Portuguese Cross-Cultural Adaptations of the Pediatric International Knee Documentation Committee Score.

INTRODUCTION: The aim of this study was to translate the Pediatric International Knee Documentation Committee Score (Pedi-IKDC) into European Portuguese language. The Pedi-IKDC was originally developed in the English language and its main construct is functional assessment of knee disorders in children and adolescents. MATERIAL AND METHODS: The original English version of the questionnaire was translated to European Portuguese using the forwardbackwards method. Patients aged eight to 17 with knee disorders were considered eligible for the study. An online platform was implemented to collect patient responses, including general patient information, the questionnaires Pedi-IKDC, EuroQol-5 Dimension Youth and Childhood Health Assessment Questionnaire. Three surveys were sent: at the moment of first evaluation (T0), after two (T1) and ten (T2) weeks. These surveys followed the Consensus-based Standards for the Selection of Health Measurement Instruments - COSMIN Checklist recommendations. The internal consistency, reliability, error of measurement, structural and construct validity (by means of correlation with previously validated scales), responsiveness and interpretability (floor/ceiling effects, MIC and ROC curve) were evaluated. RESULTS: Forty-seven patients completed T0, 42 patients completed T1 and 40 patients completed T2. The factorial analysis confirmed that the scale has one dimension. Cronbach alpha (α) was 0.94; interclass correlation coefficient was 0.92; smallest detectable change was 19.04 for individuals and 3.31 for groups; standard error of measurement was 6.87; minimum important change was 18.48; floor and ceiling effects were absent. More than 75% of the hypotheses tested for construct validity were confirmed, showing its adequacy. The variation of scores between T0 and T2 correlated with the clinical evolution of the participants (r = 0.421, p < 0.05). CONCLUSION: The Portuguese version of Pedi-IKDC demonstrated good psychometric properties, being a valuable tool for clinical assessment of pediatric patients with knee disorder.

Native Knee Septic Arthritis Due to Cutibacterium acnes: A Case Report.

Commensal skin anaerobes have been described as causative agents of prosthetic joint infections. Infection of native joints by these agents are, however, less common. We present the case of a 34-year-old male with recurrent joint effusion following closed trauma to the knee, four years ago, refractory to corticosteroid injections and several arthrocenteses. A synovial biopsy revealed Cutibacterium acnes infection leading to antibiotic therapy with clindamycin, and the patient was referred to orthopaedic and submitted to arthroscopic lavage. Atypical cartilage lesions, resembling the "growth of bacterial colonies", were found in the tibial plateaus with repeated isolation of C. acnes. Inpatient treatment with penicillin and vancomycin was conducted, followed by an oral course of amoxicillin, with no further registered recurrences. In this case, the authors describe a rare cause of native knee septic arthritis while highlighting the importance of repeated microbiology studies and adequate collection technique and sample handling, in order to better ascertain whether the isolated agent represents a contaminated sample or a true infection.

Quality by Design Approach for the Development of Liposome Carrying Ghrelin for Intranasal Administration.

The therapeutic use of peptides has increasingly recognized in the development of new therapies. However, the susceptible enzymatic cleavage is a barrier that needs to overcome. Nose-to-brain delivery associated with liposomes can protect peptides against biodegradation and improve the accessibility to brain targets. The aim was to develop a liposomal formulation as ghrelin carrier. The quality by design (QbD) approach was used as a strategy for method development. The initial risk assessments were carried out using a fishbone diagram. A screening design study was performed for the critical material attributes/critical process parameters (CMAs/CPPs) on critical quality attributes (CQAs). Liposomes were obtained by hydrating phospholipid films, followed by extrusion or homogenization, and coated with chitosan. The optimized liposome formulation was produced by high-pressure homogenization coated with chitosan, and the resulted were liposomes size 72.25 ± 1.46 nm, PDI of 0.300 ± 0.027, the zeta potential of 50.3 ± 1.46 mV, and encapsulation efficiency of 53.2%. Moreover, chitosan coating improved performance in ex vivo permeation and mucoadhesion analyzes when compared to the uncoated liposome. In this context, chitosan coating is essential for the performance of the formulations in the ex vivo permeation and mucoadhesion analyzes. The intranasal administration of ghrelin liposomes coated with chitosan offers an innovative opportunity to treat cachexia.

Perspectives and Challenges in the Fight Against COVID-19: The Role of Genetic Variability.

In the last year, the advent of the COVID-19 pandemic brought a new consideration for the multidisciplinary sciences. The unknown mechanisms of infection used by SARS-CoV-2 and the absence of effective antiviral pharmacological therapy, diagnosis methods, and vaccines evoked scientific efforts on the COVID-19 outcome. In general, COVID-19 clinical features are a result of local and systemic inflammatory processes that are enhanced by some preexistent comorbidities, such as diabetes, obesity, cardiovascular, and pulmonary diseases, and biological factors, like gender and age. However, the discrepancies in COVID-19 clinical signs observed among those patients lead to investigations about the critical factors that deeply influence disease severity and death. Herein, we present the viral infection mechanisms and its consequences after blocking the angiotensin-converting enzyme 2 (ACE2) axis in different tissues and the progression of inflammatory and immunological reactions, especially the influence of genetic features on those differential clinical responses. Furthermore, we discuss the role of genotype as an essential indicator of COVID-19 susceptibility, considering the expression profiles, polymorphisms, gene identification, and epigenetic modifications of viral entry factors and their recognition, as well as the infection effects on cell signaling molecule expression, which amplifies disease severity.

Cancer and Cardiovascular Diseases during the COVID-19 Pandemic. / Câncer e Doenças Cardiovasculares na Pandemia de COVID-19.

The challenges that the COVID-19 pandemic cretead to the healthcare system have made it necessary to adapt routines and services, with the objectives of controlling the spread of the virus and preserving health. Safe and correct management of patients in risks groups, such as elderly patients, patients with cardiovascular diseases, and patients with cancer, has become even more important. Thus, cardio-oncology has gained a new dimension, with the aim of adapting to patients' needs during the pandemic by restructuring the system of care in a manner that offers quality and safety in healthcare.

O desafio imposto ao sistema de saúde pela pandemia da COVID-19 faz com que haja uma necessidade de readequações de rotinas e serviços de saúde, com os objetivos de controlar a disseminação do vírus e preservar a saúde. Torna-se ainda mais importante o manejo seguro e correto dos pacientes dos grupos de risco, como os pacientes idosos, os portadores de doenças cardiovasculares e os pacientes com câncer. Dessa forma, a cardio-oncologia ganha novo dimensionamento, no intuito de se adequar às necessidades dos pacientes diante de uma pandemia, reestruturando o sistema de atendimento de forma a oferecer qualidade e segurança na assistência à saúde.

Câncer e Doenças Cardiovasculares na Pandemia de COVID-19 / Cancer and Cardiovascular Diseases during the COVID-19 Pandemic

Resumo O desafio imposto ao sistema de saúde pela pandemia da COVID-19 faz com que haja uma necessidade de readequações de rotinas e serviços de saúde, com os objetivos de controlar a disseminação do vírus e preservar a saúde. Torna-se ainda mais importante o manejo seguro e correto dos pacientes dos grupos de risco, como os pacientes idosos, os portadores de doenças cardiovasculares e os pacientes com câncer. Dessa forma, a cardio-oncologia ganha novo dimensionamento, no intuito de se adequar às necessidades dos pacientes diante de uma pandemia, reestruturando o sistema de atendimento de forma a oferecer qualidade e segurança na assistência à saúde.

Abstract The challenges that the COVID-19 pandemic cretead to the healthcare system have made it necessary to adapt routines and services, with the objectives of controlling the spread of the virus and preserving health. Safe and correct management of patients in risks groups, such as elderly patients, patients with cardiovascular diseases, and patients with cancer, has become even more important. Thus, cardio-oncology has gained a new dimension, with the aim of adapting to patients' needs during the pandemic by restructuring the system of care in a manner that offers quality and safety in healthcare.

Cachexia: Pathophysiology and Ghrelin Liposomes for Nose-to-Brain Delivery.

Cachexia, a severe multifactorial condition that is underestimated and unrecognized in patients, is characterized by continuous muscle mass loss that leads to progressive functional impairment, while nutritional support cannot completely reverse this clinical condition. There is a strong need for more effective and targeted therapies for cachexia patients. There is a need for drugs that act on cachexia as a distinct and treatable condition to prevent or reverse excess catabolism and inflammation. Due to ghrelin properties, it has been studied in the cachexia and other treatments in a growing number of works. However, in the body, exogenous ghrelin is subject to very rapid degradation. In this context, the intranasal release of ghrelin-loaded liposomes to cross the blood-brain barrier and the release of the drug into the central nervous system may be a promising alternative to improve its bioavailability. The administration of nose-to-brain liposomes for the management of cachexia was addressed only in a limited number of published works. This review focuses on the discussion of the pathophysiology of cachexia, synthesis and physiological effects of ghrelin and the potential treatment of the diseased using ghrelin-loaded liposomes through the nose-to-brain route.

Manejo psicológico del paciente sometido a cirugía bariátrica. Consenso Núcleo de Psicólogos de Cirugía de la Obesidad de Chile / Chilean consensus on the psychological management of patients undergoing bariatric surgery

Background Bariatric Surgery is the most effective alternative for weight reduction. However, weight regain is a serious problem. Therefore, pre and post-operative psychological management becomes relevant for these patients. Aim To unify criteria about the psychological management patients undergoing bariatric surgery. Material and Methods A questionnaire about psychological practice in bariatric surgery was sent to 50 national expert psychologists, members of the Chilean Bariatric and Metabolic Society. When no agreement among them was achieved, the Delphi methodology was applied. Scores of 86% or greater were used to reach consensus. Results The specialized clinical assessment is crucial for a good preoperative evaluation and to obtain and adequate compliance after surgery. Psychological interventions evolved towards a preparation process to achieve behavioral changes aiming to maintain good long term weight reduction results. Conclusions The indications and recommendations emanating from this consensus generated a document that establishes minimum criteria and quality care standards, which should reduce mental health risks of bariatric surgery and enhance lifestyle changes.

Resolution of an acute aortic syndrome with aortic valve insufficiency post-PCI.

BACKGROUND: Acute aortic syndrome is the modern term that includes aortic dissection, intramural hematoma, and symptomatic aortic ulcer. Iatrogenic coronary artery dissection extending to the aorta during percutaneous coronary intervention is a very rare but life-threatening complication. Despite some reports of spontaneous recovery, most of these patients are treated surgically as a spontaneous aortic dissection, especially if there is a complication of the aortic lesion. CASE REPORT: A 52-year-old white female was submitted to an angioplasty in the right coronary without success and the procedure was complicated by a dissection in aortic root with progressive extension to the ascending aorta. This lesion deformed the aortic valve, leaving it with an acute moderate regurgitation. Because of current use of clopidogrel and clinical stability of the patient, the local Heart Team decided to withdrawn this antiplatelet for 5 days before surgery despite the risk related to the aortic syndrome. A new echocardiogram 3 days later showed that the hematoma was reabsorbed with improvement of the aortic insufficiency. An angiotomography confirmed the reabsorption of the hematoma. The surgery was canceled and the patient was maintained in a conservative treatment and discharged. Seventeen months later, she was re-evaluated and was still asymptomatic without aortic regurgitation in the echocardiogram and showing progressive regression of the aortic hematoma in the tomography. CONCLUSIONS: Despite the conservative treatment, this case of iatrogenic aortic dissection complicated by an acute aortic regurgitation had a good evolution in a follow-up of 17 months.

Validation of the Killip-Kimball Classification and Late Mortality after Acute Myocardial Infarction / Validação da Classificação de Killip e Kimball e Mortalidade Tardia Após Infarto Agudo do Miocárdio

Background: The classification or index of heart failure severity in patients with acute myocardial infarction (AMI) was proposed by Killip and Kimball aiming at assessing the risk of in-hospital death and the potential benefit of specific management of care provided in Coronary Care Units (CCU) during the decade of 60. Objective: To validate the risk stratification of Killip classification in the long-term mortality and compare the prognostic value in patients with non-ST-segment elevation MI (NSTEMI) relative to patients with ST-segment elevation MI (STEMI), in the era of reperfusion and modern antithrombotic therapies. Methods: We evaluated 1906 patients with documented AMI and admitted to the CCU, from 1995 to 2011, with a mean follow-up of 05 years to assess total mortality. Kaplan-Meier (KM) curves were developed for comparison between survival distributions according to Killip class and NSTEMI versus STEMI. Cox proportional regression models were developed to determine the independent association between Killip class and mortality, with sensitivity analyses based on type of AMI. Results: The proportions of deaths and the KM survival distributions were significantly different across Killip class >1 (p <0.001) and with a similar pattern between patients with NSTEMI and STEMI. Cox models identified the Killip classification as a significant, sustained, consistent predictor and independent of relevant covariables (Wald χ2 16.5 [p = 0.001], NSTEMI) and (Wald χ2 11.9 [p = 0.008], STEMI). Conclusion: The Killip and Kimball classification performs relevant prognostic role in mortality at mean follow-up of 05 years post-AMI, with a similar pattern between NSTEMI and STEMI patients. .

Fundamento: A classificação ou índice de gravidade de insuficiência cardíaca em pacientes com infarto agudo do miocárdio (IAM) foi proposta por Killip e Kimball com o objetivo de avaliar o risco de mortalidade hospitalar e o potencial benefício do tratamento especializado em unidades coronárias (UCO) na década de 1960. Objetivos: Validar a classificação de Killip para mortalidade total em longo prazo e comparar o valor prognóstico em pacientes com IAM sem elevação do segmento ST (IAMSEST) em relação àqueles com elevação do segmento ST (IAMCEST), na era pós-reperfusão e de terapia antitrombótica moderna. Métodos: Foram avaliados 1906 pacientes com IAM confirmado, admitidos em UCO entre 1995 e 2011, com seguimento médio de cinco anos, para avaliação da mortalidade total. Curvas de Kaplan-Meier foram construídas para comparação da sobrevida por classe Killip e IAMSEST versus IAMCEST. Modelos de regressão de risco proporcional de Cox foram construídos para determinar a associação independente entre a classe Killip e a mortalidade, com análises de sensibilidade por tipo de IAM. Resultados: As proporções de óbitos e as distribuições das curvas de sobrevida foram diferentes conforme a classe Killip >1 (p <0,001) e similares entre IAMSEST e IAMCEST. Os modelos de risco identificaram a classificação de Killip como preditor significante, sustentado, consistente e independente de covariáveis relevantes (Wald χ2 16,5 [p = 0,001], IAMSEST) e (Wald χ2 11,9 [p = 0,008], IAMCEST). Conclusão: A classificação de Killip e Kimball desempenha papel prognóstico relevante na mortalidade em seguimento médio de cinco anos pós-IAM e, de modo similar, entre pacientes com IAMSEST e IAMCEST. .

Validation of the Killip-Kimball classification and late mortality after acute myocardial infarction.

BACKGROUND: The classification or index of heart failure severity in patients with acute myocardial infarction (AMI) was proposed by Killip and Kimball aiming at assessing the risk of in-hospital death and the potential benefit of specific management of care provided in Coronary Care Units (CCU) during the decade of 60. OBJECTIVE: To validate the risk stratification of Killip classification in the long-term mortality and compare the prognostic value in patients with non-ST-segment elevation MI (NSTEMI) relative to patients with ST-segment elevation MI (STEMI), in the era of reperfusion and modern antithrombotic therapies. METHODS: We evaluated 1906 patients with documented AMI and admitted to the CCU, from 1995 to 2011, with a mean follow-up of 05 years to assess total mortality. Kaplan-Meier (KM) curves were developed for comparison between survival distributions according to Killip class and NSTEMI versus STEMI. Cox proportional regression models were developed to determine the independent association between Killip class and mortality, with sensitivity analyses based on type of AMI. RESULTS: The proportions of deaths and the KM survival distributions were significantly different across Killip class >1 (p <0.001) and with a similar pattern between patients with NSTEMI and STEMI. Cox models identified the Killip classification as a significant, sustained, consistent predictor and independent of relevant covariables (Wald χ2 16.5 [p = 0.001], NSTEMI) and (Wald χ2 11.9 [p = 0.008], STEMI). CONCLUSION: The Killip and Kimball classification performs relevant prognostic role in mortality at mean follow-up of 05 years post-AMI, with a similar pattern between NSTEMI and STEMI patients.

Valor prognóstico da frequência cardíaca como preditor de risco cardiovascular e modulação terapêutica para redução da morbimortalidade / Prognostic value of heart rate as a predictor of cardiovascular risk and therapeutic modulation to reduce morbidity and mortality

A frequência cardíaca de repouso (FCR) elevada é um importante preditor de mortalidade na população geral e, principalmente, nos indivíduos com doença cardiovascular. Vários mecanismos fisiopatológicos plausíveis propostos demonstram que o aumento da FCR determina não só isquemia miocárdica em pacientes com baixa reserva coronariana, mas também maior tensão de cisalhamento sobre as coronárias, aterogênese e efeitos arrítmicos. A modulação da FCR com medidas farmacológicas e não farmacológicas é uma realidade em portadores de insuficiência cardíaca (IC), doenças arterial coronária (DAC) estável e síndromes coronárias agudas (SCA), com benefícios em morbimortalidade...