Optimization of Biodiesel Production Process Using MoO3 Catalysts and Residual Oil: A Comprehensive Experimental 23 Study.

The study aimed to utilize MoO3 catalysts, produced on a pilot scale via combustion reaction, to produce biodiesel from residual oil. Optimization of the process was conducted using a 23 experimental design. Structural characterization of the catalysts was performed through X-ray diffraction, fluorescence, Raman spectroscopy, and particle size distribution analyses. At the same time, thermal properties were examined via thermogravimetry and differential thermal analysis. Catalytic performance was assessed following process optimization. α-MoO3 exhibited a monophasic structure with orthorhombic phase, whereas α/h-MoO3 showed a biphasic structure. α-MoO3 had a larger crystallite size and higher crystallinity, with thermal stability observed up to certain temperatures. X-ray fluorescence confirmed molybdenum oxide predominance in the catalysts, with traces of iron oxide. Particle size distribution analyses revealed polymodal distributions attributed to structural differences. Both catalysts demonstrated activity under all conditions tested, with ester conversions ranging from 93% to 99%. The single-phase catalyst had a long life cycle and was reusable for six biodiesel production cycles. The experimental design proved to be predictive and significant, with the type of catalyst being the most influential variable. Optimal conditions included α-MoO3 catalyst, oil/alcohol ratio of 1/15, and a reaction time of 60 min, resulting in high biodiesel conversion rates and showcasing the viability of MoO3 catalysts in residual oil biodiesel production.

A Three-Year Study on the Nutritional Composition and Occurrence of Mycotoxins of Corn Varieties with Different Transgenic Events Focusing on Poultry Nutrition.

Corn is one of the most produced cereals in the world and plays a major role in poultry nutrition. As there is limited scientific information regarding the impact of transgenic technology on the quality and nutrient composition of the grains, this study investigated the effect of three major transgenic corn varieties-VT PRO3®, PowerCore® ULTRA, and Agrisure® Viptera 3-on the field traits, nutrient composition, and mycotoxin contamination of corn grains cultivated in southern Brazil during three consecutive harvests. VT PRO3®, while demonstrating superior crop yield, showed susceptibility to mycotoxins, particularly fumonisins. In contrast, PowerCore® ULTRA, with the lowest yield, consistently exhibited lower levels of fumonisins. VT PRO3® had higher AMEn than the other varieties, while PowerCore® ULTRA had the highest total and digestible amino acid contents over the three years. The study's comprehensive analysis reveals the distinct impact of transgenic corn technologies on both productivity and nutritional levels. Balancing the crops yield, mycotoxin resistance, and nutritional content of corn is crucial to meet the demands of the poultry feed industry. Such insights are essential for decision-making, ensuring sustainability and efficiency in agricultural production as well as meeting the demands of the poultry industry.

Association between intraoperative ketamine and the incidence of emergence delirium in laparoscopic surgeries: an observational study

Abstract Background: Emergence Delirium (ED) is an essential condition in the immediate postoperative period. Systematic review and meta-analysis of randomized controlled trials have concluded that the effect of ketamine on postoperative delirium remains unclear. The present study sought to evaluate if the intraoperative use of ketamine for postoperative analgesia is associated with postoperative ED in laparoscopic surgeries. Methods: A prospective observational study was performed in the PostAnesthetic Care Unit (PACU) to evaluate patients who had undergone laparoscopic surgery under a rigid intraoperative anesthesia protocol from July 2018 to January 2019. Patients submitted to laparoscopic surgery for cholecystectomy, oophorectomy, or salpingectomy with a score ≥1 on the Richmond Assessment Sedation Scale (RASS) or ≥2 on the Nursing Delirium Screening Scale (Nu-DESC) were considered to have ED. t-test, Chi-Square test or Fisher's exact tests were used for comparison. Results: One hundred and fifteen patients were studied after laparoscopic surgery. Seventeen patients (14.8%) developed ED, and the incidence of ED in patients who received ketamine was not different from that of other patients (18.3% vs. 10.6%, p = 0.262). Patients with ED had more postoperative pain and morphine requirement at the PACU (p = 0.005 and p = 0.025, respectively). Type of surgery (general surgery, OR = 6.4, 95% CI 1.2‒35.2) and postoperative pain (OR = 3.7, 95% CI 1.2‒11.4) were risk factors for ED. Conclusion: In this study, no association was found between ED and intraoperative administration of ketamine in laparoscopic surgeries. Type of surgery and postoperative pain were risk factors for ED.

Dialogando com lacan para uma compreensão da estrutura das psicoses / A dialogue with lacan to understand the structure of psychoses

O trabalho realizado e que vai aqui apresentado consiste em uma apresentação do percurso empreendido por Jacques Lacan ([1955-56] 1988) no Seminário sobre As Psicoses. A proposta de chamar o nosso percurso de "diálogos" baseia-se na leitura de outros textos e notícias que reportam ao tema, ajudando-nos a melhor compreendê-lo. Não é um percurso simples e tampouco óbvio. A escrita de Lacan, ou mesmo a estrutura psicótica, abre continuamente outras portas pelas quais pode o observador perscrutar, embora não lhe seja permitido adentrar com suas ansiosas pretensões interpretativas, plenas de significantes simbólicos. Contente-se, pois, o clínico, com a função de secretário do delírio, compreendendo-o não simplesmente como uma defesa, mas como uma outra forma de se organizar diante de um outro ­ imagem de si e que rejeita habitar o complexo mundo da linguagem.

The work carried out and which will be presented here consists of a presentation of the journey undertaken by Jacques Lacan ([1955-56] 1988) at the Seminar on The Psychoses. The proposal to call our journey "dialogues" is based on reading other texts and news that report on the topic, helping us to better understand it. It is not a simple or obvious route. Lacan's writing, or even the psychotic structure, continually opens other doors through which the observer can peer, although he is not allowed to enter with his anxious interpretative pretensions, full of symbolic signifiers. Therefore, the clinician is content, with the role of secretary of the delusion, understanding it not simply as a defense, but as another way of organizing himself in front of another - an image of himself that rejects inhabiting the complex world of language.

Ultrassonografia intravascular para guiar a intervenção coronária percutânea: resultados do registro nacional português / Intravascular ultrasound in percutaneous coronary intervention guidance: results from Portuguese registry

Introdução: As diretrizes atuais recomendam o uso da ultrassonografia intravascular de coronárias como ferramenta adjuvante em situações difíceis. Objetivo: Caracterizar a utilização da ultrassonografia intravascular em Portugal e comparar os desfechos após intervenção coronária percutânea no tronco da coronária esquerda, guiada ou não por ultrassonografia intravascular. Métodos: Estudo observacional retrospectivo multicêntrico, que analisou pacientes submetidos à intervenção coronária percutânea entre janeiro de 2012 e dezembro de 2018, incluídos no Portuguese Registry on Interventional Cardiology da Sociedade Portuguesa de Cardiologia. Valor de p bicaudal <0,05 foi considerado estatisticamente significativo. Resultados: Este estudo demonstrou variação significativa na utilização da ultrassonografia intravascular em Portugal (valor de p qui-quadrado para tendência <0,001). O ano com maior utilização foi 2016 (2,4%). Houve aumento progressivo, nos últimos 7 anos, na utilização da ultrassonografia intravascular na intervenção coronária percutânea do tronco da coronária esquerda (valor de p qui-quadrado para tendência <0,001), com importantes diferenças regionais. A população submetida à intervenção coronária percutânea do tronco da coronária esquerda guiada por ultrassonografia intravascular era mais jovem, mas tinha maior prevalência de fatores de risco cardiovascular, disfunção sistólica ventricular e lesões coronárias complexas. Além disso, esse grupo de pacientes teve menor prevalência do desfecho primário intra-hospitalar (1,4% versus 3,9%; p=0,024). Porém, após análise multivariada ajustada para fatores de confusão, este estudo não demonstrou impacto significativo da utilização da ultrassonografia intravascular no desfecho intra-hospitalar. Conclusão: A utilização da ultrassonografia intravascular na intervenção coronária percutânea do tronco da coronária esquerda vem aumentando lentamente nos últimos 7 anos em Portugal. Neste estudo, a utilização desse método não teve impacto estatístico nos desfechos intra-hospitalares.

Background: Current guidelines recommend the use of coronary intravascular ultrasound as an adjunctive tool in challenging situations. Objective: To characterize the use of intravascular ultrasound in Portugal and compare outcomes after left main percutaneous coronary intervention, with or without intravascular ultrasound. Methods: A retrospective multicentric observational study analyzed patients who underwent percutaneous coronary intervention between January 2012 and December 2018 and were included in the Portuguese Registry on Interventional Cardiology of the Sociedade Portuguesa de Cardiologia. A two-sided p-value<0.05 was considered statistically significant. Results: This study revealed significant variation of intravascular ultrasound usage in Portugal over time (p-value Chi-squared for trend <0.001). The year with maximum use was 2016 (2.4%). Regarding left main percutaneous coronary intervention, there was a progressive increase in use of intravascular ultrasound (p-value Chi-squared for trend<0.001) in the last 7 years, with important regional differences. The population submitted to left main percutaneous coronary intervention with intravascular ultrasound was younger, but had a higher prevalence of some cardiovascular risk factors, ventricular systolic dysfunction, and complex coronary lesions. Moreover, this group of patients had lower prevalence of intrahospital primary endpoint (1.4% versus 3.9%; p=0.024). However, after multivariate analysis adjusted to confounding factors, this study did not demonstrate a significant impact of intravascular ultrasound on intrahospital endpoint. Conclusion: The overall use of intravascular ultrasound in left main percutaneous coronary intervention has been slowly increasing in the last seven years, in Portugal. In this study, the use of this method had no statistical impact in intrahospital endpoints.

Association between intraoperative ketamine and the incidence of emergence delirium in laparoscopic surgeries: an observational study.

BACKGROUND: Emergence Delirium (ED) is an essential condition in the immediate postoperative period. Systematic review and meta-analysis of randomized controlled trials have concluded that the effect of ketamine on postoperative delirium remains unclear. The present study sought to evaluate if the intraoperative use of ketamine for postoperative analgesia is associated with postoperative ED in laparoscopic surgeries. METHODS: A prospective observational study was performed in the PostAnesthetic Care Unit (PACU) to evaluate patients who had undergone laparoscopic surgery under a rigid intraoperative anesthesia protocol from July 2018 to January 2019. Patients submitted to laparoscopic surgery for cholecystectomy, oophorectomy, or salpingectomy with a score ≥1 on the Richmond Assessment Sedation Scale (RASS) or ≥2 on the Nursing Delirium Screening Scale (Nu-DESC) were considered to have ED. t-test, Chi-Square test or Fisher's exact tests were used for comparison. RESULTS: One hundred and fifteen patients were studied after laparoscopic surgery. Seventeen patients (14.8%) developed ED, and the incidence of ED in patients who received ketamine was not different from that of other patients (18.3% vs. 10.6%, p = 0.262). Patients with ED had more postoperative pain and morphine requirement at the PACU (p = 0.005 and p = 0.025, respectively). Type of surgery (general surgery, OR = 6.4, 95% CI 1.2‒35.2) and postoperative pain (OR = 3.7, 95% CI 1.2‒11.4) were risk factors for ED. CONCLUSION: In this study, no association was found between ED and intraoperative administration of ketamine in laparoscopic surgeries. Type of surgery and postoperative pain were risk factors for ED.

Health promotion at work: assessment of lifestyles of administrative assistants in a hospital.

OBJECTIVE: To characterize the lifestyles of administrative assistants in a hospital, in order to define health promotion strategies in the workplace. METHOD: A quantitative, descriptive, cross-sectional study, carried out with administrative assistants (N = 167) of a medium-sized Portuguese hospital. The data were collected through a questionnaire (QEV&PS-SO) for sociodemographic characterization and analysis of health determinants related to lifestyles. RESULTS: It was observed that 54% of the sample did not practice physical exercise, 52% had four or fewer meals a day, 29% were smokers, 51% had insomnia, and 45% had no health surveillance, as well as 51.5% were overweight or obese and 63% had an increased or very increased risk of developing metabolic complications. No significant differences were identified in relation to weight, physical exercise or stress according to sex or age. CONCLUSION: The results support the need to develop intervention programs with strategies aimed at promoting healthy lifestyles among workers in health institutions, to be comprehensively integrated within the scope of occupational health.

A atuação do empresário no executivo municipal apresenta melhores resultados? / ¿El emprendedor en el Poder Ejecutivo Municipal tiene mejores resultados? / Is a business owner a better mayor?

Resumo O objetivo deste artigo é levantar as características demográficas dos prefeitos eleitos, enfatizando os candidatos que se declaram empresários, e analisar se esse perfil tem melhores resultados quanto ao desempenho, medidos com base na situação fiscal e no Índice de Educação Básica (IDEB) do município. Para tanto, o trabalho foi dividido em duas partes. Na primeira, por meio de regressão logística, buscou-se encontrar o perfil do candidato eleito, centrando-se no fato de ele ser empresário. Na segunda seção do artigo, com o emprego da metodologia de regressão multinível, foi analisado se tal perfil escolhido pelos eleitores era responsável por um desempenho superior. Com relação aos resultados, apesar de os empresários constituírem a maioria entre os candidatos, essa característica não foi significativa para o sucesso eleitoral. Na segunda parte da pesquisa, de modo geral os resultados não encontraram correlação entre o perfil dos eleitos e o desempenho da gestão municipal. Somente a idade do prefeito foi significativa na questão fiscal dos municípios. Dessa forma, os empresários não apresentam resultados diferentes da média, o que permite pressupor que esse grupo não tem melhores habilidades e julgamentos.

Resumen El objetivo de este artículo es sondear las características demográficas de los alcaldes electos elegidos, con énfasis en los candidatos que se declaran emprendedores, y analizar si este perfil tiene mejores resultados de desempeño, medido por la situación fiscal del municipio y el puntaje del IDEB (Índice de Desarrollo de la Educación Básica). Para ello, el trabajo se dividió en dos partes. En la primera, mediante regresión logística, se buscó encontrar el perfil del candidato elegido. En la segunda parte del artículo se analizó si el perfil elegido por los votantes era responsable de un desempeño superior. La metodología utilizada fue la de regresión multinivel. En cuanto a los resultados, a pesar de que los empresarios fueron mayoría entre los candidatos, esta característica no fue significativa para explicar el éxito electoral. En general, en la segunda parte de la investigación, los resultados no demostraron correlación entre el perfil de los elegidos y el desempeño de la gestión municipal. Solo la edad del alcalde fue significativa para explicar el tema fiscal de los municipios. De esta forma, los emprendedores no presentan resultados diferentes a la media, lo que nos permite concluir que este grupo no tiene mejores habilidades y juicios. Entre las limitaciones de este trabajo, está la cuestión de que la variable "emprendedor" haya sido declarada libremente por los candidatos.

Abstract This study analyzes the demographic characteristics of elected mayors in Brazil, emphasizing those who are business owners. The research observes whether mayors with a background as business owners obtain better performance in office, which is evaluated through the municipality's fiscal situation and the IDEB (basic education development index) score. The research was conducted in two parts. The first part used logistic regression and sought to identify the profile of elected mayors. The second part analyzed whether mayors who were business owners obtained a superior performance using the multilevel regression model. The study observed that the majority of mayors had a background as business owners, but this characteristic was not significant to explain electoral success. The results of the second part did not find a correlation between mayors who are business owners and their performance. The only demographic characteristic relevant to explain differences in municipalities' fiscal results was the mayor's age. Therefore, mayors who were business owners did not present results different from those who have other backgrounds, which allows us to assume that this group does not have better skills and judgments. One of the limitations of this study is that the characteristic of being a business owner was obtained by self-declaration.

Lingual tonsil hypertrophy: about a case of unpredictable difficult airway / Hipertrofia de la amígdala lingual: a propósito de un caso de vía aérea difícil imprevisible

Abstract: Eleven years old children, proposed for resection of pylocitic astrocytoma of cerebellum, presented with lingual tonsil hypertrophy causing a unpredictable difficult airway approach. The presence of a lingual tonsil hypertrophied isn't diagnosed most of the times, with their occurrence being associated with previous tonsillectomy in more than half of the cases. Its occurrence, and non-identification, can originate scenarios of difficult airway approach, with a higher morbility association.

Resumen: Niño con 11 años, propuesto para exéresis de recidiva de astrocitoma pilocítico del cerebelo con hipertrofia de las amígdalas linguales a condicionar vía aérea difícil no previsible. La hipertrofia de las amígdalas linguales es subdiagnosticada y se suele asociar a amigdalectomía previa en más de la mitad de los casos. Su ocurrencia y no reconocimiento, puede originar situaciones de vía aérea difícil, con alta morbilidad asociada.

How to set up regional STEMI networks: a "Stent - Save a life!" initiative.

Clinical guidelines recommend the development of ST-elevation myocardial infarction (STEMI) networks at community, regional and/or national level to ideally offer primary coronary angioplasty, or at least the best available STEMI care to all patients. However, there is a discrepancy between this clinical recommendation and daily practice, with no coordinated care for STEMI patients in many regions of the world. While this can be a consequence of lack of resources, in reality it is more frequently a lack of organisational power. In this paper, the Stent - Save a Life! Initiative (www.stentsavealife.com) proposes a practical methodology to set up a STEMI network effectively in any region of the world with existing resources, and to develop the STEMI network continuously once it has been established.

Health promotion at work: assessment of lifestyles of administrative assistants in a hospital / Promoción de la salud en el trabajo: evaluación de los estilos de vida de auxiliares administrativos en un hospital / Promoção da saúde no trabalho: avaliação dos estilos de vida de assistentes administrativos de um hospital

ABSTRACT Objective: To characterize the lifestyles of administrative assistants in a hospital, in order to define health promotion strategies in the workplace. Method: A quantitative, descriptive, cross-sectional study, carried out with administrative assistants (N = 167) of a medium-sized Portuguese hospital. The data were collected through a questionnaire (QEV&PS-SO) for sociodemographic characterization and analysis of health determinants related to lifestyles. Results: It was observed that 54% of the sample did not practice physical exercise, 52% had four or fewer meals a day, 29% were smokers, 51% had insomnia, and 45% had no health surveillance, as well as 51.5% were overweight or obese and 63% had an increased or very increased risk of developing metabolic complications. No significant differences were identified in relation to weight, physical exercise or stress according to sex or age. Conclusion: The results support the need to develop intervention programs with strategies aimed at promoting healthy lifestyles among workers in health institutions, to be comprehensively integrated within the scope of occupational health.

RESUMEN Objetivo: Caracterizar los estilos de vida de los auxiliares administrativos de un hospital, para definir estrategias de promoción de la salud en el trabajo. Método: Estudio cuantitativo, descriptivo, transversal, realizado con auxiliares administrativos (N = 167) de un hospital portugués de tamaño medio. Los datos fueron recolectados a través de un cuestionario (QEV&PS-SO), para la caracterización sociodemográfica y el análisis de los determinantes de la salud relacionados con los estilos de vida. Resultados: Se observó que el 54% de la muestra no practicaba ejercicio físico, el 52% hacía cuatro o menos comidas al día, el 29% era fumador, el 51% tenía insomnio, el 45% no tenía vigilancia de salud, así como el 51,5% tenía sobrepeso u obesidad y el 63% tenía un riesgo aumentado o muy aumentado de desarrollar complicaciones metabólicas. No se identificaron diferencias significativas en relación con el peso, el ejercicio físico o el estrés según el sexo o la edad. Conclusión: Los resultados respaldan la necesidad de desarrollar programas de intervención con estrategias dirigidas a la promoción de estilos de vida saludable entre los trabajadores de las instituciones de salud, para ser integradas integralmente en el ámbito de la salud ocupacional.

RESUMO Objetivo: Caracterizar os estilos de vida dos assistentes administrativos de um hospital, para definição de estratégias de promoção de saúde no local de trabalho. Método: Estudo quantitativo, descritivo, de caráter transversal, realizado junto a assistentes administrativos (N = 167) de um hospital português de média dimensão. Os dados foram coletados através de um questionário (QEV&PS-SO), para caracterização sociodemográfica e análise dos determinantes de saúde relacionados com estilos de vida. Resultados: Observou-se que 54% da amostra não praticava exercício físico, 52% fazia quatro ou menos refeições por dia, 29% apresentava hábitos tabágicos, 51% tinha insônia e 45% não fazia vigilância de saúde, assim como 51,5% apresentava excesso de peso ou obesidade e 63% apresentava risco aumentado ou muito aumentado para desenvolvimento de complicações metabólicas. Não se identificaram diferenças significativas em relação ao peso, prática de exercício físico ou estresse em função do sexo ou idade. Conclusão: Os resultados sustentam a necessidade do desenvolvimento de programas de intervenção com estratégias dirigidas à promoção de estilos de vida saudáveis junto aos trabalhadores das instituições de saúde, a serem integradas, de forma compreensiva, no âmbito da saúde ocupacional.

Estratégias de Revascularização em Doentes com Infarto Agudo do Miocárdio em Choque Cardiogênico - Resultados do Registo Português de Síndromes Coronárias Agudas / Revascularization Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock: Results from the Portuguese Registry on Acute Coronary Syndromes

Resumo Fundamento: Em doentes com infarto agudo do miocárdio (IAM), choque cardiogênico (CC) e doença multivaso (DMV) persistem dúvidas sobre a intervenção nas artérias não responsáveis. Objetivos: 1) caracterizar a amostra de doentes com IAM, CC e DMV incluídos no Registo Nacional Português de Síndromes Coronárias Agudas (RNSCA); 2) comparar os eventos associados a diferentes estratégias de revascularização; e 3) identificar preditores de mortalidade intra-hospitalar nesta amostra. Métodos: Estudo observacional retrospetivo de doentes com IAM, CC e DMV incluídos no RNSCA entre 2010 e 2018. Compararam-se duas estratégias de revascularização: completa durante o procedimento índice (grupo 1); e completa diferida ou incompleta durante o internamento (grupo 2-3). O endpoint primário foi a ocorrência de reinfarto ou morte intra-hospitalar. A significância estatística foi definida por um valor p < 0,05. Resultados: Identificaram-se 127 doentes com IAM, CC e DMV (18,1% no grupo 1 e 81,9% no grupo 2-3), com idade média de 70 ± 12 anos e 92,9% com IAM com supradesnivelamento do segmento ST. O endpoint primário ocorreu em 47,8% dos doentes do grupo 1 e em 37,5% do grupo 2-3 (p = 0,359). As taxas de mortalidade intra-hospitalar, reinfarto, acidente vascular cerebral e hemorragia major foram também semelhantes nos dois grupos. Os preditores de mortalidade intra-hospitalar nesta amostra foram a presença na admissão de disfunção ventricular esquerda (OR 16,8), bloqueio completo de ramo direito (OR 7,6) e anemia (OR 5,2), (p ≤ 0,02). Conclusões: Entre os doentes com IAM, CC e DMV, incluídos no RNSCA, não se verificou diferença significativa entre revascularização completa no evento índex e completa diferida ou incompleta durante o internamento, relativamente à ocorrência de morte intra-hospitalar ou reinfarto. (Arq Bras Cardiol. 2021; 116(5):867-876)

Abstract Background: In patients with acute myocardial infarction (MI), cardiogenic shock (CS), and multivessel disease (MVD) questions remain unanswered when it comes to intervention on non-culprit arteries. Objective: This article aims to 1) characterize patients with MI, CS and MVD included in the Portuguese Registry on Acute Coronary Syndromes (ProACS); 2) compare different revascularization strategies in the sample; 3) identify predictors of in-hospital mortality among these patients. Methods: Observational retrospective study of patients with MI, CS and MVD included in the ProACS between 2010 and 2018. Two revascularization strategies were compared: complete during the index procedure (group 1); and complete or incomplete during the index hospitalization (groups 2-3). The primary endpoint was a composite of in-hospital death or MI. Statistical significance was defined by a p-value <0.05. Results: We identified 127 patients with MI, CS, and MVD (18.1% in group 1, and 81.9% in groups 2-3), with a mean age of 7012 years, and 92.9% of the sample being diagnosed with ST-segment elevation MI (STEMI). The primary endpoint occurred in 47.8% of the patients in group 1 and 37.5% in group 2-3 (p = 0.359). The rates of in-hospital death, recurrent MI, stroke, and major bleeding were also similar. The predictors of in-hospital death in this sample were the presence of left ventricle systolic dysfunction on admission (OR 16.8), right bundle branch block (OR 7.6), and anemia (OR 5.2) (p ≤ 0.02 for both). Conclusions: Among patients with MI, CS, and MVD included in the ProACS, there was no significant difference between complete and incomplete revascularization during the index hospitalization regarding the occurrence of in-hospital death or MI. (Arq Bras Cardiol. 2021; 116(5):867-876)

Revascularization Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock: Results from the Portuguese Registry on Acute Coronary Syndromes. / Estratégias de Revascularização em Doentes com Infarto Agudo do Miocárdio em Choque Cardiogênico ­ Resultados do Registo Português de Síndromes Coronárias Agudas.

BACKGROUND: In patients with acute myocardial infarction (MI), cardiogenic shock (CS), and multivessel disease (MVD) questions remain unanswered when it comes to intervention on non-culprit arteries. OBJECTIVE: This article aims to 1) characterize patients with MI, CS and MVD included in the Portuguese Registry on Acute Coronary Syndromes (ProACS); 2) compare different revascularization strategies in the sample; 3) identify predictors of in-hospital mortality among these patients. METHODS: Observational retrospective study of patients with MI, CS and MVD included in the ProACS between 2010 and 2018. Two revascularization strategies were compared: complete during the index procedure (group 1); and complete or incomplete during the index hospitalization (groups 2-3). The primary endpoint was a composite of in-hospital death or MI. Statistical significance was defined by a p-value <0.05. RESULTS: We identified 127 patients with MI, CS, and MVD (18.1% in group 1, and 81.9% in groups 2-3), with a mean age of 7012 years, and 92.9% of the sample being diagnosed with ST-segment elevation MI (STEMI). The primary endpoint occurred in 47.8% of the patients in group 1 and 37.5% in group 2-3 (p = 0.359). The rates of in-hospital death, recurrent MI, stroke, and major bleeding were also similar. The predictors of in-hospital death in this sample were the presence of left ventricle systolic dysfunction on admission (OR 16.8), right bundle branch block (OR 7.6), and anemia (OR 5.2) (p ≤ 0.02 for both). CONCLUSIONS: Among patients with MI, CS, and MVD included in the ProACS, there was no significant difference between complete and incomplete revascularization during the index hospitalization regarding the occurrence of in-hospital death or MI. (Arq Bras Cardiol. 2021; 116(5):867-876).

FUNDAMENTO: Em doentes com infarto agudo do miocárdio (IAM), choque cardiogênico (CC) e doença multivaso (DMV) persistem dúvidas sobre a intervenção nas artérias não responsáveis. OBJETIVOS: 1) caracterizar a amostra de doentes com IAM, CC e DMV incluídos no Registo Nacional Português de Síndromes Coronárias Agudas (RNSCA); 2) comparar os eventos associados a diferentes estratégias de revascularização; e 3) identificar preditores de mortalidade intra-hospitalar nesta amostra. MÉTODOS: Estudo observacional retrospetivo de doentes com IAM, CC e DMV incluídos no RNSCA entre 2010 e 2018. Compararam-se duas estratégias de revascularização: completa durante o procedimento índice (grupo 1); e completa diferida ou incompleta durante o internamento (grupo 2-3). O endpoint primário foi a ocorrência de reinfarto ou morte intra-hospitalar. A significância estatística foi definida por um valor p < 0,05. RESULTADOS: Identificaram-se 127 doentes com IAM, CC e DMV (18,1% no grupo 1 e 81,9% no grupo 2-3), com idade média de 70 ± 12 anos e 92,9% com IAM com supradesnivelamento do segmento ST. O endpoint primário ocorreu em 47,8% dos doentes do grupo 1 e em 37,5% do grupo 2-3 (p = 0,359). As taxas de mortalidade intra-hospitalar, reinfarto, acidente vascular cerebral e hemorragia major foram também semelhantes nos dois grupos. Os preditores de mortalidade intra-hospitalar nesta amostra foram a presença na admissão de disfunção ventricular esquerda (OR 16,8), bloqueio completo de ramo direito (OR 7,6) e anemia (OR 5,2), (p ≤ 0,02). CONCLUSÕES: Entre os doentes com IAM, CC e DMV, incluídos no RNSCA, não se verificou diferença significativa entre revascularização completa no evento índex e completa diferida ou incompleta durante o internamento, relativamente à ocorrência de morte intra-hospitalar ou reinfarto. (Arq Bras Cardiol. 2021; 116(5):867-876).

Hematology and biochemistry of buffalo (Bubalus bubalis): influence of sex and age on reference values.

This research aimed to obtain a hematological and biochemical profile of buffalos (Bubalus bubalis) bred in a region of the Brazilian Legal Amazon. A total of 73 animals of mixed races, divided into three groups, were studied: group 1 (G1) comprised animals up to 11 months old; in group 2 (G2), subjects were 12 to 23 months old; and, in group 3 (G3), they were 24 months old and older. We performed the hematological analysis manually, and, for the biochemistry, we used biochemical analyzers. Age of the animals has influenced the monocyte count. The counting of these cells was higher (p > 0.05) in younger animals (G1). There was no difference (p > 0.05) in hematological parameters concerning sex. In regard to biochemistry, we found that age influenced results for albumin and urea. Animals from G1 had higher albumin values when compared to G2 and G3. Serum urea values were higher in animals from G3. Regarding the serum mineral parameters, there were no significant results when the different age groups and both sexes were compared. Thus, the hematological and biochemical values obtained can work as a reference for the bubaline species of animals bred in the studied region, under the same management and breeding conditions. Sex and age of the animals are necessary for the interpretation of the tests.

Neurological Complications in Patients with Infective Endocarditis: Insights from a Tertiary Centre. / Complicações Neurológicas em Pacientes com Endocardite Infecciosa: Perspectivas de um Centro Terciário.

BACKGROUND: Neurological complications are common in patients with infective endocarditis (IE). Recent data suggest that neurologic events are a major determinant of prognosis, and that surgery is critical in improving the outcome. OBJECTIVE: To characterize patients with IE and neurological complications and to determine predictors of embolization to the central nervous system (CNS) and mortality. METHODS: Retrospective analysis of patients admitted to a tertiary center with the diagnosis of IE from 2006 to 2016. Statistical significance was defined by a p-value < 0.05. RESULTS: We identified 148 episodes of IE, 20% of which had evidence of CNS embolization. In patients with CNS embolization, 76% presented with ischemic stroke. During follow-up, 35% were submitted to surgery and both in-hospital and one-year mortality were 39%. These patients had longer hospitalizations, but there were no significant differences regarding mortality in patients with and without CNS embolization. The independent predictors of neurological complications were diabetes (p=0.005) and the absence of fever at presentation (p=0.049). Surgery was associated with lower mortality (0 vs. 58%; p=0.003), while patients with septic shock had a poorer prognosis (75 vs. 25%; p=0.014). In multivariate Cox regression, human immunodeficiency virus (HIV) infection was the only independent predictor of in-hospital and 1-year mortality (p=0.011 in both). CONCLUSIONS: In this population, embolization to the CNS was common, more often presented as ischemic stroke, and was associated with longer hospitalization, although without significant differences in mortality. In patients with CNS embolization, those submitted to surgery had a good clinical evolution, while patients with septic shock and HIV infection had a worse outcome. These results should be interpreted with caution, taking into consideration that patients with more severe complications or more fragile were probably less often considered for surgery, resulting in selection bias.

FUNDAMENTO: Complicações neurológicas são comuns em pacientes com endocardite infecciosa (EI). Dados recentes sugerem que os eventos neurológicos são os principais determinantes do prognóstico e que a cirurgia é crítica para melhorar o resultado. OBJETIVO: Caracterizar pacientes com EI e complicações neurológicas e determinar preditores de embolização para o sistema nervoso central (SNC) e mortalidade. MÉTODOS: Análise retrospectiva de pacientes internados em centro terciário com diagnóstico de EI no período de 2006 a 2016. Significância estatística foi definida por um valor de p <0,05. RESULTADOS: Identificamos 148 episódios de EI, 20% dos quais tinham evidências de embolização do SNC. Em pacientes com embolização do SNC, 76% apresentaram acidente vascular cerebral isquêmico. Durante o seguimento, 35% foram submetidos à cirurgia e a mortalidade hospitalar e em um ano foi de 39%. Esses pacientes tiveram hospitalizações mais longas, mas não houve diferenças significativas em relação à mortalidade em pacientes com e sem embolização do SNC. Os preditores independentes de complicações neurológicas foram diabetes (p = 0,005) e ausência de febre na apresentação (p = 0,049). A cirurgia foi associada a menor mortalidade (0 vs. 58%; p = 0,003), enquanto os pacientes com choque séptico tiveram pior prognóstico (75 vs. 25%; p = 0,014). Na regressão multivariada de Cox, a infecção pelo vírus da imunodeficiência humana (HIV) foi o único preditor independente de mortalidade hospitalar e de 1 ano (p = 0,011 em ambos). CONCLUSÕES: Nessa população, a embolização para o SNC foi comum, mais frequentemente apresentada como acidente vascular cerebral isquêmico, e esteve associada a maior tempo de internação, embora sem diferenças significativas na mortalidade. Nos pacientes com embolização do SNC, os submetidos à cirurgia tiveram boa evolução clínica, enquanto os pacientes com choque séptico e infecção pelo HIV tiveram pior evolução. Esses resultados devem ser interpretados com cautela, levando em consideração que os pacientes com complicações mais graves ou mais frágeis foram provavelmente menos considerados para a cirurgia, resultando em viés de seleção.

Complicações Neurológicas em Pacientes com Endocardite Infecciosa: Perspectivas de um Centro Terciário / Neurological Complications in Patients with Infective Endocarditis: Insights from a Tertiary Centre

Resumo Fundamento: Complicações neurológicas são comuns em pacientes com endocardite infecciosa (EI). Dados recentes sugerem que os eventos neurológicos são os principais determinantes do prognóstico e que a cirurgia é crítica para melhorar o resultado. Objetivo: Caracterizar pacientes com EI e complicações neurológicas e determinar preditores de embolização para o sistema nervoso central (SNC) e mortalidade. Métodos: Análise retrospectiva de pacientes internados em centro terciário com diagnóstico de EI no período de 2006 a 2016. Significância estatística foi definida por um valor de p <0,05. Resultados: Identificamos 148 episódios de EI, 20% dos quais tinham evidências de embolização do SNC. Em pacientes com embolização do SNC, 76% apresentaram acidente vascular cerebral isquêmico. Durante o seguimento, 35% foram submetidos à cirurgia e a mortalidade hospitalar e em um ano foi de 39%. Esses pacientes tiveram hospitalizações mais longas, mas não houve diferenças significativas em relação à mortalidade em pacientes com e sem embolização do SNC. Os preditores independentes de complicações neurológicas foram diabetes (p = 0,005) e ausência de febre na apresentação (p = 0,049). A cirurgia foi associada a menor mortalidade (0 vs. 58%; p = 0,003), enquanto os pacientes com choque séptico tiveram pior prognóstico (75 vs. 25%; p = 0,014). Na regressão multivariada de Cox, a infecção pelo vírus da imunodeficiência humana (HIV) foi o único preditor independente de mortalidade hospitalar e de 1 ano (p = 0,011 em ambos). Conclusões: Nessa população, a embolização para o SNC foi comum, mais frequentemente apresentada como acidente vascular cerebral isquêmico, e esteve associada a maior tempo de internação, embora sem diferenças significativas na mortalidade. Nos pacientes com embolização do SNC, os submetidos à cirurgia tiveram boa evolução clínica, enquanto os pacientes com choque séptico e infecção pelo HIV tiveram pior evolução. Esses resultados devem ser interpretados com cautela, levando em consideração que os pacientes com complicações mais graves ou mais frágeis foram provavelmente menos considerados para a cirurgia, resultando em viés de seleção.

Background: Neurological complications are common in patients with infective endocarditis (IE). Recent data suggest that neurologic events are a major determinant of prognosis, and that surgery is critical in improving the outcome. Objective: To characterize patients with IE and neurological complications and to determine predictors of embolization to the central nervous system (CNS) and mortality. Methods: Retrospective analysis of patients admitted to a tertiary center with the diagnosis of IE from 2006 to 2016. Statistical significance was defined by a p-value < 0.05. Results: We identified 148 episodes of IE, 20% of which had evidence of CNS embolization. In patients with CNS embolization, 76% presented with ischemic stroke. During follow-up, 35% were submitted to surgery and both in-hospital and one-year mortality were 39%. These patients had longer hospitalizations, but there were no significant differences regarding mortality in patients with and without CNS embolization. The independent predictors of neurological complications were diabetes (p=0.005) and the absence of fever at presentation (p=0.049). Surgery was associated with lower mortality (0 vs. 58%; p=0.003), while patients with septic shock had a poorer prognosis (75 vs. 25%; p=0.014). In multivariate Cox regression, human immunodeficiency virus (HIV) infection was the only independent predictor of in-hospital and 1-year mortality (p=0.011 in both). Conclusions: In this population, embolization to the CNS was common, more often presented as ischemic stroke, and was associated with longer hospitalization, although without significant differences in mortality. In patients with CNS embolization, those submitted to surgery had a good clinical evolution, while patients with septic shock and HIV infection had a worse outcome. These results should be interpreted with caution, taking into consideration that patients with more severe complications or more fragile were probably less often considered for surgery, resulting in selection bias.