Transdisciplinary research before, during and after COVID-19 vaccination in Chile: a virtuoso collaboration with future perspectives.

The COVID-19 pandemic presented numerous challenges that required immediate attention to mitigate its devastating consequences on a local and global scale. In March 2020, the Chilean government, along with health and science authorities, implemented a strategy aimed at generating relevant evidence to inform effective public health decisions. One of the key strengths of this strategy was the active involvement of the scientific community, employing transdisciplinary approaches to address critical questions and support political decision-making. The strategy promoted collaborations between the government, public and private institutions, and transdisciplinary academic groups throughout each phase of the pandemic. By focusing on pressing problems and questions, this approach formed the foundation of this report which reflects the collaborative effort throughout the pandemic of individuals from the Instituto de Sistemas Complejos de Ingeniería (ISCI), the Faculty of Medicine of the University of Chile, government authorities and industry. Early in the pandemic, it became crucial to gather evidence on how to minimize the impact of infection and disease while awaiting the availability of vaccines. This included studying the dynamics of SARS-CoV-2 infection in children, assessing the impact of quarantines on people's mobility, implementing strategies for widespread SARS-CoV-2 polymerase chain reaction (PCR) testing, and exploring pool testing for large populations. The urgent need to reduce disease severity and transmission posed a significant challenge, as it was essential to prevent overwhelming healthcare systems. Studies were conducted to predict ICU bed requirements at the local level using mathematical models. Additionally, novel approaches, such as using cellphone mobility-based technology to actively identify infected individuals, and to optimize population sampling, were explored following the first wave of the pandemic. Chile took early action in addressing vaccination through a high-level scientific board, before vaccines became available. Studies conducted during this period included population-based immunologic evaluations of different vaccines, which helped build confidence in the population and supported the need for booster doses and potential vaccination of children. These studies and collaborations, which will be discussed here, have provided valuable insights and will inform future approaches in a post-pandemic world. Importantly, highly conservative estimates indicate that 3,000 lives and more than 300 million USD were saved by this academic-public-private collaborative effort.

ICU Admission, Invasive Mechanical Ventilation, and Mortality among Children and Adolescents Hospitalized for COVID-19 in a Private Healthcare System.

Aim: The COVID-19 pandemic devastated healthcare around the world. Data about the COVID-19 outcomes among young people are still scarce. We aim to identify factors associated with the composite outcome among children and adolescents hospitalized due to COVID-19. Methods: We performed a search in the database of a large Brazilian private healthcare system. Insured people aged 21 years or younger who were hospitalized due to COVID-19 from Feb/28th/2020 to Nov/1st/2021 were included. The primary endpoint was the composite outcome consisting of ICU admission, need for invasive mechanical ventilation, or death. Results: We evaluated 199 patients who had an index hospitalization due to COVID-19. The median monthly rate of index hospitalization was 2.7 (interquartile range [IQR], 1.6-3.9) per 100,000 clients aged 21 years or less. The median age of the patients was 4.5 years (IQR, 1.4-14.1). At the index hospitalization, the composite outcome rate was 26.6%. The composite outcome was associated with all the previous coexisting morbidities evaluated. The median follow-up was 249.0 days (IQR, 152.0-438.5). There were 27 readmissions (16 patients) within 30 days after the discharge. Conclusions: In conclusion, hospitalized children and adolescents had a composite outcome rate of 26.6% at the index hospitalization. Having previous chronic morbidity was associated with the composite.

Cardiac rehabilitation in patients with diabetes.

Cardiac rehabilitation is very important since diabetes is the set of metabolic diseases characterized by chronic hyperglycemia, with alterations in the metabolism of carbohydrates, fats and proteins as a consequence of defects in the secretion and action of insulin. When diabetes is related to cardiovascular complications, they are the main cause of death due to risk factors such as dyslipidemia, obesity and hyperglycemia, thus causing atherosclerotic changes in the vascular bed, increasing the risk of a fulminant event. The prevention of heart disease in diabetics includes preventive methods of heart disease along with that of diabetes, such as glycemic control, proper nutrition, continuing therapeutic education, physical activity, and antilipid medications, along with pharmacological measures including vasodilators, beta-blockers and antiplatelet agents, etc. We conducted a review of the literature to identify studies on diabetes, cardiovascular prevention, and cardiac complications in diabetic patients. We carry out multiple investigations in published bibliographic databases. A total of twenty-nine studies have been reviewed for this review in which 100% evidenced the favorable contribution of cardiac rehabilitation in diabetic patients. Six studies evaluated the different current contents in diabetes equivalent to 20.6%, fifteen (studies evaluated the cardiovascular risks in diabetic patients equivalent to 51.7% and eight evaluated the cardiovascular complications that occur in diabetic patients equivalent to 27.7%%. Therapeutic management of heart disease in diabetic patients is aimed at reducing cardiovascular risk, through pharmacological and non-pharmacological treatments. However, the weakest point of the treatment is the lack of adherence to the treatments. Physical exercise is an essential element, together with hypoglycemic and nutritional treatment in diabetes mellitus (DM), due to its usefulness in the control of diabetes and prevention of cardiovascular complications.

Heyde Syndrome Treated by Conventional Aortic Valve Replacement.

Heyde syndrome manifests as aortic stenosis associated with gastrointestinal bleeding. We describe the case of a 64-year-old man who came to the emergency room due to acute heart failure and intermittent gastrointestinal bleeding. Treatment involves initial correction of anemia and heart failure followed by aortic valve replacement. The prosthesis used depends on the characteristics of each patient and valve replacement allows the resolution of bleeding in most cases. Gastrointestinal bleeding in patients with aortic stenosis is associated with severity of the valve obstruction. A mechanical prosthesis was used with no recurrent bleeding even with the need for lifelong anticoagulation therapy.

Heyde syndrome treated by conventional aortic valve replacement

Abstract Heyde syndrome manifests as aortic stenosis associated with gastrointestinal bleeding. We describe the case of a 64-year-old man who came to the emergency room due to acute heart failure and intermittent gastrointestinal bleeding. Treatment involves initial correction of anemia and heart failure followed by aortic valve replacement. The prosthesis used depends on the characteristics of each patient and valve replacement allows the resolution of bleeding in most cases. Gastrointestinal bleeding in patients with aortic stenosis is associated with severity of the valve obstruction. A mechanical prosthesis was used with no recurrent bleeding even with the need for lifelong anticoagulation therapy.

Hemolysis and Inflammatory Response to Extracorporeal Circulation during On-Pump CABG: Comparison between Roller and Centrifugal Pump Systems.

OBJECTIVE: To compare the perioperative incidence rates of hemolysis and inflammatory response in patients undergoing coronary artery bypass grafting with the two main types of cardiopulmonary bypass, centrifugal and roller pumps, and establish correlations among hemolytic and inflammatory changes. METHODS: This was a prospective, randomized trial of 60 patients assigned to either roller pump (G1, n=30) or centrifugal pump (G2, n=30) bypass. Markers of hemolysis (serum haptoglobin, lactate dehydrogenase [LDH]) and inflammation (interleukin [IL]1ß, IL-6, and TNF-α) were measured and analyzed. RESULTS: There was no significant between-group difference in the variables of interest. In G1, there was a positive association with IL-6 and TNF-α (P<0.01 and P<0.05, respectively). In G2, there was a positive association with LDH in the postoperative period (P<0.5). At 24h post-cardiopulmonary bypass, there were positive associations between LDH and IL-1ß (P<0.05), LDH and TNF-α (P<0.01), haptoglobin and TNF-α (P<0.05), and LDH and TNF-α (P<0.01) in G1, and between LDH and IL-6 (P<0.01), LDH and TNF-α (P<0.01), and LDH and IL-6 (P<0.01) in G2. CONCLUSION: There were no significant between-group differences in markers of hemolysis or inflammation. IL-6 and TNF-α were positively associated with duration of cardiopulmonary bypass in G1, while LDH was positively associated with duration of cardiopulmonary bypass in G2. The rate of significant associations between markers of hemolysis and inflammation was higher in the roller pump group (G1). REGISTRATION NUMBER: ReBEC (RBR-92b9dg).

Hemolysis and inflammatory response to extracorporeal circulation during on-pump cabg: comparison between roller and centrifugal pump systems

Abstract Objective: To compare the perioperative incidence rates of hemolysis and inflammatory response in patients undergoing coronary artery bypass grafting with the two main types of cardiopulmonary bypass, centrifugal and roller pumps, and establish correlations among hemolytic and inflammatory changes. Methods: This was a prospective, randomized trial of 60 patients assigned to either roller pump (G1, n=30) or centrifugal pump (G2, n=30) bypass. Markers of hemolysis (serum haptoglobin, lactate dehydrogenase [LDH]) and inflammation (interleukin [IL]1ß, IL-6, and TNF-α) were measured and analyzed. Results: There was no significant between-group difference in the variables of interest. In G1, there was a positive association with IL-6 and TNF-α (P<0.01 and P<0.05, respectively). In G2, there was a positive association with LDH in the postoperative period (P<0.5). At 24h post-cardiopulmonary bypass, there were positive associations between LDH and IL-1ß (P<0.05), LDH and TNF-α (P<0.01), haptoglobin and TNF-α (P<0.05), and LDH and TNF-α (P<0.01) in G1, and between LDH and IL-6 (P<0.01), LDH and TNF-α (P<0.01), and LDH and IL-6 (P<0.01) in G2. Conclusion: There were no significant between-group differences in markers of hemolysis or inflammation. IL-6 and TNF-α were positively associated with duration of cardiopulmonary bypass in G1, while LDH was positively associated with duration of cardiopulmonary bypass in G2. The rate of significant associations between markers of hemolysis and inflammation was higher in the roller pump group (G1). Registration number: ReBEC (RBR-92b9dg).

Comparative Study of Electrical Stimulation of the Heart with VDD and DDD Pacemakers as to the Evolution to Atrial Fibrillation.

INTRODUCTION: The pacemaker implantation VDD is considered simpler, faster, less expensive and causes fewer complications compared to DDD. However, the VDD pacemaker has not been widely used in many centers, perhaps for fear of dysfunction of the sinus node and the reduction of atrial sensitivity by the pacemaker during follow-up after implantation. OBJECTIVE: To compare patients with DDD and VDD pacemakers regarding the evolution of chronic atrial fibrillation (AF) and length of stay outside this postoperative arrhythmia. METHODS: It was included 158 patients with dual chamber pacemakers, 48 DDD and 110 VDD. Follow-up period: between January 1, 1999 and December 31, 2015. The mean follow-up of patients with DDD was 5.35 years and the VDD, 4.74 years. The percentage of each group (DDD and VDD) which evolved to AF during follow-up was assessed. Also, it was made an actuarial study with the respective curves indicating the time free from AF for each group. Patients were classified according to the diagnosis that led to pacemaker implantation and the degree of heart failure. RESULTS: The percentage of patients who developed AF was higher in DDD group (10.42%) than in VDD group (6.36%), but without statistical significance. Patients with DDD and VDD remained free of AF for similar period. CONCLUSION: Considering the results, the VDD pacemaker continues to be a good option to the DDD for routine use in cases properly indicated.

Comparative study of electrical stimulation of the heart with vdd and ddd pacemakers as to the evolution to atrial fibrillation

Abstract Introduction: The pacemaker implantation VDD is considered simpler, faster, less expensive and causes fewer complications compared to DDD. However, the VDD pacemaker has not been widely used in many centers, perhaps for fear of dysfunction of the sinus node and the reduction of atrial sensitivity by the pacemaker during follow-up after implantation. Objective: To compare patients with DDD and VDD pacemakers regarding the evolution of chronic atrial fibrillation (AF) and length of stay outside this postoperative arrhythmia. Methods: It was included 158 patients with dual chamber pacemakers, 48 DDD and 110 VDD. Follow-up period: between January 1, 1999 and December 31, 2015. The mean follow-up of patients with DDD was 5.35 years and the VDD, 4.74 years. The percentage of each group (DDD and VDD) which evolved to AF during follow-up was assessed. Also, it was made an actuarial study with the respective curves indicating the time free from AF for each group. Patients were classified according to the diagnosis that led to pacemaker implantation and the degree of heart failure. Results: The percentage of patients who developed AF was higher in DDD group (10.42%) than in VDD group (6.36%), but without statistical significance. Patients with DDD and VDD remained free of AF for similar period. Conclusion: Considering the results, the VDD pacemaker continues to be a good option to the DDD for routine use in cases properly indicated.

Comparison of the occurrence of thromboembolic and bleeding complications in patients with mechanical heart valve prosthesis with one and two leaflets in the mitral position.

INTRODUCTION: Patients with mechanical heart valve prostheses must continuously be treated with oral anticoagulants to prevent thromboembolic events related to prosthetesis. These patients should be continually evaluated for the control of oral anticoagulation. OBJECTIVE: To compare the occurrence of thromboembolic and hemorragic complications in patients with mechanical heart valve prosthesis with one (mono) and two (bi) leaflets in the mitral position in anticoagulant therapy. METHODS: We studied the 10-year interval, 117 patients with prosthesis in the mitral position, 48 with prosthetic single leaflet and 69 with two leaflets. We evaluated the occurrence of thromboembolic and hemorrhagic major and minor degree under gravity. The results are presented in an actuarial study and the frequency of occurrence of linear events. RESULTS: The actuarial survival curves showed that over time, patients with prosthetic heart valve with one leaflet were less free of thromboembolic complications than patients with two leaflet prosthetic valve, while the latter (two leaflet) were less free of hemorrhagic accidents. The linearized frequency of occurrence of thromboembolism were higher in patients with mono leaflet prosthesis. Bleeding rates were higher for patients with bi leaflet prosthetic valve. CONCLUSION: Patients with mono leaflet prosthetic heart valve showed that they are more prone to the occurrence of serious thromboembolic events compared to those with bi leaflet prosthetic valve. Patients with bi leaflet prosthetic valve had more bleeding than patients with mono leaflet prosthetic valve, however this difference was restricted to the bleeding of minor nature.

Anticoagulação oral em portadores de próteses valvares cardíacas mecânicas: experiência de dez anos / Oral anticoagulation in carriers of mechanical heart valve prostheses: experience of ten years

INTRODUÇÃO: Dados da literatura sugerem que as taxas de tromboembolismo e sangramento em pacientes com próteses valvares cardíacas mecânicas podem ser muito reduzidas se a terapia anticoagulante for otimizada. OBJETIVOS: Avaliar a ocorrência de complicações em portadores de próteses valvares cardíacas mecânicas submetidos à terapêutica anticoagulante, otimizada por meio de ambulatório especializado. MÉTODOS: Estudou-se a ocorrência de complicações ao longo de 10 anos em 261 pacientes com próteses valvares cardíacas mecânicas, anticoagulados e acompanhados em ambulatório especializado. Esses pacientes foram divididos em dois grupos conforme porcentual de consultas com tempo de protrombina (RNI) dentro do intervalo desejado: G1-0 por cento a 50,00 por cento e G2-50,01 por cento a 100 por cento das consultas. Foram avaliadas as ocorrências de complicações tromboembólicas e hemorrágicas na sua totalidade, ou subdivididas em maiores e menores, de acordo com a gravidade. Os resultados estão apresentados sob forma de estudo atuarial e de frequência linearizada de ocorrência de eventos. RESULTADOS: O estudo atuarial mostrou que, ao longo do tempo, no grupo G2 (com 50,01 por cento a 100 por cento das consultas com a RNI no intervalo desejado) maior número de pacientes esteve livre da ocorrência de qualquer tipo de evento, de eventos hemorrágicos menores ou da elevação exacerbada da RNI. As frequências linearizadas de ocorrência, em todos os tipos eventos, também foram menores nos pacientes do grupo G2. CONCLUSÕES: O tempo de permanência dentro do intervalo de anticoagulação desejado está diretamente relacionado com a ocorrência de complicações. Entretanto, mesmo com acompanhamento otimizado por meio de ambulatório especializado, apenas cerca de um terço dos pacientes apresentaram nível de anticoagulação adequado em mais da metade das consultas.

BACKGROUND: Published data suggest that rates of thromboembolism and bleeding, in patients with mechanical heart valve prostheses, can be very small by optimizing current anticoagulant therapy. OBJECTIVE: To evaluate the occurrence of complications in patients with mechanical heart valve prostheses undergoing anticoagulant therapy optimized through specialized clinics. METHODS: We studied the occurrence of complications over 10 years in 261 anticoagulated patients with mechanical heart valve prostheses, followed in specialized clinics. These patients were divided into two groups according to percentage of queries with prothrombin time (INR) within the desired range: G1-0 percent to 50.00 percent and G2-50.01 percent to 100 percent of appointments. We evaluated the occurrence of thromboembolic and bleeding complications in their entirety or subdivided into major and minor, according to gravity. The results are presented in an actuarial study and frequency of occurrence of linear events. RESULTS: The actuarial study showed that, over time, more G2 (with 50.01 percent to 100 percent of the consultations with INR in desired range) more patients were free of the occurrence of any event, of minor bleeding events or the marked increase of RNI. The linearized frequency of occurrence in all types events, were also lower in group G2. CONCLUSIONS: The period of time that patients that remain within the desired anticoagulation interval has directly relations with occurrence of complications. Even with careful follow-up at a specialized outpatient unit, only approximately one third of the patients showed an adequate anticoagulation level in more than half of the consultations.

Oral anticoagulation in carriers of mechanical heart valve prostheses: experience of ten years.

BACKGROUND: Published data suggest that rates of thromboembolism and bleeding, in patients with mechanical heart valve prostheses, can be very small by optimizing current anticoagulant therapy. OBJECTIVE: To evaluate the occurrence of complications in patients with mechanical heart valve prostheses undergoing anticoagulant therapy optimized through specialized clinics. METHODS: We studied the occurrence of complications over 10 years in 261 anticoagulated patients with mechanical heart valve prostheses, followed in specialized clinics. These patients were divided into two groups according to percentage of queries with prothrombin time (INR) within the desired range: G1-0% to 50.00% and G2-50.01% to 100% of appointments. We evaluated the occurrence of thromboembolic and bleeding complications in their entirety or subdivided into major and minor, according to gravity. The results are presented in an actuarial study and frequency of occurrence of linear events. RESULTS: The actuarial study showed that, over time, more G2 (with 50.01% to 100% of the consultations with INR in desired range) more patients were free of the occurrence of any event, of minor bleeding events or the marked increase of RNI. The linearized frequency of occurrence in all types events, were also lower in group G2. CONCLUSIONS: The period of time that patients that remain within the desired anticoagulation interval has directly relations with occurrence of complications. Even with careful follow-up at a specialized outpatient unit, only approximately one third of the patients showed an adequate anticoagulation level in more than half of the consultations.

Primary idiopathic chylopericardium--case report.

The accumulation of chyle in the pericardial space, or chylopericardium, is a condition occurring most frequently after trauma, cardiac and thoracic surgery, or in association with tumors, tuberculosis or lymphangiomatosis. When its precise cause cannot be identified, it is called primary or idiopathic chylopericardium. This is a rare clinical entity. We report the case of a surgically treated 20-year-old female patient. A brief review of the literature and comments on the clinical presentation, etiopathogenesis, ancillary diagnostic tests and treatment options are also presented.

Quilopericárdio idiopático primário: relato de caso / Quilopericardio idiopático primario: informe de caso clínico / Primary idiopathic chylopericardium: case report

O acúmulo de quilo no espaço pericárdico ou quilopericárdio é uma condição que, com maior frequência, ocorre após trauma, cirurgia cardíaca e torácica ou associado a tumores, tuberculose ou linfoangiomatose. Quando não é possível a identificação precisa da etiologia, o quilopericárdio é denominado primário ou idiopático. Essa é uma situação clínica rara. Descrevemos um caso em paciente do sexo feminino, com 20 anos de idade, tratada cirurgicamente. A propósito do caso, apresentamos breve revisão da literatura e comentários sobre quadro clínico, etiopatogenia, exames diagnósticos complementares e opções de tratamento.

The accumulation of chyle in the pericardial space, or chylopericardium, is a condition occurring most frequently after trauma, cardiac and thoracic surgery, or in association with tumors, tuberculosis or lymphangiomatosis. When its precise cause cannot be identified, it is called primary or idiopathic chylopericardium. This is a rare clinical entity. We report the case of a surgically treated 20-year-old female patient. A brief review of the literature and comments on the clinical presentation, etiopathogenesis, ancillary diagnostic tests and treatment options are also presented.

La acumulación de quilo en el espacio pericárdico o quilopericardio es una condición que con mayor frecuencia ocurre después de trauma, cirugía cardíaca y torácica o asociado a tumores, tuberculosis o linfoangiomatosis. Cuando no es posible la identificación precisa de la etiología, el quilopericardio se denomina primario o idiopático. Esta es una situación clínica rara. Describimos un caso en paciente del sexo femenino, con 20 años de edad, tratada quirúrgicamente. A propósito del caso, presentamos una breve revisión bibliográfica y comentarios sobre el cuadro clínico, la etiopatogenia, exámenes diagnósticos complementarios y opciones de tratamiento.

Análise do controle de anticoagulação oral em pacientes portadores de próteses valvares cardíacas mecânicas por meio de ambulatório especializado. experiência de 10 anos / Control of oral anticoagulation in patients with mechanical prosthetic heart valves from specialized outpatient clinic

Estudo realizado, com base nos dados do ambulatório, para controle de anticoagulação nos pacientes portadores de próteses valvares cardíacas mecânicas do Serviço de Cirurgia Cardiovascular do Hospital das Clínicas da Faculdade de Medicina de Botucatu, no intervalo de dez anos, com os objetivos: avaliação da resposta à terapêutica profilática anticoagulante; quantificação das complicações tromboembólicas e hemorrágicas, com estratificação de sua gravidade; comparação entre tipos de anticoagulantes orais, doses e efeitos; influência da posição da prótese; presença de fibrilação atrial e tamanho do átrio esquerdo; e análise da estratégia de anticoagulação adotada. Foram incluídos, no estudo, 259 pacientes portadores de próteses mitrais (mitrais), aórticas (aórticos) e mitral e aórticas (mitro-aórticos). Foram analisadas 9714 consultas com valores do tempo de protrombina (em RNI) e dados dos registros hospitalares sobre complicações tromboembólicas e hemorrágicas com graus de gravidade. Os pacientes foram divididos em quatro grupos de acordo com o porcentual de consultas em que a RNI se encontrava dentro do intervalo desejado. Foram estudados dois anticoagulantes (Fenprocumona e Warfarina) e suas dosagens. Foi, também, avaliada a ocorrência de complicações tromboembólicas e hemorrágicas. Os resultados estão apresentados em: número de pacientes com complicações, estudo atuarial e frequência linearizada de ocorrência de eventos.

Obtenção minimamente invasiva de veia safena para cirurgia de revascularização do miocárdio / Minimally invasive procurement of saphenous veins for coronary artery bypass grafting

OBJETIVO: Analisar, comparativamente, a obtenção minimamente invasiva com o uso do MINI-HARVEST® e com instrumental tradicional adaptado. MÉTODO: De junho de 1996 a janeiro de 1999, 63 pacientes submetidos à cirurgia de revascularização do miocárdio tiveram suas veias safenas retiradas segundo técnica minimamente invasiva. Nos 30 primeiros pacientes da série utilizou-se método de visão direta com auxílio de dois afastadores de Langenbeck, e nos 33 restantes utilizou-se o MINI-HARVEST®. RESULTADOS: A idade média dos pacientes era de 61 ± 8,75 anos, sendo 52 homens e 11 mulheres. Quarenta e cinco pacientes eram diabéticos, 45 apresentavam sobrepeso/obesidade, 25 eram tabagistas ativos, 32 apresentavam história pregressa de infarto do miocárdio. O tempo médio de retirada da veia safena com afastadores Langenbeck foi de 34,2 ± 8,14 minutos e com o MINI-HARVEST® de 39,20 ± 9,12 minutos. A extensão de veia retirada foi similar nos dois grupos, variando de 10 a 30 cm. Houve uma deiscência superficial no grupo com afastadores de Langenbeck. Houve necessidade de reversão para método tradicional de retirada em dois casos do grupo MINI-HARVEST® e um do grupo Langenbeck. A incidência de infarto transoperatório foi 4,5 por cento (três) no grupo Langenbeck e 3,1 por cento(dois) no grupo MINI-HARVEST®. CONCLUSÕES: Podemos concluir que o método de obtenção de veia safena minimamente invasivo sob visão direta é efetivo e seguro, tanto com o uso de instrumentos tradicionais adaptados para este fim, como com afastadores especialmente constituídos, ressaltando-se que o MINI-HARVEST® dispensa a presença de um auxiliar.

Sutura arterial com técnicas contínua e de pontos separados, utilizando-se os fios polipropilene e polidioxanone: estudo experimental em coelhos / Arterial suture with continuous and interrupted techniques, using polypropylene and polydioxanone threads: experimental study in rabbits

OBJETIVO: Observar o comportamento da sutura arterial em aortas abdominais de coelhos em crescimento, comparando-se as técnicas contínua e com pontos separados, empregando-se dois tipos de fios: Polipropilene 7-0 (inabsorvível) e Polidioxanone 7-0 (absorvível). MÉTODOS: Grupos: GI - Controle (sem sutura); GII - Polipropilene, Pontos Separados; GIII - Polipropilene, Contínua; GIV - Polidioxanone, Pontos Separados e GV - Polidioxanone, Contínua. Cada grupo foi subdividido em quatro Momentos de Eutanásia: aos 7, 14, 30 e 60 dias de pós-operatório. Foram avaliados: peso dos animais, diâmetros e pulsos arteriais, estenose, trombose, aderências, aortografia, visibilidade do fio, cicatrizaçäo e microscopia. RESULTADOS: a) após 60 dias, o local da linha de sutura cresceu de forma significativa em todos os grupos; b) a técnica de sutura com pontos separados causou menor estenose da linha de sutura, observada tanto no ato cirúrgico, como na eutanásia dos animais; c) no exame histopatológico, as diferenças encontradas entre grupos foram transitórias, näo persistindo após 60 dias de pós-operatório. CONCLUSÄO: O polidioxanone mostrou ser a melhor opçäo, entre os dois fios, para sutura de artérias em crescimento, pois causa pouca ou nenhuma restriçäo ao crescimento arterial na linha de sutura, mesmo quando se emprega a técnica contínua

Prevalência de depressão em mulheres com diabetes mellitus tipo 2 na pós-menopausa / Prevalence of depression in postmenopausal women with type 2 diabetes mellitus

A prevalência de depressão e suas correlações com o controle metabólico foram estudadas em 80 mulheres pós-menopausadas diabéticas e em 45 mulheres não diabéticas, tendo sido utilizado o questionário de depressão de Beck (QDB) para o diagnóstico de depressão. A prevalência de depressão foi significativamente maior no grupo de diabéticas na pós-menopausa em comparação às não diabéticas (p<0,001; RR= 2,4). As pacientes não diabéticas apresentaram média de idade e de pontos do QDB superiores às diabéticas. Além disso, foram observados entre as diabéticas com depressão valores significativamente elevados de glicemia e hemoglobina glicosilada, demonstrando que as diabéticas depressivas apresentaram pior controle metabólico do que as não depressivas. Entre as diabéticas depressivas, a depressão também se correlacionou positivamente com a idade, mas não com o tempo de diagnóstico da doença.