Characteristics of ST-Elevation Myocardial Infarction during the SARS-CoV-2 Outbreak

Abstract Background The SARS-CoV-2 outbreak has led to radical transformation in social, economic, and healthcare systems. This may lead to profound indirect consequences on clinical presentation and management of patients with ST-segment-elevation myocardial infarction. Objectives The objective of this study was to describe the characteristics, management, and outcomes of patients admitted with acute myocardial infarction with ST-segment elevation (STEMI), in two tertiary reference hospitals during the SARS-CoV-2 outbreak and compare them with patients admitted in the previous year. Methods We analyzed data from a multicenter STEMI registry from reference centers in the South Region of Brazil from March 2019 to May 2021. The beginning of the COVID-19 outbreak was considered to be March 2020 and compared to the same period in 2019. Only patients with STEMI submitted to primary percutaneous coronary intervention (PCI) were included in the analysis. Mortality rates were compared with chi-square test. All hypothesis tests had a two-sided significance level of 5%. Results A total of 1169 patients admitted with STEMI were enrolled in our registry, 635 of whom were admitted during the pandemic period. The mean age of our sample was 61.6 (± 12.4) years, and 66.7% of patients were male. Pain-to-door time and door-to-balloon time were longer during the pandemic period. However, there was no difference in mortality rates or major adverse cardiovascular outcomes (MACE). Conclusions We observed a stable incidence of STEMI cases in our registry during the SARS-CoV-2 outbreak with higher pain-to-door time and door-to-balloon time, without any influence on mortality rates however.

Diferenças entre os Sexos nos Desfechos de Pacientes com Infarto do Miocárdio com Supradesnivelamento do Segmento ST Submetidos à Intervenção Coronária Percutânea Primária / Sex Differences in Outcomes of ST Elevation Myocardial Infarction Patients Submitted to Primary Percutaneous Coronary Intervention

Resumo Fundamento Vários estudos têm mostrado que as mulheres não recebem tratamento adequado e apresentam piores desfechos após infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCSST). Por isso, é necessário investigar questões relacionadas ao gênero para melhor lidar com esse problema no Brasil. Objetivo Determinar se existe associação entre o sexo feminino e eventos adversos em uma coorte contemporânea de pacientes com IAMCSST submetidos à intervenção coronária percutânea primária (ICPp). Métodos Este foi um estudo prospectivo do tipo coorte de pacientes com IAMCSST submetidos à ICPp em um hospital universitário terciário entre março de 2011 e dezembro de 2021. Os pacientes foram categorizados em grupos de acordo com o sexo ao nascimento. O primeiro desfecho clínico foi ECAM em longo prazo. Os pacientes foram acompanhados por um período máximo de cinco anos. Um nível de significância bilateral de 0,05 foi aplicado em todos os testes de hipóteses. Resultados Entre os 1457 pacientes internados por IAMCSST no período do estudo, 1362 foram incluídos e 468 (34,4%) eram do sexo feminino. As mulheres apresentaram maior prevalência de hipertensão (73% vs. 60%, p<0,001), diabetes (32% vs. 25%, p=0,003) e classe Killip 3-4 na internação (17% vs. 12%, p=0,01); o escore de risco TIMI foi maior nas mulheres [4 (2, 6) vs. 3 (2, 5), p<0.001]. A mortalidade hospitalar não foi diferente entre os grupos (12,8% vs. 10,5%; p=0,20). Os ECAMs foram numericamente maiores nas mulheres que nos homens tanto durante a internação (16,0% vs. 12,6%, p=0,085) como em longo prazo (28,7% vs. 24,4%, p=0,089), com significância limítrofe. Após a análise multivariada, o sexo feminino não foi associado a ECAMs (HR = 1,14; IC95% 0,86 - 1,51; p = 0,36). Conclusão Em uma coorte prospectiva contemporânea de pacientes com IAMCSST submetidos à ICPp, pacientes do sexo feminino apresentaram idade mais avançada e mais comorbidades no basal que os pacientes do sexo masculino, mas não houve diferenças significativas entre os sexos quanto aos desfechos adversos no hospital ou em longo prazo.

Abstract Background Several studies have shown that women are usually undertreated and have worse outcomes after ST-segment elevation myocardial infarction (STEMI), hence the need to investigate questions related to sex in Brazil to better deal with the problem. Objective To determine whether female sex is still associated with adverse events in a contemporary cohort of patients with STEMI undergoing primary percutaneous coronary intervention (pPCI). Methods This was a prospective cohort study of STEMI patients submitted to pPCI in a tertiary university hospital between March 2011 and December 2021. Patients were categorized into groups based on their sex at birth. The primary clinical outcome was long-term MACCE. Patients were followed-up for up to five years. All hypothesis tests had a two-sided significance level of 0.05. Results Among 1457 patients admitted with STEMI in the study period, 1362 were included and 468 (34.4%) were women. Female patients had a higher prevalence of hypertension (73% vs. 60%, p <0.001), diabetes (32% vs. 25%, p=0.003) and Killip class 3-4 at hospital admission (17% vs. 12%, p=0.01); TIMI risk score was higher among women (4 [2, 6] vs. 3 [2, 5], p<0.001). In-hospital mortality was not different between groups (12.8% vs. 10.5%, p=0.20). In-hospital MACCE (16.0% vs. 12.6%, p=0.085) and long-term MACCE (28.7% vs. 24.4%, p=0.089) were numerically higher in women, with borderline significance. After multivariate analysis, female sex was not associated with MACCE (HR = 1.14; 95% CI 0.86 - 1.51; p = 0.36). Conclusion In a prospective cohort of STEMI patients submitted to pPCI, female patients were older and had more comorbidities at baseline, but no significant differences were found in terms of long-term adverse outcomes.

Avaliação no Mundo Real de um Stent Eluidor de Sirolimus de Hastes Ultrafinas em Pacientes com Infarto do Miocárdio com Supradesnivelamento do Segmento ST Submetidos à Intervenção Coronária Percutânea Primária (Registro INSTEMI) / Real-World Assessment of an Ultrathin Strut, Sirolimus-Eluting Stent in Patients with ST-Elevation Myocardial Infarction Submitted to Primary Percutaneous Coronary Intervention (INSTEMI Registry)

Resumo Fundamento O padrão-ouro atual dos stents farmacológicos (SF) coronários consiste em ligas metálicas com hastes mais finas e polímeros bioabsorvíveis. Objetivos Nosso objetivo foi comparar um stent eluidor de sirolimus de hastes ultrafinas (Inspiron®) com outras plataformas de SF de terceira geração em pacientes com infarto do miocárdio com supradesnivelamento do segmento ST (IAMCSST) submetidos à intervenção coronária percutânea (ICP) primária. Métodos Analisamos dados de um registro multicêntrico de IAMCSST de centros de referência da Região Sul do Brasil. Todos os pacientes foram submetidos à ICP primária, seja com Inspiron® ou outro SF de segunda ou terceira geração. Foi calculado pareamento por escore de propensão (PEP) para gerar grupos semelhantes (Inspiron® versus outros stents) em relação às características clínicas e do procedimento. Todos os testes de hipótese tiveram um nível de significância bilateral de 0,05. Resultados De janeiro de 2017 a janeiro de 2021, 1.711 pacientes foram submetidos à ICP primária, e 1.417 pacientes preencheram nossos critérios de inclusão (709 pacientes no grupo Inspiron® e 708 pacientes no grupo dos outros SF de segunda ou terceira geração). Após PEP, a amostra do estudo foi composta por 706 pacientes (353 pacientes no grupo Inspiron® e 353 pacientes no grupo dos demais SF de segunda ou terceira geração). As taxas de revascularização do vaso alvo (odds ratio [OR] 0,52; intervalo de confiança [IC] 0,21 a 1,34; p = 0,173), trombose de stent (OR 1,00; IC 0,29 a 3,48;p = 1,000), mortalidade (hazard ratio 0,724; IC 0,41 a 1,27; p = 0,257) e os desfechos cardiovasculares maiores (OR 1,170; IC 0,77 a 1,77; p = 0,526) foram semelhantes entre os grupos após um acompanhamento mediano de 17 meses. Conclusão Nossos achados mostram que o stent Inspiron® foi eficaz e seguro quando comparado a outros SF de segunda ou terceira geração em uma coorte contemporânea do mundo real de pacientes com IAMCSST submetidos à ICP primária.

Abstract Background The current gold standard of coronary drug-eluting stents (DES) consists of metal alloys with thinner struts and bioresorbable polymers. Objectives Our aim was to compare an ultrathin strut, sirolimus-eluting stent (Inspiron®) with other third-generation DES platforms in patients with ST-elevation myocardial infarction (STEMI) submitted to primary percutaneous coronary intervention (PCI). Methods We analyzed data from a STEMI multicenter registry from reference centers in the South Region of Brazil. All patients were submitted to primary PCI, either with Inspiron® or other second- or third-generation DES. Propensity score matching (PSM) was computed to generate similar groups (Inspiron® versus other stents) in relation to clinical and procedural characteristics. All hypothesis tests had a two-sided significance level of 0.05. Results From January 2017 to January 2021, 1711 patients underwent primary PCI, and 1417 patients met our entry criteria (709 patients in the Inspiron® group and 708 patients in the other second- or third-generation DES group). After PSM, the study sample was comprised of 706 patients (353 patients in the Inspiron® group and 353 patients in the other the other second- or third-generation DES group). The rates of target vessel revascularization (OR 0.52, CI 0.21 - 1.34, p = 0.173), stent thrombosis (OR 1.00, CI 0.29 - 3.48, p = 1.000), mortality (HR 0.724, CI 0.41 - 1.27, p = 0.257), and major cardiovascular outcomes (OR 1.170, CI 0.77 - 1.77, p = 0.526) were similar between groups after a median follow-up of 17 months. Conclusion Our findings show that Inspiron® was effective and safe when compared to other second- or third-generation DES in a contemporary cohort of real-world STEMI patients submitted to primary PCI.

Extending the Indications of 5-Aminolevulinic Acid for Fluorescence-Guided Surgery for Different Central Nervous System Tumors: A Series of 255 Cases in Latin America

Introduction Fluorescence guidance with 5-aminolevulinic acid (5-ALA) is a safe and reliable tool in total gross resection of intracranial tumors, especially malignant gliomas and cases of metastasis. In the present retrospective study, we have analyzed 5-ALA-induced fluorescence findings in different central nervous system (CNS) lesions to expand the indications of its use in differential diagnoses. Objectives To describe the indications and results of 5-ALA fluorescence in a series of 255 cases. Methods In 255 consecutive cases, we recorded age, gender, intraoperative 5-ALA fluorescence tumor response, and 5-ALA postresection status, as well the complications related to the method. Postresection was classified as '5-ALA free' or '5-ALA residual'. The diagnosis of histopathological tumor was established according to the current classification of the World Health Organization (WHO). Results There were 195 (76.4%) 5-ALA positive cases, 124 (63.5%) of whom underwent the '5-ALA free' resection. The findings in the positive cases were: 135 gliomas of all grades; 19 meningiomas; 4 hemangioblastomas; 1 solitary fibrous tumor; 27 metastases; 2 diffuse large B cell lymphomas; 2 cases of radionecrosis; 1 inflammatory disease; 2 cases of gliosis; 1 cysticercosis; and 1 immunoglobulin G4-related disease.

The Influence of 25 Training Sessions on the Decision-Making Skill of U-12 Soccer Players / A Influência de 25 Sessões de Treino na Capacidade de Tomada de Decisão de Jogadores de Futebol Sub-12

Abstract The aim of this study was to verify the influence of 25 training sessions on the decision-making skill of U-12 soccer players. The sample was comprised of 25 U-12 soccer players from a first division Brazilian club. Decision making was assessed through the TacticUP® online platform. The 25 training sessions were organized based on the core tactical principles of soccer. There was a positive correlation (r=.413, p=.040) between the performance variation of decision-making and the training time for the offensive principles outside the center of play. It was concluded that training improved the decision-making skill of U-12 soccer players with respect to the tactical principles of width and length without the ball, mobility, and offensive unity.

Resumo O objetivo deste estudo foi verificar a influência de 25 sessões de treino na capacidade de tomada de decisão de jogadores de futebol sub-12. A amostra contou com 25 jogadores de futebol sub-12 de um clube de primeira divisão do Brasil. Avaliou-se a tomada de decisão através da plataforma online TacticUP®. As 25 sessões de treino foram organizadas baseadas nos princípios táticos fundamentais do futebol. Verificou-se correlação positiva (r=0,413, p=0,040) entre a variação do desempenho da tomada de decisão e o tempo de treino para os princípios ofensivos fora do centro de jogo. Conclui-se que o treino melhorou a capacidade de tomada de decisão de jogadores de futebol sub-12, para os princípios de espaço sem bola, mobilidade e unidade ofensiva.

Valor prognóstico da amplitude de distribuição das hemácias em pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST submetidos à intervenção coronariana percutânea / Prognostic value of red cell distribution width in ST-segment elevation myocardium infarction patients undergoing percutaneous coronary intervention

Objetivo: Determinar os valores da amplitude de distribuição das hemácias em pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST submetidos à intervenção coronária percutânea primária e avaliar sua associação com resultados adversos. Métodos: Os níveis de amplitude de distribuição das hemácias foram medidos em pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST antes da intervenção coronária percutânea primária e divididos conforme valor das amplitudes de distribuição das hemácias. Após a alta hospitalar, os pacientes foram acompanhados por até 3 anos para a ocorrência de eventos cardiovasculares adversos maiores e mortalidade a longo prazo. Resultados: Foram incluídos 893 pacientes com idade média de 60,7 (±12,5) anos, e 66,3% eram do sexo masculino. Na análise multivariada, a hemácia permaneceu como preditor independente de mortalidade a longo prazo. A área sob a curva para mortalidade a longo prazo foi de 0,64 (IC95% 0,61-0,67; p<0,0001). Amplitudes de distribuição das hemácias <13,3 tiveram valor preditivo negativo de 87,1% para mortalidade por todas as causas. Conclusão: Um valor elevado de amplitude de distribuição das hemácias é um preditor independente de mortalidade a longo prazo e eventos cardiovasculares adversos maiores em pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST submetidos à intervenção coronária percutânea primária. Amplitudes de distribuição das hemácias baixas têm baixo tem um excelente valor preditivo negativo para mortalidade a longo prazo. (AU)

Objective: To determine red cell distribution width values in ST-elevation acute myocardial infarction patients undergoing primary percutaneous coronary intervention and to evaluate its association with adverse outcomes. Methods: Red cell distribution width levels were measured in ST-segment elevation myocardial infarction patients before primary percutaneous coronary intervention and divided into low and high red cell distribution width. After discharge, patients were followed for up to 3 years for the occurrence of long-term major adverse cardiovascular events and mortality. Results: A total of 893 patientes were with a mean age of 60.7 (±12.5) years, 66.3% were male. In multivariate analysis, the red cell distribution width remained as an independent predictor of long-term mortality. The area under the curve for long-term mortality was 0.64 (95%CI0.61-0.67; p<0.0001). Red cell distribution width<13.3 had a negative predictive value of 87.1% for all-cause mortality. Conclusion: High number of red cell distribution width is an independent predictor of long-term mortality and major adverse cardiovascular events in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. A low number of red cell distribution width has an excellent negative predictive value for long-term mortality. Patients with sustained elevated levels of red cell distribution width have worse outcomes at long-term follow-up. (AU)

An overview of care change in the last 6 year in primary PCI in ST-elevation myocardial infarction in a Tertiary University Brazilian Hospital / Panorama da mudança do cuidado nos últimos 6 anos na ICP primária em infarto agudo do miocárdio com supradesnivelamento do segmento ST em hospital universitário de nível terciário

Background: Although new studies and guidelines can be considered useful tools, it does not necessarily mean they are put into clinical practice. Objective: The aim of the current analysis was to assess the changes in primary percutaneous coronary intervention (PCI) and mortality in a tertiary university hospital in southern Brazil during a six-year period .Methods: We have included consecutive patients with ST-elevation myocardial infarction (STEMI) who underwent primary PCI between March 2011 and February 2017. Previous clinical history, characteristics of the procedure, and reperfusion strategies were collected. In-hospital, short and long-term mortalities were also evaluated. The significance level adopted for all tests was 5%. Results: There was an increase in the use of radial access in patients from 20.0% in 2011 to 62.7% in 2016 (ptrend < 0.0001). Moreover, thrombus aspiration decreased significantly from 66.7% in 2011 to less than 3.0% in 2016 (ptrend < 0.0001). In-hospital, short and long-term mortalities remained reasonably stable from 2011 to 2016 (ptrend > 0.05). However, a lower in-hospital mortality was observed in patients treated through radial access (p < 0.001). Cardiogenic shock occurred in 11.1%, without statistical differences in the period (ptrend = 0.39), while long-term mortality rate decreased from 80.0% in 2011 to 27.3% in 2016 in this patient group (ptrend = 0.29). Conclusions: During a 6-year follow-up period, primary PCI characteristics underwent important modifications. Radial access became widely used, with a decrease in mortality with the use of this route, while aspiration thrombectomy became a rare procedure. The incidence of cardiogenic shock remained stable, but has shown a reduction in its mortality

Comparação de escores anatômicos e clínicos na predição de desfechos em intervenções coronárias percutâneas primárias / Comparison of anatomical and clinical scores in predicting outcomes in primary percutaneous coronary intervention

Fundamento: Diferentes escores baseados em variáveis anatômicas e/ou clínicas têm sido desenvolvidos para estratificação de risco em pacientes submetidos à intervenção coronariana percutânea (ICP). Estudos comparando a capacidade desses modelos na predição de eventos cardíacos e cerebrovasculares adversos maiores (ECCAM) em pacientes submetidos à ICP primária são escassos. Objetivo: O objetivo desse estudo foi o de comparar os escores SYNTAX (SS), Clinical SYNTAX (CSS), ACEF e ACEF modificado (ACEF Mod ) na predição de ECCAM em pacientes com infarto agudo do miocárdico com supradesnivelamento do segmento ST (IAMCSST) submetidos à ICP primária. Métodos: Foram analisados 311 pacientes consecutivos com IAMCSST submetidos a ICP primária entre abril/2011 e dezembro/2015. As áreas sob a curva característica de operação do receptor (ROC) foram calculadas para avaliar a habilidade desses escores em predizer ECCAM. O nível de significância adotado em todos os testes foi de 5%. Resultados: Os pacientes apresentaram idade média de 60,2 ± 12,0 anos, 35,4% eram do sexo feminino e 22,5% eram diabéticos. A ocorrência de ECCAM foi observada em 23,8% dos participantes. A área sob a curva ROC foi 0,586 (p = 0,028) para ACEF, 0,616 (p = 0,003) para SS, 0,623 (p = 0,002) para ACEF Mod e 0,658 (p < 0,001) para CSS. Na análise multivariada, apenas SS (p = 0,011) e CSS (p = 0,002) foram preditores independentes de ECCAM. Conclusões: SS e CSS elevados foram preditores independentes de ECCAM. Em nossa coorte de pacientes com IAMCSST submetidos à ICP primária, o SS calculado à cineangiocoronariografia inicial mostrou-se uma ferramenta útil para predizer ECCAM

Background: Different scores based on anatomical and/or clinical features have been developed for risk stratification of patients undergoing percutaneous coronary intervention (PCI). Studies comparing the ability of these different models in predicting major adverse cardiac and cerebrovascular events (MACCE) in patients submitted to primary PCI are limited. Objectives: The aim of this study was to compare the ability of the scores SYNTAX (SS), Clinical SYNTAX (CSS), age, creatinine and ACEF, and modified ACEF (ACEF Mod ) to predict MACCE in patients with ST-elevation myocardial infarction (STEMI) submitted to primary PCI. Methods: We analyzed 311 consecutive patients with STEMI submitted to primary PCI between April/2011 and December/2015. The area under the ROC curve was calculated to evaluate the ability of these scores in predicting MACCE. P-values were considered significant at < 0.05. Results: Mean age of the patients was 60.2 ± 12.0 years, 35.4% were females, and 22.5% had diabetes. MACCE occurred in 23.8% of the patients. The area under the ROC curve was 0.586 (p = 0.028) for ACEF, 0.616 (p = 0.003) for SS, 0.623 (p = 0.002) for ACEF Mod , and 0.658 (p < 0.001) for CSS. In multivariate analysis, only high SS (p = 0.011) and CSS (p = 0.002) were independent predictors of MACCE. Conclusions: High SS and CSS were independent predictors of MACCE. In our cohort of STEMI patients undergoing primary PCI, pure anatomical SS calculated at the baseline coronary angiography was a useful tool to predict MACCE

On- vs. off-hours admission of patients with ST-elevation acute myocardial infarction undergoing percutaneous coronary interventions: data from a tertiary university Brazilian hospital

Introduction: Early reperfusion therapy is crucial in patients with ST-elevation myocardial infarction (STEMI). Off-hours hospital presentation may increase the time from pain to coronary reperfusion, and it may be responsible for increased cardiovascular outcomes. The aim of this study was to compare the effect of different times of presentation (on- and off-hours) on early mortality and major cardiovascular outcomes in patients with STEMI who underwent primary percutaneous coronary intervention (PCI). Methods: We have included consecutive patients with STEMI who underwent primary PCI between April 2011 and November 2016 in a tertiary university hospital in southern Brazil. Patients were divided into on- and off-hours admission. In-hospital and 30-day outcomes were evaluated. Results: A total of 301 patients (57.4%) were admitted during off-hours, and 223 (42.5%) during on-hours. Baseline characteristics were well balanced between the two groups. Median door-to-balloon time was higher in the off-hours group than in the on-hours group: 75 min (IQR 60-95) vs. 60 min (IQR 50-73.7) respectively (p < 0.001). In-hospital mortality was similar between groups (odds ratio [OR] = 0.56; 95% confidence interval [95%CI] 0.31-1.03; p = 0.06) and at 30-day follow-up (OR = 0.2; 95%CI 0.02-1.72 p = 0.14). In the matched cohort, no difference was found in the rates of in-hospital mortality (OR = 2.0; 95%CI 0.75-5.32; p = 0.16) and 30-day MACE (OR= 0.9; 95%CI 0.49-1.66; p = 0.75). Conclusions: In our center with PCI available 24/7 - without in-house staff - we did not observe any difference in patient characteristics, management, and outcomes, although a significant longer door-to-balloon time was found in patients treated during night shifts. Our results are consistent with those of other trials.

Visual search strategy of soccer players according to different age groups

AIMS: The aim of this study was to assess the visual search strategy of soccer players from different age groups. METHODS: The sample comprised 51 youth soccer players. The instrument used to collect and analyse data was the Mobile Eye. This system is used to verify gaze behaviour through visual focus. Players were grouped according to their age group: U-13 (17), U-15 (17), U-17 (17). Participants were presented with a video based test. Visual search stimuli were grouped into five categories: "player in possession of the ball"; "ball"; "teammates"; "opponent"; "space". The number and time of fixations made by players, in each stimuli category was analysed. One-way ANOVA was performed to compare the three groups. RESULTS: Results displayed significant differences in one of the categories. The "space" category displayed significant differences in the number of fixations between U-13 (74.35±12.41) compared to U-15 (58.78±14.22) and U-17 (61.88±16.44) soccer players. No other significant differences were found in other categories. CONCLUSION: The U-13 players employed most of their visual search related with "space" compared with players from the U-15 and U-17 age groups. These findings are important for coaches and researchers to understand how visual search strategy change according to age group.(AU)

Síndrome coronariana aguda como apresentação atípica do fenômeno de roubo subclávio / Acute coronary syndrome as an atypical presentation of the phenomenon of subclavian steal

Roubo coronariano da subclávia (RCS) é um fenômeno raro que ocorre em pacientes submetidos a cirurgia de revascularização miocárdica com enxerto de artéria torácica interna esquerda (ATIE) e que causa estenose da artéria subclávia ipsilateral e proximal à origem da ATIE. Relatamos o caso de um paciente masculino de 65 anos que apresentou quadro atípico de síndrome do RCS, manifestando-se como síndrome coronariana aguda no pós-operatório de cirurgia vascular (AU)

Coronary subclavian steal (CSS) is a rare phenomenon that occurs in patients undergoing coronary artery bypass graft surgery using the left internal thoracic artery (LITA) causing stenosis of the ipsilateral subclavian artery proximal to the origin of the LITA. We report the case of a 65-year-old male patient who presented with atypical CSS syndrome, manifesting as acute coronary syndrome after vascular surgery (AU)

Blood pressure levels and body mass index in Brazilian adults with Down syndrome / Níveis de pressão arterial e índice de massa corporal em adultos brasileiros com síndrome de Down

ABSTRACT CONTEXT AND OBJECTIVE: Increased life expectancy among people with Down syndrome (DS) has introduced new environmental factors that may affect blood pressure (BP) and/or lead to obesity in this population. The aim here was to investigate BP levels and body mass index (BMI) in adults with DS, correlating these data with the patients' sex and age. DESIGN AND SETTING: Analytical cross-sectional observational study conducted in special schools in Curitiba (PR), Brazil. METHODS: 97 adult patients were included. BP was measured in accordance with the established guidelines. BMI was calculated by dividing the weight by the height squared (kg/m2). RESULTS: Sex had no influence on BMI; nor did systolic BP (SBP) or diastolic BP (DBP). The age range was from 18 to 56 years. No correlation was observed between increasing age and greater BMI or BP. Eighty-six individuals (88.7%) presented normal BP, eleven (11.3%) prehypertension and none hypertension. Twenty patients (20.4%) presented BP lower than 90 × 60 mmHg. BMI ranged from 18 to 48 kg/m2 (mean of 28.8 ± 3.92 kg/m2): 21.9% had normal weight; 40.7% were overweight; and 25.3% had obesity class I, 9.9% class II and 2.2% class III. Higher BMI was associated with significantly greater SBP and DBP (P = 0.0175 and P = 0.0015). CONCLUSION: Sex and age did not influence SBP, DBP or BMI in Brazilian adults with DS. Higher BMI was associated with greater BP (both systolic and diastolic).

RESUMO CONTEXTO E OBJETIVO: O aumento da expectativa de vida das pessoas com síndrome de Down (SD) introduziu novos fatores ambientais que podem afetar a pressão sanguínea e/ou levar a obesidade nessa população. O objetivo foi investigar os níveis de pressão arterial (PA) e o índice de massa corporal (IMC) em adultos com SD, correlacionando estes dados com a idade e o gênero dos pacientes. DESENHO E LOCAL: Estudo observacional, transversal e analítico, realizado em escolas especiais em Curitiba (PR), Brasil. MÉTODOS: Foram incluídos 97 pacientes adultos. A aferição da PA foi feita de acordo com as diretrizes estabelecidas. O IMC foi calculado dividindo-se o peso pela altura ao quadrado (kg/m2). RESULTADOS: O gênero não influenciou o IMC, a pressão arterial sistólica (PAS) e diastólica (PAD). A idade variou de 18 a 56 anos. Não foi observada correlação entre aumento da idade e maior IMC ou pressão arterial. 86 indivíduos (88,7%) apresentaram PA normal, 11 (11,3%) pré-hipertensão e nenhum hipertensão. Vinte (20,4%) apresentaram PA inferior a 90 × 60 mmHg. O IMC variou entre 18 e 48 kg/m2 (média de 28,8 ± 3,92), 21,9% tinham peso normal, 40,7% sobrepeso, 25,3% obesidade grau I, 9,9 % grau II e 2,2% obesidade grau III. Aumento significativo da PAS e PAD foi associado com elevação do IMC (P = 0,0175 e P = 0,0015). CONCLUSÃO: Verificou-se que sexo e idade não influenciaram PAS, PAD e IMC em adultos brasileiros com SD. O aumento significativo da PAS e PAD foi associado com o aumento do IMC.

A eficiência do comportamento tático e a data de nascimento influenciam a performance tática de jogadores de futebol da categoria sub-11? / Do tactical behavior efficiency and birthdate influence on tactical performance of under-11 soccer players?

Resumo O objetivo do estudo é verificar se a eficiência do comportamento tático e os quartis de nascimento influenciam a performance tática de jogadores de futebol da categoria sub-11. A amostra foi composta por 102 jogadores de futebol da categoria sub-11, participantes de campeonatos regionais. O instrumento utilizado para avaliar a performance tática foi o FUT-SAT. Utilizou-se o teste de Regressão Logística Multinomial para verificar associação entre as variáveis, a partir da divisão da eficiência do comportamento e da performance tática em tercis (p ≤ 0,05). Verificou-se associações positivas entre a eficiência do comportamento tático e os índices de performance tática para o princípio de unidade defensiva. Encontrou-se associações positivas entre data de nascimento e o índice de performance tática em jogadores nascidos no último quartil do ano. Conclui-se que a performance tática sofreu influência da data de nascimento e da eficiência do comportamento tático.(AU)

Abstract The aim of this study was to check if the tactical behavior efficiency and birthdate quartiles influenced the tactical performance of under-11 soccer players. The sample comprised of 102 under-11 soccer players, participants in regional level competitions. The instrument used for the tactical performance assessment was FUT-SAT. Multinomial Logistic Regression tests were used to verify the association between the variables, through the division of tactical behavior efficiency and tactical performance into terciles (p ≤ 0.05). Positive associations were verified between tactical behavior efficiency and tactical performance index for the defensive unity principle. Also, between the birthdate and the tactical performance index in players who were born within the last quartile of the year. It was concluded that tactical performance was influenced by birthdate and the tactical behavior efficiency.(AU)

Infection of the central nervous system with dengue virus 3 genotype I causing neurological manifestations in Brazil

Abstract: A case of dengue virus 3 (DENV-3) genotype I infection with neurological manifestations occurred in Belo Horizonte, Minas Gerais in October 2012. The serotype was detected by PCR, and the genotype was assessed by sequencing and phylogenetic analysis of the C-prM region. The virus causing neurological manifestations clustered with other sequences of DENV-3 genotype I. Because neurological manifestations of DENV are possibly misdiagnosed in Brazil, this study serves as an alert of the importance of DENV diagnoses in CNS infections.

Desfechos cardiovasculares em pacientes tratados com intervenção percutânea coronária primária em hospital geral terciário / Cardiovascular outcomes in patients treated with primary percutaneous coronary intervention in a general tertiary hospital

Introdução: Existem poucos dados nacionais a respeito dos resultados da intervenção coronária percutânea (ICP) primária, e os registros são uma ótima ferramenta para a avaliação do perfil dos pacientes e dos desfechos pós-procedimento. O objetivo deste estudo foi descrever o perfil dos pacientes com ICP primária em um hospital geral terciário, bem como avaliar os desfechos cardiovasculares hospitalares e em 30 dias. Métodos: Foram incluídos todos os pacientes submetidos à ICP primária entre 2012 a 2015. Trata-se de um registro prospectivo, no qual os desfechos clínicos analisados foram a ocorrência de morte, infarto ou acidente vascular cerebral, e eventos cardiovasculares e cerebrovasculares maiores (ECCAM). Resultados: Foram incluídos 323 pacientes, com idade 60 ± 12 anos, sendo 66,7% do sexo masculino, 28,5% diabéticos. Na admissão, 13,5% dos pacientes apresentavam-se em Killip III/IV. O tempo dor-porta foi de 4,4 ± 2,5 horas e o tempo porta-balão foi 68,0 ± 34,0 minutos. A mortalidade hospitalar foi de 9,9%, e 18,3% dos pacientes apresentaram ECCAM em 30 dias. Conclusões: Os pacientes submetidos à ICP primária apresentaram taxas elevadas de ECCAM, que podem ser atribuídas à apresentação clínica mais grave e a um longo tempo de isquemia. Um atendimento mais rápido destes pacientes, variável modificável, demanda uma atenção imediata do sistema de saúde

Background: There are few national data on the results of primary percutaneous coronary intervention (PCI), and registries are a great tool for assessing patient profiles and post-procedure outcomes. The aim of this study was to describe the profile of patients with primary PCI in a general tertiary hospital, as well as to evaluate in-hospital and 30-day cardiovascular outcomes. Methods: The study included all patients submitted to primary PCI between 2012 and 2015. This was a prospective registry, in which the analyzed clinical outcomes were the occurrence of death, infarction, or stroke, and major cardiovascular and cerebrovascular events (MACCE). Results: The study included 323 patients, aged 60 ± 12 years, of whom 66.7% were males, 28.5% diabetics. At admission, 13.5% of the patients were classified as Killip class III/IV. The pain-to-door time was 4.4 ± 2.5 hours and the door-to-balloon time was 68.0 ± 34.0 minutes. Hospital mortality was 9.9%, and 18.3% of the patients presented MACCE in 30 days. Conclusions: Patients submitted to primary PCI had high rates of MACCE, which can be attributed to the more severe clinical presentation and to a long time of ischemia. The faster treatment of these patients, a modifiable variable, demands immediate attention from the health system

Coerência local em crianças de 10 a 13 anos / Local coherence in children aged 10 to 13 / Coherencia local en niños de 10 a 13 años

A coerência local é caracterizada pela produção de inferências entre uma sentença e outra a partir da leitura de um texto. Aplicou-se o Local Coherence Inference Test, traduzido para a língua portuguesa, em 40 crianças normais do ensino fundamental, de 10 a 13 anos, com o objetivo de avaliar o desempenho delas. Consideraram-se o número de acertos e o tempo gasto na realização do teste, e avaliaram-se os seguintes aspectos: quociente intelectual (QI), idade e nível escolar. Os resultados mostraram que a escolaridade e a idade se correlacionam significativamente com o maior número de acertos e a velocidade de execução do teste. O nível intelectual se correlacionou significativamente com o número de acertos, porém não houve correlação significativa entre QI e velocidade na execução do teste. Este estudo contribui para o entendimento do processo de coerência local e sugere pesquisas posteriores nessa área, como a elaboração de um instrumento que avalie mais processos específicos envolvidos na compreensão textual.

Local coherence is characterized by the production of inference between two sentences in a reading passage. A Portuguese version of the Local Coherence Inference Test was applied to 40 normal children aged 10-13 in basic education, to evaluate their performance in this instrument by correlating the number of correct answers and time spent doing the test according to age, intelligence quotient (IQ) and scholar grade. The results showed that both educational level and ages correlated significantly with the highest number of correct answers and test time performance. The intellectual level was also significantly correlated with the number of correct answers, whereas there was no marked correlation between IQ and speed in performing the test. This study contributes to the understanding of local coherence process as well as suggests subsequent research in this area, as building an instrument to assess more specific processes involved in reading comprehension.

La coherencia local se caracteriza por la producción de inferencias entre una oración y otra a partir de la lectura de un texto. Se aplicó el Local Coherence Inference Test traducido al portugués en 40 niños normales de 10 a 13 años de edad, de la enseñanza primaria, con el objetivo de evaluar el desempeño de los niños en este instrumento, teniendo en cuenta el número de respuestas correctas y el tiempo empleado en la realización del test, evaluando aspectos como: edad, coeficiente de inteligencia (CI) y grado de escolaridad. Los resultados mostraron que el grado de escolaridad y la edad se correlacionan significativamente con mayor número de respuestas correctas y con la velocidad en la ejecución del test. El nivel intelectual se correlaciona significativamente con el número de respuestas correctas, sin embargo, no hubo correlación significativa entre CI y velocidad en la ejecución del test. Este estudio contribuye a la comprensión del proceso de coherencia local y sugiere una mayor investigación en esta área, como la construcción de un instrumento para evaluar procesos más específicos implicados en la comprensión de textos.

INFLUÊNCIA DO EFEITO DA IDADE RELATIVA E DO COMPORTAMENTO TÁTICO SOBRE O DESEMPENHO TÁTICO DE JOGADORES DE FUTEBOL DA CATEGORIA SUB-17 / INFLUENCE OF THE RELATIVE AGE EFFECT AND TACTICAL BEHAVIOR ON THE TACTICAL PERFORMANCE OF U-17 YOUTH SOCCER PLAYERS

RESUMOO objetivo deste estudo é verificar as associações entre o período do ano de nascimento dos jogadores e a eficiência do comportamento tático sobre o desempenho tático em jogadores de futebol da categoria sub-17. A amostra foi composta por 6308 ações táticas, realizadas por 100 jogadores. O instrumento utilizado foi o Sistema de Avaliação Tática no Futebol (FUT-SAT). Utilizou-se a Regressão Logística Multinomial para verificação da associação entre o desempenho tático com a eficiência do comportamento dos princípios táticos e a data de nascimento dos jogadores. Verificaram-se associações positivas entre a eficiência do comportamento tático e o desempenho tático para os princípios Espaço, Penetração e Contenção. Foram encontradas associações positivas entre o período do ano de nascimento e o desempenho tático para os jogadores nascidos no 2º e 3º quartil. Conclui-se que para esta amostra, a eficiência do comportamento tático e a data de nascimento influenciaram o desempenho tático.

ABSTRACTThis study aimed to assess the associations between the birth period of soccer players and tactical behavior efficiency on the tactical performance in soccer players of Under-17. The sample comprised 6308 tactical actions, performed by 100 players. The instrument used to collect and analyze data was the System of Tactical Assessment in Soccer (FUT-SAT). Multinomial Logistic Regression was used to assess the association between the tactical performance and behavior efficiency of tactical principles and players birthdate. Results displayed positive associations between the tactical behavior efficiency and tactical performance of the principles of Width and Length, Penetration and Delay. Positive associations were also found between the birth period and tactical performance of players born within the 2nd and 3rd quartile. It is concluded that for this sample, tactical behavior efficiency and birth period influenced tactical performance.

Relação entre impulsividade e comportamento tático de jogadores de futebol Sub-11 / Relation between impulsivity and tactical behavior of Under-11 youth soccer players / Relación entre impulsividad y comportamiento táctico de jugadores de fútbol Sub-11

O presente estudo tem por objetivo verificar de que forma a impulsividade se relaciona com os comportamentos táticos de jogadores de futebol da categoria Sub- -11. A amostra foi composta por 30 jogadores de futebol da categoria Sub-11. O instrumento utilizado para avaliar os comportamentos táticos foi o FUT-SAT, e, para avaliação da impulsividade, adotou-se a versão brasileira do Iowa Gambling Task (IGT-Br). Utili­zaram-se o teste de Shapiro-Wilk para verificar a distribuição dos dados e o teste de correlação de Pearson a fim de examinar a correlação entre as variáveis (p < 0,05). Verificou-se uma correlação negativa entre a impulsividade e a realização do princípio tático ofensivo de mobilidade. Dessa forma, jogadores menos impulsivos têm maiores chances de realizar comportamentos associados a esse princípio de maneira efetiva. Conclui-se que a impulsividade se relaciona com o comportamento tático de jogadores de futebol da categoria Sub-11, especificamente no princípio da mobilidade.

The aim of this study is to examine how impulsivity relates to the tactical behavior of under-11 youth soccer players. The sample comprised 30 Under-11 youth soccer players. FUT-SAT was used to assess the tactical behavior and the Iowa Gambling Task Brazilian version (IGT-Br) was used to evaluate impulsivity. Shapiro-Wilk test was performed to verify data distribution and Pearson correlation was used to verify the correlation between the variables (p < 0.05). Negative correlation between impulsivity and the performance of the offensive tactical principle of depth mobility was verified. Therefore, less impulsive players are more likely to engage in behaviors associated with this principle. It was concluded that the impulsivity relate to the tactical behavior of Under-11 youth soccer players, specifically with the principle of depth mobility.

El objetivo del estudio es comprobar cómo la impulsividad se relaciona con el comportamiento táctico de jugadores de fútbol Sub-11. La muestra consistió en 30 jugadores de fútbol Sub-11. El instrumento utilizado para evaluar los comportamientos tácticos fue el FUT-SAT y para evaluación de la impulsividad se utilizó el Iowa Gambling Task versión brasileña (IGT-Br). Se utilizó el teste Shapiro-Wilk para verificar la distribución de los datos y el teste de correlación de Pearson para comprobar la correlación entre las variables (p < 0,05). Se verificó una correlación negativa entre la impulsividad y la realización del principio táctico ofensivo de mobilidad. Así los jugadores menos impulsivos son más propensos a involucrarse en comportamientos asociados con este principio de manera efectiva. Se concluyó que la impulsividad se relación com el comportamiento táctico de jugadores de fútbol Sub-11, específicamente el principio de la mobilidad.