Ablação da Fibrilação Atrial: Impacto da Ecocardiografia Intracardíaca na Redução do Tempo de Procedimento e Internação / Atrial Fibrillation Ablation: Impact of Intracardiac Echocardiography in Reducing Procedure Time and Hospitalization

Resumo Fundamento O ecocardiograma intracardíaco (EIC) permite visualizar estruturas cardíacas e reconhecer complicações durante a ablação da fibrilação atrial (AFA). Comparado ao ecocardiograma transesofágico (ETE), o EIC é menos sensível para detecção de trombo no apêndice atrial, porém requer mínima sedação e menos operadores, tornando-o atrativo num cenário de recursos restritos. Objetivo Comparar 13 casos de AFA utilizando EIC (grupo AFA-EIC) com 36 casos de AFA utilizando ETE (grupo AFA-ETE). Método Trata-se de corte prospectiva realizada em um único centro. O desfecho principal foi o tempo de procedimento. Desfechos secundários tempo de fluoroscopia, dose de radiação (mGy/cm2), complicações maiores e tempo de internação hospitalar em horas. O perfil clínico foi comparado pelo escore CHA2DS2-VASc. Um valor de p <0,05 foi considerado uma diferença estatisticamente significativa entre os grupos. Resultados A mediana do escore de CHA2DS2-VASc score foi 1 (0-3) no grupo AFA-EIC e 1 (0-4) no grupo AFA-ETE. O tempo total de procedimento foi de 129 ± 27 min grupo AFA-EIC e 189 ± 41 no AFA-ETE (p<0,001); o grupo AFA-EIC recebeu uma dose menor de radiação (mGy/cm2, 51296 ± 24790 vs. 75874 ± 24293; p=0,002), no entanto, o tempo de fluoroscopia em minutos mostrou-se semelhante (27,48 ± 9,79 vs. 26,4 ± 9,32; p=0,671). As medianas do tempo de hospitalização não se mostraram diferentes, 48 (36-72) horas (AFA-EIC) e 48 (48-66) horas (AFA-ETE) (p=0,27). Conclusão Nesta coorte, AFA-EIC foi relacionado a menores tempos de procedimento e menor exposição à radiação, sem aumentar o risco de complicações ou o tempo de internação hospitalar.

Abstract Background Intracardiac echocardiography (ICE) allows visualization of cardiac structures and recognition of complications during atrial fibrillation ablation (AFA). Compared to transesophageal echocardiography (TEE), ICE is less sensitive to detecting thrombus in the atrial appendage but requires minimal sedation and fewer operators, making it attractive in a resource-constrained setting. Objective To compare 13 cases of AFA using ICE (AFA-ICE group) with 36 cases of AFA using TEE (AFA-TEE group). Methods This is a single-center prospective cohort study. The main outcome was procedure time. Secondary outcomes: fluoroscopy time, radiation dose (mGy/cm2), major complications, and length of hospital stay in hours. The clinical profile was compared using the CHA2DS2-VASc score. A p-value <0.05 was considered a statistically significant difference between groups. Results The median CHA2DS2-VASc score was 1 (0-3) in the AFA-ICE group and 1 (0-4) in the AFA-TEE group. The total procedure time was 129 ± 27 min in the AFA-ICE group and 189 ± 41 min in the AFA-TEE group (p<0.001); the AFA-ICE group received a lower dose of radiation (mGy/cm2, 51296 ± 24790 vs. 75874 ± 24293; p=0.002), despite the similar fluoroscopy time (27.48 ± 9. 79 vs. 26.4 ± 9.32; p=0.671). The median length of hospital stay did not differ; 48 (36-72) hours (AFA-ICE) and 48 (48-66) hours (AFA-TEE) (p=0.27). Conclusions In this cohort, AFA-ICE was related to shorter procedure times and less exposure to radiation without increasing the risk of complications or the length of hospital stay.

The influence of N95 and FFP2 masks on cardiorespiratory variables in healthy individuals during aerobic exercise: a systematic review and meta-analysis / A influência das máscaras N95 e PFF2 sobre variáveis cardiorrespiratórias em indivíduos saudáveis durante o exercício aeróbico: revisão sistemática e meta-análise

ABSTRACT Objective: In view of the current COVID-19 pandemic, the objective of this study was to determine, through a systematic review and meta-analysis, whether the use of N95/FFP2 masks during aerobic exercise has a significant impact on HR, RR, SpO2, and blood pressure (BP) in healthy individuals. Methods: We searched the MEDLINE database for studies published in English between 2005 and 2021. To reduce bias and increase reliability, only randomized controlled trials and randomized crossover clinical trials were considered for inclusion. The selected outcomes included HR, RR, SpO2, and BP, with perceived exertion being evaluated by means of the Borg scale. Results: Eight controlled trials were included in the meta-analysis. Seven evaluated HR (p > 0.05), five evaluated RR (p > 0.05), five evaluated SpO2 and BP (p > 0.05 for both), and six evaluated perceived exertion, presenting controversial results such as risk ratios that were grouped for each variable. Conclusions: This study suggests that N95 and FFP2 masks do not have significant effects on HR, RR, SpO2, and BP during aerobic exercise in healthy individuals.

RESUMO Objetivo: Diante da atual pandemia de COVID-19, o objetivo deste estudo foi determinar, por meio de uma revisão sistemática e meta-análise, se o uso de máscaras N95/PFF2 durante o exercício aeróbico tem impacto significativo na FC, FR, SpO2 e pressão arterial (PA) em indivíduos saudáveis. Métodos: Buscamos no banco de dados MEDLINE estudos publicados em inglês entre 2005 e 2021. Para reduzir o viés e aumentar a confiabilidade, foram considerados para inclusão no estudo somente ensaios clínicos controlados randomizados e ensaios clínicos cruzados randomizados. Os desfechos selecionados foram FC, FR, SpO2 e PA; a percepção de esforço foi avaliada por meio da escala de Borg. Resultados: Oito ensaios controlados foram incluídos na meta-análise. Sete avaliaram FC (p > 0,05), cinco avaliaram FR (p > 0,05), cinco avaliaram SpO2 e PA (p > 0,05 para ambas) e seis avaliaram a percepção de esforço, com resultados controversos (razões de risco agrupadas para cada variável, por exemplo). Conclusões: Este estudo sugere que as máscaras N95 e PFF2 não têm efeitos significativos na FC, FR, SpO2 e PA durante o exercício aeróbico em indivíduos saudáveis.

Seroprevalence and risk factors associated with seropositivity for equine encephalomyelitis virus in horses in Rio Grande do Norte, Brazil

The present objective was to investigate the presence of anti-equine viral encephalomyelitis (EVE) antibodies and the possible risk factors for its dissemination in horses raised in the East and West Potiguar mesoregions of the state of Rio Grande do Norte, Brazil. Serological diagnosis for neutralizing antibodies against Eastern (EEEV), Western (WEEV) and Venezuelan (VEEV). Equine viral encephalomyelitis was performed using a seroneutralization technique on 811 blood samples from horses from ninety properties and sixteen municipalities between July 2018 and February 2019. Factors associated with EVE were evaluated using an investigative epidemiological questionnaire, and the data were statistically analyzed using the Epi Info 3.5.2 software with a confidence level of 95%. The seroprevalence of anti-EVE antibodies was 14.2% (115), with 10.36% (84) for EEEV, 6.9% (56) for WEEV, and null for EVE. When analyzing risk factors, it can be concluded that horses raised in properties that do not clean installations and/or rent out their pasture are more likely to have anti-EVE antibodies. These results show evidence that horses raised in the East and West Potiguar mesoregions were exposed to EEEV and WEEV, thus reinforcing the importance of vaccination and serological survey of nonvaccinated horses as a means of monitoring the disease.

Clinical Characteristics of Patients with Tetralogy of Fallot who Underwent an Invasive Procedure for Arrhythmias

Introduction: Tetralogy of Fallot (TOF) is a cyanotic congenital heart disease that has an incidence of sudden cardiac death of 0.2% per year, being arrhythmias the main cause of its occurrence. Objective: To compare characteristics of TOF patients referred for electrophysiological study (EPS) against those that were not (No-EPS). Method: Retrospective cohort with 215 patients (57.2% men; age = 29 ± 4) with corrected TOF (median of three years, ranging from 0.33 to 51) that underwent EPS between 2009-2020. The primary outcome was composed of death, implantable cardiac defibrillator (ICD) requirement and hospitalization. Results: Pre-syncope (EPS = 4.7%, No-EPS = 0%; p = 0.004), syncope (EPS = 7.1%, No-EPS = 1.7%; p = 0.056) and palpitations (EPS = 31%, No-EPS = 5.8%; p < 0.001) were symptoms that justified electrophysiological investigation. ICD was implanted in 24% of EPS and 0.6% of No-EPS (p=0.001). Twenty-six percent of the EPS group presented non-sustained ventricular tachycardia, while 0% in No-EPS (p = 0.012). The EPS group had more atrial fibrillation or atrial Flutter (35.7% vs. 6.9%; p < 0.001). The EPS patients had a wider QRS duration than the no-EPS group (171.12 ± 29.52 ms vs. 147 ± 29.77 ms; p < 0.001). Also, 26.2% of EPS performed ablation to correct macroreentrant atrial tachycardias. The incidence of primary outcome (death + ICD requirement + hospitalization) was higher in patients in the EPS group compared to the No-EPS group (p = 0.001). However, the total of seven deaths occurred during the clinical follow-up, but without differences between the groups (EPS = 4.7% vs. No-EPS = 2.8%; p = 0.480). Conclusion: EPS group had a profile of greater risk, more complex heart disease, and a greater occurrence of the primary outcome when compared to the No-EPS group.

Laser photobiomodulation effect on fibroblasts viability exposed to endodontic medications

Aim: The literature has not yet reported investigations about the effect of laser photobiomodulation (LPBM) over the cytotoxicity of drugs for endodontic treatments. Thus, the aim of this study was to evaluate, in vitro, the effect of the association between LPBM and intracanal medications on fibroblasts viability in different exposure times. Methods: Calcium hydroxide (Ca(OH)2) and iodoform (IO) were used pure or associated to LPBM. Eluates of medications were prepared and placed in contact with the cells in three different periods: 24h, 48h and 72h. Laser irradiation (emitting radiation λ 660nm, power density of 10mW, energy density of 3 J/cm²) has been performed in two sessions within a six hour interval, for 12s per well. After each experimental time, the colorimetric assay (MTT) has been performed. Statistical analysis was applied for Mann-Whitney test with 5% α error admitted test. Results: At 24h, the use of LPBM did not increase cell viability while after 72h cell proliferation was stimulated in the group without medications. LPBM application did not increase cell viability in Ca(OH)2 group and IO at any tested time. Ca(OH)2 cytotoxicity at 24h was higher than iodoform, while at 72h not difference was observed. Therefore, after 72 hours was no statistical difference between the IO and Ca(OH)2 groups. Conclusion: LPBM was able to increase cell viability in 72h in the group without medication, although no improvement was observed in the other groups. Thus, LPBM was not able to reduce the cytotoxic effects of the materials on fibroblasts in vitro

Intervenções de educação em saúde de primeiros socorros, no ambiente escolar: uma revisão integrativa / First aid health education interventions in the school environment: an integrative review

Resumo Objectivo: Identificar na literatura quais as intervenções de educação para a saúde em primeiros socorros são utilizadas no contexto escolar. Métodos: Este é um estudo descritivo, como revisão integrada da literatura, com uma pesquisa realizada nas plataformas LILACS, BDENF, MEDLINE e PubMed, seleccionando artigos publicados entre 2009 e 2019, em português, inglês e espanhol, disponíveis para acesso livre e completo, que caracterizaram estudos de intervenção original em escolas com o tema dos primeiros socorros. Resultado: Encontrámos 1937 artigos que, após análise dos critérios de inclusão e exclusão, resultaram em 15 artigos na amostra final. Os artigos foram divididos em duas categorias de discussão: acções de educação de primeiros socorros para professores e empregados e acções de educação de primeiros socorros para estudantes. Conclusão: Empregados, professores e estudantes não estão preparados para prestar primeiros socorros nas escolas, e que o ensino de primeiros socorros, utilizando diferentes metodologias, melhora significativamente os conhecimentos e competências das pessoas neste contexto. Estes estudos justificam a necessidade de promover a educação para a saúde nas escolas em primeiros socorros.

Abstract Objective: To identify in the literature which health education interventions in first aid are used in the school setting. Method: This is a descriptive study, as an integrated review of the literature, with a search performed in the LILACS, BDENF, MEDLINE and PubMed platforms, selecting articles published between 2009 and 2019, in Portuguese, English and Spanish, available for free and complete access, which characterized original intervention studies in schools with the theme of first aid. Result: We found 1937 articles which, after analyzing the inclusion and exclusion criteria, resulted in 15 articles in the final sample. The articles were divided into two discussion categories: first aid education actions for teachers and employees and first aid education actions for students. Conclusion: Collaborators, teachers and students are not prepared to provide first aid in schools, and that teaching first aid, using different methodologies, significantly improves people's knowledge and skills in this context. These studies justify the need to promote health education in schools about first aid.

Resumen Objetivo: Identificar en la literatura qué intervenciones de educación para la salud en primeros auxilios se utilizan en el ámbito escolar. Método: Se trata de un estudio descriptivo, a modo de revisión integradora de la literatura, con una búsqueda realizada en las plataformas LILACS, BDENF, MEDLINE y PubMed, seleccionando artículos publicados entre 2009 y 2019, en portugués, inglés y español, disponibles para acceso gratuito y completo, que caracterizó originales estudios de intervención en escuelas con el tema de primeros auxilios. Resultado: Se encontraron 1937 artículos que, tras analizar los criterios de inclusión y exclusión, dieron como resultado 15 artículos en la muestra final. Los artículos se dividieron en dos categorías de discusión: acciones de educación en primeros auxilios para docentes y empleados y acciones de educación en primeros auxilios para estudiantes. Conclusión: Colaboradores, docentes y estudiantes no están preparados para brindar primeros auxilios en las escuelas, y que la enseñanza de primeros auxilios, utilizando diferentes metodologías, mejora significativamente los conocimientos y habilidades de las personas en este contexto. Estos estudios justifican la necesidad de promover la educación sanitaria en las escuelas sobre primeros auxilios.

EUS-guided gastroenterostomy: Initial experience in a brazilian tertiary center

SUMMARY INTRODUCTION: EUS-guided gastroenterostomy (EUS-GE) is a novel procedure for palliation of malignant gastric outlet obstruction (GOO). Our aim was to evaluate the outcomes of this technique in our initial experience. METHODS: Patients with GOO from our institute were included. Technical success was defined as the successful creation of a gastroenterostomy. Clinical success was defined as the ability to tolerate a soft diet after the procedure. We assessed adverse events and diet tolerance 1 month after the procedure. RESULTS: Three patients were included. Technical and clinical success was achieved in all cases. There were no adverse events and good diet tolerance was observed 1 month after the procedure in the included patients. CONCLUSION: EUS-GE is a promising treatment for patients with GOO.

RESUMO INTRODUÇÃO: A gastroenterostomia ecoguiada é um novo procedimento para paliação da obstrução maligna gastroduodenal. Nosso objetivo foi avaliar os resultados dessa técnica em nossa experiência inicial. MÉTODOS: Foram incluídos pacientes com obstrução maligna gastroduodenal de nossa instituição. O sucesso técnico foi definido como a realização adequada de uma gastroenterostomia. O sucesso clínico foi definido como boa aceitação de dieta pastosa durante a internação. Os eventos adversos e a aceitação alimentar foram avaliados um mês após o procedimento. RESULTADOS: Três pacientes foram incluídos. Os sucessos técnico e clínico foram alcançados em todos os casos. Não houve eventos adversos e a aceitação alimentar permaneceu adequada um mês após o procedimento nos pacientes incluídos. CONCLUSÃO: O EUS-GE é um tratamento promissor para pacientes com obstrução maligna gastroduodenal.

Characterizing the vaquejada horse herd in the brazilian state of Pernambuco / Caracterização do rebanho pernambucano de equinos de vaquejada

This study aimed to determine the age groups, breeds, and morphological characteristics of horses used in vaquejada competitions, as well as to define how often the animals compete, the results achieved in the contests, and the duration of training. A sample of 1,271 horses used in vaquejada competitions was employed in the study. The first step consisted in interviewing owners to obtain information on the age and breed of the horses, vaquejada circuits in which they compete, frequency of competition in vaquejada, results reached in the trials, and training duration per month, week, and day. The second step obtained 15 linear measurements and calculated eight morphometric indices. The data obtained from the interviews were submitted to descriptive statistical analyses. The linear measurements and morphometric indices were used to compare sexes using a completely randomized experimental design. The results showed that 80.3% of the vaquejada horses were between four and ten years old and that 89% of the animals were of the Quarter Horse. The morphometric measures showed that stallions had higher height at withers, back, and croup and wider heads, chest, and croup than mares and geldings. On the other hand, among the eight indices calculated, only the value of the height at the chest of the stallions was higher than the mean values in mares and geldings. It was found that 79.7% of the horses took part in two to four vaquejada trials a month while 93.3% of the animals underwent fitness training 12 months a year. The results show a predominance of Quarter Horses in the vaquejada contests in Pernambuco and that the trials require the selection of physically larger and stronger stallions. In addition, the animals are submitted to intense training and competition routines.

O estudo objetivou determinar as faixas etárias, raças e características morfológicas dos equinos competidores de vaquejadas em Pernambuco, assim como definir a frequência em que os animais competem, os resultados conquistados nas disputas e a duração dos treinamentos. Foram utilizados 1271 equinos participantes de provas de vaquejada realizadas no sertão e agreste pernambucano. A primeira etapa do trabalho consistiu em uma entrevista aos proprietários dos animais para obter informações sobre a idade dos equinos, raça, circuitos de vaquejada em que competem (oficiais ou não oficiais), frequência de participação em vaquejadas, resultados alcançados nas provas e a duração mensal, semanal e diária dos treinamentos. Na segunda etapa foram mensuradas 15 medidas lineares e calculados oito índices morfométricos. Os dados obtidos a partir das entrevistas foram submetidos à análises estatísticas descritivas. Já as medidas lineares e índices morfométricos foram utilizados para comparar os sexos, por meio de delineamento experimental inteiramente ao acaso. Os resultados morfométricos foram submetidos à análise de variância e as médias comparadas pelo teste de Tukey (P<0,05). Observou-se que 80,3% dos equinos de vaquejada tinham entre quatro e 10 anos de idade e que 89% dos animais eram da raça Quarto de Milha. Em relação às medidas morfométricas, registrou-se nos garanhões maiores alturas na cernelha, dorso e garupa e maiores larguras de cabeça, peito e garupa que nas éguas e nos machos castrados. Por outro lado, dentre os oito índices calculados, apenas o valor do vazio subesternal dos garanhões foi superior as médias das fêmeas e dos machos castrados. Constatou-se que 79,7% dos equinos participavam de duas a quatro provas de vaquejada por mês e que 93,3% dos animais eram condicionados fisicamente 12 meses por ano. Concluiu-se que nas vaquejadas realizadas no estado de Pernambuco há predomínio de equinos da raça Quarto de Milha, na faixa etária entre quatro e dez anos e as provas exigem seleção de garanhões fisicamente maiores e mais fortes. Além disso, os animais são submetidos a intensas rotinas de competições e treinamento.

Analysis of Conduction Intervals in Normal Electrophysiological Studies: Establishment of Reference Values the Brazilian Population

Abstract Background In the investigation of cardiac rhythm disorders, a normal electrophysiological (EPS) study is associated with a favorable prognosis. One of the normality criteria is established by conduction intervals within expected range. Objective To establish reference values in EPS for the intracavitary conduction intervals (PA, AH and HV) in a Brazilian population. Methods A retrospective cohort study of the first 1,500 patients submitted to EPS ablation was performed at Instituto de Cardiologia do Rio Grande do Sul, Brazil. The EPS was considered normal if the test was performed for diagnostic purpose; absence of induced arrhythmias; and conduction intervals within the expected range. The REDCap software was used for data collection and management, and the SPSS Statistics 22.0 used for data analysis. Continuous variables were compared with Student's t-test for independent samples and categorical variables with the chi-square test (X 2 ). Values of p ≤ 0.05 were considered significant. Results A total of 124 (8.3%) with EPS considered normal were included; mean age was 52 ± 21 years, and 63 were male. The mean values in milliseconds of PA, AH and HV were 23 ± 9, 88 ± 25 and 44 ± 7, respectively. The PA, AH, and HV percentile ranges were 13 - 25, 81-107 and 40 - 52, respectively. When the patients were divided into three age groups (1 to 18 years, 19 to 64 years and 65 or more), we observed that the group of older patients had significantly higher values of PA, AH and HV compared with younger patients. Conclusion This study showed that intracavitary conduction intervals in a sample of the Brazilian population were similar to previously published studies. Elderly patients tend to have higher values of intracavitary conduction intervals in EPS. Future studies including broader age ranges could enable the acquisition of more reliable and reproducible reference values. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

Internal Validation of a Risk Score for Prediction of Postoperative Atrial Fibrillation after Cardiac Surgery

Abstract Background: Postoperative atrial fibrillation (POAF) after cardiac surgery has great clinical and economic implications. Many attempts have been made to identify risk factors aiming at a better evaluation of prophylactic treatment strategies. Objective: To perform an internal validation of a risk score for POAF. Methods: A prospective cohort of 1,054 patients who underwent myocardial revascularization and/or valve surgery was included. The risk score model was developed in 448 patients, and its performance was tested in the remaining 606 patients. Variables with a significance level of 5% in the cohort were included and subjected to a multiple logistic regression model with backward selection. Performance statistics was performed using the c-statistic, the chi-square and the Hosmer-Lemeshow (HL) goodness-of-fit, Pearson's correlation coefficient. Results: Four variables were considered predictors of outcome: age (≥ 70 years), mitral valve disease, the non-use or discontinuation of beta-blockers and a positive water balance (> 1,500 mL). The ROC curve was 0.76 (95% confidence interval [CI]: 0.72-0.79). The risk model showed a good ability according to the performance statistics - HL test x(2) = 0.93; p = 0.983 and r = 0.99 (Pearson's coefficient). There was an increase in the frequency of POAF with the increase of the score: very low risk = 0.0%; low risk = 3.9%; intermediate risk = 10.9%; and high risk = 60.0%; p < 0.0001. Conclusion: The predictive variables of POAF allowed us to construct a simplified risk score. This scoring system showed good accuracy and can be used in routine clinical practice.

Basic principles of risk score formulation in medicine

SUMMARY Risk models play a vital role in monitoring health care performance. Despite extensive research and the widespread use of risk models in medicine, there are methodologic problems. We reviewed the methodology used for risk models in medicine. The findings suggest that many risk models are developed in an ad hoc manner. Important aspects such as the selection of risk factors, handling of missing values, and size of the data sample used for model development are not dealt with adequately. Methodologic details presented in publications are often sparse and unclear. Model development and validation processes are not always linked to the clinical aim of the model, which may affect their clinical validity. We make some suggestions in this review for improving methodology and reporting.

RESUMO Os modelos de risco desempenham um papel fundamental no monitoramento dos desempenhos dos serviços de saúde. Apesar de extensa pesquisa e do amplo uso dos modelos de risco na Medicina, existem problemas metodológicos. Revisamos a metodologia utilizada nestes modelos na Medicina. Os achados sugerem que muitos modelos de risco são desenvolvidos de maneira ad-hoc. Aspectos importantes, como a seleção de fatores de risco, a forma utilizada de dados perdidos e o tamanho da amostra empregada não são detalhados adequadamente. Detalhes metodológicos presentes em publicações são frequentemente esparsos e incertos. Os modelos de desenvolvimento e de validação nem sempre estão associados com o objetivo clínico do modelo, o que pode afetar sua validade clínica. Nós produzimos algumas sugestões nesta revisão para otimizar a metodologia e as publicações.

Synopsis of the tribe Cocoseae Mart. (Arecoideae, Arecaceae) in the state of Maranhão, Brazil / Sinopse da tribo Cocoseae Mart. (Arecoideae, Arecaceae) no estado do Maranhão, Brasil

Abstract: This study presents a synopsis of the tribe Cocoseae (Arecaceae) for the Maranhão state, which was based on the descriptive analysis of voucher specimens of national and international herbaria, from loans, collection visits, digital platforms, and materials collected in expeditions. Twenty-five species belonging to seven genera were identified. The genus Bactris Jacq. ex Scop. was the most representative with seven species, followed by Attalea Kunth. (five spp.), Syagrus Mart. (five spp.), Astrocaryum G. Mey. (three spp.), Desmoncus Mart. (three spp.), Acrocomia Mart (one spp.), and Allagoptera Nees (one sp.). Four new records of occurrence were found for Maranhão: Allagoptera leucocalyx (Drude) Kuntze, Attalea barreirensis Glassman, Attalea phalerata Mart. ex Spreng. and Syagrus glazioviana (Dammer) Becc. This paper presents a taxonomic key for the species, as well as geographic distribution maps and photographic plates with the distinguishing characteristics for each taxon. Besides the taxonomic characteristics, common names, ecological data, and conservation status are included.

Resumo: Este trabalho apresenta uma sinopse da tribo Cocoseae (Arecaceae) para o estado do Maranhão, embasada na análise descritiva de amostras de herbários nacionais e internacionais, provenientes de empréstimos, visitas aos acervos e consultas em plataformas digitais, além de materiais coletados em expedições. Foram identificadas 25 espécies, pertencentes a sete gêneros. Bactris Jacq. ex Scop. foi o gênero mais representativos com sete espécies, seguido de Attalea Kunth. (cinco spp.), Syagrus Mart. (cinco spp.), Astrocaryum G. Mey. (três spp.), Desmoncus Mart. (três spp.), Acrocomia Mart. (uma spp.) e Allagoptera Nees (uma spp.). Foram encontrados quatro novos registros de ocorrência para o território maranhense: Allagoptera leucocalyx (Drude) Kuntze, Attalea barreirensis Glassman, Attalea phalerata Mart. ex Spreng. e Syagrus glazioviana (Dammer) Becc. É apresentada neste artigo uma chave taxonômica para as espécies, além de mapas de distribuição geográfica e pranchas fotográficas com características distintivas para cada táxon. São incluídos, além das características taxonômicas das espécies, nomes populares, informações ecológicas e status de conservação..

Update on management of postoperative atrial fibrillation after cardiac surgery

Abstract Postoperative atrial fibrillation (POAF) after cardiac surgery remarkably remains the most prevalent event in perioperative cardiac surgery, having great clinical and economic implications. The purpose of this study is to present recommendations based on international evidence and adapted to our clinical practice for the perioperative management of POAF. This update is based on the latest current literature derived from articles and guidelines regarding atrial fibrillation.

Recurrencia de fibrilación auricular posablación de venas pulmonares. Identificación de factores predictores / Atrial fibrillation recurrence post pulmonary vein ablation. Identification of predictive factors / Recorrência da fibrilação atrial pós-ablação das veias pulmonares. Identificação de fatores preditivos

Resumen: La ablación de la fibrilación auricular mediante el aislamiento de las venas pulmonares, es una estrategia ampliamente utilizada en la actualidad. La recurrencia posablación es un problema frecuente. Se han investigado varios predictores de recurrencia con el fin de optimizar la elección del paciente que más se beneficia del procedimiento. Actualmente la evidencia es controvertida, siendo necesarios más estudios al respecto.

Summary: The ablation of atrial fibrillation based on pulmonary veins isolation, is a widely used strategy nowadays. Post ablation recurrence is a frequent problem. Several recurrence predictors have been researched, with the purpose of choosing the patient that would benefit the most from this procedure. Current evidence is controversial and more research is needed.

Unscheduled Emergency Visits after Cardiac Devices Implantation: Comparison between Cardioverter Defibrillators and Cardiac Resynchronization Therapy Devices in less than one year of Follow Up / Consultas Não Programadas em Emergência após Implante de Dispositivos Cardíacos: Comparativo entre Cardiodesfibriladores e Ressincronizadores em Seguimento Inferior a 1 Ano

Abstract Background: The use of Cardiovascular Implantable Electronic Devices (CIED), such as the Implantable Cardioverter Defibrillator (ICD) and Cardiac Resynchronization Therapy (CRT), is increasing. The number of leads may vary according to the device. Lead placement in the left ventricle increases surgical time and may be associated with greater morbidity after hospital discharge, an event that is often confused with the underlying disease severity. Objective: To evaluate the rate of unscheduled emergency hospitalizations and death after implantable device surgery stratified by the type of device. Methods: Prospective cohort study of 199 patients submitted to cardiac device implantation. The groups were stratified according to the type of device: ICD group (n = 124) and CRT group (n = 75). Probability estimates were analyzed by the Kaplan-Meier method according to the outcome. A value of p < 0.05 was considered significant in the statistical analyses. Results: Most of the sample comprised male patients (71.9%), with a mean age of 61.1 ± 14.2. Left ventricular ejection fraction was similar between the groups (CRT 37.4 ± 18.1 vs. ICD 39.1 ± 17.0, p = 0.532). The rate of unscheduled visits to the emergency unit related to the device was 4.8% in the ICD group and 10.6% in the CRT group (p = 0.20). The probability of device-related survival of the variable "death" was different between the groups (p = 0.008). Conclusions: Patients after CRT implantation show a higher probability of mortality after surgery at a follow-up of less than 1 year. The rate of unscheduled hospital visits, related or not to the implant, does not differ between the groups.

Resumo Fundamento: O uso de dispositivos cardíacos eletrônicos implantáveis (DCEI) como o cardiodesfibrilador (CDI) e terapia de ressincronização cardíaca (TRC) - é cada vez maior. O número de eletrodos de estimulação e desfibrilação varia de acordo com o dispositivo. A colocação do eletrodo no ventrículo esquerdo aumenta o tempo cirúrgico podendo associar-se a maior morbidade no acompanhamento após alta hospitalar, evento muitas vezes confundível com a gravidade da patologia base. Objetivo: Avaliar a taxa de internação não programada na emergência e óbito após cirurgia de dispositivos implantáveis estratificados pelo tipo de aparelho. Métodos: Estudo de coorte prospectivo analisando 199 pacientes submetidos à implante de dispositivos cardíacos. Os grupos foram divididos de acordo com o tipo de dispositivo: CDI (n = 124) e TRC (n = 75). Estimativas de probabilidades foram analisadas pelo método de Kaplan-Meier de acordo com o desfecho. Valor de p < 0,05 foi considerado significativo nas análises estatísticas. Resultados: A maioria da amostra era do sexo masculino (71,9%) - idade média de 61,1 ± 14,2. A fração de ejeção do ventrículo esquerdo foi similar entre os grupos (TRC 37,4 ± 18,1 vs. CDI 39,1 ± 17,0; p = 0,532). A taxa de visita não programada na emergência relacionada ao dispositivo foi de 4,8% no grupo CDI e de 10,6% no grupo TRC (p = 0,20). A probabilidade de sobrevida relacionada ao dispositivo da variável "óbito" mostrou-se diferente entre os grupos (p = 0,008). Conclusões: Paciente após o implante de TRC apresenta maior probabilidade de mortalidade após o procedimento cirúrgico no seguimento menor que 1 ano. A taxa de visita hospitalar não programada, relacionadas ou não ao implante, não difere entre os grupos.

Evolutionary study of potentially zoonotic hepatitis E virus genotype 3 from swine in Northeast Brazil

Hepatitis E virus (HEV), an emerging virus associated with acute hepatic disease, leads to thousands of deaths worldwide. HEV has already been reported in Brazil; however, there is a lack of epidemiological and molecular information on the genetic variability, taxonomy, and evolution of HEV. It is thus unclear whether hepatitis E is a neglected disease in Brazil or it has low relevance for public health in this country. Here, for the first time, we report the presence of HEV in Northeast Brazil. A total of 119 swine faecal samples were screened for the presence of HEV RNA using real-time polymerase chain reaction (RT-PCR) and further confirmed by conventional RT-PCR; among these, two samples were identified as positive. Molecular evolution analyses based on capsid sequences revealed that the samples had close proximities to HEV sequences belonging to genotype 3 and were genetically related to subtype 3f isolated in humans. Parsimony ancestral states analysis indicated gene flow events from HEV cross-species infection, suggesting an important role of pig hosts in viral spillover. HEV's ability for zoonotic transmission by inter-species host switching as well as its possible adaptation to new animal species remain important issues for human health.

Alterações da proteína C reativa e fator reumatoide em cães naturalmente infectados por Leishmania spp / Changes in C-reactive protein and rheumatoid factor in dogs naturally infected by Leishmania spp

A leishmaniose visceral canina é uma zoonose considerada doença tropical de prioridade. A leishmaniose afeta vários sistemas do corpo dos cães, incluindo vísceras e pele. A proteína C reativa (PCR) e o fator reumatoide (FR) são exames realizados na medicina para detecção de inflamação e artrites em seres humanos, no entanto, há poucos trabalhos voltados para cães com leishmaniose que demonstrem as alterações ocorridas na PCR e FR. Este trabalho teve como objetivo demonstrar as alterações de PCR e FR e sua correlação com a hiperproteinemia e hiperalbuminemia, além da compararação com o desvio a esquerda presente no exame hematológico. O trabalho foi realizado no Hospital Veterinário do Centro Universitário da Grande Dourados/MS e Centro de Controle de Zoonoses, no qual foram avaliados 34 cães, de diversar raças e idade e submetidos a colheita de sangue venosa para realização de exames em imuno-látex, bioquímica sérica e hemograma, em cães naturalmente infectados por Leishmania spp. Foram utilizados somente cães positivos ao teste rápido DPP® para leishmaniose, juntamente com resultado positivo no exame parasitológico, depois de diagnosticados foram realizados exames hematológicos e bioquímicos. Quando realizado o teste para quantificação de FR em soro sanguíneo, para os 34 animais estudados, foi observado positividade em apenas 1 animal, enquanto que os cães foram positivos para a PCR em 38,23% dos casos estudados. Em casos de animais com leishmaniose é possível estabelecer níveis inflamatórios precocemente, enquanto que o FR demonstrou não ser um bom marcador para animais soropositivos para a doença.(AU)

Canine visceral leishmaniasis is a zoonosis considered a priority tropical disease. The disease affects various body systems of dogs, including viscera and skin. C-reactive protein (CRP) and rheumatoid factor (RF) are tests performed in medicine for the detection of inflammation and arthritis in humans, however, there are few studies aimed at dogs with leishmaniasis that demonstrate changes in CRP and RF. This work aimed to demonstrate the changes of CRP and RF and its correlation with hyperproteinemia and hyperalbuminemia, in addition to the comparison with the left deviation present in the hematological examination. The work was carried out at the Veterinary Hospital of the University Center of Grande Dourados/MS and Zoonoses Control Center, in which 34 dogs of different breeds and ages were submitted to venous blood collection for immuno-latex exams, Biochemistry and blood count in dogs naturally infected with Leishmania spp. Only dogs to the DPP® rapid test for leishmaniasis were used, together with a positive result in parasitological examination, after hematological and biochemical tests were performed. When the test for the quantification of FR in serum was performed, for the 34 animals studied, positivity was observed in only 1 animal, while the dogs were PCR positive in 38.23% of the cases studied. In cases of animals with leishmaniasis it is possible to establish inflammatory levels early, whereas the FR showed not to be a good marker for animals seropositive for the disease.(AU)

Cohort of Patients Referred for Brugada Syndrome Investigation in an Electrophysiology Service - 19-Year Registry / Coorte de Pacientes Encaminhados para Investigação de Síndrome de Brugada em um Serviço Terciário de Eletrofisiologia - Registro de 19 Anos

Abstract Background: Brugada syndrome (SBr) is an arrhythmic condition characterized by ST-T segment abnormalities in the right precordial leads associated with a high risk of ventricular arrhythmias and sudden death. Local data regarding the clinical characteristics of patients with a typical electrocardiographic (ECG) pattern undergoing electrophysiological study are scarce. Objective: To evaluate patients with an ECG pattern suggestive of SBr referred for electrophysiological evaluation in a specialized center. Methods: Cohort study of patients referred for electrophysiological study because of an ECG pattern compatible with SBr between January 1998 and March 2017. Results: Of the 5506 procedures, 35 (0.64%) were for SBr investigation, 25 of which (71.42%) were performed in men. The mean age was 43.89 ± 13.1 years. The ECG patterns were as follows: type I, 22 (62.85%); type II, 12 (34.30%); and type III, 1 (2.85%). Twenty-three patients (65.7%) were asymptomatic, 6 (17.14%) had palpitations, 5 (14.3%) had syncope, and 3 (8.6%) had a family history of sudden death. Electrophysiological study induced ventricular tachyarrhythmias in 16 cases (45.7%), the mean ventricular refractory period being 228 ± 36 ms. Ajmaline / procainamide was used in 11 cases (31.4%), changing the ECG pattern to type I in 7 (63.6%). Sixteen cases (45.7%) received an implantable cardioverter defibrillator (ICD). In a mean 5-year follow-up, 1 of the 16 patients (6.25%) with ICD had appropriate therapy for ventricular fibrillation. There was no death. Other arrhythmias occurred in 4 (11.4%) cases. Conclusions: Most patients are men, and a type I ECG pattern is the main indication for electrophysiological study. Class IA drugs have a high ECG conversion rate. The ICD event rate was 6%. (Arq Bras Cardiol. 2018; [online].ahead print, PP.0-0)

Resumo Fundamento: Síndrome de Brugada (SBr) é uma condição arrítmica definida por anormalidades do segmento ST-T em derivações V1-V3 associada a risco elevado de arritmias ventriculares e morte súbita. Dados locais quanto às características clínicas dos pacientes com padrão eletrocardiográfico (ECG) típico avaliados por estudo eletrofisiológico (EEF) são escassos. Objetivo: Avaliar pacientes com padrão ECG sugestivo de SBr encaminhados para EEF em um centro especializado. Métodos: Estudo de coorte de casos encaminhados para EEF por padrão ECG compatível com SBr, entre janeiro de 1998 e março de 2017. Resultados: Dos 5506 procedimentos, 35 (0,64%) foram para investigação de SBr. Vinte e cinco (71,42%) eram homens. Idade média 43,89 ± 13,1 anos. Apresentação ECG foi tipo I em 22 casos (62,85%), tipo II em 12 (34,30%) e tipo III em 1 (2,85%). Vinte e três (65,7%) eram assintomáticos, 6 (17,14%) apresentavam palpitações, 5 (14,3%) síncope, 3 (8,6%) história familiar de morte súbita. Estudo eletrofisiológico induziu taquiarritmias ventriculares em 16 casos (45,7%), sendo o período refratário ventricular médio de 228 ± 36 ms. Utilizou-se ajmalina/procainamida em 11 casos (31,4%), sendo o padrão ECG transformado em tipo I em 7 (63,6%). Dezesseis casos (45,7%) receberam cardiodes fibrilador (CDI). Em seguimento médio de 5 anos, 1 dos 16 pacientes (6,25%) com CDI teve terapia apropriada para fibrilação ventricular. Nenhuma morte foi registrada. Outras arritmias ocorreram em 4 (11,4%) casos. Conclusões: Homens são maioria, sendo o padrão ECG tipo I a principal indicação de EEF. Droga classe IA possui alta taxa de conversão do padrão ECG. A taxa de eventos no CDI foi de 6%. (Arq Bras Cardiol. 2018; [online].ahead print, PP.0-0)