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1.
Acta Paul. Enferm. (Online) ; 34: eAPE00171, 2021. tab, graf
Article in Portuguese | LILACS, BDENF | ID: biblio-1152647

ABSTRACT

Resumo Objetivo: Sintetizar e analisar criticamente a literatura a respeito de potenciais biomarcadores associados à desfechos clínicos no pós-operatório de cirurgia cardíaca em lactentes e crianças em cuidados intensivos. Métodos: Revisão integrativa, cuja busca ocorreu nos meses de setembro e dezembro de 2019, nas bases de dados MEDLINE, ISI of Knowledge, CENTRAL Cochrane, EMBASE, CINAHL, Science Direct e LILACS para responder à questão norteadora: "Quais as evidências científicas acerca de potenciais biomarcadores relacionados à desfechos clínicos no pós-operatório de cirurgia cardíaca de lactentes e crianças em cuidado intensivo?" Foram incluídos artigos originais publicados entre 2000 e 2019, nos idiomas inglês, português ou espanhol. Excluiu-se toda a literatura cinzenta. Resultados: A amostra final foi constituída por oito artigos, sendo seis estudos observacionais prospectivos descritivos e dois coortes prospectivas. Na maioria dos estudos os pacientes pediátricos foram submetidos à técnica de Bypass Cardiopulmonar (BCP) intraoperatória durante cirurgia de cardiopatia congênita. Os potenciais biomarcadores analisados foram moléculas participantes de processos imune-inflamatórios, predominantemente citocinas pró-inflamatórias tais como IL-1β, IL-6, IL-8 e o fator de necrose tumoral-α (TNF-α) e seu receptor, ou citocinas anti-inflamatórias como a IL-10. Conclusão: As citocinas IL-6, IL-8 e IL-10, o cortisol e o lactato, apresentaram-se como moléculas promissoras para elucidação de mecanismos subjacentes a desfechos clínicos no pós-operatório de cirurgia cardíaca em lactentes e/ou crianças em cuidado intensivo. Tais moléculas podem assumir um caráter preventivo, podendo futuramente ser utilizadas como ferramentas diagnósticas e prognósticas alternativas para um regime que permita identificar pacientes sob alto risco de desenvolver complicações clínicas nos pós-operatórios.


Resumen Objetivo: Sintetizar y analizar críticamente la literatura sobre potenciales biomarcadores relacionados con resultados clínicos en el posoperatorio de cirugía cardíaca de lactantes y niños en cuidados intensivos. Métodos: Revisión integradora, cuya búsqueda ocurrió en los meses de septiembre y diciembre de 2019, en las bases de datos MEDLINE, ISI of Knowledge, CENTRAL Cochrane, EMBASE, CINAHL, Science Direct y LILACS para responder la pregunta orientadora: "¿Cuáles son las evidencias científicas sobre potenciales biomarcadores relacionados con resultados clínicos en el posoperatorio de cirugía cardíaca de lactantes y niños en cuidados intensivos?". Se incluyeron artículos originales publicados entre los años 2000 y 2019, en idioma inglés, portugués o español. Se excluyó toda la literatura gris. Resultados: La muestra final fue formada por ocho artículos, de los cuales seis eran estudios observacionales prospectivos y dos cohortes prospectivas. En la mayoría de los estudios, los pacientes pediátricos fueron sometidos a la técnica de bypass cardiopulmonar (BCP) intraoperatoria durante la cirugía de cardiopatía congénita. Los potenciales biomarcadores analizados fueron moléculas participantes de procesos inmunoinflamatorios, predominantemente citocinas proinflamatorias tales como IL-1β, IL-6, IL-8 y el factor de necrosis tumoral-α (TNF-α) y su receptor, o citocinas antinflamatorias como la IL-10. Conclusión: Las citocinas IL-6, IL-8 e IL-10, el cortisol y el lactato, se presentaron como moléculas promisorias para explicar mecanismos subyacentes de los resultados clínicos en el posoperatorio de cirugía cardíaca de lactantes o niños en cuidados intensivos. Estas moléculas pueden asumir un carácter preventivo y, en un futuro, pueden utilizarse como herramientas alternativas de diagnóstico y pronóstico para un régimen que permita identificar pacientes con alto riesgo de presentar complicaciones clínicas en el posoperatorio.


Abstract Objective: To summarize and critically analyze the literature on potential biomarkers associated with clinical outcomes in the postoperative cardiac surgery period in infants and children under intensive care. Methods: Integrative review, whose search was carried out in September and December 2019 in the databases MEDLINE, ISI Web of Knowledge, Cochrane Central Register of Controlled Trials, Embase, Cumulative Index to Nursing and Allied Health Literature, Science Direct, and Latin America and Caribbean Center on Health Sciences Information to answer the following guiding question: "What is the scientific evidence on potential biomarkers associated with clinical outcomes in the postoperative cardiac surgery period in infants and children under intensive care?". Original articles published between 2000 and 2019 in English, Spanish, or Portuguese were included. Gray literature was excluded. Results: Eight articles made up the final sample (six descriptive observational prospective studies and two prospective cohort studies). Most studies, pediatric patients were submitted to the intraoperative cardiopulmonary bypass technique during congenital heart disease surgeries. The potential biomarkers analyzed were molecules that participate in immune-inflammatory processes, mainly proinflammatory cytokines such as IL-1β, IL-6, IL-8, and tumor necrosis factor-alpha and its receptor, as well as anti-inflammatory cytokines such as IL-10. Conclusion: The IL-6, IL-8, and IL-10 cytokines, cortisol, and lactate showed as promising molecules for elucidating mechanisms underlying clinical outcomes in the postoperative cardiac surgery period in infants and/or children under intensive care. These molecules can take on a preventive role by being used as a diagnostic and prognostic tool in the future in a protocol that allows to identify patients with high risk to develop clinical complications during the postoperative period.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Pediatric Nursing , Thoracic Surgery , Biomarkers , Cardiopulmonary Bypass/methods , Intensive Care Units, Pediatric , Heart Diseases/surgery , Heart Diseases/congenital , Postoperative Period , Epidemiology, Descriptive , Prospective Studies , Databases, Bibliographic , Observational Study
2.
Rev. bras. cir. cardiovasc ; 35(6): 1010-1012, Nov.-Dec. 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1143999

ABSTRACT

Abstract We report the case of a 60-year-old patient who underwent orthotopic heart transplant 14 years earlier. Routine echocardiography showed giant masses in the left atrium. There were no symptoms or thromboembolic events in the past. Magnetic resonance imaging study revealed very enlarged left atrium (8.7 × 10.6 cm) occupied by irregular smooth mass (7 × 5 × 6.1 cm) with a stalk that was attached to the posterior left atrial wall in the area of graft suture lines. Intraoperative examination revealed a massive thrombus (12 × 10 cm) that filled almost the entire left atrial area.


Subject(s)
Humans , Middle Aged , Thromboembolism , Thrombosis/diagnostic imaging , Heart Transplantation/adverse effects , Heart Diseases/surgery , Heart Diseases/etiology , Heart Diseases/diagnostic imaging , Thrombosis/etiology , Echocardiography , Heart Atria/diagnostic imaging
3.
Rev. bras. cir. cardiovasc ; 35(4): 549-554, July-Aug. 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1137295

ABSTRACT

Abstract Introduction: The medical use of three-dimensional (3-D) images has been a topic in the literature since 1988, but 95% of papers on 3-D printing were published in the last six years. The increase in publications is the result of advances in 3-D printing methods, as well as of the increasing availability of these machines in different hospitals. This paper sought to review the literature on 3-D printing and to discuss thoughtful ideas regarding benefits and challenges to its incorporation into cardiothoracic surgeons' routines. Methods: A comprehensive and systematic search of the literature was performed in PubMed and included material published as of March 2020. Results: Using this search strategy, 9,253 publications on 3-D printing and 497 on "heart" 3-D printing were retrieved. Conclusion: 3 -D printed models are already helping surgeons to plan their surgeries, helping patients and their families to understand complex anatomy, helping fellows and residents to practice surgery, even for rare cases, and helping nurses and other health care staff to better understand some conditions, such as heart diseases.


Subject(s)
Humans , Heart Diseases/surgery , Cardiac Surgical Procedures , Printing, Three-Dimensional , Heart , Models, Anatomic
4.
Rev. bras. cir. cardiovasc ; 35(4): 565-572, July-Aug. 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1137290

ABSTRACT

Abstract Introduction: Hydatid cyst is a parasitic disease caused by Echinococcus granulosus, most commonly seen in the liver and lungs. The hydatid cyst is rarely seen in the heart and iliofemoral region, representing less than 2% of all cases. In this article, we report our cases of hydatid cysts in unusual loci. Methods: Between 2015 and 2018, 6 rare cases of hydatid cysts were diagnosed at the Cardiovascular Surgery Department of Harran University. Four of these patients had cardiac localization and two patients had their cysts located in the iliofemoral region, extending to the pelvic zone. All patients were female. Three patients had no other organ involvement. One patient with cardiac hydatid cyst underwent normothermic cardiopulmonary bypass + total pericystectomy + Cooley-like aneurysmectomy. Total pericystectomy was performed in three other patients with intrathoracic locus by normothermic cardiopulmonary bypass. Two patients who were referred to our clinic with palpable iliofemoral mass were evaluated with appropriate imaging methods and diagnosed accordingly. Multiple iliofemoral cysts were managed with pericystectomy and drainage by a single incision made over the inguinal ligament. Conclusion: Hydatid cyst disease can develop in cardiac chambers and inguinal region with or without hepatic or pneumatic involvement. Normothermic cardiopulmonary bypass can be safely used in patients with cardiac hydatid cysts, and capitonnage similar to ventricular aneurysm repair in patients with a widely involved cystic lesion can be very useful for the protection of ventricular functions.


Subject(s)
Humans , Female , Child , Adolescent , Adult , Young Adult , Echinococcosis/surgery , Echinococcosis/diagnostic imaging , Heart Diseases/surgery , Heart Diseases/diagnostic imaging , Heart , Heart Ventricles , Liver
6.
Med. infant ; 26(2): 147-150, Junio 2019.
Article in Spanish | LILACS | ID: biblio-1016395

ABSTRACT

El cateterismo cardíaco en niños ha mostrado un avance significativo en las últimas décadas, transformándose de un procedimiento casi exclusivamente diagnóstico en sus inicios a un método predominantemente terapéutico en la actualidad. Para ello han contribuido la aparición de múltiples tecnologías de imágenes, así como el creciente desarrollo de materiales de muy bajo perfil y gran versatilidad que permiten el empleo de dispositivos cada vez más específicos para tratar adecuadamente un sinnúmero de enfermedades cardíacas con gran eficacia y seguridad. Esta tendencia continúa creciendo día a día, con la ayuda de nuevas modalidades de tratamiento híbrido donde cardiólogos intervencionistas y cirujanos cardiovasculares interactúan para ayudarse mutuamente, de manera tal de resolver los problemas existentes o aquellos que se van generando con el correr de los años y que afectan la vida de nuestros pacientes. Existen aún como es lógico controversias en algunos casos especiales, que se irán resolviendo paulatinamente en base a la evidencia reunida con las diferentes terapéuticas médicas utilizadas para mejorar el presente y futuro de los niños con cardiopatías (AU)


Cardiac catheterization in children has shown significant progress in recent decades, transforming from an initially almost exclusively diagnostic procedure to a predominantly therapeutic method today. The emergence of multiple imaging technologies has contributed to this progress, as has the growing development of very low-profile and highly versatile materials that allow the use of increasingly specific devices to adequately treat different types of heart disease with great efficacy and safety. This trend continues to grow day by day, with the help of new hybrid treatment modalities where interventional cardiologists and cardiovascular surgeons interact with mutual support, in order to solve existing problems or those that are generated over the years affecting the lives of our patients. Obviously, there are still controversies in specific cases, which will gradually be resolved based on the evidence that becomes available with the use of different medical therapies used to improve the present and future of children with heart disease.(AU)


Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Cardiac Catheterization/methods , Heart Diseases/surgery , Heart Diseases/therapy , Heart Diseases/diagnostic imaging , Cardiac Surgical Procedures/trends , Hemodynamics
7.
Rev. cir. (Impr.) ; 71(3): 266-269, jun. 2019. graf
Article in Spanish | LILACS | ID: biblio-1058268

ABSTRACT

INTRODUCCIÓN: El quiste hidatídico cardiaco es una patología infrecuente, producida por la llegada de Equinococcus granulosus a la circulación coronaria. MATERIALES Y MÉTODO: Hombre de 52 años, con antecedente de quiste hidatídico cardiaco operado hace 27 años, insuficiencia cardiaca y enfermedad coronaria. Presentó disnea progresiva de un año de evolución. Estudio con radiografía de tórax, ecocardiografía y tomografía computada que mostró imagen compatible con hidatidosis cardiaca recidivada en el ventrículo izquierdo, arteria pulmonar e hilio pulmonar izquierdo, rodeando por completo el tronco coronario común izquierdo y parte proximal de la arteria descendente anterior. Se constató fracción de eyección de ventrículo izquierdo aproximadamente de 30%. No se encontró evidencia de enfermedad hidatídica extracardiaca. Se decidió tratamiento quirúrgico. Se abordó por esternotomía media y en circulación extracorpórea, se observaron lesiones compatibles con quiste hidatídico multiloculado de ubicación miocárdica en ventrículo izquierdo, con incontables vesículas hijas. Se realizó quistectomía más periquistectomía hidatídica sin incidentes. Presentó hemorragia postoperatoria por lo que requirió reintervención quirúrgica precoz. Evolucionó favorablemente y fue dado de alta sin complicaciones. A seis años de seguimiento se encuentra asintomático, sin evidencia tomográfica y ecocardiográfica de recidiva. DISCUSIÓN: La hidatidosis es una zoonosis endémica en Chile. La ubicación cardiaca es infrecuente, correspondiendo al 0,5 al 2% de los casos. Suele asociarse a la presencia de quistes extracardiacos. La ubicación más frecuente es la pared libre del ventrículo izquierdo a nivel intramiocárdico. El tratamiento médico suele ser insuficiente, por lo que se recomienda la resección quirúrgica.


INTRODUCTION: Cardiac hydatid cyst is a rare disease caused by Echinococcus granulosus arrival of the coronary circulation. MATERIAL AND METHOD: 52 years old man with a history of cardiac hydatid cyst operated 27 years ago, heart failure and coronary artery disease. He presented with a history of one year of progressive dyspnoea. Study with chest radiography, echocardiography and computed tomography showed an image compatible with cardiac hydatid disease recurrence in relation to the left ventricle, pulmonary artery and anterior descending artery. Ejection fraction of the left ventricle was approximately 30%. No evidence of extracardiac hydatid disease was found and surgical treatment was decided. Addressed by median sternotomy and extracorporeal circulation, a multiloculated myocardial hydatid cyst, with hundreds of daughter vesicles of different size was found. Pericystectomy of the hydatid cyst was performed without incident. The patient presented postoperative bleeding which required early reoperation. Posteriorly, was discharged without complications. DISCUSSION: Hydatid disease is an endemic zoonosis in Chile. Heart location is infrecuent and correspond to 0.5 to 2% of the cases, usually associated with the presence of extracardiac cysts. The most common location is the free wall of the left ventricle at intramyocardial level. Medical treatment is often inadequate and surgical resection is recommended.


Subject(s)
Humans , Male , Middle Aged , Echinococcosis/surgery , Heart Diseases/surgery , Heart Ventricles/surgery , Recurrence , Reoperation , Echocardiography , Radiography, Thoracic , Echinococcosis/diagnostic imaging , Heart Diseases/parasitology , Heart Diseases/diagnostic imaging , Heart Ventricles/parasitology
8.
Article in English | AIM | ID: biblio-1272733

ABSTRACT

Background: Median sternotomy wound infections are infrequent yet potentially fatal complication following cardiac surgery. The reported incidence of sternal infections ranges from 0.9 to 20%, and the incidence of mediastinitis is 1­2% in most studies. Several studies have examined and identified possible causes and risk factors associated with sternal infections. They include patient-related risk factors, and procedure-related factors. Aim of the study is the assessment of the patient's risk factors related to incidence of infection. Patients and Methods: ninety-eight cardiac surgery patients operated via median sternotomy were included in the study and the role of patient related factors (age, gender, obesity and diabetes mellitus) in the incidence of postoperative superficial and deep sternal wound infection was accessed. Results: Sternal wound infection (SWI) developed in 18 patients (18.36%). 15 patients (15.3%) had superficial SWI while 3 patients (3.06%) had deep SWI. The most common causative organism in our study was staph. aureus especially MRSA.Conclusion: Patient-related risk factors such as age, gender, obesity and diabetes mellitus are important risk factors in the development sternal wound infection


Subject(s)
Cardiac Surgical Procedures , Egypt , Heart Diseases/surgery , Risk Factors , Surgical Wound Infection
9.
Acta cir. bras ; 33(11): 1037-1042, Nov. 2018. tab, graf
Article in English | LILACS | ID: biblio-973474

ABSTRACT

Abstract Early cancer diagnosis, new therapies that increased survival of patients, besides the increasingly elderly population are some factors would be associated with possible cancer dissemination in patients under cardiopulmonary bypass (CPB) cardiac surgery. Also, the benefits, and risks, regarding long-term survival, have not yet been established. Therefore, cardiac surgery morbimortality may be superior in patients with cancer disease. Also, immunologic and inflammatory changes secondary to CPB can also increase tumor recurrence. After a brief introduction and CPB immunologic the two main topic subjects included: 1) Combined heart surgery and lung resection and; 2) Possible influence of neoplasia type. After observing the relative literature scarcity, we keep the opinion that "CPB has a modest association with cancer progression" and that "CPB and cancer dissemination should be a logical but unlikely association."


Subject(s)
Humans , Cardiopulmonary Bypass/adverse effects , Cardiac Surgical Procedures/adverse effects , Neoplasms/complications , Risk Factors , Disease Progression , Heart Diseases/surgery , Heart Diseases/complications
10.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 28(3 (supl)): 345-352, jul.-set. 2018. tab
Article in English, Portuguese | LILACS, SES-SP, SESSP-IDPCPROD, SES-SP | ID: biblio-964372

ABSTRACT

As emergências cardiológicas podem causar rápidas e profundas alterações na resposta metabólica e sistêmica. Essas alterações contribuem acentuadamente para a mobilização das reservas corporais que repercutirão no estado nutricional. A avaliação nutricional, ainda que não seja realizada na fase crítica da assistência interdisciplinar, deverá ser realizada o quanto antes, visando a adoção da alimentação adequada e reposição hídrica e de eletrólitos. O uso de ferramentas subjetivas capazes de estimar o risco nutricional global é de fácil aplicação devido a sua praticidade e rapidez. Entre essas destaca-se o Nutritional Risk Score ­ NRS 2002. Sempre que possível, a avaliação nutricional global deve ser complementada pela avaliação nutricional objetiva e pelo uso de marcadores nutricionais bioquímicos, os quais auxiliarão na avaliação mais precisa do estado nutricional do paciente crítico. Essas ferramentas devem ser utilizadas por nutricionistas treinados e os resultados devem ser discutidos pela equipe multidisciplinar de terapia nutricional que decidirá as estratégias mais adequadas para o início da terapia nutricional precoce nos quadros de emergências cardiológicas


Cardiac emergencies can cause rapid and profound changes in the metabolic and systemic response. These changes contribute significantly to the mobilization of body reserves, which will affect nutritional status. Nutritional evaluation, although not performed in the critical phase of interdisciplinary care, should be carried out as early as possible in order to ensure an adequate diet, and water and electrolyte replacement. The use of subjective tools capable of estimating the global nutritional risk is easy to apply due to its effective and rapid application. One such tool is the Nutritional Risk Score ­ NRS 2002. Whenever possible, the global nutritional assessment should be complemented with objective nutritional assessment and the use of biochemical nutritional markers, which will help obtain a more accurate evaluation of the nutritional status of the critically ill patient. These tools should be applied by trained nutritionists, and the results should be discussed by the multidisciplinary nutritional therapy team, which will decide on the most appropriate strategies for the initiation of early nutritional therapy in cardiac emergency situations


Subject(s)
Humans , Male , Female , Adult , Cardiology , Nutrition Assessment , Emergencies , Prognosis , Atrial Fibrillation/complications , Atrial Fibrillation/physiopathology , Cardiovascular Surgical Procedures/adverse effects , Cardiovascular Surgical Procedures/methods , Ultrasonics/methods , Body Mass Index , Anthropometry/methods , Guidelines as Topic/standards , Heart Diseases/surgery , Hospitalization
11.
Arch. cardiol. Méx ; 88(1): 1-8, ene.-mar. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-1054982

ABSTRACT

Resumen: Objetivo: Describir la evolución clínica de pacientes pediátricos operados por cardiopatías congénitas en la UMAE de Yucatán. Métodos: Encuesta descriptiva sobre expedientes de pacientes pediátricos intervenidos quirúrgicamente por cardiopatía congénita del 1 de noviembre de 2011 al 30 de noviembre de 2013. Resultados: Las cardiopatías más frecuentes fueron la persistencia del conducto arterioso (37.6%) y la transposición de grandes vasos. La estancia en cuidados intensivos fue de 3 días (mediana). El 11.76% fallecieron por choque séptico (44.4%) en la mayoría de los casos. Las complicaciones más frecuentes fueron sepsis (5.9%), síndrome de bajo gasto (4.7%), paro cardíaco, bloqueo AV y taquicardia ventricular (2.4% cada uno). Existe una correlación positiva moderada entre las complicaciones trans y posquirúrgicas y la sobrevida o muerte del paciente. Conclusiones: El volumen de pacientes quirúrgicos es menor comparado con centros de referencia de cirugía cardiovascular. Existe una marcada tendencia a la realización de cirugías correctivas y paliativas en patologías específicas en pacientes con riesgos agregados o con «mala¼ anatomía cardiaca que impiden la corrección total de primera intención. Se deben realizar estudios epidemiológicos y clínicos prospectivos para conocer el comportamiento de las cardiopatías congénitas atendidas en la región. © 2016 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (https://creativecommons.org/licenses/by-nc-nd/4.0/).


Abstract: Objective: To describe the clinical course of paediatric patients undergoing surgery for congenital heart disease in UMAE of Yucatan. Methods: Descriptive review was performed on the records of paediatric patients undergoing surgery for congenital heart disease from 1 November 2011 to 30 November 2013. Results: The most frequent heart diseases were persistent ductus arteriosus (37.6%) and trans- position of the great vessels. The median intensive care stay was 3 days. Mortality was 11.76%, with septic shock (44.4%) in most cases. The most frequent complications were sepsis (5.9%), low cardiac output syndrome (4.7%), cardiac arrest, and AV block and ventricular tachycardia (2.4% each). There was a moderate positive correlation between surgical complications and survival or death. Conclusions: The number of surgical patients is lower compared to reference centres for cardiovascular surgery. There is a marked tendency to perform corrective and palliative surgeries in specific disease in patients with added risk or 'bad' cardiac anatomy that prevent full correction at the first attempt. Prospective epidemiological and clinical studies should be conducted to understand the behaviour of congenital heart diseases treated in the region. © 2016 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Postoperative Complications/epidemiology , Heart Defects, Congenital/surgery , Heart Diseases/surgery , Heart Diseases/congenital , Morbidity , Mexico
13.
Rev. bras. cir. cardiovasc ; 32(2): 138-140, Mar.-Apr. 2017. tab, graf
Article in English | LILACS | ID: biblio-843470

ABSTRACT

Abstract Cardiac hydatid cyst is an uncommon but potentially fatal disease. In cystic Echinococcus humans are an accidental host. Liver and lungs are the most frequently involved organs. Herein a unique case of intramyocardial hydatid cyst of left ventricle along with pulmonary hydatid cyst in a 38-year-old lady is reported. Surgical removal of the cardiac hydatid cyst was done with the aid of cardiopulmonary bypass followed by removal of pulmonary hydatid cyst.


Subject(s)
Humans , Female , Adult , Echinococcosis/surgery , Echinococcosis, Pulmonary/surgery , Heart Diseases/surgery , Thoracotomy , Echocardiography , Tomography, X-Ray Computed , Echinococcosis/complications , Echinococcosis/diagnostic imaging , Echinococcosis, Pulmonary/complications , Echinococcosis, Pulmonary/diagnostic imaging , Heart Diseases/complications , Heart Diseases/diagnostic imaging , Heart Ventricles/surgery , Heart Ventricles/diagnostic imaging
14.
Rev. chil. cardiol ; 36(1): 17-23, 2017. ilus, tab
Article in Spanish | LILACS | ID: biblio-844305

ABSTRACT

La infección del virus de inmunodeficiencia humana (VIH) se adquiere principalmente a través del contagio sexual y los pacientes infectados siguen aumentando en el mundo. El tratamiento antirretroviral (TARV) moderno es capaz de suprimir la replicación viral y mejorar el recuento de linfocitos T CD4+, aumentando la supervivencia de los pacientes. De esta manera, aumenta el riesgo de presentar enfermedades crónicas siendo las cardiovasculares las más frecuentes. Objetivo: Comunicar nuestra experiencia en pacientes con infección por VIH sometidos a cirugía cardiovascular. Pacientes y Método: Estudio retrospectivo en que se revisó la base de datos del Servicio de Cirugía Cardiovascular entre los años 2009 y 2015. Identificamos a los pacientes con infección por VIH sometidos a cirugía cardiovascular. Resultados: Catorce pacientes presentaban esa condición. La mayoría estaba en control y con TARV (11 casos) logrando que la carga viral fuera indetecta-ble. La principal vía de infección fue la sexual (13/14 casos). Durante la cirugía se tomaron las precauciones universales de protección para el equipo quirúrgico, las que fueron efectivas en todos los casos. La enfermedad más frecuentemente tratada fue la cardiopatía coronaria (9 casos), seguido de valvulopatías severas (4 casos) en que solo uno presentaba Endocarditis Infecciosa. No hubo mortalidad asociada al procedimiento ni en el seguimiento a tres años de la cirugía. Conclusión: Los pacientes con infección por VIH están expuestos a desarrollar enfermedades cardiovasculares que requieren de tratamiento quirúrgico. Estos pueden ser realizados en forma segura con gran beneficio en su calidad de vida y de su supervivencia.


Infection with human immunodeficiency virus (HIV+) is primarily acquired through sexual transmission and the number of infected people continues to increase. Anti-retroviral therapy (HAART) suppress viral replication and improves CD4 T cell count, increasing survival and the risk of developing chronic diseases. Cardiovascular disease is prevalent among these patients. Objective: To report our experience in patients positive for HIV undergoing cardiovascular surgery. Patients and Methods: We reviewed the Cardiovascular Surgery Service database from 2009 to 2015 to identify HIV-infected patients that underwent cardiovascular surgery. Results: There were 14 HIV positive patients. Most of them were receiving HAART and the viral load was undetectable in 11 patients Thee main route of infection was sexual (13/14 cases). Universal precautions to protect the surgical team were taken during surgery. These were effective in all cases. Coronary artery disease was the most common condition treated (9 cases), followed by severe valve disease (4). Only one patients had infective endocarditis. There was no mortality associated with the procedure. Al patients were alive and asymptomatic 3 years after surgery. Conclusion: Patients with HIV infection are likely to develop cardiovascular diseases requiring surgical treatment. These can be performed safely with great benefit in quality of life and survival.


Subject(s)
Humans , Male , Adult , Middle Aged , Aged , Cardiac Surgical Procedures , Heart Diseases/surgery , HIV Infections , Retrospective Studies , Treatment Outcome
15.
CoDAS ; 28(5): 646-652, Sept.-Oct. 2016. tab, graf
Article in Portuguese | LILACS | ID: biblio-828565

ABSTRACT

RESUMO Objetivo Identificar os principais fatores relacionados à disfagia orofaríngea no pós-operatório de cirurgia cardíaca, por meio de uma revisão sistemática de literatura. Método Foi realizada pesquisa bibliográfica nas bases PubMed e ScienceDirect, utilizando os termos cardiac surgery, deglutition disorders e dysphagia. Critérios de seleção Foram selecionados artigos sem limitação de ano escritos em português, inglês ou espanhol e que referissem disfagia orofaríngea no pós-operatório de cirurgia cardíaca. Apenas os estudos disponíveis na íntegra foram incluídos. Análise dos dados Cada artigo passou pela análise de títulos e resumos, sendo posteriormente submetido à avaliação na íntegra por dois juízes cegados. Os seguintes dados foram extraídos: autores/ano, desenho do estudo, amostra, variáveis avaliadas e principais resultados. Resultados Os principais fatores relacionados à disfagia orofaríngea no pós-operatório de cirurgia cardíaca foram: idade avançada, presença de comorbidades e outras doenças associadas, tempo de intubação e condições cirúrgicas. Conclusão Os estudos foram bastante heterogêneos, demonstrando que sujeitos submetidos a procedimentos cirúrgicos cardíacos, em especial idosos, apresentam diversos fatores relacionados à disfagia orofaríngea no pós-operatório, como o uso de circulação extracorpórea e ecocardiografia transesofágica, comorbidades associadas, desenvolvimento de sepse pós-operatória e condições cardíacas prévias.


ABSTRACT Purpose To identify the main factors associated with oropharyngeal dysphagia following cardiac surgery through a systematic review of the literature. Methods A bibliographic search was conducted in the PubMed and ScienceDirect databases using the following keywords: “cardiac surgery”, “deglutition disorders”, and “dysphagia”. Selection criteria Articles published in Portuguese, English, or Spanish addressing oropharyngeal dysphagia following cardiac surgery were selected with no time limitation. Only studies available in full were included. Data analysis First, articles were screened for title and abstract. Subsequently, they were submitted to full assessment by two blinded referees. The following data were extracted: authors, year of publication, study design, sample size, variables evaluated, and main results. Results The main factors related to oropharyngeal dysphagia in post-cardiac surgery were advanced age, presence of comorbidities and other diseases, intubation time, and surgical conditions. Conclusion The studies showed high heterogeneity, demonstrating that individuals who undergo cardiac surgical procedures, especially the elderly, present several factors related to oropharyngeal dysphagia postoperatively, such as cardiopulmonary bypass, transesophageal echocardiography, associated comorbidities, development of postoperative sepsis, and previous heart conditions.


Subject(s)
Humans , Postoperative Complications/etiology , Deglutition Disorders/etiology , Cardiac Surgical Procedures/adverse effects , Postoperative Complications/physiopathology , Postoperative Period , Deglutition Disorders/physiopathology , Risk Factors , Heart Diseases/surgery , Intensive Care Units
16.
Arq. bras. cardiol ; 107(3): 245-256, Sept. 2016. tab, graf
Article in English | LILACS | ID: lil-796031

ABSTRACT

Abstract Background: Complications after surgical procedures in patients with cardiac implantable electronic devices (CIED) are an emerging problem due to an increasing number of such procedures and aging of the population, which consequently increases the frequency of comorbidities. Objective: To identify the rates of postoperative complications, mortality, and hospital readmissions, and evaluate the risk factors for the occurrence of these events. Methods: Prospective and unicentric study that included all individuals undergoing CIED surgical procedures from February to August 2011. The patients were distributed by type of procedure into the following groups: initial implantations (cohort 1), generator exchange (cohort 2), and lead-related procedures (cohort 3). The outcomes were evaluated by an independent committee. Univariate and multivariate analyses assessed the risk factors, and the Kaplan-Meier method was used for survival analysis. Results: A total of 713 patients were included in the study and distributed as follows: 333 in cohort 1, 304 in cohort 2, and 76 in cohort 3. Postoperative complications were detected in 7.5%, 1.6%, and 11.8% of the patients in cohorts 1, 2, and 3, respectively (p = 0.014). During a 6-month follow-up, there were 58 (8.1%) deaths and 75 (10.5%) hospital readmissions. Predictors of hospital readmission included the use of implantable cardioverter-defibrillators (odds ratio [OR] = 4.2), functional class III­-IV (OR = 1.8), and warfarin administration (OR = 1.9). Predictors of mortality included age over 80 years (OR = 2.4), ventricular dysfunction (OR = 2.2), functional class III-IV (OR = 3.3), and warfarin administration (OR = 2.3). Conclusions: Postoperative complications, hospital readmissions, and deaths occurred frequently and were strongly related to the type of procedure performed, type of CIED, and severity of the patient's underlying heart disease.


Resumo Fundamento: Complicações após procedimentos cirúrgicos em portadores de dispositivos cardíacos eletrônicos implantáveis (DCEI) são um problema emergente devido ao aumento crescente na taxa destes procedimentos e ao envelhecimento da população, com consequente aumento de comorbidades. Objetivos: Identificar as taxas de complicações pós-operatórias, mortalidade e readmissão hospitalar, e pesquisar fatores de risco para a ocorrência desses eventos. Métodos: Registro prospectivo e unicêntrico que incluiu todos os indivíduos submetidos a procedimentos cirúrgicos em DCEI no período de fevereiro a agosto de 2011. Os pacientes foram distribuídos por tipos de procedimento nos seguintes grupos: implantes iniciais (coorte 1), troca de gerador (coorte 2) e procedimentos em cabos-eletrodos (coorte 3). Os desfechos foram avaliados por um comitê independente. Empregou-se a análise univariada e multivariada para a pesquisa de fatores de risco e o método de Kaplan-Meier para análise de sobrevida. Resultados: Foram incluídos 713 pacientes, sendo 333, 304 e 76 distribuídos nas coortes 1, 2 e 3, respectivamente. Complicações pós-operatórias foram detectadas em 7,5%, 1,6% e 11,8% dos pacientes nas coortes 1, 2 e 3, respectivamente (p = 0,014). Durante os 6 meses de seguimento, houve 58 (8,1%) óbitos e 75 (10,5%) readmissões hospitalares. Preditores de readmissão hospitalar incluíram o uso de cardioversor-desfibrilador implantável ( odds ratio [OR] = 4,2), classe funcional III-IV (OR = 1,8) e uso de warfarina (OR = 1,9). Preditores de mortalidade incluíram idade acima de 80 anos (OR = 2,4), disfunção ventricular (OR = 2,2), classe funcional III-IV (OR = 3,3) e uso de warfarina (OR = 2,3). Conclusões: Complicações pós-operatórias, readmissões hospitalares e óbitos foram frequentes. Esses eventos estiveram fortemente relacionados ao tipo de procedimento realizado, tipo de DCEI e gravidade da doença cardíaca do paciente.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Pacemaker, Artificial/adverse effects , Patient Readmission/statistics & numerical data , Postoperative Complications/etiology , Defibrillators, Implantable/adverse effects , Cardiac Resynchronization Therapy/adverse effects , Heart Diseases/surgery , Postoperative Complications/mortality , Reoperation/statistics & numerical data , Stroke Volume , Time Factors , Logistic Models , Prospective Studies , Risk Factors , Age Factors , Risk Assessment , Kaplan-Meier Estimate , Cardiac Resynchronization Therapy/mortality , Heart Diseases/mortality
17.
Trends psychiatry psychother. (Impr.) ; 38(3): 178-182, July-Sept. 2016.
Article in English | LILACS | ID: lil-796275

ABSTRACT

Abstract Introduction: The world renowned comedian and four-time Oscar nominated actor Robin Williams died on August 11, 2014. From the outset, the news indicated that his death was believed to be a suicide and this was later confirmed to be true by the autopsy reports. Williams had been suffering from severe depression, which is believed to be the leading contributor to his suicide. In this case study, I will highlight the event of the actor's suicide and the main risk factors along with depression leading to his tragic death. As of the end of 2015, no other case study seemed to have addressed or explored the links between the cause (or causes) and events leading to Robin Williams' suicide. Case description: Robin Williams was suffering from relationship problems, financial problems, drug addiction, and major depression. All of these factors led to his suicide. Comments: The chances of committing suicide drastically increase in the presence of any of the key risk factors. Unfortunately, the actor Robin Williams was dealing with four of the major risk factors all together, which put him at a high risk of committing suicide and eventually led to his tragic death.


Resumo Introdução: O ator Robin Williams, comediante reconhecido internacionalmente e quatro vezes indicado ao Oscar, faleceu no dia 11 de agosto de 2014. Desde o início, os noticiários indicavam que sua morte provavelmente resultara de suicídio, e isso foi confirmado posteriormente nos relatórios da autópsia. Williams vinha sofrendo de depressão severa, a qual, acredita-se, foi o fator que mais contribuiu para seu suicídio. Neste estudo de caso, vou discorrer sobre o suicídio do ator e sobre os principais fatores de risco, além da depressão, que levaram à sua morte trágica. Do final de 2015 para cá, nenhum outro estudo de caso parece ter abordado ou explorado as associações entre a causa (ou as causas) e os eventos que levaram ao suicídio do ator Robin Williams. Descrição do caso: Robin Williams vinha sofrendo com problemas de relacionamento, problemas financeiros, abuso de drogas e depressão severa. Todos esses fatores levaram ao seu suicídio. Comentários: As chances de cometer suicídio aumentam drasticamente na presença de qualquer fator de risco chaves. Infelizmente, o ator Robin Williams estava exposto a quatro fatores de risco chaves simultaneamente, colocando-o sob um alto risco de cometer suicídio, o que eventualmente culminou com sua trágica morte.


Subject(s)
Humans , Male , History, 20th Century , History, 21st Century , Suicide/history , Famous Persons , Socioeconomic Factors , Substance-Related Disorders/complications , Depressive Disorder, Major/complications , Heart Diseases/surgery , Heart Diseases/complications , Heart Diseases/psychology , Interpersonal Relations , Middle Aged , Motion Pictures/history
18.
Trends psychiatry psychother. (Impr.) ; 38(2): 71-79, abr. jun. 2016. tab
Article in English | LILACS | ID: lil-788009

ABSTRACT

Abstract Introduction: The Psychotherapy Process Q-Set (PQS) prototype method is used to measure the extent to which ideal processes of different psychotherapies are present in real cases, allowing researchers to examine how adherence to these models relates to or predicts change. Results from studies of short-term psychotherapies suggest that the original psychodynamic prototype is more suitable for studying psychoanalysis and long-term psychodynamic psychotherapy than its time-limited counterparts. Furthermore, culture probably influences how therapies are typically conducted in a given country. Therefore, it seems appropriate to develop Brazilian prototypes on which to base studies of short-term psychodynamic and cognitive-behavioral processes in this country. Objective: To develop prototypes for studying processes of short-term psychotherapies and to examine the degree of adherence of two real psychotherapy cases to these models. Methods: Expert clinicians used the PQS to rate a hypothetical ideal session of either short-term psychodynamic psychotherapy (STPP) or cognitive-behavioral therapy (CBT). Ratings were submitted to Q-type factor analysis to confirm the two groups. Regressive factor scores were rank ordered to describe the prototypes. These ideal models were correlated with ratings of actual therapy processes in two complete psychotherapy cases, one STPP and the other CBT. Results: Agreement levels between expert ratings were high and the two ideal models were confirmed. As expected, the PQS ratings for actual STPP and CBT cases had significant correlations with their respective ideal models, but the STPP case also adhered to the CBT prototype. Conclusion: Overall, the findings reveal the adequacy of the prototypes for time-limited therapies, providing initial support of their validity.


Resumo Introdução: O método dos protótipos derivados do Psychotherapy Process Q-Set (PQS) mensura em que medida processos de diferentes psicoterapias estão presentes em casos reais, permitindo pesquisadores examinarem como a adesão a esses modelos se relaciona com ou prediz a mudança. Resultados de estudos com psicoterapias breves sugerem que o protótipo psicodinâmico original é mais adequado para estudar psicanálise e psicoterapia psicodinâmica de longo prazo do que suas variantes de tempo limitado. Além disso, a cultura provavelmente influencia o modo como as psicoterapias são tipicamente conduzidas em determinado país. Portanto, parece apropriado o desenvolvimento de protótipos brasileiros para subsidiar estudos de processos psicodinâmicos e cognitivo-comportamentais de curto prazo neste país. Objetivo: Desenvolver protótipos para o estudo dos processos de psicoterapias de curta duração e examinar o grau de adesão de dois casos reais de psicoterapia a esses modelos. Métodos: Especialistas brasileiros usaram o PQS para avaliar uma sessão hipotética ideal de psicoterapia psicodinâmica breve (PPB) ou de terapia cognitivo-comportamental (TCC). A análise fatorial do tipo Q foi realizada para confirmar os dois fatores. Os escores fatoriais regressivos foram ordenados para descrever os protótipos. Os protótipos foram correlacionados com as avaliações de processos reais de terapia em dois casos completos, um de PPB e outro de TCC. Resultados: Houve alta concordância entre especialistas, e os dois modelos ideais foram confirmados. Como esperado, os escores do PQS para os casos reais de PPB e TCC apresentaram correção significativa com seus respectivos modelos ideais, mas o caso de PPB aderiu também ao protótipo TCC. Conclusões: No geral, os resultados revelam a adequação dos protótipos para terapias com tempo limitado, fornecendo suporte inicial de sua validade.


Subject(s)
Humans , Male , Female , Psychotherapy, Brief/methods , Cognitive Behavioral Therapy/methods , Psychotherapy, Psychodynamic/methods , Anxiety/etiology , Anxiety/therapy , Brazil , Regression Analysis , Factor Analysis, Statistical , Patient Compliance , Compulsive Behavior/therapy , Depression/etiology , Depression/therapy , Heart Diseases/surgery , Heart Diseases/psychology , Middle Aged
19.
Int. j. cardiovasc. sci. (Impr.) ; 29(2): 134-138, mar.-abr. 2016. tab, ilus
Article in French | LILACS | ID: biblio-831104

ABSTRACT

Fundamentos: Nos últimos anos houve aumento do número de cirurgias cardíacas (CC). Estas são acompanhadas por processos complexos que possibilitam complicações. A ventilação mecânica invasiva (VMI) pode gerar acentuada redução da força muscular respiratória e periférica, sendo encontrados atualmente protocolos de desmame e mobilização precoce, que visam diminuir o tempo de VMI.Objetivo: Correlacionar o tempo de VMI sobre a força muscular periférica em pacientes submetidos à cirurgia cardíaca. Métodos: Estudo transversal prospectivo, realizado com pacientes da Unidade de Terapia Intensiva (UTI) de hospital de referência em cardiologia da cidade de Feira de Santana, BA, Brasil, no período de abril de 2014 a agosto de 2015. Os pacientes foram avaliados no período pré-operatório em relação a sua força muscular periférica através da escala da Medical Research Council (MRC). Foi anotado o tempo de VMI durante a cirurgia. Após 12 horas do procedimento cirúrgico houve reavaliação da força muscular periférica pelo MRC. Resultados: Estudados 69 pacientes (56,5% homens) com média de idade 55,9±14,2 anos. Verificadas diferenças significativas entre o tempo de assistência ventilatória invasiva (7,3±2,6 horas) e redução da força muscular periférica final (47,5±3,8) através do MRC, com p=0,0001. Também se correlacionou o MRC inicial e final (59,8±0,5 vs. 47,5±3,8;p=0,21) e o tempo de circulação extracorpórea (CEC) e MRC final (65,1±20,1 minutos vs. 47,5±3,8; p=0,74). Conclusão: Observou-se que o maior tempo de VMI ocasionou redução da força muscular periférica de pacientes submetidos à cirurgia cardíaca.


Background: In recent years, there has been an increasing number of heart surgeries (HS). These are accompanied by complex processes that lead to complications. Invasive mechanical ventilation (IMV) can cause severe reduction in respiratory and peripheral muscle strength. Protocols of early weaning and mobilization are currently found, aimed at reducing IMV time. Objective: To correlate IMV time on peripheral muscle strength in patients undergoing heart surgery. Methods: Prospective cross-sectional study involving patients from the Intensive Care Unit (ICU) of a reference cardiology hospital in the city of Feira de Santana, BA, Brazil, from April 2014 to August 2015. The patients were evaluated preoperatively regarding their peripheral muscle strength through the Medical Research Council (MRC) scale. IMV time during surgery was noted down. After 12 hours of surgery, peripheral muscle strength was re-evaluated using the MRC scale. Results: The study included 69 patients (56.5% men) with mean age of 52.5±16.9 years. Significant differences were found between invasive ventilatory assistance time (7.3±2.6 hours) and reduction in final peripheral muscle strength (47.5±3.8) through the MRC scale, with p=0.0001. Initial and final MRC (59.8±0.5 vs. 47.5±3.8; p=0.21) and cardiopulmonary bypass (CPB) time and final MRC (65.1±20.1 minutes vs. 47.5±3.8; p=0.74) were also correlated. Conclusion: It was found that longer IMV time caused a reduction in peripheral muscle strength in patients undergoing heart surgery.


Subject(s)
Humans , Male , Female , Middle Aged , Heart Diseases/surgery , Heart Diseases/therapy , Postoperative Care/methods , Respiration, Artificial/methods , Thoracic Surgery , Extracorporeal Circulation , Cross-Sectional Studies/methods , Postoperative Period , Preoperative Period , Cardiac Surgical Procedures/methods , Risk Factors , Data Interpretation, Statistical
20.
Esc. Anna Nery Rev. Enferm ; 20(3): e20160072, 2016. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-953418

ABSTRACT

Objetivo: Verificar a relação dos sintomas de ansiedade e depressão com o sexo e a idade de pacientes em pré-operatório de primeira cirurgia cardíaca. Métodos: Estudo correlacional, transversal, com 84 participantes. Utilizada a Escala Hospitalar de Ansiedade e Depressão. Realizado o teste t de Student para amostras independentes (sexo), ANOVA (idade agrupada) e análises de regressões lineares, com nível de significância de 5%. Resultados: As mulheres apresentaram mais sintomas de ansiedade e de depressão, com maiores médias e diferenças estatisticamente significantes (p = 0,007 e p = 0,001). Na análise de regressão, o sexo foi significativo no modelo (p = 0,011). Considerando-se a idade, as diferenças encontradas em relação à presença desses sintomas não foram estatisticamente significantes, tanto na ANOVA quanto na regressão. Conclusão: As mulheres apresentaram mais sintomas de ansiedade e de depressão no pré-operatório de cirurgias cardíacas. Esses dados devem ser considerados pelos enfermeiros ao elaborarem os planos de educação do paciente cirúrgico.


Objetivo: Investigar la relación de los síntomas de ansiedad y depresión con el sexo y la edad de pacientes en preoperatorio de la primera cirugía cardíaca. Métodos: Estudio correlacional, transversal, con 84 participantes. Fue utilizada la Escala Hospitalaria de Ansiedad y Depresión. Se ha realizado el teste t de Student para muestras independientes (sexo), ANOVA (edad agrupada) y análisis de regresiones lineales, con nivel de significación del 5%. Resultados: Las mujeres presentaron más síntomas de ansiedad y depresión, con mayores promedios y diferencias estadísticamente significantes (p = 0,007 y p = 0,001). En el análisis de regresión, el género fue significativo en el modelo (p = 0,011). Considerando la edad, las diferencias no fueron estadísticamente significantes, tanto en ANOVA, como en la regresión. Conclusión: Las mujeres presentaron más síntomas de ansiedad y depresión en el preoperatorio de cirugías cardíacas. Estos datos deben ser considerados por los enfermeros en los planes de educación del paciente quirúrgico.


Objective: To investigate the association between anxiety and depression symptoms and sex and age among preoperative patients submitted to their first cardiac surgery. Methods: This is a correlational cross-sectional study, with 84 participants. The Hospital Anxiety and Depression Scale was used. Student's t-test for independent samples (sex), ANOVA (age group), and linear regression analysis were used, with a significance level of 5%. Results: Women had more anxiety and depression symptoms, with higher mean values and statistically significant differences (p = 0.007 and p = 0.001). In the regression analysis, sex was significant in the model (p = 0.011). Considering age, the differences regarding the presence of these symptoms were not statistically significant, either in ANOVA or in the regression analysis. Conclusion: Women had more anxiety and depression symptoms in the preoperative period of cardiac surgeries. Nurses should consider these results during the educational plan preparation for surgical patients.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Anxiety/prevention & control , Perioperative Nursing/statistics & numerical data , Thoracic Surgery/statistics & numerical data , Depression/prevention & control , Heart Diseases/surgery
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