Survivin expression as a prognostic marker for breast cancer

SUMMARY OBJECTIVE: Due to the speed of development observed in breast cancer, several studies aimed at discovering new biomarkers have been carried out in order to arrive at an early diagnosis. As survivin plays a fundamental role in the evasion of apoptosis in tumor cells, the aim of this study was to verify the expression profile of the survivin gene in paraffin-embedded breast tumor samples and associate it with the clinical characteristics of the patients. METHODS: This is a cross-sectional study, for which 100 tumor samples were obtained from cancer patients treated throughout the year 2019 at Instituto de Mama do Cariri (Juazeiro do Norte, in the state of Ceará). This study included women over 30 years old who had confirmed breast cancer through anatomopathological examination but excluded those with non-neoplastic breast comorbidities, other neoplasms, or chronic diseases. Survivin gene expression was assessed by quantitative polymerase chain reaction. RESULTS: The expression of survivin is associated with the lack of expression of estrogen (p=0.027) and progesterone (p>0.0005) receptors. It means that survivin expression is higher in patients in which labeling was absent for estrogen receptor and progesterone receptor. CONCLUSION: Our data reinforce that survivin expression is higher in estrogen receptor-patients, thus representing an additional prognostic tool.

Implementation of risk stratification for the care of glaucoma patients during the resumption of in-person care during the COVID-19

Introduction: the COVID-19 pandemic sparked a serious health crisis in which non-essential medical services were suspended, with the management of serious diseases not related to the pandemic, including glaucoma, becoming secondary in importance. With the flexibilization of social isolation measures, resuming outpatient care was necessary, respecting the health equity provided by the Brazilian Unified Health System.Objective: to describe a risk classification of glaucoma progression based on clinical ophthalmology criteria during the COVID-19 pandemic.Methods: observational study of an administrative nature. A review was carried out of the medical records of patients who had scheduled appointments between March and September of 2020 in the glaucoma sector of the FMABC University Center's Department of Ophthalmology. A total of 489 medical records (881 eyes) were reviewed, and patients were divided into 4 groups according to the risk of glaucoma progression. Eyes were evaluated for visual acuity (VA), optic disc cup, pachymetry, intraocular pressure (IOP), mean number of eyes drop medications used, and global visual field indexes.Results: groups were homogeneous in terms of age (mean 67.04 ± 11.72 years) and sex (55.5% women and 44.5% men). Primary open-angle glaucoma was the most prevalent etiology, present in 45.2% of patients, followed by primary angle-closure glaucoma in 15.7%. The groups were compared with each other, and a statistical difference (p<0.005) was found in 04 of the 08 aspects analyzed: VA, optic disc cup, IOP and mean number of eyes drop medications used.Conclusion: the risk classification for progression proposed in this study was easily applied and aided managers in prioritizing the most serious care during the COVID-19 pandemic

History and legal aspects of bone marrow donor banks in Brazil

INTRODUCTION: Bone marrow transplants primarily depend on people who previously registered to be donors. From then on, the search for compatibility between donor and recipient begins. OBJECTIVE: To describe the historical landmarks and the legal apparatus of bone marrow donor banks in Brazil based on an integrative review. METHODS: LILACS database and PubMed and SciELO journals were used. The term bone marrow transplantation was the descriptor. Eligibility criteria were: articles with the theme of Bone Marrow Transplantation (BMT) and studies carried out on the national territory. RESULTS: A total of 88,855 articles were identified, among which 185 met the eligibility criteria. After they were thoroughly read, 14 articles were selected. The studies pointed out fragments that dealt with important historical landmarks for the establishment of bone marrow transplantation as a conventional treatment for oncohematological diseases. CONCLUSION: The use of BMT has a history of more than thirty years in Brazil. However, none of the articles identified specifically addresses the historical content of bone marrow transplantation.

Vitamin D deficiency in bedridden elderly people at home

SUMMARY OBJECTIVE: The aim of this study was to evaluate serum 25(OH)D concentrations in the homebound elderly people and relate them to level of dementia, nutritional risk, and route of dietary administration. METHODS: This is a cross-sectional study involving 207 bedridden elderly people assisted by the Home Care Service in the city of Santo André - SP, from June to December 2016. The following factors were evaluated: dietary intake of vitamin D, arm circumference, triceps skin fold thickness, calf circumference, nutritional risk by Mini-Nutritional Assessment, level of dementia by the adapted Clinical Dementia Rating questionnaire, and laboratory tests such as serum concentrations of 25(OH)D, ultrasensitive C-reactive protein, alkaline phosphatase, serum calcium, and parathormone. RESULTS: The mean age of the elderly people was 81.6 (9.2) years. Deficiency of 25(OH)D was observed in 76.3% of the elderly people. There was an inverse correlation between serum concentrations of 25(OH)D: parathormone (r=-0.418, p<0.001) and alkaline phosphatase (r=-0.188, p=0.006) and a direct correlation with serum calcium (r=-0.158, p=0.022). Logistic regression showed that vitamin D deficiency was directly and independently associated with oral feeding (odds ratio 7.71; 95%CI 2.91-20.40). CONCLUSION: Bedridden households showed high prevalence of vitamin D deficiency without association with nutritional risk and level of dementia. Oral diet was associated with vitamin D deficiency, possibly due to low consumption of source foods.

Perfil pedagógico da preceptoria na residência médica em anestesiologia da cidade de Manaus / Pedagogical profile of preceptorship in anesthesiology medical residency in the city of Manaus

Resumo: Introdução: A residência médica é identificada como o melhor programa de formação de médicos em especialidades, sendo desenvolvida em cenário de treinamento em serviço, de duração extensa, entendida como um espaço de educação e ensino constantes. Nela, o médico em formação desenvolve não unicamente habilidades técnicas, mas também práticas de conduta responsável. Objetivo: Este estudo teve como objetivos conhecer o perfil de formação profissional dos preceptores do Programa de Residência Médica em Anestesiologia, verificar a percepção deles sobre a sua prática educativa desenvolvida no programa e identificar os modelos pedagógicos utilizados no mesmo ambiente. Método: Trata-se de um estudo transversal, do tipo descritivo exploratório, com abordagem quantitativa e componente analítico, realizado no período de janeiro de 2017 a janeiro de 2018, em três instituições públicas de ensino que oferecem o Programa de Residência Médica em Anestesiologia na cidade de Manaus, no Amazonas. Os dados foram coletados por meio de um instrumento contendo informações sociodemográficas, um questionário validado (com foco na percepção acerca da preceptoria), acrescido de uma questão sobre o modelo pedagógico adotado. Resultado: A amostra do estudo foi composta majoritariamente por preceptores do sexo feminino (60%) e com maior titulação na residência médica (96,6%). Um percentual expressivo (80%) informou não possuir formação pedagógica para desenvolver a preceptoria. O modelo pedagógico tradicional foi o mais adotado na prática docente dos preceptores. Conclusão: Mostra-se a importância do diagnóstico situacional da preceptoria na residência médica em Anestesiologia, apontando a necessidade de formação docente para o desenvolvimento da atividade do preceptor, bem como sua valorização adequada, objetivando a melhor formação médica.

Abstract: Introduction: Medical Residency is identified as the best program for training physicians in specialties, developed in an in-service training setting for an extensive period, and understood as a space for constant education and teaching. The trainee doctor develops not only technical skills but also practices of responsible conduct. Objectives: To understand the professional training profile of preceptors of the Medical Residency Program in Anesthesiology, to verify the preceptors' view of their educational practice developed in the Program, and to identify the pedagogical models used in the same environment. Methods: This is a cross-sectional, exploratory descriptive study, with a quantitative approach and analytical component, carried out from January 2017 to January 2018, in three public educational institutions that offer the Medical Residency Program in Anesthesiology in the city of Manaus - AM. Data were collected using an instrument containing sociodemographic information; a validated questionnaire (focusing on perception regarding preceptorship); plus a question about the adopted pedagogical model. Results: The study sample consisted mostly of female preceptors (60%) with medical residency as the highest level of their qualification (96.6%). A significant percentage (80%) reported not having pedagogical training to develop preceptorship. The traditional pedagogical model was the most commonly adopted in the teaching practice of preceptors. Conclusions: The importance of the situational diagnosis of preceptorship in the Medical Residency in Anesthesiology is shown, pointing out the need for teacher training for the development of the preceptor role, as well as it being given its due value, with the aim of achieving the best medical training.

Relationship of irisin expression with metabolic alterations and cardiovascular risk in type 2 diabetes mellitus: a preliminary study

SUMMARY OBJECTIVE: The aim of this study was to investigate the role of irisin in type 2 diabetes mellitus and its association with metabolic alterations and obesity. METHODS: A cross-sectional case-control study was conducted on participants treated at Centro Universitário FMABC between August 2018 and July 2019, by comparing a control group (n=14) with type 2 diabetes mellitus patients (n=16). The control group consisted of participants aged above 21 years with no chronic diseases, diabetes, smoking, or illicit drug use. The type 2 diabetes mellitus group included patients aged above 21 years, who were diagnosed with type 2 diabetes for at least 5 years (glycated hemoglobin>7%). Exclusion criteria were not willing to continue, recent hospitalization, and failure to meet inclusion criteria. Biochemical parameters included blood glucose, glycated hemoglobin, plasma irisin levels, and irisin gene expression in peripheral blood. RESULTS: Type 2 diabetes mellitus patients exhibited significantly higher plasma glucose levels [143 (40) vs. 92 (13) mg/dL, *p<0.05] and glycated hemoglobin levels [7.1% (1.6) vs. 5.6% (0.5), *p<0.05] compared to the control group. Irisin gene expression in type 2 diabetes mellitus patients was lower 0.02288 (0.08050) than the control group 8.506e-006 (1.412e-005) (p=0.06). Correlation analysis revealed a positive association between irisin expression and body mass index in type 2 diabetes mellitus (Rho=0.5221, 95%CI -0.058 to 0.838, p=0.06), while plasma irisin showed a negative correlation with body mass index (Rho=-0.656, 95%CI -0.836 to 0.215, p=0.03). No significant correlations were found between plasma glucose or glycated hemoglobin levels and irisin expression. CONCLUSION: The data suggests that body mass index directly influences plasma irisin levels and the regulation of irisin gene expression, possibly linking irisin to adiposity changes observed in obesity-related type 2 diabetes mellitus.

The 30-year cardiovascular risk trajectories and their independently associated factors in participants of a Brazilian cohort (CUME Study) / As trajetórias de risco cardiovascular de 30 anos e seus fatores independentemente associados em participantes de uma coorte brasileira (Estudo CUME) / Las trayectorias de riesgo cardiovascular de 30 años y sus factores asociados de forma independiente en participantes de una cohorte brasileña (Estudio CUME)

Abstract: We aimed to analyze the different trajectories of 30-year cardiovascular risk (CVR) and its independently associated factors in participants of the CUME Study, a prospective study with alumni from federal universities of Minas Gerais State, Brazil. In this study, 1,286 participants who answered the baseline (2016) and follow-up (2018 and 2020) questionnaires were included. Trajectories of CVR, according to the Framingham score, were identified with the latent class growth modelling technique with the use of the censored normal model. Analysis of the factors independently associated with each of the trajectories was conducted with multinomial logistic regression technique. Three CVR trajectories were identified: Low-Low (68.3%), Medium-Medium (26.2%), and High-High (5.5%). Male sex, living in a stable union, and having moderate and high intakes of ultra-processed foods were positively associated with the Medium-Medium and High-High CVR trajectories. Having non-healthcare professional training and working were positively associated with the Medium-Medium CVR trajectory, whereas being physically active was negatively associated with the High-High CVR trajectory. In conclusion, more than one-third of participants had CVR trajectories in the Medium-Medium and High-High categories. Food consumption and physical activity are modifiable factors that were associated with these trajectories; thus, implementing health promotion measures could help prevent the persistence or worsen of CVR. On the other hand, sociodemographic and labor characteristics are non-modifiable factors that were associated with Medium-Medium and High-High trajectories, which could help identify people who should be monitored with more caution by health services.

Resumo: Nosso objetivo foi analisar as diferentes trajetórias de risco cardiovascular (RCV) de 30 anos e seus fatores independentemente associados em participantes do Estudo CUME, um estudo prospectivo com ex-alunos de universidades federais de Minas Gerais, Brasil. Este estudo incluiu 1.286 participantes que responderam aos questionários de linha de base (2016) e acompanhamento (2018 e 2020). As trajetórias de RCV, de acordo com o escore de Framingham, foram identificadas por modelagem de crescimento de classe latente com o uso do modelo normal censurado. A análise dos fatores independentemente associados a cada uma das trajetórias foi realizada por regressão logística multinomial. Foram identificadas três trajetórias de RCV: Baixo-Baixo (68,3%), Médio-Médio (26,2%) e Alto-Alto (5,5%). Sexo masculino, união estável e consumo moderado e alto de alimentos ultraprocessados foram positivamente associados às trajetórias de RCV Médio-Médio e Alto-Alto. Formação profissional e trabalhar em áreas não relacionadas à saúde foram positivamente associados à trajetória de RCV Médio-Médio, enquanto ser fisicamente ativo foi negativamente associado à trajetória de RCV Alto-Alto. Em conclusão, mais de um terço dos participantes apresentou trajetórias de RCV nas categorias Médio-Médio e Alto-Alto. Fatores modificáveis foram associados a essas trajetórias (consumo de alimentos e atividade física); assim, medidas de promoção da saúde podem evitar a manutenção ou a piora do RCV. Por outro lado, os fatores não modificáveis associados às trajetórias Médio-Médio e Alto-Alto (características sociodemográficas e laborais) permitem traçar o perfil das pessoas que devem ser monitoradas com mais cautela pelos serviços de saúde.

Resumen: Nuestro objetivo fue analizar las diferentes trayectorias de riesgo cardiovascular (RCV) de 30 años y sus factores asociados de forma independiente en participantes del Estudio CUME, un estudio prospectivo con exalumnos de universidades federales de Minas Gerais, Brasil. Este estudio incluyó a 1.286 participantes que completaron los cuestionarios de referencia (2016) y de seguimiento (2018 y 2020). Las trayectorias de RCV, según el índice de Framingham, se identificaron mediante el modelado de crecimiento de clase latente utilizando el modelo normal censurado. El análisis de los factores asociados de forma independiente a cada una de las trayectorias se realizó mediante regresión logística multinomial. Se identificaron tres trayectorias de RCV: Bajo-Bajo (68,3%), Medio-Medio (26,2%) y Alto-Alto (5,5%). El género masculino, la unión estable y el consumo moderado y alto de alimentos ultraprocesados se asociaron positivamente con las trayectorias de RCV Medio-Medio y Alto-Alto. La formación profesional y el trabajo en áreas no relacionadas con la salud se asociaron positivamente con la trayectoria de RCV Medio-Medio, mientras que la actividad física se asoció negativamente con la trayectoria de RCV Alto-Alto. En conclusión, más de la tercera parte de los participantes presentó trayectorias de RCV en las categorías Medio-Medio y Alto-Alto. A estas trayectorias se asociaron factores modificables (consumo de alimentos y actividad física); por lo tanto, las medidas de promoción de la salud pueden prevenir el mantenimiento o el empeoramiento del RCV. Por otra parte, los factores no modificables asociados a las trayectorias Medio-Medio y Alto-Alto (características sociodemográficas y laborales) permiten delinear el perfil de las personas que deben ser monitoreadas con más atención por los servicios de salud.

The effects of the Covid-19 pandemic on eye-related emergency visits / Efeitos da pandemia da Covid-19 em atendimentos de emergência ocular

ABSTRACT Objective To evaluate the effects of the Covid-19 pandemic on the profile of emergency eye-related visits and compare the findings with the same period before the pandemic. Methods Cross-sectional study performed during one year at a reference eye hospital. Cases registered at the emergency Municipal Hospital Complex of Santo Andre, Brazil, between March, 2019 and February, 2020 were included in the study as the Pre-pandemic group. Cases registered between March, 2020 and February, 2021 were included as the Pandemic group. Cases were classified according to the International Classification of Diseases ICD-10 and Related Health Problems. Results There was a decrease of 52.1% in the emergency eye care visits during the pandemic period (n=9,198) when compared to the pre-pandemic period (n=19,220), with significant reductions in nonspecific cases (-98.1%), postoperative visits (-67.0%), disorders of the conjunctiva (-54.1%), tear film (-49.4%) and refraction (-85.6%) during the pandemic period. Conditions such as retina disorders (+202.7%), sclera disorders (+76.2%), orbit disorders (+20.2%), glaucoma (+66.6%) and trauma (+19.4%) have shown increased rates, as well as those related to eyelids (+186.9%), cornea (+33.4%), uvea (+40.2%), and herpes (+55.3%). Conclusion A drastic reduction in the number of eye-related emergency visits was observed during the Covid-19 pandemic, outlining a new profile of care, with higher frequency of sight-threatening conditions and lower frequency of contagious and non-specific diagnosis.

RESUMO Objetivo Avaliar os efeitos da pandemia da Covid-19 no perfil dos atendimentos oftalmológicos de emergência e comparar os achados com os do período anterior à pandemia. Métodos Estudo transversal realizado ao longo de 1 ano em um hospital oftalmológico de referência. Casos registrados no Complexo Hospitalar Municipal de Emergências de Santo André (SP, Brasil) entre março de 2019 e fevereiro de 2020 foram incluídos no estudo como Grupo Pré-Pandemia. Os casos registrados entre março de 2020 e fevereiro de 2021 foram incluídos no Grupo Pandemia. Os casos foram classificados de acordo com a Classificação Internacional de Doenças e Problemas Relacionados à Saúde. Resultados Houve redução de 52,1% no número de atendimentos oftalmológicos de emergência durante o período pandêmico (n=9.198) quando comparado ao pré-pandêmico (n=19.220), com reduções significativas em casos inespecíficos (-98,1%), visitas pós-operatórias (-67,0%), distúrbios da conjuntiva (-54,1%), filme lacrimal (-49,4%) e refração (-85,6%) durante o período de pandemia. Condições como distúrbios da retina (+202,7%), distúrbios da esclera (+76,2%), distúrbios da órbita (+20,2%), glaucoma (+66,6%) e trauma (+19,4%) apresentaram taxas aumentadas, bem como aquelas relacionadas a pálpebras (+186,9%), córnea (+33,4%), úvea (+40,2%) e herpes (+55,3%). Conclusão Observou-se drástica redução no número de atendimentos oftalmológicos durante a pandemia da Covid-19, delineando um novo perfil de atendimento, com maior frequência de quadros que levam à baixa de visão e à menor frequência de diagnósticos contagiosos e inespecíficos.

30-Year High Cardiovascular Risk Incidence and its Determinants: CUME Study / Incidencia del alto riesgo cardiovascular de 30 años y sus determinantes: Estudio CUME / Incidência do alto risco cardiovascular de 30 anos e seus determinantes: Estudo CUME

ABSTRACT Objective: Estimate the incidence of the 30-year high cardiovascular risk and its determinants among graduates of federal universities in Minas Gerais. Methods: This is a prospective cohort of 2,854 adults aged 20 to 59. The incidence of the outcome was calculated using the Framingham equation and its determinants were determined through multivariate Cox regression. Results: After an average of 2.62 years, the incidence of high cardiovascular risk was 8.09 and 20.1 cases per 1,000 person-years, for females and males respectively. Being male (HR: 2.34; 95% CI: 1.58 - 3.46), employment (HR: 2.13; 95% CI: 1.13 - 3.99), high consumption of processed foods (HR: 2.44; 95% CI: 1.21 - 4.90), and being physically active (HR: 0.63; 95% CI: 0.41 - 0.98) were associated with high cardiovascular risk. Conclusions: Among highly educated adults, being male, employment, and high consumption of processed foods are predictors of high cardiovascular risk, while being physically active acts as a protective factor.

RESUMEN Objetivo: Estimar la incidencia del alto riesgo cardiovascular de 30 años y sus determinantes en graduados de universidades federales de Minas Gerais. Métodos: Cohorte prospectiva con 2.854 adultos de 20 a 59 años. Se calculó la incidencia del desenlace usando la ecuación de Framingham y sus determinantes a través de la regresión multivariante de Cox. Resultados: Después de un promedio de 2,62 años, la incidencia del alto riesgo cardiovascular fue de 8,09 y 20,1 casos por 1.000 personas-año, respectivamente, en los géneros femenino y masculino. Ser masculino (HR: 2,34; IC95%: 1,58 - 3,46), trabajar (HR: 2,13; IC95%: 1,13 - 3,99), un alto consumo de alimentos procesados (HR: 2,44; IC95%: 1,21 - 4,90) y ser activo físicamente (HR: 0,63; IC95%: 0,41 - 0,98) se asociaron con el alto riesgo cardiovascular. Conclusiones: En adultos con alta educación, ser masculino, trabajar y el alto consumo de alimentos procesados son predictores del alto riesgo cardiovascular, mientras que ser activo físicamente es un factor de protección.

RESUMO Objetivo: Estimar a incidência do alto risco cardiovascular de 30 anos e seus determinantes em egressos de universidades federais mineiras. Métodos: Coorte prospectiva com 2.854 adultos de 20 a 59 anos. Calculou-se a incidência do desfecho pela equação de Framingham e seus determinantes pela regressão de Cox multivariada. Resultados: Após uma média de 2,62 anos, a incidência do alto risco cardiovascular foi de 8,09 e 20,1 casos/1.000 pessoas-ano, respectivamente, nos sexos feminino e masculino. O sexo masculino (HR: 2,34; IC95%: 1,58 - 3,46), trabalhar (HR: 2,13; IC95%: 1,13 - 3,99), elevado consumo de alimentos processados (HR: 2,44; IC95%: 1,21 - 4,90) e ser ativo fisicamente (HR: 0,63; IC95%: 0,41 - 0,98) associaram-se ao alto risco cardiovascular. Conclusões: Em adultos com alta escolaridade, o sexo masculino, trabalhar e o elevado consumo de alimentos processados são preditivos do alto risco cardiovascular, enquanto ser ativo fisicamente é um fator de proteção.

Spatial clusters of diabetes: individual and neighborhood characteristics in the ELSA-Brasil cohort study / Aglomerados espaciais de diabetes: características individuais e de vizinhança no estudo longitudinal ELSA-Brasil / Grupos espaciales de diabetes: características individuales y vecinales en el estudio longitudinal ELSA-Brasil

This study identified spatial clusters of type 2 diabetes mellitus among participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) residing in two cities and verified individual and neighborhood socioeconomic environmental characteristics associated with the spatial clusters. A cross-sectional study was conducted with 4,335 participants. Type 2 diabetes mellitus was defined as fasting blood glucose ≥ 126mg/dL (7.0mmol/L), oral glucose tolerance test ≥ 200mg/dL (11.1mmol/L), or glycated hemoglobin ≥ 6.5% (48mmol/L); by antidiabetic drug use; or by the self-reported medical diagnosis of type 2 diabetes mellitus. Neighborhood socioeconomic characteristics were obtained from the 2011 Brazilian census. A spatial data analysis was conducted with the SaTScan method to detect spatial clusters. Logistic regression models were fitted to estimate the magnitude of associations. In total, 336 and 343 participants had type 2 diabetes mellitus in Belo Horizonte, Minas Gerais State (13.5%) and Salvador, Bahia State (18.5%), respectively. Two cluster areas showing a high chance of type 2 diabetes mellitus were identified in Belo Horizonte and Salvador. In both cities, participants living in the high type 2 diabetes mellitus cluster area were more likely to be mixed-race or black and have a low schooling level and manual work; these were also considered low-income areas. On the other hand, participants in the low type 2 diabetes mellitus cluster area of Salvador were less likely to be black and have low schooling level (university degree) and live in a low-income area. More vulnerable individual and neighborhood socioeconomic characteristics were associated with living in clusters of higher type 2 diabetes mellitus occurrence , whereas better contextual profiles were associated with clusters of lower prevalence.

Este estudo identificou aglomerados espaciais de diabetes mellitus tipo 2 entre participantes do Estudo Longitudinal de Saúde do Adulto no Brasil (ELSA-Brasil) em duas cidades e verificou características socioeconômicas ambientais individuais e de vizinhança associadas aos aglomerados espaciais. Se trata de um estudo transversal com 4.335 participantes. Diabetes mellitus tipo 2 foi definido com base em glicemia de jejum ≥ 126mg/dL (7,0mmol/L); teste oral de tolerância à glicose ≥ 200mg/dL (11,1mmol/L); hemoglobina glicada ≥ 6,5% (48mmol/L); uso de drogas antidiabéticas; ou pelo autodiagnóstico médico de diabetes mellitus tipo 2. As características socioeconômicas do bairro foram obtidas a partir do censo brasileiro de 2011. A análise dos dados espaciais foi realizada pelo método SaTScan para detectar os aglomerados espaciais. Os modelos de regressão logística foram ajustados para estimar a magnitude das associações. Um total de 336 e 343 participantes apresentaram diabetes mellitus tipo 2 em Belo Horizonte, Minas Gerais (13,5%) e Salvador, Bahia (18,5%), respectivamente. Foram identificadas duas áreas de aglomerados com alta probabilidade de diabetes mellitus tipo 2 em Belo Horizonte e Salvador. Em ambas as cidades, os participantes residentes nos aglomerados com alta taxa de diabetes mellitus tipo 2 tinham maior probabilidade de relatar cor de pele parda ou preta, baixa escolaridade e ocupação de trabalho manual; essas áreas também foram consideradas de baixa renda. Por outro lado, os participantes do aglomerado com baixa taxa de diabetes mellitus tipo 2 de Salvador tinham menor probabilidade de serem negros e maior probabilidade de terem diploma universitário, além de morarem em áreas de alta renda. Características socioeconômicas individuais e de vizinhança mais vulneráveis estavam associadas à residência em aglomerados de maior ocorrência de diabetes mellitus tipo 2, enquanto o oposto foi observado para perfis contextuais melhores.

Este estudio identificó grupos espaciales de diabetes mellitus tipo 2 entre los participantes del Estudio Longitudinal de Salud del Adulto en Brasil (ELSA-Brasil) en dos ciudades y verificó las características socioeconómicas ambientales individuales y de vecindario asociadas con los grupos espaciales. Se trata de un estudio transversal con 4.335 participantes. La diabetes mellitus tipo 2 se definió en base a glucosa en ayunas ≥ 126mg/dL (7,0mmol/L); prueba de tolerancia oral a la glucosa ≥ 200mg/dL (11,1mmol/L); hemoglobina glicosilada ≥ 6,5% (48mmol/L); uso de medicamentos antidiabéticos; o por autodiagnóstico médico de diabetes mellitus tipo 2. Las características socioeconómicas del barrio se obtuvieron a partir del censo brasileño de 2011. El análisis de datos espaciales se realizó utilizando el método SaTScan para detectar grupos espaciales. Los modelos de regresión logística se ajustaron para estimar la magnitud de las asociaciones. Un total de 336 y 343 participantes presentaron diabetes mellitus tipo 2 en Belo Horizonte, Minas Gerais (13,5%) y Salvador, Bahia (18,5%), respectivamente. Se identificaron dos áreas de grupos con alta probabilidad de diabetes mellitus tipo 2 en Belo Horizonte y Salvador. En ambas ciudades, los participantes que residían en las áreas del grupo con una alta tasa de diabetes mellitus tipo 2 tenían más probabilidades de informar el color de piel pardo o negro, la baja educación y la ocupación del trabajo manual; estas áreas también se consideraron de bajos ingresos. Por el contrario, los participantes en el área del grupo con baja tasa de diabetes mellitus tipo 2 de Salvador tenían menos probabilidades de ser negros y más probabilidades de tener un título universitario, además de vivir en áreas de altos ingresos. Las características socioeconómicas individuales y de vecindario más vulnerables se asociaron con la residencia en grupos de mayor incidencia de diabetes mellitus tipo 2, mientras que se observó lo contrario para mejores perfiles contextuales.

Is chemical exposure present in informal work associated with Sars-CoV-2 infection?

ABSTRACT OBJECTIVE To compare the incidence of covid-19 symptoms between informal home-based workers and a control group and to assess the association of these cases with blood elements concentrations and other relevant risk factors for Sars-Cov-2 infection. METHODS Welders chemically exposed to potentially toxic elements (PTEs) (n = 26) and control participants (n = 25) answered questionnaires on adherence to social distancing and signs and symptoms of the disease for five months during the covid-19 pandemic. After follow-up, covid-19 serology tests were performed on a subsample of 12 chemically exposed workers and 20 control participants. Before the pandemic, PTE concentrations in blood (As, Mn, Ni, Cd, Hg, Sb, Sn, Cu, Zn, and Pb) were measured by ICP-MS. RESULTS The chemically exposed group had higher lead and cadmium levels in blood (p < 0.01). The control group presented lower adherence to social distancing (p = 0.016). Although not significant, welders had a 74% greater chance of having at least one covid-19 symptom compared with control participants, but their adherence to social distancing decreased this chance by 20%. The use of taxis for transportation was a risk factor significantly associated with covid-19 symptoms. CONCLUSION The lower adherence to social distancing among the control group greatly influences the development of covid-19. The literature lacks data linking exposure to PTEs and Sars-Cov-2 infection and/or severity. In this study, despite chemical exposure, working from home may have protected welders against covid-19, considering that they maintained greater social distancing than control participants.

Recipient vessels for free flaps in advanced facial oncologic defects

Abstract Objectives To prospectively compare the results of microvascular flap reconstruction of midface and scalp advanced oncologic defects using superficial temporal versus cervical as recipient vessels. Methods This is a parallel group clinical trial with 1:1 allocation ratio of patients who underwent midface and scalp oncologic reconstruction with free tissue flap from April 2018 to April 2022 in a tertiary oncologic center. Two groups were analyzed: those in whom superficial temporal vessels were used as the recipient vessels (Group A) and those in whom cervical vessels were used as the recipient vessels (Group B). Patient gender and age, cause and localization of the defect, flap choice for reconstruction, recipient vessels, intraoperative outcome, postoperative course, and complications were recorded and analyzed. A Fisher's exact test was used to compare outcomes between the 2 groups. Results On the basis of the different recipient vessels, 32 patients were randomized into 2 groups, and of these 27 patients completed the study: Group A with superficial temporal recipient vessels (n = 12) and Group B with cervical recipient vessels (n = 15). There were 18 male and 09 female patients with an average age of 53.92 ± 17.49 years. The overall flap survival rate was 88.89%. The overall complication rate for vascular anastomosis was 14.81%. The total flap loss rate in patients with superficial temporal recipient vessels was higher than the complication rate in those with cervical recipient vessels but with no statistical significance (16.67% vs. 6.66%, p= 0.569). Minor complications occurred in 05 patients without statistical significance between the groups (p= 0.342). Conclusion In the group with superficial temporal recipient vessels, the postoperative rate of free flap complications was similar than the cervical recipient vessel group. Therefore the use of superficial temporal recipient vessels for midface and scalp oncologic reconstruction could be a reliable option.

Thirty-day unplanned readmission after spine surgery: analysis of 650 cases / Readmissão não planejada em 30 dias após cirurgias da coluna: análise de 650 casos / Reingreso no planificado a los 30 días después de cirugías de la columna: análisis de 650 casos

ABSTRACT: Objective: Postoperative readmission rates can be used to assess hospital care quality. The rates of unplanned readmission within 30 days after spine surgery are variable in the literature, and no studies have evaluated such rates in a single Latin American center. This study aimed to assess the rate of unplanned hospital readmission within 30 days after a spine surgery at a single Brazilian institution and to identify possible risk factors. Methods: Patients who underwent spine surgery at a single private hospital between January 2018 and December 2020 were retrospectively analyzed, and those with unplanned readmissions within 30 days of discharge were identified. Risk factors were determined, and the reoperation rate was assessed. Results: 650 patients were included in the analysis, and 74 (11.28%) were readmitted within 30 days after surgery. Higher readmission rates were observed after vertebroplasty and surgeries involving spinal or bone tumors. The risk factors found in the series were older age, longer hospital stays, higher ASA scores, instrumented surgeries, diabetes mellitus, and surgeries involving primary or secondary spinal tumors. The most common causes of unplanned readmission were infection and pain. Of the readmissions, 28.37% required a return to the operating room. Conclusions: This study suggests infection and pain management were the most common causes of unplanned readmission after spine surgery. Strategies to improve perioperative and postoperative care are required to reduce unplanned readmissions. Level of Evidence III; Retrospective Comparative Study.

RESUMO: Objetivo: As taxas de readmissão pós-operatórias podem ser usadas para avaliação da qualidade assistencial hospitalar. As taxas de readmissão não planejada em 30 dias após cirurgias de coluna são variáveis na literatura, e não há estudos avaliando tais taxas em centros únicos da América Latina. Este estudo teve como objetivo avaliar as taxas de readmissões não planejadas em 30 dias após cirurgias de coluna em uma única instituição brasileira e identificar possíveis fatores de risco. Métodos: Pacientes submetidos a cirurgias de coluna em um único hospital privado entre janeiro de 2018 e dezembro de 2020 foram avaliados retrospectivamente, e aqueles readmitidos dentro de 30 dias foram identificados. Fatores de risco foram determinados e a taxa de reoperação foi avaliada. Resultados: 650 pacientes foram incluídos na análise, e 74 (11,28%) foram readmitidos dentro de 30 dias após a cirurgia. Maiores taxas de readmissão foram observadas após vertebroplastia e cirurgias envolvendo tumores espinhais ou tumores ósseos. Os fatores de risco encontrados em nossa série foram idade mais elevada, maior tempo de hospitalização, maior escore ASA, cirurgias com instrumentação, diabetes mellitus e cirurgias envolvendo tumores vertebrais primários ou secundários. As causas mais comuns de readmissão não planejada foram infecção e dor. Dentre os pacientes reinternados, 28,37% necessitaram de reoperação. Conclusões: Este estudo sugere que infecção e manejo de dor foram as causas mais comuns de readmissão não planejada após cirurgias de coluna. Estratégias para melhorar os cuidados pre e pós-operatórios são necessárias para reduzir readmissões não planejadas. Nível de Evidência III; Estudo Retrospectivo Comparativo.

RESUMEN: Objetivo: Las tasas de reingreso después de la cirugía de columna son variables y ningún estudio ha evaluado tales tasas en un solo centro latinoamericano. Este estudio tuvo como objetivo evaluar la tasa de reingreso hospitalario no planificado dentro de los 30 días posteriores a la cirugía de columna en una sola institución brasileña e identificar posibles factores de riesgo. Métodos: Se analizaron retrospectivamente los pacientes que se sometieron a cirugía de columna en un solo hospital entre enero de 2018 y diciembre de 2020, y se identificaron aquellos con reingresos no planificados dentro de los 30 días posteriores al alta. Se determinaron los factores de riesgo y se evaluó la tasa de reoperación. Resultados: En el análisis se incluyeron un total de 650 pacientes, y 74 (11,28%) reingresaron dentro de los 30 días posteriores a la cirugía. Se observaron tasas de reingreso más altas después de la vertebroplastia y las cirugías que involucraron tumores espinales u óseos. Los factores de riesgo encontrados en nuestra serie fueron la edad avanzada, la estancia hospitalaria más prolongada, las puntuaciones ASA más altas, las cirugías instrumentadas, la diabetes mellitus y las cirugías de tumores espinales. Las causas más frecuentes de reingreso fueron la infección y el dolor. De los reingresos, el 28,37% requirieron volver al quirófano. Conclusiones: Este estudio sugiere que la infección y el manejo del dolor fueron las causas más comunes de reingreso. Se requieren estrategias para mejorar la atención perioperatoria y posoperatoria y así reducir las readmisiones no planificadas. Nivel de Evidencia III; Estudio comparativo retrospectivo.

Epidemiological indicators of Chagas disease in the metropolitan region of Salvador, Bahia, Brazil

ABSTRACT Background: Chagas disease (CD) is caused by Trypanosoma cruzi and transmitted by triatomines. Historical information from the 20th century demonstrates T. cruzi records in the metropolitan region of Salvador (MRS), the third largest urban agglomeration in the Brazilian Northeast and the eighth largest in Brazil, an area with intense migratory activity from CD-endemic regions. Therefore, this study aimed to evaluate CD indicators (prevalence and mortality) in the MRS. Methods: A mixed ecological and descriptive study was conducted using secondary data. We analyzed data from 2008 to 2015: deaths due to CD, self-reported cases of CD, and blood donors that were non-negative for T. cruzi infection. Results: São Francisco do Conde was one of the municipalities with the highest mortality rates due to CD. The seroprevalence rates varied by year and municipality; those with the highest values were 2008: Vera Cruz, 2009: Mata de São João, 2010: Dias D'Ávila, 2011 and 2015: São Francisco do Conde, 2012: São Sebastião do Passé, and 2013 and 2014: Pojuca. Spatial correlations between the municipalities were not detected. Conclusions: We conclude that CD is present in the MRS. The indicators analyzed in the MRS are below-state-level data. Given the importance of indicator analysis for the surveillance and control of CD at the state and national levels, it is important to strengthen the surveillance program at the municipal level, including the regions classified as low risk for T. cruzi vector transmission.

Serum amyloid A in children and adolescents: association with overweight and carotid intima-media thickness

ABSTRACT Objective To compare serum amyloid A concentrations between overweight and eutrophic children and adolescents and to relate it to lipid profiles, glucose tolerance, and carotid intima-media thickness. Methods One hundred children and adolescents (mean age: 10.8±3.16 years) were included and divided into two groups: overweight and non-overweight. The following were evaluated: Z-score body mass index, carotid intima-media thickness, lipid metabolism biomarkers (lipid profile and apolipoproteins A1 and B), inflammatory biomarkers (ultra-sensitive C-reactive protein and serum amyloid A), and glucose homeostasis model assessment of insulin resistance. Results The groups were homogeneous in age, sex, and pubertal stage. Higher levels of triglycerides, apolipoprotein B, homeostasis model assessment of insulin resistance, ultrasensitive C-reactive protein, serum amyloid A, and carotid intima-media thickness were observed in the overweight group. In the multivariate analysis, age (OR=1.73; 95%CI: 1.16-2.60, p=0.007), Z-score body mass index (OR=3.76; 95%CI: 1.64-8.59, p=0.002), apolipoprotein-B (OR=1.1; 95%CI: 1.01-1.2, p=0.030), and carotid intima-media thickness (OR=5.00; 95%CI: 1.38-18.04, p=0.014) were independently associated with serum amyloid A levels above the fourth quartile of the studied sample (>9.4mg/dL). Conclusion Overweight children and adolescents had higher serum amyloid A concentrations than eutrophic children. There was an independent association between higher concentrations of serum amyloid A and Z-score, body mass index, apolipoprotein B, and carotid intima-media thickness, indicating the importance of this inflammatory biomarker in identifying the early risk of atherosclerosis.

DIGEST Scale Predictis More Quality of Life Than PAS: The Residue Influence on Supracricoid Laryngectomy

Abstract Introduction Supracricoid laryngectomy (SCL CHEP) removes ~ 70% of the larynx, resulting in structural rearrangement and modification of the swallowing mechanism, promoting chronic dysphagia. One of the consequences of this new physiology is the formation of pharyngeal residues that can increase the possibility of aspiration. The formation of residues after SCL CHEP, its functional consequences, and its influence on quality of life (QOL) is still poorly described in the literature. Objective To investigate and compare the association between self-reported QoL and objective assessments of swallowing function in patients undergoing SCL CHEP. Methods A cross-sectional study was performed from 2018 to 2020 in a reference service for head and neck surgery in Brazil. A total of 860 swallowing videofluoroscopy images were evaluated using the Penetration and Aspiration Scale (PAS) and Dynamic Imaging Grade of Swallowing Toxicity (DIGEST). Results In a group of 86 patients, there was a significant relationship between oncological staging and the global (p<0.001) and total (p = 0.002) QoL domains. There was a negative correlation between the DIGEST scale and the emotional domain of the QoL protocol (p = 0.045). The swallowing function proved to be relevant for QoL. Conclusion The PAS scale did not show any correlation with QoL. The functional performance of swallowing according to the DIGEST scale was coherent with the QOL scores. It is suggested that the residue may be a more relevant aspect for QoL than the aspiration, making DIGEST a promising tool in the assessment of dysphagic patients.

Biochemical markers and anthropometric profile of children enrolled in public daycare centers

Abstract Objective: The nutritional status resultant from dietary habits along with socioeconomic conditions and the school environment are directly related to the individual's health condition not only in their childhood but also throughout adulthood. The aim of this study was to evaluate the effects of socioeconomic factors on the anthropometric profile and to analyze a probable association between this profile and biochemical markers in children attending public daycare centers. Methods: It is a transversal study developed in a probability sample of clusters of children from 6 months to 5 years old. Anthropometric and socioeconomic data were gathered at the CMEIs, questionnaires on the nutritional status were applied and blood was collected at the Family Health Units (USFs). Results: Female children are three times more likely to be underweight; in families with five members, it is 1/3 more likely that children of higher-educated parents are overweight. Among the results of the biochemical tests, hypervitaminosis A was a relevant aspect, positively correlating with copper (p=0.005) and zinc (p=0.008). Conclusion: Therefore, since the influence of the family is an important predictor of overweight and its future outcomes related to nutritional deficiencies and inadequate dietary intake, educational interventions are vital as a way to pave the path to prevention.

A comunicação dos Tribunais de Contas e Ministérios Públicos nas redes sociais: os desafios da accountability na democracia digital / Comunicación de los Tribunales de Cuentas y Ministerios Públicos en redes sociales: desafíos de la accountability en la democracia digital / The communication of Courts of Accounts and Prosecution Services on social media: the challenges of accountability in the digital democracy

Resumo Este artigo trata da comunicação que os Tribunais de Contas (TCs) e os Ministérios Públicos (MPs) brasileiros promovem nas redes sociais Facebook, Twitter e Instagram, desde a abertura de suas contas. Inova na discussão a respeito do controle democrático sobre a administração pública com foco na chamada "democracia digital", mostrando que os controladores também precisam se preocupar com a transparência e responsabilização nesses espaços. Tendo verificado que os TCs e os MPs mantêm departamentos profissionais de comunicação que operam intensamente nas redes sociais, com destaque para o TC da União (TCU) e o MP Federal (MPF) no Twitter, este trabalho analisa, de forma específica, o conteúdo da comunicação das duas instituições nessa rede, com a ajuda do software Iramuteq. Tanto o TCU como o MPF mantiveram intensa atividade de postagem de conteúdos diversos no Twitter, desde a abertura de suas contas e em momentos importantes da história política recente. A pergunta que orienta o trabalho é: ampliar os canais de comunicação significa necessariamente maior accountability? O que se constatou é que, ao se apresentar mais à sociedade pelos meios digitais, esses órgãos de controle não necessariamente responderam aos requisitos de responsabilização pública presentes na teoria democrática.

Resumen Este artículo trata de la comunicación que los Tribunales de Cuentas (TC) y los Ministerios Públicos (MP) brasileños promueven en las redes sociales Facebook, Twitter e Instagram, desde la apertura de sus cuentas. Innova en la discusión acerca de los controles democráticos sobre la administración pública en la llamada "democracia digital", mostrando que los controladores también deben preocuparse por su transparencia y rendición de cuentas. Habiendo comprobado que mantienen departamentos de comunicación profesional que operan intensamente en las redes sociales, con énfasis en el Tribunal de Cuentas de la Unión (TCU) y el Ministerio Público Federal (MPF) en Twitter, el artículo analiza específicamente el contenido de la comunicación entre las dos instituciones en esta red con la ayuda del software Iramuteq. Tanto el TCU como el MPF mantuvieron sus intensas actividades de publicación de contenidos varios en Twitter desde la apertura de sus cuentas y en momentos importantes de la historia política reciente. La pregunta que guía el trabajo es: ¿expandir los canales de comunicación significa necesariamente una mayor accountability? Lo que se encontró es que, al presentarse más a la sociedad a través de los medios digitales, estos organismos de control no respondían necesariamente a los requerimientos de rendición pública de cuentas presentes en la teoría democrática.

Abstract This article deals with the communication of Brazilian Courts of Accounts and Prosecution Services on social media platforms Facebook, Twitter, and Instagram, since the opening of their accounts. The study innovates in the discussion about democratic controls over public administration in the so-called "digital democracy," focusing on institutional communication of Courts of Accounts and Prosecution Services, showing that controllers also need to be concerned about their transparency and accountability. Having verified that they maintain professional communication departments that operate intensively on social media, with emphasis on the Federal Court of Accounts (TCU) and the Federal Prosecution Service (MPF) on Twitter, the article specifically analyzes the content of the two institutions' communication in this platform by using the Iramuteq software. Both TCU and MPF kept posting a variety of content on Twitter since first opening their accounts and at important moments in recent political history. The research question addressed was: Does expanding communication channels necessarily mean greater accountability? The study found that these institutions, when communicating with society on social media, did not necessarily respond to the public accountability requirements that democratic theory implies.

Cardiovascular Risk Factors in Haul Truck Operators of the Mining Sector Working a Rotational Schedule

Abstract Background: Due to the growing concern about work-related social and health aspects, occupational health and safety has become relevant. Objective: This work aims to develop a model to assist cardiovascular risk management in a team of haul truck operators, who work in rotating shifts at a mining company in Brazil. Methods: This longitudinal study evaluated risk factors for cardiovascular diseases of 191 mineworkers at three times points - 2010, 2012, and 2015. In addition, the risk of developing cardiovascular diseases was calculated, and the risk factors were analyzed using the chi-square test, the U Mann-Whitney test, and binary logistic regression. The significance level was set at 5%. Results: In the study period, body weight, body mass index (BMI), waist-to-height ratio (WHR), systolic (SBP), and diastolic blood pressure (DBP), total cholesterol, high-density lipoprotein cholesterol (HDL-C), and triglycerides levels of the study group increased. In 2015, there was a high prevalence of alcohol intake, overweight or obesity, central obesity, inadequate WHR, high blood pressure, total cholesterol above 190 mg/dL, and triglycerides above 150 mg/dL. An association was identified between increased cardiovascular risk and age, SBP, HDL-C, low-density lipoprotein cholesterol (LDL-C), and elevated glucose levels. Conclusion: Intense interventions for reduction and prevention of elevated alcohol intake, blood pressure levels, WHR, metabolic syndrome, blood glucose, and LDL-C levels, and low HDL-C levels are needed. In addition, a close monitoring of mine workers over 38 years of age who smoke, consume alcoholic beverages, and have altered blood glucose levels is important.

Evolução e Estado Atual das Práticas de Implante Transcateter de Válvula Aórtica na América Latina - Estudo WRITTEN LATAM / Recent Developments and Current Status of Transcatheter Aortic Valve Replacement Practice in Latin America - the WRITTEN LATAM Study

Resumo Fundamento: Implante transcateter de valva aórtica (TAVI) é um procedimento adotado em todo o mundo e suas práticas evoluem rapidamente. Variações regionais e temporais são esperadas. Objetivo: Comparar a prática de TAVI na América Latina com aquela no resto do mundo e avaliar suas mudanças na América Latina de 2015 a 2020. Método: A pesquisa foi realizada em centros de TAVI em todo o mundo entre março e setembro de 2015, e novamente nos centros latino-americanos entre julho de 2019 e janeiro de 2020. As seguintes questões foram abordadas: i) informação geral sobre os centros; ii) avaliação pré-TAVI; iii) técnicas do procedimento; iv) conduta pós-TAVI; v) seguimento. As respostas da pesquisa dos centros latino-americanos em 2015 (LATAM15) foram comparadas àquelas dos centros no resto do mundo (WORLD15) e ainda àquelas da pesquisa dos centros latino-americanos de 2020 (LATAM20). Adotou-se o nível de significância de 5% na análise estatística. Resultados: 250 centros participaram da pesquisa em 2015 (LATAM15=29; WORLD15=221) e 46 na avaliação LATAM20. No total, foram 73.707 procedimentos, sendo que os centros WORLD15 realizaram, em média, 6 e 3 vezes mais procedimentos do que os centros LATAM15 e LATAM20, respectivamente. Os centros latino-americanos realizaram menor número de TAVI minimalista do que os do restante do mundo, mas aumentaram significativamente os procedimentos menos invasivos após 5 anos. Quanto à assistência pós-procedimento, observaram-se menor tempo de telemetria e de manutenção do marca-passo temporário, além de menor uso de terapia dupla antiplaquetária nos centros LATAM20. Conclusão: A despeito do volume de procedimentos ainda significativamente menor, muitos aspectos da prática de TAVI nos centros latino-americanos evoluíram recentemente, acompanhando a tendência dos centros dos países desenvolvidos.

Abstract Background: Transcatheter aortic valve replacement (TAVR) is a worldwide adopted procedure with rapidly evolving practices. Regional and temporal variations are expected to be found. Objective: To compare TAVR practice in Latin America with that around the world and to assess its changes in Latin America from 2015 to 2020. Methods: A survey was applied to global TAVR centers between March and September 2015, and again to Latin-American centers between July 2019 and January 2020. The survey consisted of questions addressing: i) center's general information; ii) pre-TAVR evaluation; iii) procedural techniques; iv) post-TAVR management; v) follow-up. Answers from the 2015 survey of Latin-American centers (LATAM15) were compared with those of other centers around the world (WORLD15) and with the 2020 updated Latin-American survey (LATAM20). A 5% level of significance was adopted for statistical analysis. Results: 250 centers participated in the 2015 survey (LATAM15=29; WORLD15=221) and 46 in the LATAM20. Combined centers experience accounted for 73 707 procedures, with WORLD15 centers performing, on average, 6- and 3-times more procedures than LATAM15 and LATAM20 centers, respectively. LATAM centers performed less minimalistic TAVR than WORLD15 centers, but there was a significant increase in less invasive procedures after 5 years in Latin-American centers. For postprocedural care, a lower period of telemetry and maintenance of temporary pacing wire, along with less utilization of dual antiplatelet therapy was observed in LATAM20 centers. Conclusion: Despite still having a much lower number of procedures, many aspects of TAVR practice in Latin-American centers have evolved in recent years, followingthe trend observed in developed country centers.