Tratamiento trombolítico de rescate en paciente con fístula arteriovenosa para hemodiálisis trombosada / Rescue thrombolytic treatment in patients with arteriovenous fistula for thrombosed hemodialysis

Introducción: La hemodiálisis continúa siendo la modalidad de terapia de reemplazo renal prevalente en el mundo. La disfunción de la fístula arteriovenosa para hemodiálisis tiene efectos negativos en el paciente y su calidad de vida, por lo que el acceso vascular funcional se necesita para un adecuado tratamiento de hemodiálisis en pacientes con enfermedad renal terminal. El mayor inconveniente del acceso vascular resulta su alta incidencia de oclusión trombótica, causada por la estenosis, la cual se inicia por lesiones hiperplásicas de la capa intimal del vaso. Una de las modalidades de tratamiento a nivel internacional es la trombólisis del acceso vascular trombosado de menos de 24 horas de evolución. Objetivo: Exponer los resultados obtenidos con la aplicación de la trombólisis percutánea del acceso vascular para hemodiálisis trombosado en paciente con enfermedad renal terminal. Presentación del caso: Paciente masculino de 52 años, con diagnóstico de trombosis aguda del acceso vascular para hemodiálisis por enfermedad renal terminal, de 5 días de evolución, con deterioro de su estado de salud por encontrarse subdializado y urémico, con agotamiento del acceso vascular global para hemodiálisis. Se utilizó el tratamiento fibrinolítico directo del acceso vascular percutáneo a 100 mil UI/hora de Heberquinasa® en 10 horas, con recuperación del latido, thrill y repermeabilización de la fístula para hemodiálisis. Conclusiones: El tratamiento fibrinolítico con Heberquinasa® permitió la recuperación del paciente con trombosis aguda del acceso vascular para hemodiálisis. Se evitaron complicaciones asociadas a la subdiálisis y/o colocación de catéter central, y se incorporó al paciente a su programa de hemodiálisis, con garantías para su calidad de vida(AU)

Introduction: Hemodialysis continues to be the prevalent renal replacement therapy modality in the world. Arteriovenous fistula dysfunction for hemodialysis has negative effects on the patients and their quality of life, so functional vascular access is needed for adequate hemodialysis treatment in patients with end-stage renal disease. The greatest drawback of vascular access is its high incidence of thrombotic occlusion, caused by stenosis, which is initiated by hyperplastic lesions of the intimate layer of the vessel. One of the treatment modalities at the international level is the thrombolysis of the thrombosed vascular access of less than 24 hours of evolution. Objective: To present the results obtained with the application of percutaneous thrombolysis of vascular access for thrombosed hemodialysis in patients with end-stage renal disease. Case presentation: Male patient of 52 years, with diagnosis of acute thrombosis of vascular access for hemodialysis due to end-stage renal disease, 5 days of evolution, with deterioration of his health state due to being sub-dialized and uremic, with exhaustion of the global vascular access for hemodialysis. Direct fibrinolytic treatment of percutaneous vascular access at 100 thousand IU/hour of Heberkinase® was used in 10 hours, with recovery of the heartbeat, thrill and repermeabilisation of the fistula for hemodialysis. Conclusions: Fibrinolytic treatment with Heberkinase® allowed the recovery of the patient with acute thrombosis from the vascular access for hemodialysis. Complications associated with sub-dialysis and/or central catheter placement were avoided, and the patient was incorporated into their hemodialysis program, with guarantees for their quality of life(AU)

Trombolisis dirigida por catéter en paciente con oclusión arterial periférica aguda / Catheter-directed thrombolysis in patients with acute peripheral arterial occlusion

Introducción: Las oclusiones arteriales periféricas agudas de menos de 14 días y de causa embólica y trombótica están asociadas a una alta morbimortalidad. La trombólisis dirigida por catéter representa en la actualidad una modalidad de tratamiento efectivo para la oclusión de vasos distales infrageniculares, que históricamente ha tenido malos resultados mediante embolectomía convencional, debido a la oclusión preexistente de vasos colaterales y al daño mecánico al endotelio, que conlleva esta técnica tradicional. Se decidió presentar este caso por ser la primera vez que se practica esta modalidad de tratamiento en Cuba. Objetivo: Exponer los resultados obtenidos con la aplicación de la trombolisis fibrinolitica mediante catéter en un paciente afectado por trombosis arterial periférica aguda. Presentación del caso: Paciente masculino de 57 años de edad con diagnóstico de trombosis arterial aguda de la arteria poplítea del miembro inferior izquierdo, con más de 24 horas de evolución de la isquemia y del compromiso de la viabilidad de la extremidad. Se utilizó el tratamiento fibrinolítico, mediante infusión de 250 000 unidades de Heberkinasa® en tres horas y se logró la mejoría del nivel de amputación. Conclusiones: El tratamiento fibrinolítico con Heberkinasa® fue útil en el paciente tratado porque redujo el nivel de amputación en el paciente, que presentó isquemia irreversible y criterio inicial de amputación supracondílea alto, en la extremidad comprometida(AU)

Introduction: Acute peripheral arterial occlusions of less than 14 days and of embolic and thrombotic cause are associated with a high morbidity and mortality. Catheter-directed thrombolysis currently represents an effective treatment modality for the occlusion of infragenicular distal vessels, which has historically had poor results by conventional embolectomy, due to the pre-existing occlusion of collateral vessels and the mechanical damage to the endothelium, which this traditional technique entails. It was decided to present this case because it is the first time that this modality of treatment is practiced in Cuba. Objective: Present the results obtained with the application of fibrinolytic thrombolysis by catheter in a patient affected by acute peripheral arterial thrombosis. Case presentation: A 57-year-old male patient diagnosed with acute arterial thrombosis of the popliteal artery of the left lower limb, with more than 24 hours of evolution of ischemia and compromised viability of the limb. Fibrinolytic treatment was used, by infusion of 250,000 units of Heberkinase® in three hours and the improvement of the amputation level was achieved. Conclusions: Fibrinolytic treatment with Heberkinase® was useful in the treated patient because it reduced the level of amputation in the patient, who presented irreversible ischemia and initial criteria of high supracondylar amputation in the compromised limb(AU)

La gestión del tiempo como competencia docente en la clase de Danza Clásica / A gestão do tempo como competência docente na classe de Dança Clássica / Time management as a teaching competence in classical Dance Lessons

Esta investigación se ha llevado a cabo para conocer las diferencias en las variables temporales que conforman la competencia docente "Tiempo de compromiso motor" en la clase de Danza Clásica, bien acompañada de música grabada o por profesor pianista acompañante de danza. Se ha procedido al análisis de 50 grabaciones con ambos soportes musicales en un Conservatorio Superior de Danza de 89 alumnas que realizaban sus clases en un aula de ballet. Los resultados obtenidos destacan que según el soporte musical utilizado hay diferencias en las categorías de "Tiempo de Tarea" y "Tiempo de Organización", mostrándose un mayor valor en el "Tiempo de Tarea" en las sesiones en las que se utilizó la música en vivo, así como un menor tiempo en la "Organización", por lo que emplear la música en vivo podría proporcionar sesiones más productivas y con menor pérdida de tiempo

Esta pesquisa foi realizada com o objetivo de conhecer as diferenças nas variáveis temporais que compõem a competência docente, "Tempo de compromisso motor" nas aulas de Dança Clássica, seja acompanhado por música gravada ou por professor pianista acompanhando a dança. A análise de 50 gravações com ambos os suportes musicais foi realizada em um Conservatório Superior de Dança de 89 alunos que realizaram suas aulas em uma sala de ballet. Os resultados obtidos destacam que, de acordo com o suporte musical utilizado, existem diferenças nas categorias de "Tempo de Tarefa" e "Tempo de Organização", mostrando um maior valor no "Tempo de Tarefa" nas sessões em que a música ao vivo foi utilizada, bem como um menor tempo na "Organização", de modo que o uso de música ao vivo poderia proporcionar sessões mais produtivas com menor perda de tempo

This study looked into time variable differences in the teaching competence "Time of motor commitment" in Classical Dance lessons accompanied by either recorded music or a pianist teacher. Fifty recordings of 89 students of a Higher Education Dance Conservatory were analyzed in their ballet lessons with both musical supports. The results show differences in the categories of "Task Time" and "Organization Time" according to the musical support used, showing longer "Task Time" and shorter "Organization time" in lessons with live music. Therefore, live music could provide more productive lessons with less loss of time

Administración exitosa de omalizumab en pacientes con síndrome de sobreposición asma-EPOC en un hospital universitario de Puebla / Successful use of omalizumab in patients with overlap syndrome asthma-COPD in a University Hospital of Puebla

Resumen: El término asma/EPOC, denominado SOAE (sobreposición asma/EPOC), incluye a un subconjunto de pacientes con persistencia y limitación del flujo aéreo con características clínicas de asma y de EPOC. La falta de consenso de una definición de sobreposición asma/EPOC ha llevado a la amplia gama en prevalencia que varía entre 11 y 56% en la EPOC, 13 y 61% en el asma y 2% entre la población general. Los estudios iniciales han demostrado que omalizumab puede ser útil en pacientes con sobreposición asma/EPOC porque ha demostrado aliviar los síntomas, reducir las exacerbaciones y la hospitalización, así como mejorar los parámetros de función pulmonar y disminuir el requerimiento de esteroides en estos pacientes. Este artículo describe el efecto de omalizumab en cinco pacientes con diagnóstico de síndrome de sobreposición asma/EPOC y administración de omalizumab. Se describe la experiencia de nuestro centro y los beneficios que el tratamiento ha dado a nuestros pacientes, que han permitido mejor calidad de vida y disminuir de manera radical su morbilidad.

Abstract The term asthma/COPD, called SOAE (overlap asthma/EPOC acronym in English ACOS [asthma COPD overlap syndrome]), includes a subset of patients with persistence and airflow limitation that presents clinical features of both asthma and COPD. Lack of consensus on a definition of ACOS has led to the wide range in prevalence ranging between 11 and 56% in COPD, 13 and 61% in asthma, and 2% in the general population. The initial studies have shown that omalizumab may be useful in patients with ACOS, it has been shown to improve symptoms, reduce exacerbations and hospitalization, as well as improve lung function parameters and reduce steroid requirement in these patients. This paper describes the effect of omalizumab in 5 patients with a diagnosis of overlying asthma/COPD syndrome (SOAE) and administration of omalizumab. We describe the experience of our center and the benefits that the treatment has given to our patients. These benefits have allowed the patient a better quality of life and radically reduce their morbidity.

Administración de omalizumab en pacientes mexicanos con diagnóstico de asma moderada a grave no atópica / Administration of omalizumab in Mexican patients diagnosed with moderate-severe non-atopic asthma

Resumen: OBJETIVO Determinar la mejoría clínica en los pacientes con diagnóstico de asma moderada a severa no atópica en tratamiento con omalizumab. MATERIAL Y MÉTODO estudio prospectivo y observacional en el que del 1 de enero de 2017 al 1 de enero de 2018 se incluyeron pacientes adultos que, a pesar del tratamiento diario con o sin mantenimiento con corticoesteroides orales, tenían asma moderada a severa no atópica descontrolada; los pacientes se asignaron a recibir omalizumab por concentraciones de IgE. El punto final primario fue el cambio en los parámetros clínicos y funcionales de los pacientes por medio de examen de la prueba ACT (Asthma Control Test). RESULTADOS Se incluyeron 20 pacientes. Tras 52 semanas de administración de omalizumab los pacientes mostraron aumento moderado en el FEV1 y mejoría de los parámetros clínicos y funcionales. El alivio sintomático de los pacientes se consideró principalmente con el aumento en la prueba ACT de 10 a 20 puntos. También se observó buena tolerancia al medicamento, sin ningún efecto adverso grave y mejoría en la calidad de vida de los pacientes. CONCLUSIONES Omalizumab tiene un papel terapéutico en el asma no atópica moderada a severa. Nuestros resultados apoyan la eficacia clínica de omalizumab en los pacientes asmáticos no atópicos mexicanos.

Abstract: OBJECTIVE To determine the clinical improvement in patients diagnosed with moderate-severe non-atopic asthma in treatment with omalizumab. MATERIAL AND METHOD A prospective and observational study was made from January 1st 2017 to January 1st 2018 in adult patients who, despite daily treatment with or without maintenance oral corticosteroids, had uncontrolled moderate to severe non-atopic asthma; patients were assigned to receive omalizumab at doses of IgE levels. The primary endpoint was the change in the clinical and functional parameters of the patients by means of Asthma Control Test. RESULTS There were included 20 patients. After 52 weeks of administration of omalizumab they showed a moderate increase in FEV1 and in clinical and functional parameters. The symptomatic improvement of the patients was mainly considered by an increase of 10 to 20 points in Asthma Control Test. Good tolerance to the drug was also observed, without any serious adverse effects, as well as improvement in the quality of life of the patients. CONCLUSIONS Omalizumab has a therapeutic role in moderate to severe non-atopic asthma. Our results support the clinical efficacy of omalizumab in Mexican non-atopic asthmatic patients.

Prevalencia de eosinofilia y características clínicas en una cohorte de pacientes con enfermedad pulmonar obstructiva crónica en un hospital de tercer nivel de Puebla / Eosinophilia prevalence and clinical characteristics in a cohort of patients with chronic obstructive pulmonary disease in a third-level hospital in Puebla

Resumen: ANTECEDENTES La prevalencia de eosinofilia en la enfermedad pulmonar obstructiva crónica (EPOC) es de gran importancia para la prevención de complicaciones y tratar episodios de sobreagudización. La existencia de un biomarcador permitiría este seguimiento. La revisión de la bibliografía pone de manifiesto la posible relación eosinofilia-enfermedad pulmonar obstructiva crónica. Se tiene poca información en estudios médicos. MATERIAL Y MÉTODO Estudio descriptivo y observacional de la población atendida en la consulta externa de Neumología en el Hospital Universitario de Puebla. Se analizaron las siguientes variables: edad, sexo, años de diagnóstico de enfermedad pulmonar obstructiva crónica, hemograma (se estableció el diagnóstico de eosinofilia con > 2% o más de 200 células totales), gravedad (por GOLD) y número de exacerbaciones en un año de estudio. RESULTADOS Se incluyeron 50 pacientes con diagnóstico de enfermedad pulmonar obstructiva crónica (74% mujeres y 26% hombres), 50% asociado con tabaquismo y 50% asociado con humo de leña; 36% tenían eosinofilia representativa (mayor de 2% o mayor de 200 células totales), 64% tenían eosinofilia no representativa (menos de 2% o menos de 200 células totales). CONCLUSIÓN Este trabajo demuestra en una población la importancia de la eosinofilia como biomarcador en el fenotipo de la enfermedad pulmonar obstructiva crónica que permita el tratamiento adecuado y dirigido a mejorar la calidad de vida y a disminuir la progresión y aparición de complicaciones y exacerbaciones.

Abstract: OBJECTIVE The prevalence of eosinophilia in chronic obstructive pulmonary disease is of great importance for the prevention of complications and to treat episodes of overactivity. The existence of a bio-marker would allow this monitoring. The review of the literature reveals the possible eosinophilia-chronic obstructive pulmonary disease relationship. There is little information in medical studies. MATERIAL AND METHOD We designed a descriptive observational study of the population attended in the external consultation of Pneumology in the University Hospital of Puebla. The following variables were analyzed: age, sex, years of diagnosis of chronic obstructive pulmonary disease, blood count (diagnosis of eosinophilia with > 2% or more than 200 total cells), severity (by GOLD) and number of exacerbations in one year of study. RESULTS Fifty patients with a diagnosis of chronic obstructive pulmonary disease (74% female and 26% male), 50% associated with smoking and 50% associated with wood smoke were present; 36% had representative eosinophilia (greater than 2% or greater than 200 total cells), 64% had non-representative eosinophilia (less than 2% or less than 200 total cells). CONCLUSION This work demonstrates in a population the importance of eosinophilia as a biomarker in the phenotype of chronic obstructive pulmonary disease that allows adequate treatment and aimed at improving quality of life and to decrease the progression and appearance of complications and exacerbations.

Síndrome coronario agudo y enfermedad de Erdheim-Chester. Patogénesis e implicaciones terapéutica / Acute Coronary Syndrome in Erdheim-Chester. Etiopathogenesis and therapeutic Implications

Resumen La enfermedad de Erdheim-Chester es una histiocitosis celular diferente a la histiocitosis de Langerhans, de origen incierto. Se caracteriza por una implicación multi-orgánica debida a la infiltración de los histiocitos CD68+/CD1a-, en forma de xantogranulomas, que afectan principal y comúnmente a la metáfisis y diáfisis de huesos largos. El diagnóstico se realiza mediante biopsia, donde se revelan histiocitos CD68+/CD1a-, carencia de proteína S, y presencia de gránulos de Birbeck. Se ha subestimado la implicación cardiovascular. Reportamos un caso de un varón de 67 años con la enfermedad de Erdheim-Chester e infarto de miocardio agudo, debido a implicación coronaria, además de enfermedad ósea, vascular, pituitaria y retroperitoneal. Revisamos la literatura relevante y describimos el tratamiento clínico de estos pacientes.

Abstract Erdheim-Chester disease is a non-Langerhans cell histiocytosis of uncertain origin. It is characterized by multiorgan involvement due to infiltration of CD68+/CD1a- histiocytes, in the form of xantogranulomas, most commonly affecting the metaphysis and diaphysis of long bones. The diagnosis is made by biopsy showing CD68+/CD1ahistiocytes, lack of S protein and Birbeck granules. Cardiovascular involvement is underestimated. We report a case of a 67 year-old man with Erdheim-Chester disease and acute myocardial infarction due to coronary involvement, in addition to bone, vascular, pituitary and retroperitoneal disease. We review relevant literature and describe the clinical management of these patients.

Splenic Rupture after Infective Endocarditis by Enterococcus faecalis: Case Report.

Aims: In patients with infective endocarditis, with risk of embolization, early identification of parenchymal changes may suggest the risk of splenic rupture. Presentation of Case: A 68-year-old male presented with a history of 2 months of fever and also left upper quadrant pain initiated 2 days before admission. Transesophageal echocardiogram demonstrated the presence of two mobile vegetations on the ventricular side of the aortic valve; the largest diameter being 2.1 cm. Enterococcus faecalis was isolated in blood culture after a diagnosis of subacute aortic valve infective endocarditis. He complained of abdominal pain. An abdominal computed tomography scan revealed infarction of the upper region of the spleen (septic embolism). Therapy with penicillin and gentamicin was initiated, but the patient developed symptoms of heart failure that led to a surgical treatment, and aortic bioprosthesis was implanted on day 14. On day 5 postoperatively, the patient developed sudden hemorrhagic shock signs due to splenic rupture and underwent emergency splenectomy. A pathological examination revealed areas of splenic laceration of the capsule, splenic infarction areas, and the absence of abscesses. Splenic rupture is a complication much rarely occurring due to infectious endocarditis caused by E. faecalis. Conclusion: This case highlights the importance of conducting serial imaging, particularly in symptomatic patients, for the early detection of parenchymal changes that may suggest the risk of rupture.

Improving Indicators in a Brazilian Hospital Through Quality-Improvement Programs Based on STS Database Reports

ABSTRACT OBJECTIVE: To report the initial changes after quality-improvement programs based on STS-database in a Brazilian hospital. METHODS: Since 2011 a Brazilian hospital has joined STS-Database and in 2012 multifaceted actions based on STS reports were implemented aiming reductions in the time of mechanical ventilation and in the intensive care stay and also improvements in evidence-based perioperative therapies among patients who underwent coronary artery bypass graft surgeries. RESULTS: All the 947 patients submitted to coronary artery bypass graft surgeries from July 2011 to June 2014 were analyzed and there was an improvement in all the three target endpoints after the implementation of the quality-improvement program but the reduction in time on mechanical ventilation was not statistically significant after adjusting for prognostic characteristics. CONCLUSION: The initial experience with STS registry in a Brazilian hospital was associated with improvement in most of targeted quality-indicators.

Human Tissue Kallikrein Activity in Angiographically Documented Chronic Stable Coronary Artery Disease / Atividade da Calicreína Tecidual Humana na Doença Coronariana Crônica Estável Angiograficamente Documentada

AbstractBackground:Human tissue kallikrein (hK1) is a key enzyme in the kallikrein–kinin system (KKS). hK1-specific amidase activity is reduced in urine samples from hypertensive and heart failure (HF) patients. The pathophysiologic role of hK1 in coronary artery disease (CAD) remains unclear.Objective:To evaluate hK1-specific amidase activity in the urine of CAD patientsMethods:Sixty-five individuals (18–75 years) who underwent cardiac catheterism (CATH) were included. Random midstream urine samples were collected immediately before CATH. Patients were classified in two groups according to the presence of coronary lesions: CAD (43 patients) and non-CAD (22 patients). hK1 amidase activity was estimated using the chromogenic substrate D-Val-Leu-Arg-Nan. Creatinine was determined using Jaffé’s method. Urinary hK1-specific amidase activity was expressed as µM/(min · mg creatinine) to correct for differences in urine flow rates.Results:Urinary hK1-specific amidase activity levels were similar between CAD [0.146 µM/(min ·mg creatinine)] and non-CAD [0.189 µM/(min . mg creatinine)] patients (p = 0.803) and remained similar to values previously reported for hypertensive patients [0.210 µM/(min . mg creatinine)] and HF patients [0.104 µM/(min . mg creatinine)]. CAD severity and hypertension were not observed to significantly affect urinary hK1-specific amidase activity.Conclusion:CAD patients had low levels of urinary hK1-specific amidase activity, suggesting that renal KKS activity may be reduced in patients with this disease.

ResumoFundamento:A calicreína tecidual humana (hK1) é enzima-chave do sistema calicreína-cinina (SCC). A atividade amidásica da hK1 está reduzida na urina de pacientes com hipertensão e insuficiência cardíaca (IC); seu papel na doença arterial (DAC) coronariana ainda não está esclarecido.Objetivo:Avaliar a atividade amidásica da hK1 na urina de pacientes com DAC.Métodos:Sessenta e cinco indivíduos (18 a 75 anos) que se submeteram ao cateterismo cardíaco (CAT) coletaram amostra do jato médio de urina imediatamente antes do CAT. Baseando-se na presença de lesões coronarianas, os pacientes eram classificados em dois grupos: DAC (43 pacientes) e sem DAC (22 indivíduos). A atividade amidásica da hK1 foi estimada com o substrato cromogênico D-Val-Leu-Arg-Nan. Creatinina foi determinada pelo método de Jaffé. A atividade amidásica específica da hK1 urinária foi expressa em µM/(min . mg de creatinina) para corrigir diferenças no fluxo urinário.Resultados:A atividade amidásica da hK1 urinária foi semelhante entre os pacientes com DAC [0,146 µM/(min . mg de creatinina)] e aqueles sem DAC [0,189 µM/(min . mg de creatinina)] (p = 0,803), e permaneceu entre os baixos valores previamente publicados para pacientes com hipertensão primária [0,210 µM/(min . mg de creatinina)] e para aqueles com IC [0,104 µM/(min . mg de creatinina)], respectivamente. Nenhum efeito estatisticamente significativo da gravidade da DAC e da hipertensão sobre a atividade amidásica da hK1 urinária foi observado.Conclusão:A atividade amidásica da hK1 na urina estava reduzida nos pacientes com DAC, o que pode sugerir que a atividade do SCC renal esteja reduzida nessa doença.

Adaptación de la escala Creative Environment Perceptions al español / Adaptation of the Creative Environment Perceptions Scale into Spanish

Este estudio se enmarca dentro de la propuesta de Mayfield y Mayfield (2008, 2010) sobre las percepciones del entorno creativo. El objetivo fue realizar la adaptación al español de la escala Creative Environment Perceptions de nueve ítems y analizar sus propiedades psicométricas. Los participantes fueron 975 empleados españoles (48.5% hombres y 51.5% mujeres). Los resultados obtenidos demuestran, después de realizar análisis confirmatorio, una estructura constituida por tres factores: Apoyo a la Creatividad, Características del Trabajo y Bloqueos a la Creatividad. Además, los tres factores obtenidos tienen una fiabilidad adecuada e igualmente se constatan indicios de validez, si se toman como referencia algunos correlatos externos y algunas escalas que hacen referencia a la adicción al trabajo, el burnout y el potencial creativo. En suma, la presente escala puede resultar idónea para identificar de manera apropiada los tres factores.

This study falls within the framework of Mayfield and Mayfield's proposal (2008, 2010) on creative environment perceptions. The objective was to adapt the 9-item Creative Environment Perceptions Scale into Spanish and analyse its psychometric properties. The sample for the present study was made up of 975 Spanish employees (48.5% men and 51.5% women). After carrying out a confirmatory analysis the results displayed a three factor structure: Support to creativity, Job characteristics and Blocks to creativity. Furthermore, the three factors showed appropriate reliability and some signs of validity were also found when they were contrasted with certain external correlates and scales that refer to workaholism, burnout and creative potential. By way of summing up, the present scale may prove ideal for appropriately identifying support to creativity, job characteristics and blocks to creativity.

Evaluation of the Society of Thoracic Surgeons score system for isolated coronary bypass graft surgery in a Brazilian population / Avaliação dos escores da Society of Thoracic Surgeons para cirurgia de revascularização miocárdica isolada em uma população brasileira

Objective: Report the experience with the Society of Thoracic Surgeons scoring system in a Brazilian population submitted to isolated coronary artery bypass graft surgery. Methods: Data were collected from January-2010 to December-2011, and analyzed to determine the performance of the Society of Thoracic Surgeons scoring system on the determination of postoperative mortality and morbidity, using the method of the receiver operating characteristic curve as well as the Hosmer-Lemeshow and the Chi-square goodness of fit tests. From the 1083 cardiac surgeries performed during the study period 659 represented coronary artery bypass graft procedures which are included in the present analysis. Mean age was 61.4 years and 77% were men. Results: Goodness of fit tests have shown good calibration indexes both for mortality (X2=6.78, P=0.56) and general morbidity (X2=6.69, P=0.57). Analysis of area under the ROC-curve (AUC) demonstrated a good performance to detect the risk of death (AUC 0.76; P<0.001), renal failure (AUC 0.79; P<0.001), prolonged ventilation (AUC 0.80; P<0.001), reoperation (AUC 0.76; P<0.001) and major morbidity (AUC 0.75; P<0.001) which represents the combination of the assessed postoperative complications. STS scoring system did not present comparable results for short term hospital stay, prolonged length of hospital stay and could not be properly tested for stroke and wound infection. Conclusion: Society of Thoracic Surgeons scoring system presented a good calibration and discrimination in our population to predict postoperative mortality and the majority of the harmful events following coronary artery bypass graft surgery. Analysis of larger samples might be needed to further validate the use of the score system in Brazilian populations. .

Objetivo: Relatar a experiência com o "Society of Thoracic Surgeons scoring system" em uma amostra de pacientes da população brasileira submetida a cirurgia de revascularização miocárdica isolada. Métodos: Foram coletados dados de janeiro de 2010 até dezembro de 2011 e analisados para determinar o desempenho do "Society of Thoracic Surgeons scoring system" na determinação de mortalidade e morbidade pós-operatória, utilizando o método da característica de operação do receptor (ROC-curve) e tes tes Chi-quadrado e Hosmer-Lemeshow para qualidade de ajus te. Das 1083 cirurgias cardíacas realizadas durante o período de estudo, 659 foram cirurgias de revascularização miocárdica que são aqui analisadas. A idade média foi de 61,4 anos e 77% dos pacientes eram homens. Resultados: Testes de bondade de ajustamento demonstraram boa calibração tanto para mortalidade (X2=6,78, P=0,56) quanto para morbidade geral (X2=6,69, P=0,57). A análise da área sob a curva ROC (AUC) demonstrou bom desempenho para detectar o risco de morte (AUC 0,76; P<0,001), insuficiência renal (AUC 0,79; P<0,001), ventilação prolongada (AUC 0,80; P<0,001), reoperação (AUC 0,76; P<0,001) e morbidade maior (AUC 0,75; P<0.001) que representa a combinação das complicações avaliadas. O escore Society of Thoracic Surgeons não apresentou resultados comparáveis para internação de curta duração, internação hospitalar prolongada e não pôde ser adequadamente testado para acidente vascular cerebral e infecção de ferida operatória. Conclusão: O sistema de escore Society of Thoracic Surgeons apresentou boa calibração e discriminação em nossa população para a predição de mortalidade p...

Pyschometric Properties and the Factor Structure of the Spanish Version of the Cognitive Adaptability Scale (MAC) / Propiedades psicométricas y estructura factorial de la versión española de la Escala de Adaptabilidad Cognitiva (MAC)

In the context of entrepreneurship, cognitive adaptability is a key competence. Thus, researchers in this field are making an effort to find instruments to measure this ability in a way that allows us to predict success in the context of enterprise creation or intention. We conducted a series of exploratory and confirmatory analyses of the cognitive adaptability scale (MAC), using a sample of Spanish (N = 494), in addition to the reliability and validity analyses. We found that a three-factor solution of the MAC best fit the data. The reliability coefficients of consistency were acceptable. The validity of the MAC was confirmed by its correlation with Need for Cognition (NFC). The NFC measures the degree to which individuals enjoy cognitive activity. The present study suggests that more studies are needed in different contexts that would allow the structure of cognitive adaptability to be validated, improved or modified.

En el contexto del emprendimiento, la adaptabilidad cognitiva es una competencia clave. Por lo tanto, los investigadores en este campo están haciendo esfuerzos para encontrar instrumentos que midan la capacidad de emprendimiento y que permitan predecir el éxito en el contexto de la intención o creación de empresas. Utilizando una muestra española ( N = 494), Se llevaron a cabo una serie de análisis exploratorios y confirmatorios de la Escala de la Capacidad de Adaptación Cognitiva (MAC), utilizando una muestra española (N = 494), además de la confiabilidad y validez de los análisis. Se encontró una solución de tres factores del MAC que se ajusta mejor a los datos. Los coeficientes de fiabilidad fueron aceptables. La validez de la MAC fue confirmada por su correlación con Necesidad de Cognición (NFC). La NFC mide el grado en que los individuos disfrutan de la actividad cognitiva. El presente estudio sugiere que se necesitan más estudios en diferentes contextos que permitan que la Escala de Capacidad de Adaptación Cognitiva pueda ser validada, mejorada o modificada.

Cognitive Scripts and Entrepreneurial Success / Habilidades cognitivas y éxito empresarial

This paper examines the scripts (cognitive abilities) of successful entrepreneurs and compares them with the scripts of less successful entrepreneurs in order to increase understanding of the factors underlying the entrepreneurial experience. We propose that success (real or perceived) depend on the level of expertise in entrepreneurial scripts. We used a sample of 104 business owners. We adapted a scale for measuring in entrepreneurial scripts. The results confirm that entrepreneurs with high script expertise showed greater levels of perceived success than entrepreneurs with lower levels of expertise. However, there were no differences in venture growth. Our study increases the applications of cognitive abilities as a key factor for entrepreneurial success and opens the door for a Cognitive Training Program for entrepreneurial success.

Este artículo examina los guiones (habilidades cognitivas) de los emprendedores éxitosos y los compara con los guiones de los empresarios con menos éxito, con el fin de aumentar la comprensión de los factores que subyacen a la experiencia empresarial. Se propone que el éxito (real o percibido) depende del nivel de experiencia en habilidades empresariales. Para este estudio se utilizó una muestra de 104 dueños de negocios. Se adaptó una escala para medir los guiones empresariales. Los resultados confirman que los empresarios con alta experiencia mostraron mayores niveles de éxito percibido que los empresarios con bajos niveles de experiencia. Sin embargo, no hubo diferencias en el crecimiento de participación. El presente trabajo aumenta las aplicaciones de las capacidades cognitivas como un factor clave para el éxito empresarial, y abre la puerta para un programa de entrenamiento cognitivo para el éxito empresarial.

Estimaciones de la masa grasa y la masa muscular por métodos antropométricos y de bioimpedancia eléctrica / Assessment of fat mass and skeletal muscle mass by means of conventional anthropometry and bioelectrical impedance analysis

Determinar la masa grasa y sus diferencias estimadas por técnicas de antropometría y bioimpedancia eléctrica de cuerpo entero, así como presentar datos de masa muscular esquelética en jóvenes en edad escolar, por métodos antropométricos. Método: Se ha procedido a la valoración de la composición corporal de 75 niños y 75 niñas de entre 12 y 18 años, mediante técnicas antropométricas y de bioimpedancia eléctrica de cuerpo entero para estimar la masa grasa (Slaughter y Houtkooper, respectivamente), así como la masa muscular esquelética (Poortmans). El análisis estadístico consistió en un estudio comparativo entre métodos que se realizó mediante la prueba de la t de Student, un estudio correlacional mediante el coeficiente de correlación de Spearman, así como un estudio de concordancia entre métodos mediante los procedimientos de Bland-Altman. Resultados: No existen diferencias significativas de la masa grasa determinada por ambos métodos (p > 0.05). Existen diferencias estadísticas en la masa muscular esquelética entre niños y niñas (p < 0.05). El estudio de concordancia muestra pequeñas diferencias entre métodos con errores proporcionales para el grupo de niños, no así en niñas,y con muy amplios límites de concordancia entre métodos. Conclusiones: En general, se puede concluir que la metodología antropométrica y de bioimpedancia eléctrica para la estimación de la composición corporal no son intercambiables para valoraciones longitudinales, en niños en edad escolar de 12 a 18 años, y aunque se observan pequeñas diferencias, existe un efecto de error proporcional entre método...

Implantação de protocolo institucional para o uso racional de hemoderivados e seu impacto no pós-operatório de cirurgias de revascularização miocárdica / Implementation of an institutional protocol for rational use of blood products and its impact on postoperative of coronary artery bypass graft surgery

OBJETIVO: Cirurgias cardíacas são, por vezes, acompanhadas de perdas sanguíneas significativas, e transfusões de sangue podem ser necessárias. No entanto, o uso indiscriminado de hemoderivados pode resultar em efeitos danosos para o paciente. Neste estudo, avaliamos os efeitos imediatos da implantação de um protocolo para o uso racional de hemoderivados no perioperatório de cirurgias de revascularização miocárdica. MÉTODOS: Entre os meses de abril e junho de 2011, foi implementado um protocolo institucional em um hospital privado especializado em cardiologia com a anuência e a colaboração de sete equipes de cirurgia cardíaca, visando ao uso racional de hemoderivados. Foram verificados dados clínicos e demográficos dos pacientes, e avaliados o uso de hemoderivados e os desfechos clínicos no período intra-hospitalar, antes e após a implantação do protocolo. O protocolo consistiu em uma campanha institucional junto às equipes cirúrgicas, de anestesiologia e intensivistas, para difundir a prática do uso de hemoderivados com base em critérios clínicos objetivos (anemia com repercussões hemodinâmicas e disfunção ventricular significativa), bem como tornar rotineira a prescrição de ácido epsilon-aminocaproico no intraoperatório, que é prática recomendada por diretrizes internacionais baseadas em evidência científica. RESULTADOS: Após os 3 meses de implantação do protocolo, houve aumento do uso de ácido epsilon-aminocaproico de 31% para 100%. Antes da implantação do protocolo, 67% das cirurgias utilizaram alguma transfusão sanguínea; após a implantação, 40% das cirurgias necessitaram de alguma transfusão sanguínea nos meses subsequentes do mesmo ano (p<0,001). Não houve diferença significativa nos desfechos clínicos avaliados antes e após implantação do protocolo. CONCLUSÃO: O uso racional de hemoderivados, associado à infusão do ácido epsilon-aminocaproico, tem o potencial de reduzir o número de hemotransfusões no perioperatório de cirurgias cardíacas...

OBJECTIVE: Cardiac surgeries are sometimes followed by significant blood loss, and blood transfusions may be necessary. However, indiscriminant use of blood components can result in detrimental effects for the patient. We evaluated the short-term effects of implementation of a protocol for the rational use of blood products in the perioperative period of cardiac surgery. METHODS: Between April and June 2011, an institutional protocol was implemented in a private hospital specializing in cardiology to encourage rational use of blood products, with the consent and collaboration of seven cardiac surgery teams. We collected clinical and demographic data on the patients. The use of blood products and clinical outcomes were analyzed during hospital stay before and after protocol implementation. The protocol consisted of an institutional campaign with an educational intervention to surgical and anesthesiology teams; the goal was to tailor blood transfusion practice according to clinical goals (anemia with hemodynamic changes and significant ventricular dysfunction) and to make routine the prescription of å-aminocaproic acid intraoperatively, which is recommended by international guidelines based on scientific evidence. RESULTS: After three months of protocol implementation, the use of å-aminocaproic acid increased from 31% to 100%. A total of 67% of surgeries before protocol implementation required any blood transfusion, compared with 40% that required any blood transfusion after protocol implementation in subsequent months of the same year (p<0.001). There was no significant difference in clinical outcomes assessed before and after implementation of the protocol. CONCLUSION: The rational use of blood products associated with infusion of å-aminocaproic acid has the potential to reduce the number of blood transfusions in perioperative of cardiac surgeries, but it can affect the risk of complications.

Associação de níveis plasmáticos de PAI-1 e polimorfismo 4G/5G em pacientes com doença arterial coronariana / PAI-1 4G/5G polymorphism and plasma levels association in patients with coronary artery disease

FUNDAMENTO: O polimorfismo 4G/5G do inibidor ativador do plasminogênio tipo 1 (PAI-1) pode influenciar a expressão do PAI-1. Níveis plasmáticos elevados de PAI-1 estão associados com Doença Arterial Coronariana (DAC). OBJETIVO: O presente estudo investigou a influência do polimorfismo 4G/5G do PAI-1 nos níveis plasmáticos de PAI-1 e sua associação com DAC avaliada por angiografia coronária. MÉTODOS: Foi avaliada amostra de sangue de 35 indivíduos com artérias coronárias angiograficamente normais, 31 indivíduos apresentando ateromatose leve/moderada, 57 indivíduos apresentando ateromatose grave e 38 indivíduos saudáveis (controles). Em pacientes e controles, o polimorfismo 4G/5G do PAI-1 foi determinado por amplificação da proteína-C reativa utilizando primers específicos de alelo. Os níveis plasmáticos de PAI-1 foram quantificados pelo ensaio ELISA (American Diagnostica). RESULTADOS: Não houve diferença entre os grupos quanto a sexo, idade e índice de massa corporal. Níveis plasmáticos de PAI-1 e frequência do genótipo 4G/4G mostravam-se significativamente maiores no grupo com ateromatose grave em comparação com os outros grupos (p < 0,001). Além disso, os pacientes com genótipo 4G/4G (r = 0,28, p < 0,001) apresentaram níveis plasmáticos de PAI-1 significativamente maiores do que aqueles com o genótipo 5G/5G (r = 0,02, p = 0,4511). Além disso, em um modelo de regressão logística múltipla, ajustado para todas as outras variáveis, o PAI-1 esteve independentemente associado com DAC > 70 por cento (p < 0,001). CONCLUSÃO: O achado mais importante deste estudo foi a associação entre o genótipo 4G/4G, elevados níveis plasmáticos de PAI-1 e estenose coronariana superior a 70 por cento em indivíduos brasileiros. Ainda não foi estabelecido se elevados níveis plasmáticos de PAI-1 são um fator decisivo para o agravamento da aterosclerose ou se são uma consequência.

BACKGROUND: Type-1 plasminogen activator inhibitor (PAI-1) 4G/5G polymorphism may influence the PAI-1 expression. High plasma levels of PAI-1 are associated with coronary artery disease (CAD). OBJECTIVE: This study investigated the influence of PAI-1 4G/5G polymorphism on plasma PAI-1 levels and its association with CAD assessed by coronary angiography. METHODS: Blood sample of 35 individuals with angiographycally normal coronary arteries, 31 individuals presenting mild/moderate atheromatosis, 57 individuals presenting severe atheromatosis and 38 healthy individuals (controls) were evaluated. In patients and controls, the PAI-1 4G/5G polymorphism was determined by PCR amplification using allele-specific primers. Plasma PAI-1 levels were quantified by ELISA assay (American Diagnostica). RESULTS: No difference was found between groups regarding age, gender and body mass index. Plasma PAI-1 levels and 4G/4G genotype frequency were significantly higher in the severe atheromatosis group compared to the other groups (p<0.001). Furthermore, patients with 4G/4G genotype (r=0.28, p<0.001) had significantly higher plasma PAI-1 levels than those with 5G/5G genotype (r=0.02, p=0.4511). In addition, in a multiple logistic regression model, adjusted for all the other variables, PAI-1 was observed to be independently associated with CAD > 70 percent (p<0.001). CONCLUSION: The most important finding of this study was the association between 4G/4G genotype, high plasma PAI-1 levels and coronary stenosis higher than 70 percent in Brazilian individuals. Whether high plasma PAI-1 levels are a decisive factor for atherosclerosis worsening or it is a consequence remains to be established.

Comparação das vias radial e femoral nas intervenções coronárias percutâneas: resultados do registro TotalCor / Comparison of radial vs. femoral access in percutaneous coronary interventions: outcomes of the TotalCor registry

Introdução: A intervenção coronária percutânea (ICP) por via radial ainda é pouco utilizada em nosso meio. O objetivo do presente estudo foi avaliar a prevalência e os resultados da ICP por via radial, comparada à via femoral, em uma população do mundo real. Métodos: Registro unicêntrico, com 507 pacientes consecutivos submetidos a ICP pelas vias radial (n = 121) e femoral (n = 386), de acordo com a escolha do operador. Resultados: Os pacientes que utilizaram a via radial (23,9%) eram mais frequentemente do sexo masculino (78,5% vs. 69,9%; P = 0,07) e tabagistas (19,8% vs. 11,7%; P = 0,02), com maior prevalência de lesões uniarteriais (59,5% vs. 46,4%), tipo A/B1 (39% vs. 28,4%) e com função ventricular preservada (87,1% vs. 73%; P < 0,01). Nesse grupo foram utilizados stents de maior diâmetro e menor comprimento. O sucesso do procedimento foi elevado (97,3% vs. 96,3%; P = 0,56) e a incidência de óbito foi baixa, não diferindo entre os grupos (0,8% vs. 0,8%; P = 0,96), assim como as taxas de infarto do miocárdio (2,5% vs. 2,1%; P = 0,73). Não ocorreram revascularizações do vaso-alvo de urgência. Os pacientes tratados pela via radial permaneceram menos tempo internados (1 dia vs. 2 dias; P = 0,02) e não apresentaram complicações vasculares (0 vs. 3,4%; P = 0,045). Conclusões: A utilização da ICP por via radial representa o dobro da média nacional na instituição em que o estudo foi realizado, e a escolha de pacientes para essa técnica trouxe resultados do procedimento equivalentes aos da via femoral, nenhuma complicação vascular, e reduziu à metade o tempo de internação hospitalar.

BACKGROUND: In our country radial access is still underused in percutaneous coronary interventions (PCI). The objective of this study was to evaluate the prevalence and compare radial to femoral vascular access for PCI in a real-world population. METHODS: Single center registry, with 507 consecutive patients undergoing PCI by radial (n = 121) and femoral (n = 386) access, according to the operator's choice. RESULTS: Patients using radial access (23.9%) were more often male (78.5% vs. 69.9%; P = 0.07) and smokers (19.8% vs. 11.7%; P = 0.02), had a higher prevalence of single-vessel disease (59.5% vs. 46.4%), type A/B1 (39% vs. 28.4%) lesions and had preserved ventricular function (87.1% vs. 73%; P < 0.01). Larger diameter and shorter stents were used in this group. Procedure success was high (97.3% vs. 96.3%; P = 0.56), the incidence of death was low and was not different between groups (0.8% vs. 0.8%; P = 0.96), as well as myocardial infarction rates (2.5% vs. 2.1%; P = 0.73). There were no urgent target-vessel revascularizations. Patients treated by the radial approach had a shorter hospitalization period (1 day vs. 2 days; P = 0.02) and did not have vascular complications (0 vs. 3.4%; P = 0.045). CONCLUSIONS: The use of radial access for PCI in our institution is twice the national average and the choice of patients for this technique provided similar results to those obtained by the femoral approach, no vascular complications and halved patients' average stay in hospital.

Evaluación de la Personalidad Emprendedora: Validez Factorial del Cuestionario de Orientación Emprendedora (COE) / Evaluation of Entrepreneurial Personality: Factorial validity of Entrepreneurial Orientation Questionnaire (COE)

El objetivo del presente estudio es examinar la validez factorial del cuestionario de orientación emprendedora (COE). El COE se administró a una muestra de 1.810 estudiantes universitarios de España, Portugal, México, Brasil y Argentina. Se realizaron los estudios psicométricos para analizar la estructura factorial (a través del análisis factorial exploratorio y confirmatorio) y la consistencia interna. La consistencia interna de las escalas evaluadas por el coeficiente Alfa de Cronbach mostró alta fiabilidad, por encima del mínimo establecido (.70). Los índices de ajuste mostraron valores significativos. Los resultados de este estudio muestran que las escalas del COE poseen propiedades satisfactorias de validez de constructo y de consistencia interna. Fases posteriores de esta investigación incluirán análisis de la estabilidad del instrumento y de la validez de criterio.

The aim of the current study is to test the factorial validity of the entrepreneurial orientation questionnaire (COE). The COE was administered to a sample of universitary students (1,810), of the Spain, Portugal, Mexico, Brazil and Argentina. Psychometric studies analyzing the factorial structure (through exploratory and confirmatory factor analysis) and internal consistency of their scales were accomplished. The internal consistency of the scales evaluated by Cronbach's Alpha coefficient showed high reliability, over the.70 minimum established. The fit indices showed significative values. The results of this study show that the COE scales possess satisfactory properties of construct validity and internal consistency. Subsequent phases of this research will include analysis of the instrument's stability and criterion validity.

Doença arterial coronariana: ausência de associação entre o índice apoB/apoA-I e o grau de ateromatose / Coronary artery disease: lack of association between apoB/apoA-I ratio and atheromatosis extent

O índice apoB/apoA-I representa o balanço entre partículas aterogênicas ricas em apolipoproteína B e as anti-aterogênicas, ricas em apolipoproteína A-I. O objetivo deste estudo, de caráter transversal, foi investigar a associação entre o índice apoB/apoAI e o grau de ateromatose coronariana em um grupo de indivíduos submetidos à angiografia, buscando estabelecer a possível correlação entre este parâmetro e a gravidade da doença arterial coronariana (DAC). Os níveis plasmáticos das apolipoproteínas A-I e Bforam determinados em amostras de sangue de 38 indivíduos hígidos (controle), 35 indivíduos angiograficamente normais, 31 indivíduos apresentando ateromatose leve/moderada e 57 apresentando ateromatose grave. Os níveis plasmáticos de apolipoproteína B e oíndice apoB/apoA-I foram significativamente mais baixos no grupo controle quando comparados com os demais grupos (p<0,001), enquantoque os níveis de apolipoproteína A-I foram significativamente mais altos no grupo controle em relação aos demais (p<0,001). Não foram observadas diferenças significativas para idade, sexo, índice de massa corporal, hipertensão arterial, história familiar e perfil lipídico entre os três grupos de indivíduos submetidos à angiografia coronariana. Apesar do índice apoB/apoA-I ter sido associado com a doença arterial coronariana, o mesmo não apresentou correlação com o grau de ateromatose nos indivíduos estudados.