantio do eucalipto (12x2 e 12x4m), as sub-parcelas da distância da braquiaria e o eucalipto (6; 4 e 2m) e a subparcela do local de cultivo da braquiária (linha e entrelinha do milho). Além disso, foi adicionado um tratamento composto pela braquiária cultivada a pleno sol. O cultivo do capim-maradu na entrelinha do milho associado ao sombreamento intenso proporcionado pelo espaçamento mais adensado de eucalipto (12x2m) e a proximidade das plantas de capim-marandu às copas das árvores de eucalipto altera negativamente a condutância estomática, o carbo interno e a taxa transpiratória das plantas de capim-marandu. A eficiência no uso da água das plantas de capim - maradu é reduzida independente do arranjo espacial do eucalipto e da distância entre aforrageira e as árvores quando a forrageira é cultivada na linha do milho.

Perfil dos programas de iniciação esportiva adotados pelas Secretarias Municipais de Esporte da microrregião de CIANORTE / Profile of sports initiation programs adopted by the Municipal Sports Departments of the CIANORTE microregion

Entende-se que, a iniciação esportiva é o período no qual a criança começa a aprender, de forma específica, a prática de um ou vários esportes. A iniciação esportiva é marcada pela prática regular e orientada de uma ou mais modalidades esportivas, e o objetivo imediato é dar continuidade ao desenvolvimento da criança de forma integral, não implicando em competições regulares. Entende-se também como iniciação esportiva o primeiro momento de contato com a prática específica do esporte, caracterizando-se pelo objetivo educacional, de formação integral do ser humano a fim de contribuir para seu desenvolvimento físico, cognitivo, afetivo e social. Será de grande importância a aplicação sistemática, planejada e consciente de um determinado método de ensino-aprendizagem-treinamento para o êxito e evolução do nível de desempenho do praticante. Com base nesses conceitos o objetivo deste artigo foi verificar e analisar os programas e as formas de iniciação esportiva, identificando as metodologias e idades em que se dividem as respectivas estruturações de iniciação ao esporte, adotados pelas secretarias municipais de Esporte da região noroeste do Paraná, de modalidades individuais e coletivas por meio de entrevistas para gestores esportivos e técnicos ou professores responsáveis pela modalidade esportiva. Para isso, foram aplicadas pessoalmente entrevistas semiestruturadas ao supervisor ou coordenador esportivo de 11 entidades esportivas. Os resultados indicaram que as entidades promovem treinamento específico em idades abaixo das recomendadas pela literatura e permitiu sugerir adequações aos programas visando um treinamento a longo prazo para que não ocorra uma especialização esportiva precoce.

Sports initiation is understood by the period when a child begins to specifically learn the practice of one or more sports. Sport initiation is marked by regular and oriented practice of one or more sports, and the immediate goal is to continue the holistic development of the child, not implying in participation in regular competitions. It is also understood as the first contact of the child with the specific practice of the sport, being characterized by the educational purpose as an integral training of human beings, in order to contribute towards their physical, cognitive, emotional and social development. The systematic, planned and conscious application of a specific teaching-learning-training method is fundamental for the success and progress of the student's performance. Based on these principles, the purpose of this article is to verify and analyze the programs and forms of individual and team sports initiation, identifying methodologies and ages in which the corresponding sports initiation structures are divided, and adopted by the municipal sports departments in the northwestern region of Paraná through interviews with sports managers and coaches or teachers responsible for the sports modality. Semi-structured interviews were personally applied to the sports supervisor or coordinator of 11 sports institutions. The results have shown that the institutions promote specific training in ages below the ones recommended in the literature, allowing to suggest adaptations to the programs aiming at a long-term training in order to avoid early sports specialization.

Current management of brain metastases / Manejo atual de metástases cerebrais

Brain metastases are the most common tumors within the central nervous system. Recent advances on diagnosis and treatment modalities have allowed for longer survival. In this paper we review the indication of each modality of treatment: surgery, whole brain radiotherapy and stereotactic radiosurgery, as also recent advances on the knowledge of brain metastases biology that may improve the use of medical treatment and chemotherapy.

Metástases cerebrais são os tumores mais comuns do sistema nervoso central. Avanços recentes no diagnóstico e modalidades de tratamento têm aumentado a sobrevida dos pacientes. Neste artigo, revisamos a indicação de cada modalidade de tratamento: cirurgia, radioterapia convencional, radiocirurgia estereotáxica, como também os recentes avanços no conhecimento da biologia das metástases cerebrais que poderão ampliar o uso do tratamento clínico com quimioterapia.

Long-term control of epileptic drop attacks with the combination of valproate, lamotrigine, and a benzodiazepine: a 'proof of concept,' open label study.

PURPOSE: Long-term medical management of epileptic drop attacks is usually unsatisfactory and more effective antiepileptic drug (AED) regimens are needed. The present study aimed at providing proof of concept that previously refractory epileptic drop attacks could be significantly and safely controlled by the specific combination of valproate, lamotrigine, and a benzodiazepine. METHODS: An open label trial providing class IV evidence of efficacy, including 32 patients with cryptogenic/symptomatic, generalized or multifocal epilepsies, and refractory drop attacks. Following baseline, the combination under study was introduced and patients followed for 12 months. Frequency of drop attacks was compared at 3-month intervals with that during baseline and correlated with clinical, electroencephalography (EEG), and imaging variables. A list of putative side effects was read to patients and caregivers at each visit. KEY FINDINGS: Four patients were excluded, one due to a Stevens-Johnson syndrome (SJS). Median number of drop attacks decreased 96% between baseline and the fourth trimester of the study (from 50 to 2; p<0,001). Intention-to-treat (ITT) analysis showed that 15 patients (47%) had complete control, 7 (21%) had a 75% and 5 (15%) had a 50-74% reduction in the frequency of falls in the fourth trimester. Twenty-two patients (68%) had side effects, but except for the three excluded because of early rash, caregivers did not consider discontinuation. Mean final dose of valproate was 35.9 mg/kg/day and that of lamotrigine 4.9 mg/kg/day. Twenty patients used clobazam, eight nitrazepam, and the other four clonazepam as the elected benzodiazepine. Outcome did not correlate with clinical, EEG, and imaging variables. SIGNIFICANCE: This open label study suggests that the combination of valproate, lamotrigine, and a benzodiazepine can markedly reduce the frequency of epileptic drop attacks in patients with generalized or multifocal epilepsies. Careful clinical monitoring for early signs of SJS is needed.

Emagrecimento e desempenho cardíaco / Weight loss and cardiac performance

RACIONAL: As doenças cardiovasculares representam as complicações mais frequentemente associadas à obesidade. O emagrecimento determina diminuição da pressão arterial e melhora nos parâmetros dos lipídeos e glicose séricos. A perda de peso e sua manutenção reduzem os fatores de risco para doenças cardiovasculares, tornando, reversíveis as alterações cardíacas decorrentes da obesidade. OBJETIVO: Avaliar o efeito da perda de peso sobre a capacidade física e as alterações estruturais e funcionais do coração de obesos submetidos à procedimento cirúrgico bariátrico. MÉTODOS: Quarenta e três pacientes submetidos à derivação gástrica em Y-de-Roux, foram analisados por eletrocardiograma, teste ergométrico e ecodopplercardiograma no pré-operatório e um ano após a derivação. Na análise estatística utilizaram-se os testes de Wilcoxon, t de Student, Shapiro-Wilk com nível de significância de 5 por cento. RESULTADOS: O peso diminuiu de 116,5 kg ± 21,5 para 80 kg ± 15,9; o IMC de 41,8kg/m2 ± 4,4 para 28,4kg/m2 ± 3,8; a frequência cardíaca reduziu de 77,9 bpm ± 9,6 para 70,9bpm ± 7,8; a pressão sistólica de 130 mmHg ± 20 para 120mmHg ± 10; a diastólica de 80 mmHg ± 10 para 80 mmHg ± 0. O teste ergométrico mostrou aumentos na distância percorrida de 378,9m ± 126,5m para 595m ± 140,4; no coeficiente metabólico (MET) de 6,7 ± 2,4 ml de O2/kg/min para 8,3 ± 2,6ml de O2/kg/min; no consumo de oxigênio (VO2) de 23,1 ± 8,4 para 30 ± 10,3. O ecodopplercardiograma mostrou redução no septo interventricular de 12 mm ± 2 para 10 mm ± 1; parede posterior de 11 mm ± 2 para 10 mm ± 1; massa ventricular de 273 g ± 85 para 216g ± 60. Houve melhora na função diastólica com aumento na relação E'/A'e E/A e da fração de ejeção com elevação de 70,2 por cento ± 7,2 para 72,9 por cento ± 6,4. CONCLUSÃO: Obesos submetidos à cirurgia bariátrica apresentaram melhora na capacidade física e melhora estrutural e funcional do coração.

BACKGROUND: Cardiovascular diseases are the most frequent complications associated with obesity. The weight loss determine blood pressure decrease and improvement in parameters of lipid and glucose levels. Weight loss and maintenance reduce the risk factors for cardiovascular disease, making reversible cardiac changes resulting from obesity. AIM: To evaluate the effect of weight loss on physical capacity and the structural and functional heart of obese patients undergoing to bariatric surgery. METHODS: Forty-three patients who underwent gastric Roux-en-Y bypass, were analyzed by ECG, and echocardiography preoperatively and one year after the bypass. Statistical analysis used the Wilcoxon and Student t test, Shapiro-Wilk test with a significance level of 5 percent. RESULTS: The weight decreased from 116.5 kg to 21.5 ± 15.9 ± 80 kg, BMI of 41.8 kg/m 2 ± 4.4 to 28.4 kg/m 2 ± 3.8, heart rate decreased from 77.9 ± 9.6 bpm to 70.9 ± 7.8 bpm, systolic pressure of 130 ± 20 mmHg to 120 mmHg ± 10, diastolic 80 mmHg ± 10 mmHg to 80 ± 0. The exercise test showed increases in distance traveled of 378.9 m ± ​​126.5 m to 140.4 ± 595m; coefficient in metabolic equivalents (METs) from 6.7 ± 2.4 ml O 2 / kg / min to 8.3 ± 2.6 ml O 2 / kg / min, oxygen consumption (VO 2) 23.1 ± 8.4 to 10.3 ± 30. The echocardiogram showed a reduction in the interventricular septum of 12 mm to 10 mm ± 2 ± 1; posterior wall of 11 mm to 10 mm ± 2 ± 1; ventricular mass of 273 ± 85 g to 216g ± 60. There was improvement in diastolic function with increase in E '/ A'e E / A and ejection fraction with an increase of 70.2 percent ± 7.2 to 72.9 ± 6.4 percent. CONCLUSION: Obese patients undergoing bariatric surgery showed improvement in physical capacity and in the structure/functioning of the heart.

Morphofunctional evaluation of the heart of obese patients before and after bariatric surgery.

BACKGROUND: This study aims to evaluate the effect of weight loss on the physical capacity and the structure and function of the heart after bariatric surgery. METHODS: Forty-three adult obese patients, 31 women (72.1%) and 12 men (27.9%), were submitted to electrocardiogram, ergometric test, and echo Doppler cardiogram at presurgical stage and 1 year after Roux-en-Y gastric bypass. The statistical analysis utilized the Wilcoxon, Student's t, and Shapiro-Wilk tests with 5% significance level. RESULTS: Weight was reduced from 116.5 ± 21.5 to 80 ± 15.9 kg and body mass index from 41.8 ± 4.4 to 28.4 ± 3.8 kg/m(2). Cardiac frequency was reduced from 77.9 ± 9.6 to 70.9 ± 7.8 bpm, systolic pressure from 130 ± 20 to 120 ± 10 mmHg, and diastolic pressure from 80 ± 10 to 80 ± 0 mmHg. Ergometric tests showed distance covered from 378.9 ± 126.5 to 595 ± 140.4 m, metabolic coefficient from 6.7 ± 2.4 to 8.3 ± 2.6 ml O(2)/kg/min, and oxygen consumption (VO(2)) from 23.1 ± 8.4 to 30 ± 10.3 metabolic equivalents of task. The echo Doppler cardiogram showed interventricular septum from 12 ± 2 to 10 ± 1 mm, posterior wall from 11 ± 2 to 10 ± 1 mm, and ventricular mass from 273 ± 85 to 216 ± 60 g. There was improvement in the diastolic function with an increase in the E'/A' and E/A relationship and the ejection fraction with an increase from 70.2 ± 7.2% to 72.9 ± 6.4%. CONCLUSIONS: Bariatric surgery improved physical capacity as well as structural and functional improvement of the heart.

Avaliação cardiológica tardia de crianças com insuficiência mitral reumática, submetidas a cirurgia reconstrutora com anel de Gregori / Late heart evaluation of children with rheumatic mitral regurgitation submitted to reconstructive surgery with implantation of Gregori's ring

OBJETIVO: Avaliar crianças com insuficiência mitral reumática (IMR) submetidas a cirurgia reconstrutora na valva mitral com implante do anel de Gregori (CRVM), de 1987 a 2003. MÉTODOS: Quarenta e três crianças com IMR, submetidas a CRVM, com idades variando de cinco a doze anos, média de 9,7 ± 2,2 anos, sendo 25 (58,1 por cento) pacientes do sexo feminino. Os pacientes foram avaliados mediante parâmetros clínicos: classe funcional de insuficiência cardíaca, ausculta cardíaca, eletrocardiograma, radiografia de tórax e parâmetros ecocardiográficos. RESULTADOS: Quarenta e três pacientes foram avaliados no préoperatório e, no pós, 31, em virtude de seis óbitos e seis trocas valvares. O seguimento foi de 100 por cento. A classe funcional da insuficiência cardíaca, sopro sistólico mitral, área cardíaca pela radiografia de tórax, sobrecarga ventricular esquerda no eletrocardiograma e o grau de insuficiência mitral pelo ecocardiograma diminuíram significativamente. Após 188 meses a taxa de sobrevida foi de 82 por cento e a de mortalidade anual de 0,38 por cento. Estavam livres de reoperação 31 (72,6 por cento) pacientes, e a taxa de reoperação anual foi de 0,51 por cento. CONCLUSÃO: A CRVM apresenta resultados eficazes no tratamento da IMR em crianças, com melhora significativa na classe funcional, sopro sistólico mitral e grau de insuficiência mitral pelo ecocardiograma.

[Late heart evaluation of children with rheumatic mitral regurgitation submitted to reconstructive surgery with implantation of Gregori's ring]. / Avaliação cardiológica tardia de crianças com insuficiência mitral reumática, submetidas a cirurgia reconstrutora com anel de Gregori.

OBJECTIVE: Assess late cardiological evolution of children with rheumatic mitral regurgitation (RMR) who underwent mitral valve reconstructive surgery with implantation of Gregori's ring (MVR), from 1987 to 2003. METHODS: A study was conducted to analyze a series of cases of 43 children with RMR who underwent MVR with ages ranged from five to twelve years (mean age 9.7 +/- 2.2 years); 25 of the patients were females (58.1%). Patients were evaluated as per the following clinical parameters: functional class of heart failure, heart auscultation, electrocardiogram, chest X-ray and echocardiographic findings. RESULTS: Forty-three patients underwent preoperative evaluation during the postoperative period, the number of patients evaluated decreased to 31 due to the fact that 6 patients had died and 6 others underwent valve replacement surgery. Follow-up was carried out for 100% of the patients. A significant reduction of heart failure functional class was observed. Mitral systolic murmur became less intense during the postoperative period. The cardiac area on chest X-ray and the presence of left ventricular overload on electrocardiogram were reduced, as well as the mitral regurgitation level on echocardiographic study. After 188 months, the survival rate was 82%, and the annual mortality rate, 0.38%. Thirty-one (72.6%) patients did not require reoperation and the annual rate of patients who required further surgery was 0.51%. CONCLUSION: MVR is an effective procedure for treating RMR in children, resulting in a significant improvement of functional class, mitral systolic murmur and level of mitral regurgitation, as shown on Doppler echocardiogram.