A versatile physical phantom design and construction for I-125 dose measurements and dose-to-medium determination.

PURPOSE: In this paper we present a phantom designed to provide conditions to generate set of "true" independent reference data as requested by TG-186, and mitigating the scarcity of experimental studies on brachytherapy validation. It was used to perform accurate experimental measurements of dose of 125I brachytherapy seeds using LiF dosimeters, with the objective of experimentally validating Monte Carlo (MC) calculations with model-based dose calculation algorithm (MBDCA). In addition, this work intends to evaluate a methodology to convert the experimental values from LiF into dose in the medium. METHODS AND MATERIALS: The proposed PMMA physical phantom features cavities to insert a LiF dosimeter and a 125I seed, adjusted in different configurations with variable thickness. Monte Carlo calculations performed with MCNP6.2 code were used to score the absorbed dose in the LiF and the dose conversion parameters. A sensitivity analysis was done to verify the source of possible uncertainties and quantify their impact on the results. RESULTS: The proposed phantom and experimental procedure developed in this work provided precise dose data within 5.68% uncertainty (k = 1). The achieved precision made it possible to convert the LiF responses into absorbed dose to medium and to validate the dose conversion factor methodology. CONCLUSIONS: The proposed phantom is simple both in design and as in its composition, thus achieving the demanded precision in dose evaluations due to its easy reproducibility of experimental setup. The results derived from the phantom measurements support the dose conversion methodology. The phantom and the experimental procedure developed here can be applied for other materials and radiation sources.

Guideline of the Brazilian Society of Cardiology on Diagnosis and Treatment of Patients with Chagas Disease Cardiomyopathy / Diretriz da Sociedade Brasileira de Cardiologia sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas

This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.  Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities.   Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.  The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.  The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.     Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.

Esta diretriz teve como objetivo principal atualizar os conceitos e formular as normas de conduta e evidências científicas que as suportam, quanto ao diagnóstico e tratamento da CDC, com especial ênfase na base de racionalidade que a embasou. A DC no século XXI mantém padrão epidemiológico de endemicidade em 21 países da América Latina. Investigadores e gestores de países endêmicos e não endêmicos indigitam a necessidade de se adotarem políticas abrangentes, de saúde pública, para controle eficaz da transmissão inter-humanos da infecção pelo T. cruzi, e obter-se nível otimizado de atendimento aos indivíduos já infectados, com foco em oportunização diagnóstica e terapêutica. Mecanismos patogênicos e fisiopatológicos da CDC foram revisitados após atualização aprofundada e ficou bem consolidada a noção de que necrose e fibrose sejam estimuladas pela persistência parasitária tissular e reação imune adversa, como mecanismos fundamentais, coadjuvados por distúrbios autonômicos e microvasculares. Alguns deles recentemente constituíram alvos potenciais de terapêuticas. A história natural das fases aguda e crônica foi revista, com realce para a transmissão oral, a forma indeterminada e as síndromes crônicas. Metanálises recentes de estudos observacionais estimaram o risco de evolução a partir das formas aguda e indeterminada e de mortalidade após instalação da cardiomiopatia crônica. Condutas terapêuticas aplicáveis aos indivíduos com a FIDC foram abordadas especificamente. Todos os métodos para detectar alterações estruturais e/ou funcionais com variadas técnicas de imageamento cardíaco também foram revisados, com recomendações de uso nos vários cenários clínicos. Estratificação de risco de mortalidade fundamentada no escore de Rassi, com estudos recentes de sua aplicação, foi complementada por métodos que detectam fibrose miocárdica. A metodologia atual para diagnóstico etiológico e as consequentes implicações do tratamento tripanossomicida mereceram enfoque abrangente e aprofundado. Também o tratamento de pacientes em risco ou com insuficiência cardíaca, arritmias e eventos tromboembólicos, baseado em recursos farmacológicos e complementares, recebeu especial atenção. Capítulos suplementares subsidiaram as condutas aplicáveis a diversos contextos especiais, entre eles o da co-infecção por T. cruzi/HIV, risco durante cirurgias, em grávidas, na reativação da infecção após transplante cardíacos, e outros.    Por fim, dois capítulos de grande significado social, abordando a estruturação de serviços especializados para atendimento aos indivíduos com a CDC, e revisando os conceitos de cardiopatia grave e suas implicações médico-trabalhistas completaram esta diretriz. 

Modeling the diffusion-erosion crossover dynamics in drug release.

A computational model is proposed to investigate drug delivery systems in which erosion and diffusion mechanisms are participating in the drug release process. Our approach allowed us to analytically estimate the crossover point between those mechanisms through the value of the parameter b (b_{c}=1) and the scaling behavior of parameter τ on the Weibull function, exp[-(t/τ)^{b}], used to adjust drug release data in pharmaceutical literature. Numerical investigations on the size dependence of the characteristic release time τ found it to satisfy either linear or quadratic scaling relations on either erosive or diffusive regimes. Along the crossover, the characteristic time scales with the average coefficient observed on the extreme regimes (i.e., τ∼L^{3/2}), and we show that this result can be derived analytically by assuming an Arrhenius relation for the diffusion coefficient inside the capsule. Based on these relations, a phenomenological expression for the characteristic release in terms of size L and erosion rate κ is proposed, which can be useful for predicting the crossover erosion rate κ_{c}. We applied this relation to the experimental literature data for the release of acetaminophen immersed in a wax matrix and found them to be consistent with our numerical results.

Effect of a Marathon on Skin Temperature Response After a Cold-Stress Test and Its Relationship With Perceptive, Performance, and Oxidative-Stress Biomarkers.

CONTEXT: Although skin-temperature assessment has received much attention in recent years as a possible internal-load measurement, scientific evidence is scarce. PURPOSE: To analyze baseline skin temperature and its rewarming through means of a cold-stress test before and after performing a marathon and to study the association between skin temperature and internal/external-load measurements. METHODS: A total of 16 runners were measured 48 and 24 h before and 24 and 48 h after completing a marathon. The measurements on each day of testing included urine biomarkers of oxidative stress, pain and fatigue perception, skin temperature (at baseline and after a cold-stress test), and jump performance. RESULTS: Reduced jump performance (P < .01 and effect size [ES] = 0.5) and higher fatigue and pain perception were observed 24 h after the marathon (P < .01 and ES > 0.8). Although no differences in baseline skin temperature were observed between the 4 measuring days, posterior legs presented lower constant (P < .01 and ES = 1.4) and higher slope (P = .04 and ES = 1.1) parameters in the algorithmic equations fitted for skin-temperature recovery after the cold-stress test 24 h after the marathon than on the day before the marathon. Regressions showed that skin-temperature parameters could be predicted by the ratio of ortho-tyrosine isomer to phenylalanine (oxidative stress biomarker) and body fat composition, among others. CONCLUSIONS: Although baseline skin temperature was not altered 24 or 48 h after a marathon, the application of cold stress after the marathon would appear to be a good method for providing information on vasoconstriction and a runner's state of stress.

Association between Microvolt T-Wave Alternans and Malignant Ventricular Arrhythmias in Chagas Disease / Associação entre Microalternância de Onda T e Arritmias Ventriculares Malignas na Doença de Chagas

Abstract Background: Sudden cardiac death is the most frequent death mechanism in Chagas disease, responsible for 55% to 65% of the deaths of patients with chronic Chagas cardiomyopathy (CCC). The most often involved electrophysiological mechanisms are ventricular tachycardia and ventricular fibrillation. The implantable cardioverter defibrillator (ICD) has a beneficial role in preventing sudden death due to malignant ventricular arrhythmias, and, thus the correct identification of patients at risk is required. The association of microvolt T-wave alternans (MTWA) with the appearance of ventricular arrhythmias has been assessed in different heart diseases. The role of MTWA is mostly unknown in patients with CCC. Objectives: To evaluate the association between MTWA and the occurrence of malignant ventricular arrhythmias in patients with CCC. Method: This is a case-control study including patients with CCC and ICD, with history of malignant ventricular arrhythmias (case group), and patients with CCC and no history of those arrhythmias (control group). The MTWA test results were classified as negative and non-negative (positive and indeterminate). The significance level adopted was a = 0.05. Results: We recruited 96 patients, 45 cases (46.8%) and 51 controls (53.1%). The MTWA test was non-negative in 36/45 cases (80%) and 15/51 controls (29.4%) [OR = 9.60 (95%CI: 3.41 - 27.93)]. After adjustment for known confounding factors in a logistic regression model, the non-negative result continued to be associated with malignant ventricular arrhythmias [OR = 5.17 (95%CI: 1.05 - 25.51)]. Conclusion: Patients with CCC and history of malignant ventricular arrhythmias more often have a non-negative MTWA test as compared to patients with no history of arrhythmia.

Resumo Fundamento: A morte súbita cardíaca é o mecanismo de morte mais comum na doença de Chagas, responsável pelo óbito de 55% a 65% dos pacientes com cardiomiopatia chagásica crônica (CCC). Os mecanismos mais frequentemente envolvidos são as taquiarritmias ventriculares. O cardioversor-desfibrilador implantável (CDI) apresenta impacto na redução da mortalidade por arritmias ventriculares e faz-se necessária a correta identificação de pacientes sob risco. A associação de microalternância de onda T (MTWA) com o aparecimento de arritmias ventriculares foi avaliada em diferentes cardiopatias através de um teste. O papel da MTWA na identificação de pacientes sob risco na CCC permanece incerto. Objetivo: Avaliar a associação entre MTWA e a ocorrência de arritmias ventriculares malignas na CCC. Método: Trata-se de um estudo caso-controle, que incluiu pacientes com CCC em uso de CDI, com história prévia de arritmias ventriculares malignas (casos) ou sem história prévia (controles). Os resultados do teste foram classificados em negativo e não negativo (positivo e indeterminado). O nível de significância foi a = 0,05. Resultado: Foram recrutados 96 pacientes, 45 no grupo caso (46,8%) e 51 no grupo controle (53,1%). O teste de MTWA apresentou resultado não negativo em 36/45 pacientes no grupo caso (80%) e 15/51 no grupo controle (29,4%), OR = 9,60 (IC95%: 3,41 - 27,93). Após ajuste para fatores de confusão num modelo de regressão logística, o resultado não negativo continuou associado à presença de arritmias ventriculares malignas, com OR = 5,17 (IC95%: 1,05 - 25,51). Conclusão: Na CCC, pacientes com história de arritmia ventricular maligna apresentam maior frequência de teste de MTWA não negativo quando comparados a pacientes sem ocorrência prévia de arritmias.

Association between Microvolt T-Wave Alternans and Malignant Ventricular Arrhythmias in Chagas Disease.

BACKGROUND: Sudden cardiac death is the most frequent death mechanism in Chagas disease, responsible for 55% to 65% of the deaths of patients with chronic Chagas cardiomyopathy (CCC). The most often involved electrophysiological mechanisms are ventricular tachycardia and ventricular fibrillation. The implantable cardioverter defibrillator (ICD) has a beneficial role in preventing sudden death due to malignant ventricular arrhythmias, and, thus the correct identification of patients at risk is required. The association of microvolt T-wave alternans (MTWA) with the appearance of ventricular arrhythmias has been assessed in different heart diseases. The role of MTWA is mostly unknown in patients with CCC. OBJECTIVES: To evaluate the association between MTWA and the occurrence of malignant ventricular arrhythmias in patients with CCC. METHOD: This is a case-control study including patients with CCC and ICD, with history of malignant ventricular arrhythmias (case group), and patients with CCC and no history of those arrhythmias (control group). The MTWA test results were classified as negative and non-negative (positive and indeterminate). The significance level adopted was a = 0.05. RESULTS: We recruited 96 patients, 45 cases (46.8%) and 51 controls (53.1%). The MTWA test was non-negative in 36/45 cases (80%) and 15/51 controls (29.4%) [OR = 9.60 (95%CI: 3.41 - 27.93)]. After adjustment for known confounding factors in a logistic regression model, the non-negative result continued to be associated with malignant ventricular arrhythmias [OR = 5.17 (95%CI: 1.05 - 25.51)]. CONCLUSION: Patients with CCC and history of malignant ventricular arrhythmias more often have a non-negative MTWA test as compared to patients with no history of arrhythmia.

Safety of early performance of the six-minute walk test following acute myocardial infarction: a cross-sectional study.

BACKGROUND: The six-minute walk test (6MWT) is a simple, low cost, reliable, and valid method for evaluating the functional capacity of cardiac patients. However, its early use and safety following acute myocardial infarction (AMI) is recent and has been little investigated. OBJECTIVE: To evaluate and to compare the safety and the cardiac behavior of early performance of the 6MWT in patients following uncomplicated AMI up to 4 days or more than 4 days after the event. METHODS: Following discharge from the Coronary Care Unit, 152 stable asymptomatic patients diagnosed with uncomplicated AMI performed the 6MWT. During the test, in addition to the distance walked, heart rate (HR), blood pressure (BP), and adverse events were also recorded. Electrocardiography was recorded using a Holter monitor in 105 patients. Patients were allocated considering two groups according to the number of days since AMI: Up to 4 Days Group and After 4 Days Group. RESULTS: All patients completed the 6MWT, 66 in the Up to 4 Days Group and 86 in the After 4 Days Group. The walking distance was similar in both groups (85% of the predicted value), as well as the physiological responses (increase in systolic BP and HR), reaching 63% (median) of maximum HR. Only 3.9% of patients had major complications (angina, drop in BP, or ventricular tachycardia), with no difference between the groups. None of the complications regarded as severe led to truly significant complications or death. CONCLUSION: The 6MWT was proven to be safe and feasible for early functional evaluation following uncomplicated AMI.

Usefulness of microvolt T-wave alternans for predicting outcome in patients with Chagas disease with implantable cardioverter defibrillators.

BACKGROUND: Chagas disease (ChD) may lead to life-threatening heart disease, including malignant ventricular arrhythmias. The use of implantable cardioverter defibrillators (ICDs) has become the main therapeutic strategy for secondary prevention of SCD in Chagas disease (ChD). Microvolt T-wave alternans (MTWA) is a direct measure of ventricular repolarization instability and has emerged as a potentially useful way of determining arrhythmia vulnerability. However, this methodology has not been evaluated in patients with ChD. OBJECTIVE: To evaluate the predictive value of MTWA testing for appropriate therapy or death in ChD patients with ICDs. METHODS: This prospective study included consecutive patients who received ICD implantations in a Brazilian tertiary referral center. RESULTS: Seventy-two patients were followed for a median time of 422 (range 294-642) days. Thirty-three patients had ChD. The MTWA was non-negative (positive or indeterminate) in 27 (81.8%) of ChD patients. The combined primary outcome (appropriate ICD therapy or death) occurred in 29 patients (40.3%); 17 out 33 ChD patients presented the primary outcome. There was a statistically significant difference in event-free survival between ChD patients with negative and non-negative MTWA results (p=0.02). Non-negative MTWA tests nearly triple the risk of appropriate ICD therapy or death (HR=2.7, 95% CI: 1.7-4.4, p=0.01) in patients with ChD and was the only variable associated with outcomes. The sensitivity and the negative predictive value was 100% in ChD patients. CONCLUSIONS: MTWA may be useful in recognizing high-risk ICD patients who may require adjunctive therapies with antiarrhythmic drugs or catheter ablation.

Residual entropy and waterlike anomalies in the repulsive one dimensional lattice gas.

The thermodynamics and kinetics of the one dimensional lattice gas with repulsive interaction are investigated using transfer matrix technique and Monte Carlo simulations. This simple model is shown to exhibit waterlike anomalies in density, thermal expansion coefficient, and self-diffusion. An unified description for the thermodynamic anomalies in this model is achieved based on the ground state residual entropy which appears in the model due to mixing entropy in a ground state phase transition.

Cadaveric study of breast measurements during augmentation with implants.

BACKGROUND: The goal of this study was to compare immediate changes in breast shape and nipple position using different implant shapes and volumes, with variable release of the pectoralis major muscle in fresh cadavers. METHODS: Seventeen fresh cadaveric breasts were analyzed. Six different augmentation procedures were performed, including pocket dissection in the submuscular and subglandular planes, and partial and full release of the pectoralis major muscle insertion. Round and contoured implant volumes of 200, 300, 400, 500, and 600 ml were used, resulting in a total of 30 procedures per breast. RESULTS: Projection was greater when subjects received contoured implants versus round implants in all volumes both in submuscular and in subglandular pockets (p < 0.001). For implants larger than 200 ml, projection was greater when a subglandular pocket was chosen (p < 0.02), for both round and contoured implants. Nipple-to-inframammary fold distance was increased with contoured implants compared with round implants in both subglandular and submuscular pockets for all implant volumes (p < 0.05). CONCLUSIONS: Implant shape, volume, and pocket location influence projection, causing it to increase in a linear fashion. Partial pectoralis major release seems to affect projection only for small volumes, but does not influence nipple position in the immediate setting. As projection increases with augmentation volume, cephalad movement of the nipple is produced by a relative increase in nipple-to-inframammary fold distance compared with the midclavicular point-to-nipple distance in our cadaveric sample.

Ventricular arrhythmias in Chagas disease.

Sudden death is one of the most characteristic phenomena of Chagas disease, and approximately one-third of infected patients develop life-threatening heart disease, including malignant ventricular arrhythmias. Fibrotic lesions secondary to chronic cardiomyopathy produce arrhythmogenic substrates that lead to the appearance and maintenance of ventricular arrhythmias. The objective of this study is to discuss the main clinical and epidemiological aspects of ventricular arrhythmias in Chagas disease, the specific workups and treatments for these abnormalities, and the breakthroughs needed to determine a more effective approach to these arrhythmias. A literature review was performed via a search of the PubMed database from 1965 to May 31, 2014 for studies of patients with Chagas disease. Clinical management of patients with chronic Chagas disease begins with proper clinical stratification and the identification of individuals at a higher risk of sudden cardiac death. Once a patient develops malignant ventricular arrhythmia, the therapeutic approach aims to prevent the recurrence of arrhythmias and sudden cardiac death by the use of implantable cardioverter defibrillators, antiarrhythmic drugs, or both. In select cases, invasive ablation of the reentrant circuit causing tachycardia may be useful. Ventricular arrhythmias are important manifestations of Chagas cardiomyopathy. This review highlights the absence of high-quality evidence regarding the treatment of ventricular arrhythmias in Chagas disease. Recognizing high-risk patients who require specific therapies, especially invasive procedures such as the implantation of cardioverter defibrillators and ablative approaches, is a major challenge in clinical practice.

Ventricular arrhythmias in Chagas disease

Sudden death is one of the most characteristic phenomena of Chagas disease, and approximately one-third of infected patients develop life-threatening heart disease, including malignant ventricular arrhythmias. Fibrotic lesions secondary to chronic cardiomyopathy produce arrhythmogenic substrates that lead to the appearance and maintenance of ventricular arrhythmias. The objective of this study is to discuss the main clinical and epidemiological aspects of ventricular arrhythmias in Chagas disease, the specific workups and treatments for these abnormalities, and the breakthroughs needed to determine a more effective approach to these arrhythmias. A literature review was performed via a search of the PubMed database from 1965 to May 31, 2014 for studies of patients with Chagas disease. Clinical management of patients with chronic Chagas disease begins with proper clinical stratification and the identification of individuals at a higher risk of sudden cardiac death. Once a patient develops malignant ventricular arrhythmia, the therapeutic approach aims to prevent the recurrence of arrhythmias and sudden cardiac death by the use of implantable cardioverter defibrillators, antiarrhythmic drugs, or both. In select cases, invasive ablation of the reentrant circuit causing tachycardia may be useful. Ventricular arrhythmias are important manifestations of Chagas cardiomyopathy. This review highlights the absence of high-quality evidence regarding the treatment of ventricular arrhythmias in Chagas disease. Recognizing high-risk patients who require specific therapies, especially invasive procedures such as the implantation of cardioverter defibrillators and ablative approaches, is a major challenge in clinical practice.

Prognostic score for acute coronary syndrome in a private terciary hospital.

BACKGROUND: Available predictive models for acute coronary syndromes (ACS) have limitations as they have been elaborated some years ago or limitations with applicability. OBJECTIVES: To develop scores for predicting adverse events in 30 days and 6 months in ST-segment elevation and non-ST-segment elevation ACS patients admitted to private tertiary hospital. METHODS: Prospective cohort of ACS patients admitted between August, 2009 and June, 2012. Our primary composite outcome for both the 30-day and 6-month models was death from any cause, myocardial infarction or re-infarction, cerebrovascular accident (CVA), cardiac arrest and major bleeding. Predicting variables were selected for clinical, laboratory, electrocardiographic and therapeutic data. The final model was obtained with multiple logistic regression and submitted to internal validation with bootstrap analysis. RESULTS: We considered 760 patients for the development sample, of which 132 had ST-segment elevation ACS and 628 non-ST-segment elevation ACS. The mean age was 63.2 ± 11.7 years, and 583 were men (76.7%). The final model to predict 30-day events is comprised by five independent variables: age ≥ 70 years, history of cancer, left ventricular ejection fraction (LVEF) < 40%, troponin I > 12.4 ng /ml and chemical thrombolysis. In the internal validation, the model showed good discrimination with C-statistic of 0.71. The predictors in the 6-month event final model are: history of cancer, LVEF < 40%, chemical thrombolysis, troponin I >14.3 ng/ml, serum creatinine>1.2 mg/dl, history of chronic obstructive pulmonary disease and hemoglobin < 13.5 g/dl. In the internal validation, the model had good performance with C-statistic of 0.69. CONCLUSION: We have developed easy to apply scores for predicting 30-day and 6-month adverse events in patients with ST-elevation and non-ST-elevation ACS.

Escore Prognóstico para Síndrome Coronariana Aguda em Hospital Terciário Privado / Prognostic Score for Acute Coronary Syndrome in a Private Terciary Hospital

Fundamento: Os modelos prognósticos disponíveis para Síndrome Coronariana Aguda (SCA) podem ter limitações de performance, por terem sido elaborados há vários anos, ou problemas de aplicabilidade. Objetivos: Elaborar escores para predição de eventos desfavoráveis em 30 dias e 6 meses, em pacientes com SCA, com ou sem Supradesnivelamento de ST (SST), atendida em hospital privado terciário. Métodos: Coorte prospectiva de pacientes consecutivos com SCA admitidos entre agosto/2009 a junho/2012. O desfecho primário composto foi a ocorrência de óbito, infarto ou reinfarto, Acidente Vascular Cerebral (AVC), parada cardiorrespiratória e sangramento maior. As variáveis preditoras foram selecionadas de dados clínicos, laboratoriais, eletrocardiográficos e da terapêutica. O modelo final foi obtido por meio de regressão logística e submetido a validação interna, utilizando-se bootstraping. Resultados: Incluímos 760 pacientes, 132 com SCA com SST e 628 sem SST. A idade média foi 63,2 ± 11,7 anos, sendo 583 homens (76,7%). O modelo final para eventos em 30 dias contém cinco preditores: idade ≥ 70 anos, antecedente de neoplasia, Fração de Ejeção do Ventrículo Esquerdo (FEVE) < 40%, troponinaI > 12,4 ng/mL e trombólise. Na validação interna, o modelo mostrou ter boa performance com área sob a curva de 0,71.Os preditores do modelo para 6 meses são: antecedente de neoplasia, FEVE < 40%, trombólise, troponina I > 14,3 ng/mL, creatinina > 1,2 mg/dL, antecedente de doença pulmonar obstrutiva crônica e hemoglobina < 13,5 g/dL. Na validação interna, o modelo apresentou boa performance com área sob a curva de 0,69. Conclusões: Desenvolvemos escores de fácil utilização e boa performance ...

Background: Available predictive models for acute coronary syndromes (ACS) have limitations as they have been elaborated some years ago or limitations with applicability. Objectives: To develop scores for predicting adverse events in 30 days and 6 months in ST-segment elevation and non-ST-segment elevation ACS patients admitted to private tertiary hospital. Methods: Prospective cohort of ACS patients admitted between August, 2009 and June, 2012. Our primary composite outcome for both the 30-day and 6-month models was death from any cause, myocardial infarction or re-infarction, cerebrovascular accident (CVA), cardiac arrest and major bleeding. Predicting variables were selected for clinical, laboratory, electrocardiographic and therapeutic data. The final model was obtained with multiple logistic regression and submitted to internal validation with bootstrap analysis. Results: We considered 760 patients for the development sample, of which 132 had ST-segment elevation ACS and 628 non-ST-segment elevation ACS. The mean age was 63.2 ± 11.7 years, and 583 were men (76.7%). The final model to predict 30-day events is comprised by five independent variables: age ≥ 70 years, history of cancer, left ventricular ejection fraction (LVEF) < 40%, troponin I > 12.4 ng /ml and chemical thrombolysis. In the internal validation, the model showed good discrimination with C-statistic of 0.71. The predictors in the 6-month event final model are: history of cancer, LVEF < 40%, chemical thrombolysis, troponin I >14.3 ng/ml, serum creatinine>1.2 mg/dl, history of chronic obstructive pulmonary disease and hemoglobin < 13.5 g/dl. In the internal validation, the model had good performance with C-statistic of 0.69. Conclusion: We have developed easy to apply scores for predicting 30-day and 6-month adverse events in patients with ST-elevation and non-ST-elevation ACS. .

Laparoscopic cholecystectomy with suprapubic approach.

BACKGROUND: The laparoscopic cholecystectomies performed through single site surgery, despite undoubted aesthetic results, are costly and technically difficult to be performed. The suprapubic approach presents as a simpler and cheaper alternative with good aesthetic results. AIM: To report the experience of Garavelo Hospital on laparoscopic cholecystectomy with suprapubic approach. METHODS: Descriptive, crossectional study with retrospective data retrieval. The variables to be analyzed were success rate; occurrence of complications; surgical time and the length of stay. RESULTS: The sample consisted of 42 patients, of which females were predominant (76.2%). The age ranged from 18 to 65 years with an average age of 36 years. The success rate was 95.3%. The average time for the procedure was 33.4 minutes. There were no intraoperative complications and all patients were discharged within 24 hours after surgery. CONCLUSION: Laparoscopic cholecystectomy with suprapubic approach is safe and easy to domain. It can be performed in a time similar to traditional laparoscopy, without special instruments. It offers a good cosmetic result, and deserves more attention.

Colecistectomia laparoscópica com abordagem supra-púbica / Laparoscopic cholecystectomy with suprapubic approach

RACIONAL: As colecistectomias laparoscópicas realizadas através de acesso abdominal único, apesar de seu inquestionável resultado estético, são procedimentos de custo elevado e tecnicamente difíceis de serem realizados. A abordagem supra-púbica é alternativa mais simples e barata com bom resultado estético. OBJETIVO: Relatar a experiência do Hospital Garavelo com a colecistectomia laparoscópica com abordagem supra-púbica. MÉTODO: Estudo descritivo de delineamento transversal e coleta retrospectiva dos dados. Foram avaliados o tempo cirúrgico, taxas de sucesso e de conversão para procedimento laparoscópico tradicional ou mesmo operação aberta, bem como a ocorrência de complicações intra ou pós-operatórias e tempo de internação. Os dados foram coletados através de instrumento criado especificamente para realização do estudo, permitindo a coleta de dados quantitativos dos registros hospitalares e observações feitas durante avaliações ambulatoriais. RESULTADOS: A amostra foi constituída por 42 pacientes. O sexo feminino foi predominante (76,2%). A média de idade foi de 36 anos (18-65). A taxa de sucesso foi de 95,3%. O tempo médio para realização do procedimento foi de 33,4 minutos. Não houve complicações intra-operatórias e todos os pacientes receberam alta hospitalar nas primeiras 24 horas após a operação. CONCLUSÃO: A colecistectomia laparoscópica com abordagem supra-púbica é técnica segura, de fácil domínio, com bom resultado estético, podendo ser técnica alternativa para os procedimentos convencionais.

BACKGROUND: The laparoscopic cholecystectomies performed through single site surgery, despite undoubted aesthetic results, are costly and technically difficult to be performed. The suprapubic approach presents as a simpler and cheaper alternative with good aesthetic results. AIM: To report the experience of Garavelo Hospital on laparoscopic cholecystectomy with suprapubic approach. METHODS: Descriptive, crossectional study with retrospective data retrieval. The variables to be analyzed were success rate; occurrence of complications; surgical time and the length of stay. RESULTS: The sample consisted of 42 patients, of which females were predominant (76.2%). The age ranged from 18 to 65 years with an average age of 36 years. The success rate was 95.3%. The average time for the procedure was 33.4 minutes. There were no intraoperative complications and all patients were discharged within 24 hours after surgery. CONCLUSION: Laparoscopic cholecystectomy with suprapubic approach is safe and easy to domain. It can be performed in a time similar to traditional laparoscopy, without special instruments. It offers a good cosmetic result, and deserves more attention.