Corrected sinus node recovery time as a screening test in patients with typical atrial flutter post-ablation to predict pacemaker implantation / Tiempo de recuperación del nodo sinusal corregido como prueba de tamizaje en pacientes con aleteo atrial típico postablación para predecir la implantación de marcapasos

Abstract Objective: The objective of the study was to establish the prognostic value of CSNRT regarding the necessity for pacemaker implantation in patients with atrial flutter (AFL) post-ablation. Methods: This prospective cohort study, conducted at the National Institute of Cardiology "Ignacio Chavez" in Mexico City, assessed patients who had undergone ablation procedures to correct AFL, posterior to which an autonomic blockade was performed, and CSNRT was measured. Results: The sample for this investigation was 40 patients. These were subdivided into two study groups depending on their requirement of pacemaker implant post-ablation (Pacemaker P, No Pacemaker NP). Sinus node (SN) dysfunction was diagnosed in 13 (32.5%) of the 40 participants, 10 (71.43%) of which required a pacemaker implant, while only 4 participants (28.57%) with normal SN function required pacemakers. Ten out of the 14 patients (71.43%) who required a pacemaker had an elevated CSNRT > 500 ms (p ≤ 0.01). Post-ablation CSNRT mean was 383.54 ms ± 67.96 ms in the NP group versus 1972.57 ms ± 3423.56 ms in the P group. Furthermore, SN pause in the P group had a mean of 1.86 s ± 0.96 s versus the NP group with 1.196 s ± 0.52 s. Conclusion: CSNRT has the potential to be a quantitative prognostic tool for the assessment of future pacemaker implants in patients with AFL post-ablation. This could aid in the timely diagnosis of sinus node dysfunction, which could, in the long run, result in the reduction of cardiac functional capacity loss due to cardiac remodeling.

Resumen Objetivo: Establecer el valor pronóstico del TRNSC basado en la necesidad de marcapasos en pacientes diagnosticados con aleteo atrial, pos-ablación. Métodos: Este cohorte prospectivo, realizado en el Instituto Nacional de Cardiología "Ignacio Chávez" en la Ciudad de México, evaluó pacientes sometidos a ablación para corregir el aleteo atrial; se midió el TRNSC post bloqueo autonómico. Resultados: La muestra de 40 pacientes se subdividió en 2 grupos según su requerimiento de marcapasos posterior a la ablación (P y NP). Se diagnosticó disfunción del nodo sinusal en 13 participantes (32.5%), de los cuales 10 (71.43%) requirieron marcapasos en comparación a 4 (28.57%) con función normal. En el grupo P la pausa del nodo sinusal post-ablación tuvo una media de 1.86 ± 0.96 s versus el grupo NP con 1.196 ± 0.52 s. En relación con el TRNSC, el grupo NP tuvo una media de 383.54 ± 67.96 ms vs. 1972.57 ± 3423.56 ms en el grupo P. 10 pacientes (25%) obtuvieron un TRNSC > 500 ms, de los cuales 100% requirieron marcapasos; de los 14 pacientes que requirieron marcapasos 10 (71.43%) tenían un TRNSC elevado (p ≤ 0.01). Conclusiones: El TRNSC tiene el potencial de ser una herramienta de pronóstico cuantitativo para la necesidad de futuros implantes de marcapasos en pacientes con disfunción del nodo sinusal, resultado de aleteo atrial pos-ablación. Esto podría ayudar a diagnosticar más temprano una disfunción del nodo sinusal, resultando en la reducción de la pérdida a largo plazo de la función cardíaca como efecto de la remodelación.

Vértigo en gestantes: presentación clínica, impacto en la calidad de vida y factores asociados / Vertigo in pregnancy: clinical presentation, impact on quality of life and associated factors

OBJETIVO: Evaluar las características clínicas, el impacto en la calidad de vida y los factores asociados con vértigo en gestantes hospitalizadas en una institución de alta complejidad. MÉTODO: Estudio transversal. Se realizó una encuesta dirigida a la presencia de vértigo y sus características clínicas en 2020-2021. La calidad de vida se evaluó con el cuestionario Dizziness Handicap Inventory (DHI). El análisis estadístico incluyó un modelo lineal generalizado. RESULTADOS: De 103 mujeres, el 19,4% indicaron vértigo principalmente en el segundo trimestre de gestación (60%), con una mediana de 3,5 (rango intercuartil: 1,5-7,5) episodios. Fueron referidos vértigos episódicos asociados con cambios posicionales (40%), acompañados de inestabilidad (60%), cefalea (60%), fotopsias (55%) y tinnitus (45%). Las mujeres con vértigo presentaron mayor frecuencia de discapacidad moderada a grave en las dimensiones del DHI emocional (30 vs. 2,4%; p = 0,001), funcional (40 vs. 2,4%; p < 0,001) y física (55 vs. 2,4%; p < 0,001) en comparación con las mujeres sin la patología. La hospitalización durante el embarazo Razón de proporción (RP): 4,02; intervalo de confianza del 95% [IC95%]: 1,64-9,85; p = 0,002) y la presencia de vértigo pregestacional (RP: 2,37; IC95%: 1,15-4,88; p = 0,019) se identificaron como factores asociados. CONCLUSIONES: La alta frecuencia de vértigo en las gestantes sugiere la importancia de estudiar esta condición durante el embarazo, para lograr un manejo integral y generar acciones de prevención y control efectivas.

OBJECTIVE: To evaluate clinical characteristics, impact on quality of life and factors associated with vertigo in pregnant women hospitalized in a highly complex institution. METHOD: A cross-sectional study was conducted in 2021-2022. One focused survey including Dizziness Handicap Inventory (DHI) was performed. The statistical analysis was performed using a generalized lineal regression. RESULTS: 103 patients were included, 19.4% indicated vertigo mostly during the second semester (60%). A median of 3.5 episodes was obtained (RIC: 1.5-7.5). Positional and episodic vertigos (40%) associated with unsteadiness (60%), headache (60%), photopsia (55%) and tinnitus (45%) were described. DHI in pregnant females with vertigo compared to those without vertigo, presented higher rates of moderate to severe disability in the emotional (30 vs. 2.4%: p = 0.001), functional (40 vs. 2.4%; p < 0.001) and physical (55 vs. 2.4%; p < 0.001) dimensions. Hospitalizations during the pregnancy (RP: 4.02; 95%CI: 1.64-9.85; p = 0.002) and previous episodes before pregnancy (RP: 2.37; 95%CI: 1.15-4.88; p = 0.019) were identified as associated factors with current vertigo episodes. CONCLUSIONS: The high frequency of vertigo in pregnant women suggests the importance of studying this condition during pregnancy, to achieve comprehensive management and generate effective prevention and control actions.

Aneurisma aórtico e insuficiencia valvular severa por sífilis terciaria en paciente joven, una enfermedad desatendida / Aortic aneurysm and severe valvular insufficiency due to tertiary syphilis in a young patient, a neglected disease / Aneurisma da aorta e insuficiência valvular grave devido à sífilis terciária em um paciente jovem, uma doença negligenciada

La sífilis es causada por Treponema pallidum, es reconocida por la variedad de sus manifestaciones clínicas; compromete el sistema nervioso, tegumentario y cardiovascular. Las alteraciones cardiovasculares ocurren en 70% de los casos con sífilis no tratada, el 71% de las aortitis sifilíticas desarrollan aneurismas aórticos y la complicación más frecuente es la insuficiencia aórtica. El tratamiento va dirigido a la enfermedad subyacente, con manejo antibiótico para la sífilis terciaria y las complicaciones tromboembólicas y si requiere reparación quirúrgica. Presentamos un caso poco frecuente de un paciente diagnosticado de infección por el virus de la inmunodeficiencia humana y complicaciones cardiovasculares típicas de la sífilis terciaria, que precisó tratamiento médico y quirúrgico, que fue exitoso. Destacamos la pericia clínica de los profesionales de nuestra institución para diagnosticar e identificar las complicaciones cardiovasculares de la sífilis terciaria.

Syphilis is caused by Treponema pallidum and is recognized by the variety of its clinical manifestations; it involves the nervous, integumentary and cardiovascular systems. Cardiovascular alterations occur in 70% of cases with untreated syphilis, 71% of syphilitic aortitis develop aortic aneurysms and the most frequent complication is aortic insufficiency. Treatment is directed at the underlying disease, with antibiotic treatment for tertiary syphilis and thromboembolic complications and if necessary surgical repair. We present a rare case of a patient diagnosed with human immunodeficiency virus infection and cardiovascular complications typical of tertiary syphilis, who required medical and surgical treatment, which was successful. We highlight the clinical experience of our institution's professionals in the diagnosis and identification of cardiovascular complications of tertiary syphilis.

A sífilis é causada pelo Treponema pallidum e é reconhecida pela variedade de suas manifestações clínicas; ela afeta os sistemas nervoso, tegumentar e cardiovascular. As alterações cardiovasculares ocorrem em 70% dos casos de sífilis não tratada, 71% dos casos de aortite sifilítica desenvolvem aneurismas aórticos e a complicação mais frequente é a insuficiência aórtica. O tratamento é direcionado para a doença subjacente, com tratamento antibiótico para sífilis terciária e complicações tromboembólicas e, se necessário, reparo cirúrgico. Apresentamos um caso raro de um paciente diagnosticado com infecção pelo vírus da imunodeficiência humana e complicações cardiovasculares típicas da sífilis terciária, que precisou de tratamento médico e cirúrgico, que foi bem-sucedido. Apresentamos um caso raro de um paciente com diagnóstico de infecção pelo vírus da imunodeficiência humana e complicações cardiovasculares típicas da sífilis terciária, que necessitou de tratamento médico e cirúrgico, o qual foi bem-sucedido. Destacamos a experiência clínica dos profissionais de nossa instituição no diagnóstico e na identificação das complicações cardiovasculares da sífilis terciária.

Brazilian Portuguese Childhood Autism Spectrum Test: an investigation of the factor structure of autistic traits in school-aged children

Objective: There is limited evidence about the cross-cultural validity of autistic symptoms in school-aged children in Brazil. We used data from a large school survey to evaluate the factor structure of autism symptoms in community-dwelling children and adolescents. Methods: We translated the Childhood Autism Spectrum Test to Brazilian Portuguese and performed factor analyses to investigate the factor structure of parent-reported autistic symptoms in a large sample (n=8,571) of children/adolescents from a school survey in the metropolitan area of São Paulo. Results: Autistic symptoms were best conceptualized under a correlated-factors model with two factors: one predominantly characterized by social-communication symptoms and the other by symptoms of inflexible/restricted language, behaviors, and interests. Conclusions: These findings provide evidence that the structure of autistic symptoms in Brazil is similar to that described in other countries, indicating the cross-cultural validity of autism in Brazil.

Patient with Rosai-Dorfman-Destombes disease:18F-FDG-PET/CT as a diagnostic tool

Rosai-Dorfman-Destombes disease (RDD) is a rare non-Langerhans cell histiocytosis, with sinus involvement and massive lymphadenopathy. RDD is usually self-limited; it can appear alone or related to other diseases. We present a 9-year-old male with biopsy of that lesion was taken, giving as result a benign histiocytosis, compatible with RDD. The patient was scanned with full body 18F-FDG PET/CT, the results of the study showed hypermetabolic focal lesions in the sphenoid sinus, ethmoid sinus, and bilateral nasal involvement with hypermetabolic focal injury in the middle third of the left tibia, findings in relation to high-grade expansive injury. The study of 18F-FDG PET/CT demonstrated avid FDG lesions at nodal and extranodal sites, and it also can be used in monitoring and/or evaluating response to treatment.

La enfermedad de Rosai-Dorfman-Destombes (RDD) es una rara histiocitosis de células no Langerhans, con compromiso de los senos nasales y linfadenopatías masivas. RDD es usualmente autolimitada, y puede aparecer sola o asociada a otras enfermedades. Se presenta el caso de un niño varón de 9 años cuyo resultado histopatológico mostró histiocitosis benigna compatible con RDD. El paciente se sometió a una Tomografía Computarizada/Tomografía de Emisión de Positrones con 18F-fluorodeoxyglucosa (18F-FDG-TEP/TC) de todo el cuerpo, que mostró lesiones focales hipermetabólicas en los senos esfenoidales, etmoidales, y nasales bilaterales, junto a una lesión focal hipermetabólica en el tercio medio de la tibia izquierda. El estudio con 18F-FDG-PET/CT pudo demostrar lesiones ávidas de glucosa en sitios nodales y extra-nodales, y también puede servir en la monitorización o evaluación de la respuesta al tratamiento.

Mortalidad excesiva porcentual por la COVID-19 en Cuba: un primer acercamiento / Percentage excessive mortality from COVID-19 in Cuba: a first approach

RESUMEN Fundamento: la mortalidad excesiva es considerada como un indicador especialmente útil para evaluar el impacto sanitario de la COVID-19; a nivel internacional, su empleo ha ido en aumento durante todo el 2021, pero en la literatura científica nacional su presencia es, hasta donde conocemos, nula. Objetivo: definir el indicador mortalidad excesiva y describir su empleo en el cálculo de la mortalidad excesiva para Cuba en el 2020, comparándola con la de otros países. Métodos: estudio ilustrativo del empleo e interpretación de un indicador de impacto de la COVID-19. Resultados: la mortalidad excesiva en Cuba en 2020 se compara, favorablemente, con la de otros países, en particular del área Latinoamericana. Conclusiones: la incidencia de la enfermedad, junto con las intervenciones no farmacéuticas implementadas por los gobiernos, entre otros factores, influyen en la mortalidad excesiva. En el caso de Cuba, es necesario calcularla para 2021, dado que en ese año se observaron las mayores tasas de incidencia, y de esa manera contribuir a la evaluación de la resiliencia global de nuestro Sistema de Salud en el enfrentamiento a la pandemia

ABSTRACT Background: Excessive Mortality is considered an especially useful indicator to assess the health impact of COVID-19 at the international level; its employment has been increasing throughout 2021, but in the national scientific literature its presence is, as far as we know, null. Objectives: to define and discuss the characteristics and computation requirements. To illustrate the use of the indicator through calculation of Excessive Mortality for Cuba, and compare results with other countries. Methods: Illustrative study of the use and interpretation of an indicator of COVID-19 impact. Results: Excessive Mortality in Cuba compares favorably with that of other countries, in particular in the Latin American region. Conclusions: The incidence of the disease, together with the Non-Pharmaceutical Interventions implemented by Governments, among other factors, influence Excessive Mortality. In the case of Cuba, it is necessary to calculate the Excessive Mortality for 2021, given that in that year the highest incidence rates were observed, and thus contribute to the evaluation of the global resilience of our Health System in the face of the pandemic.

Supresión de la visita de tercer trimestre en embarazo de bajo riesgo en la pandemia de SARS-CoV-2 / Third trimester suppression in low-risk pregnancy in the SARS-CoV-2 pandemic

Resumen Objetivo: La pandemia de SARS-CoV-2 ha obligado a una reorganización de las visitas presenciales, y por ese motivo se han minimizado hasta el punto de reconsiderar la realización de la visita del tercer trimestre. Nuestro centro suprimió dicha visita obstétrica y obtuvo datos propios para comparar los resultados perinatales logrados con dicho manejo. Método: Se realizó un estudio de cohortes retrospectivo, en marzo de 2020, con una cohorte con visita presencial única en la semana 40 de gestación (122 gestantes) frente a una cohorte con seguimiento convencional con visita presencial en la semana 36 de gestación (162 gestantes). Se evaluaron la restricción del crecimiento fetal, la edad gestacional al nacimiento, el peso neonatal y las tasas de inducciones, partos eutócicos y cesáreas urgentes en trabajo de parto. Resultados: Se encontraron diferencias leves en la tasa de nuliparidad (p < 0,04), sin hallarlas en el resto de las variables maternas. No hubo diferencias entre las dos cohortes en los resultados neonatales. Conclusiones: No hay diferencias entre los resultados materno-fetales obtenidos en gestantes con seguimiento gestacional con restricción de la visita del tercer trimestre respecto del seguimiento tradicional, excepto en el diagnóstico de las alteraciones de la estática fetal al término de la gestación.

Abstract Objective: The SARS-CoV-2 pandemic has forced a reorganization of face-to-face visits, for this reason they have been minimized to the point of reconsidering the completion of the third trimester visit. Our center eliminated the performance of this obstetric visit and obtained its own data to compare the perinatal results obtained with such management. Method: A retrospective cohort study was carried out in March 2020, with a cohort with a single face-to-face visit at 40th week of gestation (122 pregnant women), versus a cohort with conventional follow-up with face-to-face visit at 36th week of gestation (162 pregnant women). The following were evaluated fetal growth restriction, gestational age at birth, neonatal weight, rate of inductions, of eutocic deliveries, and of urgent cesarean sections in labor. Results: Slight differences were found in the nulliparity rate (p < 0.04), without finding them in the rest of the maternal variables. There were no differences between the two cohorts in neonatal outcomes. Conclusions: There were no differences between the maternal-fetal results obtained in pregnant women with gestational follow-up with restriction of the third trimester visit compared to traditional follow-up, except in the diagnosis of alterations in fetal statics at the end of pregnancy.

Ventilador mecânico invasivo de emergência resistente e de fácil manutenção / Robust, maintainable, emergency invasive mechanical ventilator

RESUMO Objetivo: Desenvolver um ventilador mecânico invasivo simples, resistente, seguro e eficiente que possa ser utilizado em áreas remotas do mundo ou zonas de guerra, em que a utilidade prática de equipamentos mais sofisticados é limitada por questões de manutenção, disponibilidade de peças, transporte e/ou custo. Métodos: O dispositivo implementa o modo de ventilação mandatória contínua com pressão controlada, complementado por um simples modo assisto-controlado. Pode-se também utilizar a pressão positiva contínua nas vias aéreas. Ao se evitar o fluxo contínuo de oxigênio ou ar, minimiza-se o consumo de gases comprimidos. As taxas respiratórias e as relações de tempo de inspiração e expiração são determinadas eletronicamente. Além disso, conta com um alarme de apneia/falta de energia. Resultados: Os perfis de pressão foram medidos para uma série de condições, sendo considerados ajustáveis dentro de uma margem de erro de ± 2,5cmH2O, e foram considerados bem estáveis dentro dessa variação durante um período de 41 horas. Os parâmetros de tempo do ciclo respiratório foram precisos dentro de alguns pontos percentuais durante o mesmo período. O dispositivo foi testado quanto à durabilidade por um período equivalente a 4 meses. Os testes químicos e biológicos não conseguiram identificar qualquer contaminação do gás por compostos orgânicos voláteis ou micro-organismos. Em comparação com um ventilador bem estabelecido, o teste de ventilação em um animal de grande porte mostrou que este poderia ser ventilado adequadamente durante um período de 60 minutos, sem quaisquer efeitos negativos perceptíveis durante o período subsequente de 24 horas. Conclusão: Este projeto de ventilador pode ser viável após novos testes em animais e aprovação formal pelas autoridades competentes, para aplicação clínica nas circunstâncias atípicas anteriormente mencionadas.

ABSTRACT Objective: To develop a simple, robust, safe and efficient invasive mechanical ventilator that can be used in remote areas of the world or war zones where the practical utility of more sophisticated equipment is limited by considerations of maintainability, availability of parts, transportation and/or cost. Methods: The device implements the pressure-controlled continuous mandatory ventilation mode, complemented by a simple assist-control mode. Continuous positive airway pressure is also possible. The consumption of compressed gases is minimized by avoiding a continuous flow of oxygen or air. Respiratory rates and inspiration/expiration time ratios are electronically determined, and an apnea/power loss alarm is provided. Results: The pressure profiles were measured for a range of conditions and found to be adjustable within a ± 2.5cmH2O error margin and stable well within this range over a 41-hour period. Respiratory cycle timing parameters were precise within a few percentage points over the same period. The device was tested for durability for an equivalent period of four months. Chemical and biological tests failed to identify any contamination of the gas by volatile organic compounds or microorganisms. A ventilation test on a large animal, in comparison with a well established ventilator, showed that the animal could be adequately ventilated over a period of 60 minutes, without any noticeable negative aftereffects during the subsequent 24-hour period. Conclusion: This ventilator design may be viable, after further animal tests and formal approval by the competent authorities, for clinical application in the abovementioned atypical circumstances.

Percepción de riesgo, automedicación, mitos y creencias relacionados con COVID-19 entre jefes de hogar peruanos / Risk perception, self-medication, myths, and beliefs related with COVID-19 among Peruvian head of households

Resumen Introducción: A más de un año del inicio de la pandemia COVID-19, el número de contagiados y muertes aún presenta frecuencias que escapan al control de manejo hospitalario. Aunado al temor, se acrecentó la aparición de mitos, creencias, automedicación e inadecuada percepción de riesgo en la población. Objetivo: Identificar la percepción de riesgo, automedicación, mitos y creencias de prevención respecto al COVID-19 en adultos jefes de hogar del distrito Gregorio Albarracín de Tacna en el 2020. Material y métodos: Se aplicó una encuesta a una muestra representativa de 250 jefes de hogar, residentes en el distrito Gregorio Albarracín. Resultados: El promedio total del grupo en percepción del riesgo expresado en porcentaje fue de 60,96 % (59,81-62,11) de un total de probable esperado ideal de 100 %. La percepción de "estar en riesgo en la pandemia" es baja. Solo el 15,20 % acató el aislamiento domiciliario estricto cuando fue indicado. El 14,8 % se automedicaba y en este grupo, los productos usados fueron Ivermectina (48,6 %) y dióxido de cloro (45,9 %). Los mitos y creencias más frecuentes fueron "rociarse con alcohol o cloro mata el virus" y "los remedios caseros pueden curar o prevenir el coronavirus". Hubo diferencia según edad (p<0,05), nivel de instrucción (p<0,001). Conclusiones: La automedicación estuvo fuertemente asociada con elevada percepción de riesgo (p<0,001) y presencia de mitos y creencias (p<0,001). El nivel de instrucción estuvo altamente asociado con la presencia de mitos y creencias (p<0,001)

Abstract Introduction: More than a year after the beginning of the COVID-19 pandemic, the number of infections and deaths is still beyond the control of hospital management. In addition to fear, myths, beliefs, self-medication and inadequate risk perception in the population have increased. Objective: To identify the perception of risk, self-medication, myths and prevention beliefs regarding COVID-19 in adult heads of household in the Gregorio Albarracin district of Tacna in 2020. Method: A survey was administered to a representative sample of 250 heads of household residing in the Gregorio Albarracin district. Results: The total average of the group in risk perception expressed as a percentage was 60.96% (59.81-62.11) out of a total expected ideal of 100%. The perception of "being at risk in the pandemic" is low. Only 15.20% adhered to strict home isolation when instructed to do so. The 14.8% self-medicated and in this group, the products used were ivermectin (48.6%) and chlorine dioxide (45.9%). The most frequent myths and beliefs were "spraying with alcohol or chlorine kills the virus" "home remedies can cure or prevent coronavirus"; there were differences according to age (p<0.05) and educational level (p<0.001). Conclusions: self-medication was strongly associated with high-risk perception (p<0.001) and presence of myths and beliefs (p<0.001). Educational level was highly associated with the presence of myths and beliefs (p<0.001).

Appraising the effectiveness of electrical and magnetic brain stimulation techniques in acute major depressive episodes: an umbrella review of meta-analyses of randomized controlled trials

Electrical and magnetic brain stimulation techniques present distinct mechanisms and efficacy in the acute treatment of depression. This was an umbrella review of meta-analyses of randomized controlled trials of brain stimulation techniques for managing acute major depressive episodes. A systematic review was performed in the PubMed/MEDLINE databases from inception until March 2020. We included the English language meta-analysis with the most randomized controlled trials on the effects of any brain stimulation technique vs. control in adults with an acute depressive episode. Continuous and dichotomous outcomes were assessed. A Measurement Tool to Assess Systematic Reviews-2 was applied and the credibility of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. Seven meta-analyses were included (5,615 patients), providing evidence for different modalities of brain stimulation techniques. Three meta-analyses were evaluated as having high methodological quality, three as moderate, and one as low. The highest quality of evidence was found for high frequency-repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation, and bilateral rTMS. There is strong clinical research evidence to guide future clinical use of some techniques. Our results confirm the heterogeneity of the effects across these techniques, indicating that different mechanisms of action lead to different efficacy profiles.

Tratamiento endovascular de la enfermedad obstructiva aortoilíaca / Endovascular management of aortoiliac occlusive disease

Resumen Introducción: La angioplastia transluminal percutánea (ATP), se ha convertido en una técnica aceptada, en el tratamiento de la enfermedad obstrutiva aortoilíaca, con tasas de éxito del 90-92% y permeabilidad primaria del 55-72% a 5 años. Objetivo: Evaluar los resultados del tratamiento endovascular del sector aortoilíaco. Material y Método: Estudio descriptivo, retrospectivo (revisión de serie de casos unicéntrica), de pacientes, sometidos consecutivamente al tratamiento endovascular (ATP simple y ATP con stent) de la patología obstructiva del sector aortoilíaco, durante un período de 7 años (2002-2019), en el Hospital Dr. Eduardo Pereira de Valparaíso, Chile. Resultados: Se realizaron 103 procedimientos en 94 pacientes, sexo masculino: 63,83%, femenino: 36,17%, edad promedio: 67,4 años (rango 47-96), distribución de las lesiones según la clasificación TASC II: A (46,24%), B (39,78%), C (8,60%), D (5,38%), remodelando la biburfaccción aórtica (kissing stent) en un 6,80%, procedimientos híbridos (12,62%), seguimiento promedio (47,13 meses), éxito clínico (90,29%), exito técnico (94,17%), permeabilidad primaria, primaria asistida y secundaria a 5 años del 68,09%, 75,53% y 81,91% respectivamente, tasa de salvación de la extremidad a 5 años del 84,04%, mortalidad < 30 días del 1,94%, supervivencia a 5 años del 90,42%. Discusión: Las técnicas endovasculares del sector aortoilíaco son fiables, sus resultados ténicos y permeabilidad, están influenciados por el estadio clínico del paciente y severidad de las lesiones tratadas. Conclusión: En pacientes adecuadamente seleccionados, el tratamiento endovascular del sector aortoilíaco presenta excelentes resultados, permitiendo aumentar la indicación de tratamiento en pacientes considerados de alto riesgo.

Introduction: Percutaneous transluminal angioplasty (PTA) has become an accepted technique in the treatment of aortoiliac occlusive disease, with success rates of 90-92%, and primary patency of 55-72% at 5 years. Aim: To evaluate the results of endovascular treatment (PTA or PTA with stents) of the aortoiliac sector. Material and Method: Descriptive, retrospective study (single-center case series) of patients, consecutively subjected to endovascular treatment (PTA or PTA with stents) of aortoiliac occlusive disease, during a period of 7 years (2002 - 2019), at the Dr. Eduardo Pereira Hospital in Valparaíso, Chile. Results: 103 procedures were performed in 94 patients, male: 63.83%, female: 36.17%, mean age: 67.4 years (range 47-96), distribution of the lesions according to the TASC II classification: A (46.24%), B (39.78%), C (8.60%), D (5.38%), remodeling the aortic bifaction (kissing stent) in 6.80%, hybrid procedures (12.62%), average follow-up (47.13 months), clinical success (90.29%), technical success (94.17%), primary patency, assisted primary and secondary at 5 years of 68.09%, 75, 53% and 81.91% respectively, 5-year limb salvage rate of 84.04%, mortality < 30 days of 1.94%, 5-year survival of 90.42%. Discussion: Endovascular techniques in the aortoiliac sector are reliable, their technical results and patency are influenced by the clinical stage of the patient and the severity of the lesions treated. Conclusion: In appropriately selected patients, endovascular treatment of the aortoiliac sector, presents excellent results, allowing an increase in the indication for treatment in patients considered to be at high risk.

Reparación endovascular de la aorta torácica, resultados a largo plazo / Endovascular repair of the thoracic aorta, long-term results

Resumen Introducción: Las diversas patologías de la aorta torácica descendente, representan una implícita amenaza para la vida, y son potencialmente tratables mediante reparación endovascular. Objetivo: Evaluar los resultados de la reparación endovascular de la aorta torácia descendente (TEVAR). Material y Método: Estudio observacional, retrospectivo y descriptivo, donde se analiza TEVAR, en un período de 10 años (2009 al 2019), en el Hospital Dr. Eduardo Pereira de Valparaíso, Chile. Resultados: Se realizó TEVAR en 31 pacientes, sexo masculino 74,2%, femenino 25,8%, edad promedio 67,8 años (rango 53-85), patologías asociadas: hipertensión arterial sistémica (77,4%), tabaquismo (67,7%) y dislipidemia (38,7%), las indicaciones para TEVAR fueron: el aneurisma de la aorta descendente (51,61%), la disección tipo B crónica complicada (29,03%), y la disección tipo B aguda complicada (19,35%), relacionado al procedimiento se evidenció: morbilidad cardiovascular (12,9%) y morbilidad neurológica (6,45%), complicaciones relacionadas a la endoprótesis (29,03%), incidencia de endofugas (19,35%), estancia hospitalaria promedio de 5,2 días (rango 3 a 17), seguimiento promedio de 47,3 meses (9-108), éxito técnico primario (100%), tasa de reintervención: 3,22%, tasa de supervivencia a 1, 3, 5 años del 96,77%, 93,54 y 90,32% respectivamente, no hubo mortalidad menor a 30 días. Discusión: La evidencia demuestra que TEVAR puede realizarse en forma segura y efectiva, cumpliendo estrictos criterios clínicos y condiciones anatómicas, representando la modalidad de elección para la reparación de las lesiones de la aorta descendente. Conclusión: Los resultados demuestran que TEVAR, representa una excelente estrategia terapeutica, menos invasiva, con baja morbilidad y mortalidad asociada.

Introduction: The pathological injuries of the descending thoracic aorta, represent an implicit threat to life, and are potentially treatable by endovascular repair. Aim: To evaluate the results of endovascular repair of the descending thoracic aorta (TEVAR) in the medium and long term. Material and Method: Observational, retrospective and descriptive study, where TEVAR is analyzed, over a period of 10 years (2009 to 2019), at the Dr. Eduardo Pereira Hospital in Valparaíso, Chile. Results: TEVAR was performed in 31 patients, male sex 74.2%, average age 67.8 years (range 53-85), symptomatic 64.5%, associated pathologies: systemic arterial hypertension (77.4%), smoking (67.7%) and dyslipidemia (38.7%), indications for endovascular repair were descending aortic aneurysm (51.61%), complicated Stanford type B chronic aortic dissection (29.03%), and complicated Stanford type B acute aortic dissection (19.35%), neurological morbidity (6.45%), cardiovascular morbidity (12.9%), complications related to the stent (29.03%), where endoleaks predominate (19.35%), average hospital stay of 5.2 days (range 3 to 17), average followup of 47.3 months (9-108), primary technical success (100%), survival rate at 1, 3, 5 years of 96.77%, 93.54 and 90.32% respectively, there was no mortality less than 30 days or reoperation. Discussion: the evidence shows that TEVAR can be performed safely and effectively, meeting strict clinical criteria and anatomical conditions, which represents the modality of choice for the repair of lesions in the descending aorta. Conclusion: The results show that TEVAR represents an excellent therapeutic strategy, less invasive, with low associated morbidity and mortality.

Reparación endovascular de las lesiones traumáticas de la arteria subclavia / Endovascular repair of traumatic subclavian artery injuries

Resumen Introducción: La reparación convencional de la arteria subclavia es desafiante, con una morbilidad del 24% y mortalidad del 5% al 25%; las técnicas endovasculares permiten la reparación arterial subclavia desde un acceso distal, reduciendo la elevada morbimortalidad asociada. Objetivo: Evaluar los resultados a largo plazo del tratamiento endovascular de las lesiones traumáticas de la arteria subclavia. Materiales y Método: Estudio descriptivo, observacional (revisión de serie de casos unicéntrica) de pacientes sometidos a la reparación endovascular de la arteria subclavia, debido a lesiones traumáticas, utilizando dos técnicas (stent balón expandible y oclusión endovascular con balón) durante un período de 12 años (2007-2019) en el Hospital Dr. Eduardo Pereira de Valparaíso, Chile. Resultados: Se realizaron 15 procedimientos consecutivos, electivos (86,67%), urgencias (13,33%), sexo masculino (66,67%), femenino (33,33%), edad promedio de 55,8 años (rango 26-69), abordaje utilizado: arteria femoral común (93,33%) y arteria braquial (6,67%), etiología de las lesiones: iatrogenia (66,67%) y trauma (33,33%), reparación mediante stent balón expandible (66,67%), oclusión endovascular con balón (33,33%), tasa de éxito técnico (100%), tasa de permeabilidad primaria a 1, 5, 10 años del 100%, 93,33% y 86,66% respectivamente, seguimiento medio (61,4 meses), estancia hospitalaria promedio (3,3 días), tiempo quirúrgico promedio (75 min), no hubo morbilidad cardiovascular, neurológica central o mortalidad relacionada al procedimiento. Discusión: La técnica endovascular elimina la necesidad de disección quirúrgica, disminuyendo el riesgo de lesión de estructuras adyacentes, especialmente en pacientes politraumatizados. Conclusión: En pacientes adecuadamente seleccionados, la técnica endovascular representa una excelente estrategia terapéutica de reparación de las lesiones subclavias.

Introduction: Conventional subclavian artery repair is challenging, with 24% morbidity and 5% to 25% mortality. Endovascular techniques allow subclavian repair from a distal artery, reducing the associated high morbidity and mortality. Aim: To evaluate the long-term results of endovascular treatment of traumatic lesions of the subclavian artery. Materials and Method: Descriptive, observational study (single-center case series review) of patients undergoing endovascular repair of the subclavian artery due to traumatic injuries, using two techniques (expandable balloon stent and endovascular balloon occlusion), during a period of 12 years (2007-2019), at the Dr. Eduardo Pereira Hospital in Valparaíso, Chile. Results: 15 consecutive procedures were performed, elective (86.67%), emergencies (13.33%), male sex (66.67%), female (33.33%), average age of 55.8 years (range 26-69), approach used: common femoral artery (93.33%) and brachial artery (6.67%), etiology of the lesions: iatrogenesis (66.67%) and trauma (33.33%), repair by expandable balloon stent (66.67%), balloon occlusion (33.33%), technical success rate (100%), primary patency rate at 1, 5, 10 years of 100%, 93.33% and 86.66% respectively, mean follow-up (61.4 months), average hospital stay (3.3 days), average surgical time (75 min), there was no cardiovascular, central neurological morbidity or mortality related to the procedure. Discussion: Endovascular techniques eliminate the need for surgical dissection, reducing the risk of injury to adjacent structures, especially in multiple trauma patients. Conclusion: In properly selected patients, the endovascular technique represents an excellent therapeutic strategy for the repair of subclavian artery lesions.

Síndrome postimplantación en la reparación aórtica endovascular / Post implantation syndrome in endovascular aortic repair

Resumen Introducción: El síndrome postimplantación es un trastorno frecuente, producido en el posoperatorio inmediato posterior al tratamiento endovascular de la enfermedad aórtica, caracterizado por la presencia de anorexia, dolor lumbar, leucocitosis, fiebre y elevación de la proteína C reactiva, asociado ocasionalmente a disminución del recuento de plaquetas o alteración de la coagulación. Objetivos: Determinar la incidencia y morbilidad asociada al síndrome postimplantación, posterior a la reparación endovascular de la patología aórtica. Material y Métodos: Estudio observacional y descriptivo, donde se analiza la presencia del síndrome post implantación en pacientes sometidos a Reparación endovascular torácica aórtica (TEVAR) y Reparación endovascular de aneurisma (EVAR), durante un período de 10 años (2009 al 2019), en el Hospital Dr. Eduardo Pereira de Valparaíso, Chile. Resultados: Se incluyeron 112 reparaciones endovasculares, 72,32% correspondientes a EVAR y 27,68% a TEVAR, incidencia del síndrome post implantación (17,85%), factores de riesgo asociados: edad ≤ 75 años, uso de endoprótesis compuesta por poliester, recubrimiento aórtico ≥ 20cm y tiempo quirúrgico >180 min; (p < 0,05), evidenciando en este grupo de pacientes mayor readmisión, estancia hospitalaria y morbilidad cardiovascular (p < 0,05). Discusión: El síndrome post implantación conduce a una recuperación posoperatoria más exigente, aumentando la morbilidad cardiovascular, readmisión y estancia hospitalaria, con los correspondientes riesgos y costos asociados, en consecuencia podría considerarse una complicación de la reparación aórtica endovascular. Conclusión: La respuesta inflamatoria puede ser intensa posterior a la reparación endovascular de la aorta, el grupo de pacientes que desarrolla este síndrome, amerita una estrecha vigilancia, con énfasis durante el primer mes de post operatorio.

Introduction: Postimplantation syndrome is a common disorder, produced in the immediate postoperative period after endovascular treatment of aortic disease, characterized by anorexia, thoracic or low back pain, leukocytosis, fever and elevation of C-reactive protein, occasionally associated with decreased platelet count or coagulation disorders. Aim: To assess postimplantation syndrome after endovascular aortic repair. Material and Methods: This is an observational, and descriptive study; we analyze the presence of postimplantation syndrome, in 112 successive endovascular repairs of the thoracic and abdominal aorta, over a period of 10 years (2009 to 2019), in the Hospital Dr. Eduardo Pereira in Valparaíso, Chile. Results: 112 endovascular repairs were performed, 81 cases (72.32%) corresponding to EVAR and 31 cases (27.68%) to TEVAR, incidence of post-implantation syndrome was 17.85%. Associated risk factors were age ≤ 75 years, use of polyester stent grafts, aortic covered ≥ 20 cm, surgical time ≥ 180 min, (p < 0.05). As a consequence, in this group of patients, there were associated with greater readmission rates, hospital stay rates and cardiovascular morbidity (p < 0.05). Discussion: The post-implantation syndrome leads to an increase in cardiovascuar morbidy hospital stay rates and a slower postoperative recovery, with the corresponding associated risks and costs, therefore it could be considered a complication of endovascular aortic repair. Conclusion: The inflammatory response after endovascular repair of the aorta, may be intense in some patients, the group of patients who develop this syndrome deserve close monitoring, with emphasis during the first month after surgery.

Filtro de vena cava inferior, resultados a mediano y largo plazo / Inferior vena cava filter medium to long-term results

Resumen Introducción: El tromboembolismo pulmonar sin tratamiento, presenta un riesgo de recurrencia del 20%, con una mortalidad del 18% al 26%, en pacientes con embolia pulmonar donde esta contraindica o fracasa la anticoagulación, es necesario interrumpir parcialmente la vena cava inferior, siendo los filtros de vena cava la alternativa más utilizada. Objetivo: Analizar las variables epidemiológicas involucradas en la enfermedad tromboembólica y los resultados de la inserción del filtro de vena cava inferior. Materiales y Método: Estudio retrospectivo, observacional y descriptivo, donde se analiza la inserción sucesiva de 82 filtros de vena cava inferior, en un período de 10 años (2009 al 2019), en el Hospital Dr. Eduardo Pereira de Valparaíso, Chile. Resultados: Sexo femenino 53,6%, edad promedio 60,4 años (rango 19-86), la principal causa para desarrollar enfermedad tromboembólica fueron las enfermedades oncológicas (56,09%), la principal vía de acceso fue la vena femoral común (69,51%), localización del filtro suprarrenal (4,87%), se obtuvo un seguimiento actualizado en el 89,02%, la supervivencia a 5 años fue de 73,17% y a 10 años de 57,32%, morbilidad en relación al procedimiento (9,75%), éxito del procedimiento (97,5%), no hubo mortalidad relacionada. Discusión: Los grandes ensayos, demuestran el beneficio de la interrupción de la vena cava inferior mediante filtros, especialmente en pacientes oncológicos, con elevado riesgo de embolia pulmonar. Conclusión: La inserción de un filtro de vena cava inferior, adecuadamente indicado, es un procedimiento mínimamente invasivo, de bajo riesgo y con excelentes resultados en la profilaxis de la embolia pulmonar.

Introduction: Pulmonary thromboembolism without treatment presents a risk of recurrence of 20%, with a mortality of 18% to 26%. In patients with pulmonary embolism, when anticoagulation therapy is contraindicated or failed, it is necessary to intervene partially the inferior vena cava on which cava vein filters are the main used alternative. Aim: Analyze the epidemiological variables involved on thromboembolic disease, and the outcomes of the inferior vena cava filter insertions. Materials and Method: Retrospective, observational and descriptive study, which analyzes the successive insertion of 82 inferior vena cava filters, over a period of 10 years (2009 to 2019), in the Dr. Eduardo Pereira Hospital, Valparaíso, Chile. Results: Female sex 53.6%, average age 60.4 years (range 19-86), the main cause to develop thromboembolic disease were oncological diseases (56.09%); the main access path was the common femoral vein (69.51%); in a 4.87% the location of the filter was suprarenal. Complete follow-up was obtained in 89.02% of the cases, 5-year survival with 73.17% ratio and 10-years survival of 57.32%, morbidity in relation to the procedure was 9.75%; success of the procedure 97.5%; there was no mortality related. Discussion: Large studies demonstrate the benefits of interruption on the inferior vena cava through filters, especially in cancer patients with high risk of pulmonary embolism. Conclusion: The insertion of an inferior vena cava filter when indication is adequate, is a minimally invasive procedure with low risk and excellent results in the prophylaxis of pulmonary embolism.

Effects of lumbar myelography on subarachnoid pressure and cardiorespiratory parameters in healthy sheep / Efeitos da mielografia lombar na pressão subaracnoidea e nos parâmetros cardiorrespiratórios em ovelhas saudáveis

The purpose of this study was to evaluate the effects of lumbar myelography on subarachnoid pressure, cardiorespiratory parameters and pressure-volume index in sheep. Eight sheep were evaluated. The animals were submitted to puncture of the cisterna magna for monitoring of subarachnoid pressure (SaP). Lumbar myelography was performed through applying Iohexol (0.4mL/kg). ToC, PAS, PAD, MAP, InspISO, FeISO, SaP and CPP were recorded immediately after anesthetic stabilization (M0), during lumbar puncture (M1), and two, four and six minutes after contrast application (M2, M3 and M4, respectively). Blood pressure initially increased, then decreased, returning to basal level, similarly observed for InspISo and FeISo. The SaP rose initially thereafter remaining stable. Despite of the effect on subarachnoid pressure, lumbar myelography can be considered safe in sheep.(AU)

O objetivo foi avaliar os efeitos da mielografia lombar na pressão subaracnóidea, parâmetros cardiorrespiratórios e índice pressão-volume em ovinos. Oito ovelhas foram avaliadas. Os animais foram submetidos à punção da cisterna magna para monitoramento da pressão subaracnoidea (SaP). A mielografia lombar foi realizada com a aplicação de Iohexol (0,4mL/kg). Os momentos estudados foram: imediatamente após a estabilização anestésica (M0), durante a punção lombar (M1), dois, quatro e seis minutos após a aplicação do contraste (M2, M3 e M4, respectivamente), para avaliar as seguintes variáveis: ToC, PAS, PAD, MAP, InspISO, FeISO, Sap e CPP. A pressão arterial aumentou inicialmente, depois diminuiu, retornando aos valores iniciais, padrão também observado para o InspISo e o FeISo. O SaP subiu inicialmente, posteriormente, permanecendo estável. A mielografia lombar, apesar de influenciar a pressão subaracnoidea, pode ser considerada segura em ovinos.(AU)

Effects of lumbar myelography on subarachnoid pressure and cardiorespiratory parameters in healthy sheep

ABSTRACT: The purpose of this study was to evaluate the effects of lumbar myelography on subarachnoid pressure, cardiorespiratory parameters and pressure-volume index in sheep. Eight sheep were evaluated. The animals were submitted to puncture of the cisterna magna for monitoring of subarachnoid pressure (SaP). Lumbar myelography was performed through applying Iohexol (0.4mL/kg). ToC, PAS, PAD, MAP, InspISO, FeISO, SaP and CPP were recorded immediately after anesthetic stabilization (M0), during lumbar puncture (M1), and two, four and six minutes after contrast application (M2, M3 and M4, respectively). Blood pressure initially increased, then decreased, returning to basal level, similarly observed for InspISo and FeISo. The SaP rose initially thereafter remaining stable. Despite of the effect on subarachnoid pressure, lumbar myelography can be considered safe in sheep.

RESUMO: O objetivo foi avaliar os efeitos da mielografia lombar na pressão subaracnóidea, parâmetros cardiorrespiratórios e índice pressão-volume em ovinos. Oito ovelhas foram avaliadas. Os animais foram submetidos à punção da cisterna magna para monitoramento da pressão subaracnoidea (SaP). A mielografia lombar foi realizada com a aplicação de Iohexol (0,4mL/kg). Os momentos estudados foram: imediatamente após a estabilização anestésica (M0), durante a punção lombar (M1), dois, quatro e seis minutos após a aplicação do contraste (M2, M3 e M4, respectivamente), para avaliar as seguintes variáveis: ToC, PAS, PAD, MAP, InspISO, FeISO, Sap e CPP. A pressão arterial aumentou inicialmente, depois diminuiu, retornando aos valores iniciais, padrão também observado para o InspISo e o FeISo. O SaP subiu inicialmente, posteriormente, permanecendo estável. A mielografia lombar, apesar de influenciar a pressão subaracnoidea, pode ser considerada segura em ovinos.

Clinical usefulness of tomographic standards for COVID-19 pneumonia diagnosis: Experience from a Brazilian reference center

ABSTRACT Background: COVID-19 is a new disease and the most common complication is pneumonia. The Radiological Society of North America (RSNA) proposed an expert consensus for imaging classification for COVID-19 pneumonia. Objective: To evaluate sensitivity, specificity, accuracy, and reproducibility of chest CT standards in the beginning of the Brazilian COVID-19 outbreak. Methods: Cross-sectional study performed from March 1st to April 14th, 2020. Patients with suspected COVID-19 pneumonia submitted to RT-PCR test and chest computed tomography (CT) were included. Two thoracic radiologists blinded for RT-PCR and clinical and laboratory results classified every patient scan according to the RSNA expert consensus. A third thoracic radiologist also evaluated in case of discordance, and consensus was reached among the three radiologists. A typical appearance was considered a positive chest CT for COVID-19 pneumonia. Sensitivity, specificity, positive and negative predictive values were calculated. Cohen's kappa coefficient was used to evaluate intra- and inter-rater agreements. Results: A total of 159 patients were included (mean age 57.9 ± 18.0 years; 88 [55.3%] males): 86 (54.1%) COVID-19 and 73 (45.9%) non-COVID-19 patients. Eighty (50.3%) patients had a positive CT for COVID-19 pneumonia. Sensitivity and specificity of typical appearance were 88.3% (95%CI, 79.9-93.5) and 94.5% (95%CI, 86.7-97.8), respectively. Intra- and inter-rater agreement were assessed (Cohen's kappa = 0.924, P= 0.06; Cohen's kappa=0.772, P= 0.05, respectively). Conclusion: Chest CT categorical classification of COVID-19 findings is reproducible and demonstrates high level of agreement with clinical and RT-PCR diagnosis of COVID-19. In RT-PCR scarcity scenarios or in equivocal cases, it may be useful for attending physicians in the evaluation of suspected COVID-19 pneumonia patients attended at the emergency unit.

Competência Prognóstica Distinta entre Modelo Clínico e Anatômico em Síndromes Coronarianas Agudas: Comparação por Tipo de Desfecho / Prognostic Contrast between Anatomical and Clinical Models Regarding Fatal and Non-Fatal Outcomes in Acute Coronary Syndromes

Resumo Fundamento Eventos isquêmicos recorrentes decorrem de instabilidade de placa aterosclerótica, enquanto morte após um evento isquêmico decorre da gravidade do insulto. A natureza diversa desses tipos de eventos pode fazer com que dados clínicos e anatômicos tenham diferentes capacidades prognósticas a depender do tipo de desfecho. Objetivo Identificar as predileções prognósticas de dados clínicos e dados anatômicos em relação a desfechos coronários fatais e não fatais durante hospitalização de pacientes com síndromes coronarianas agudas (SCA). Métodos Pacientes consecutivamente admitidos por SCA que realizaram coronariografia foram recrutados. O escore SYNTAX foi utilizado como modelo anatômico e o escore GRACE como modelo clínico. A capacidade preditora desses escores foi comparada quando à predição de desfechos isquêmicos não fatais (infarto ou angina refratária) e de morte cardiovascular durante hospitalização. Significância estatística foi definida por p < 0,05. Resultados Entre 365 indivíduos, 4,4% foi a incidência de óbito hospitalar e 11% de desfechos isquêmicos não fatais. Para morte cardiovascular, ambos os escores — SYNTAX e GRACE — apresentaram capacidade discriminatória, com estatísticas-C similares: 0,80 (95%IC: 0,70-0,92) e 0,89 (95%IC 0,81-0,96), respectivamente — p=0,19. Quantos aos desfechos isquêmicos não fatais, o escore SYNTAX apresentou valor preditor (estatística-C = 0,64; 95%IC 0,55-0,73), porém o escore GRACE não mostrou associação com esse tipo de desfecho (estatística-C = 0,50; 95%IC: 0,40-0,61) — p=0,027. Conclusão Os modelos clínico e anatômico predizem satisfatoriamente morte cardiovascular em SCA, enquanto a recorrência de instabilidade coronária é melhor prevista por características anatômicas do que por dados clínicos. (Arq Bras Cardiol. 2020; 115(2):219-225)

Abstract Background Recurrent ischemic events are mediated by atherosclerotic plaque instability, whereas death after an ischemic event results from gravity of insult and ability of the organism to adapt. The distinct nature of those types of events may respond for different prediction properties of clinical and anatomical information regarding type of outcome. Objective To identify prognostic properties of clinical and anatomical data in respect of fatal and non-fatal outcomes of patients hospitalized with acute coronary syndromes (ACS). Methods Patients consecutively admitted with ACS who underwent coronary angiography were recruited. The SYNTAX score was utilized as an anatomic model and the GRACE score as a clinical model. The predictive capacity of those scores was separately evaluated for prediction of non-fatal ischemic outcomes (infarction and refractory angina) and cardiovascular death during hospitalization. It was considered as significant a p-value <0,05. Results EAmong 365 people, cardiovascular death was observed in 4,4% and incidence of non-fatal ischemic outcomes in 11%. For cardiovascular death, SYNTAX and GRACE score presented similar C-statistic of 0,80 (95% IC: 0,70 - 0,92) and 0,89 (95% IC 0,81 - 0,96), respectively - p = 0,19. As for non-fatal ischemic outcomes, the SYNTAX score presented a moderate predictive value (C-statistic = 0,64; 95%IC 0,55 - 0,73), whereas the GRACE score did not presented association with this type of outcome (C-statistic = 0,50; 95%IC 0,40-0,61) - p = 0,027. Conclusion Clinical and anatomic models similarly predict cardiovascular death in ACS. However, recurrence of coronary instability is better predicted by anatomic variables than clinical data. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Occupational health in the framework of the COVID-19 pandemic: a scoping review / Seguridad y salud en el trabajo en el marco de la pandemia por COVID-19: una revisión exploratoria

ABSTRACT Objective To collect the available evidence related to occupational health in the face of the introduction of the new SARS-CoV-2 coronavirus pandemic. Methods Scoping review developed from the Arksey and O'Malley framework. The search was performed in the databases PubMed, Academic Search Complete, Science Direct, Medline, Scopus, Web of Science and Google Scholar. Documents on COVID-19 and its relationship with occupational health published in English, Portuguese and Spanish were included. The review, selection and characterization of the studies was carried out by five reviewers. Results The search and selection identified 43 documents published between December 2019 and April 2020. The topics covered include occupational exposure, protection measures, psychosocial affectations of workers, particularly health, as well as conditions of work organization that can influence contagion. Conclusions Health workers are the most exposed workforce. Accompaniment, coaching and training in relation to patient care and the use of personal protection equipment are essential to reduce contagion among health personnel. In other work activities, social distancing is the standard measure for the mitigation of transmission, as well as the continuous disinfection of workplaces.(AU)

RESUMEN Objetivo Recopilar la evidencia disponible relacionada con la salud laboral frente a la introducción de la nueva pandemia por el coronavirus SARS-CoV-2. Métodos Revisión exploratoria desarrollada a partir del marco de Arksey y O'Malley. La búsqueda se realizó en las bases de datos PubMed, Academic Search Complete, Science Direct, Medline, Scopus, Web of Science y Google Scholar. Se incluyeron documentos sobre COVID-19 y su relación con la salud ocupacional publicados en inglés, portugués y español. La revisión, selección y caracterización de los estudios fue desarrollada por cinco revisores. Resultados La búsqueda y selección identificó 43 documentos publicados entre diciembre de 2019 y abril de 2020. Las temáticas abordadas incluyen exposición ocupacional, medidas de protección, afectaciones psicosociales de los trabajadores, particularmente de la salud, así como condiciones de la organización del trabajo que pueden influir en el contagio. Conclusiones Los trabajadores de la salud son la fuerza laboral más expuesta. El acompañamiento, entrenamiento y la capacitación en relación con la atención de pacientes y el uso de elementos de protección personal son fundamentales para disminuir el contagio entre personal de salud. En otras actividades laborales el distanciamiento social es la medida estándar para la mitigación de la transmisión, así como la desinfección continua de los lugares de trabajo.(AU)