Assessing cardiac resynchronization therapy response in heart failure patients: a comparative analysis of efficacy and outcomes between transvenous and epicardial leads.

Cardiac resynchronization therapy (CRT) is an effective treatment for selected heart failure (HF) patients. Although transvenous implantation is the standard method, it is not feasible in some patients, so the epicardial lead emerges as an alternative. We aim to compare CRT response, procedure-related complications, and the occurrence of clinical outcomes between patients with transvenous and epicardial leads. In a single-center retrospective study, we enrolled consecutive HF patients submitted to CRT implantation with a defibrillator between 2013 and 2022. Clinical response was defined as an improvement of at least one of the New York Heart Association classes with no occurrence of cardiovascular death or HF hospitalization in the first year of follow-up. Echocardiographic response was attained with an increase in left ventricular ejection fraction 10% or a reduction of left ventricular end-diastolic volume >15% at 6-12 months after CRT implantation. Major adverse cardiovascular events (MACE) (cardiovascular mortality and HF hospitalization) and all-cause mortality were evaluated. From a total of 149 patients, 38% (n=57) received an epicardial lead. Clinical (63% versus 60%, p=0.679) and echocardiographic (63% versus 60%, p=0.679) responses were similar between the transvenous and epicardial groups. Patients in the transvenous group had a shorter hospital stay (2 versus 7 days, p<0.001). Procedure-related complications were comparable between groups (24% versus 28%, p=0.572), but left ventricular lead-related complications were more frequent in the transvenous group (14% versus 2%). During a median follow-up of 4.7 years, the rate of MACE was 30% (n=44), with no differences in both groups (p=0.591), neither regarding HF hospitalization (p=0.917) nor cardiovascular mortality (p=0.060). Nevertheless, the epicardial group had a higher rate of all-cause mortality (35% versus 20%, p=0.005), the majority occurring during long-term follow-up (>12 months), with no deaths in the postoperative period. Considering the comparable rates of CRT response, procedure-related complications, and MACE between groups, we conclude that epicardial lead is a feasible alternative for CRT when transvenous lead implantation is not possible. The occurrence of a higher number of all-cause deaths in epicardial patients in the long-term follow-up was mainly due to infectious complications (unrelated to the lead) and the progression of oncological/chronic diseases.

Associations between psychological stress, discrimination, and oral health-related quality of life: the buffering effects of social support networks.

Stress and discrimination negatively affect quality of life, but social support may buffer their effects. This study aims: (1) to examine the associations between psychological stress, discrimination, and oral health-related quality of life (OHRQoL); and (2) to assess whether social support, stress and discrimination interact to modify their associations with OHRQoL. We used cross-sectional household-based data from a study including 396 individuals aged 14 years and over from families registered for government social benefits in a city in Southern Brazil. OHRQoL was measured with the Oral Impacts on Daily Performance (OIDP) scale; psychological stress was assessed with the Perceived Stress Scale (PSS); social support was assessed based on the number of close relatives or friends of the participant, and discrimination was assessed with a short version of the Everyday Discrimination Scale. Interactions were estimated using the relative excess of risk due to interaction (RERI). Adjusted effects were calculated with logistic regression. The prevalence of oral impacts among people with higher and lower PSS scores was 81.6% and 65.5%, respectively (p < 0.01). Social support was found to have no interactions with stress levels and discrimination. The association between social discrimination and OHRQoL (OIDP score > 0) was OR = 2.03 (95%CI: 1.23; 3.34) among people with a low level of stress, but was OR = 12.6 (95%CI: 1.31; 120.9) among those with higher levels (p = 0.09, for interaction). Individuals who reported experiencing higher levels of psychological stress and discrimination had worse OHRQoL; a synergistic effect with social support was not clear.

Associations between psychological stress, discrimination, and oral health-related quality of life: the buffering effects of social support networks / Associações entre estresse psicológico, discriminação e qualidade de vida relacionada à saúde bucal: os efeitos amortecedores das redes de apoio social / Asociaciones entre estrés psicológico, discriminación y calidad de vida relacionada con la salud bucal: los efectos atenuantes de las redes de apoyo social

Stress and discrimination negatively affect quality of life, but social support may buffer their effects. This study aims: (1) to examine the associations between psychological stress, discrimination, and oral health-related quality of life (OHRQoL); and (2) to assess whether social support, stress and discrimination interact to modify their associations with OHRQoL. We used cross-sectional household-based data from a study including 396 individuals aged 14 years and over from families registered for government social benefits in a city in Southern Brazil. OHRQoL was measured with the Oral Impacts on Daily Performance (OIDP) scale; psychological stress was assessed with the Perceived Stress Scale (PSS); social support was assessed based on the number of close relatives or friends of the participant, and discrimination was assessed with a short version of the Everyday Discrimination Scale. Interactions were estimated using the relative excess of risk due to interaction (RERI). Adjusted effects were calculated with logistic regression. The prevalence of oral impacts among people with higher and lower PSS scores was 81.6% and 65.5%, respectively (p < 0.01). Social support was found to have no interactions with stress levels and discrimination. The association between social discrimination and OHRQoL (OIDP score > 0) was OR = 2.03 (95%CI: 1.23; 3.34) among people with a low level of stress, but was OR = 12.6 (95%CI: 1.31; 120.9) among those with higher levels (p = 0.09, for interaction). Individuals who reported experiencing higher levels of psychological stress and discrimination had worse OHRQoL; a synergistic effect with social support was not clear.

O estresse e a discriminação afetam negativamente a qualidade de vida, mas o apoio social pode amortecer seus efeitos. Os objetivos deste estudo são: (1) examinar as associações entre estresse psicológico, discriminação e qualidade de vida relacionada à saúde bucal (QVRSB); e (2) avaliar se apoio social, estresse e discriminação interagem para modificar suas associações com QVRSB. Os dados são de uma pesquisa transversal de base domiciliar de um estudo que incluiu 396 indivíduos com 14 anos ou mais de famílias registradas para benefícios federais em uma cidade no sul do Brasil. A QVRSB foi mensurada pelo Impactos Orais no Desempenho Diário (OIDP), enquanto o estresse psicológico foi avaliado pela Escala de Estresse Percebido (PSS). Além disso, o apoio social foi avaliado pelo número de parentes ou amigos próximos e a discriminação por meio da Escala de Discriminação Diária (EDS). As interações foram estimadas por meio do excesso relativo de risco devido à interação (RERI). Os efeitos ajustados foram calculados por meio de regressão logística. A prevalência de impactos bucais entre as pessoas com maior e menor escores de PSS foi de 81,6% e 65,5%, respectivamente (p < 0,01). O apoio social mostra interações inclusivas com níveis de estresse e discriminação. A associação entre discriminação social e QVRSB (escore OIDP > 0) foi OR = 2,03 (IC95%: 1,23; 3,34) dentre pessoas com baixo nível de estresse, mas foi de OR = 12,6 (IC95%: 1,31; 120,9) dentre aqueles com níveis mais altos (p = 0,09, para interação). Indivíduos que relataram níveis mais elevados de estresse psicológico e discriminação apresentaram pior QVRSB; o efeito sinérgico com o apoio social não foi evidente.

El estrés y la discriminación afectan negativamente a la calidad de vida, pero el apoyo social puede mitigar sus efectos. Los objetivos de este estudio son: (1) examinar las asociaciones entre el estrés psicológico, la discriminación y la calidad de vida relacionada con la salud bucal (CVRSB); y (2) evaluar si el apoyo social, el estrés y la discriminación interactúan para modificar sus asociaciones con la CVRSB. Los datos provienen de una encuesta transversal de hogares cuyo estudio incluyó a 396 individuos de 14 años o más de familias registradas en beneficios del gobierno en una ciudad del Sur de Brasil. La CVRSB se midió mediante el Impactos Orales en el Rendimiento Diario (OIDP), mientras que el estrés psicológico se evaluó mediante la Escala de Estrés Percibido (PSS). El apoyo social se basó en el número de familiares o amigos cercanos, y la discriminación en la Escala de Discriminación Cotidiana (EDS). Las interacciones se estimaron mediante el excesivo de riesgo relativo debido a la interacción (RERI). Los efectos ajustados se calcularon mediante regresión logística. La prevalencia de impactos orales entre las personas con puntajes de PSS más altas y más bajas fue del 81,6% y del 65,5%, respectivamente (p < 0,01). El apoyo social presenta interacciones inclusivas con niveles de estrés y discriminación. La asociación entre discriminación social y OHRQoL (puntuación OIDP > 0) fue OR = 2,03 (IC95%: 1,23; 3,34) entre personas con un nivel bajo de estrés, pero fue OR = 12,6 (IC95%: 1,31; 120,9) entre aquellos con niveles más altos (p = 0,09, para interacción). Las personas que informaron tener niveles más elevados de estrés psicológico y discriminación tuvieron una peor CVRSB; el efecto sinérgico con el apoyo social no estaba claro.

Early motor development: risk factors for delay in a population study in Southern Brazil.

OBJECTIVE: To assess risk factors associated with motor development delay at three months of age. METHODS: Cross-sectional study with mothers and their three-month-old babies in Southern Brazil. The Bayley-III Scale of Infant and Toddler Development (BSID-III) and the Alberta Infant Motor Scale (AIMS) were used to assess motor development. RESULTS: We evaluated 756 mothers and their three-month-old babies. The overall mean motor development assessed by the BSID-III and the AIMS was 104.7 (SD 13.5) and 55.4 (SD 25.4), respectively. When assessed by the BSID-III, the lowest motor development scores were among babies born by cesarean delivery (p = 0.002), prematurely (p < 0.001), and with low birth weight (p < 0.001). When assessed by the AIMS, babies born prematurely (p = 0.002) and with low birth weight (p=0.004) had the lowest motor development means. After a cluster analysis, we found that babies born by cesarean delivery, with low birth weight, and prematurely had more impaired motor development compared with children born without any risk factors. CONCLUSION: Identifying risk factors allows the implementation of early interventions to prevent motor development delay and, therefore, reduce the probability of other future problems.

Early motor development: risk factors for delay in a population study in Southern Brazil

ABSTRACT OBJECTIVE To assess risk factors associated with motor development delay at three months of age. METHODS Cross-sectional study with mothers and their three-month-old babies in Southern Brazil. The Bayley-III Scale of Infant and Toddler Development (BSID-III) and the Alberta Infant Motor Scale (AIMS) were used to assess motor development. RESULTS We evaluated 756 mothers and their three-month-old babies. The overall mean motor development assessed by the BSID-III and the AIMS was 104.7 (SD 13.5) and 55.4 (SD 25.4), respectively. When assessed by the BSID-III, the lowest motor development scores were among babies born by cesarean delivery (p = 0.002), prematurely (p < 0.001), and with low birth weight (p < 0.001). When assessed by the AIMS, babies born prematurely (p = 0.002) and with low birth weight (p=0.004) had the lowest motor development means. After a cluster analysis, we found that babies born by cesarean delivery, with low birth weight, and prematurely had more impaired motor development compared with children born without any risk factors. CONCLUSION Identifying risk factors allows the implementation of early interventions to prevent motor development delay and, therefore, reduce the probability of other future problems.

Bridging the Gap Between Family Medicine and Adolescents: Creating Opportunities Through Sex Education.

INTRODUCTION: Despite school sex education programs defined by law and a national healthcare service with dedicated family planning appointments, the number of teenage pregnancies in Portugal remains significant. The implementation of these programs has been found lacking and a disconnection between adolescents and primary healthcare has been identified. Adolescents have low literacy in contraception, with males being less involved and informed. With this project, the authors sought to propose an alternative approach to school sex education, aiming to improve the global knowledge and adequate use of contraception methods by teenagers.  Material and Methods: Single-arm prospective interventional study was done to assess the impact of a new model of sexual education learning on adolescents' knowledge and use of contraception methods. A 30-minute lecture was developed by Family Medicine residents focusing on the main aspects of contraception and sexual education, using informal language and slideshow presentations. A form using "Yes/No", "True or False", multiple answer, and Likert scale questions was built to assess attitudes and levels of literacy. Two time points were defined to assess the impact of the intervention, applying the form before and one month after the lecture. Four high schools were invited to enter the study, with 190 students enrolled after personal and guardian authorization. IBM SPSS Statistics for Windows, Version 27.0 (Released 2020; IBM Corp., Armonk, New York, United States) was used to perform statistical analysis. RESULTS: A total of 190 participants aged between 14 and 19 years answered both forms. A high 73.7% reported never having had a family planning appointment, with "Not knowing about the possibility" and "Not feeling comfortable with" being the main reasons; 26.3% were sexually active, from which 44% admitted having had intercourse without any kind of protection. Regarding sources of information about contraception, "School," "Internet," and "Friends" were the most prevalent, with only 43% considering the healthcare providers a source. In the contraceptive literacy evaluation, the participants overestimated their knowledge pre-intervention; however, this gap was attenuated in the second evaluation. Moreover, there was a statistically significant improvement in literacy between assessments for all genders. After the intervention, 40.6% reported discussing contraception outside the classroom.  Discussion: The low attendance of the family planning appointments and the low number of participants that considered healthcare services as a source of information in contraception conveys the idea that primary healthcare does not play the desired role in disseminating reliable information on contraception among teenagers. This is concerning considering the overestimated knowledge, low literacy, and risky behaviors identified. The intervention managed to improve the teenagers' literacy while reinforcing the importance of family planning appointments and inciting dialogue among the participants.  Conclusion: This project presents an alternative to current school sex education models and focuses on streamlining communication by resorting to younger communicators, scientific but informal messaging, and short sessions. While extended research comparing against the set models needs to be done, it poses an opportunity to bring adolescents closer to primary healthcare while gathering data to improve clinical practice.

Can maternal exposure to tamoxifen compromise sperm and behavioural parameters of male rat offspring?

Tamoxifen, a selective non-steroidal estrogen receptor modulator, is the standard adjuvant endocrine treatment for breast cancer. Since information on the risk of using tamoxifen during pregnancy is still scarce, this study evaluated whether the in utero and lactational treatment with this drug could compromise reproductive and behavioural parameters in male offspring. Pregnant Wistar rats were exposed to three doses of tamoxifen (0.12; 0.6; 3 µg/kg), by gavage, from gestational day 15 to lactational day 20. Tamoxifen exposure did not alter the anogenital distance in the male offspring; however, there was a significant increase in the body weight in the 0.12 µg/kg dose and a decrease in the 0.6 µg/kg dose. The male offspring treated with the highest dose exhibited a delay in the onset of puberty, evidenced by an increase in the age of preputial separation. Regarding sperm parameters, there was an increase in the sperm count in the cauda epididymis in the intermediate and highest dose groups, in addition to an increase in the number of static sperm and a decrease in the progressive sperm in the same groups. Moreover, an increase in the number of hyperplasia of the epithelial clear cells was observed in the epididymis. In conclusion, the present study demonstrated that maternal exposure to tamoxifen compromised the installation of puberty of the male offspring and the maturation of the epididymis, affecting sperm storage and motility in the adult life.

People living with HIV/AIDS: body image and its important associations with mental health and BMI.

Patients on antiretroviral therapy face new challenges, such as bodily changes. We conducted a cross-sectional study with people living with HIV/AIDS. We investigate the self-perception of body image and its associations. Most of the patients reported negative self-perception of body image (NSPBI), being mostly women, up to 40 years old and with changes in BMI. NSPBI was associated with depressive symptoms and punctual alterations in the redistribution of body fat: face, abdomen and legs, subjects still little elucidated. Assessing neglected aspects can improve the way these patients see themselves, and come to understand the disease as only a part of their lives.

Surgical Treatment of Posttraumatic Laterognathia: A Case Report and a Literature Review, Focused on the Effects of a Condylar Fracture on the Face.

Facial asymmetry, following early childhood condylar trauma, is a common complaint among patients who seek surgical treatment. G.D.M., a 27-year-old male patient, sought professional help to correct his cosmetic flaw, caused by a condylar fracture when he was 8-years-old. After the proper orthodontic treatment, he underwent a double jaw orthognathic surgery and, 9 months later, a second one to correct the remaining asymmetry. Two years after this second procedure, the patient is still under surveillance and has no complaints.

Análise digital indireta da radiopacidade de resinas compostas / Indirect digital analysis of the radiopacity of composite resins

O objetivo deste trabalho foi avaliar a acurácia da imagem digital indireta o escaner (Scan Maker II Microtek International Inc. Hsinchu 300, Taiwan ROC) e o programa de computador Adobe Phostoshop 6.0 e compará-la com o Densitômetro digital. E, mediante esses métodos, descrever a radiopacidade de 5 tipos de resinas compostas (híbrida, condensável, tipo flow, indireta e de micropartícula). Para complementar o estudo, pesquisaram-se a influência da espessura do material e o tempo de exposição do filme radiográfico nos valores de radiopacidade e, finalmente, a influência da transposição dental nos valores de radiopacidade de resinas compostas. Foram confeccionados corpos-de-prova de todas as resinas de amálgama, com auxílio de matrizes de teflon com diâmetro interno de 5 mm e 2, 4, 6 mm de espessura, os quais foram radiografados em filmes radiográficos Insight (Kodak Co., Rochester, NY, USA) junto com um disco de estrutura dental e um penetrômetro de aluminio puro, seguindo os requerimentos da ISO 4049 para avaliar a radiopacidade de resinas compostas. O tempo de exposição utilizado de 0,4 e 0,8 segundos. Estes filmes foram processados manualmente pela técnica tempo/temperatura. As imagens radiográficas obtidas foram analisadas pelo densitômetro digital (MRA, Indústria de Equipamentos Eletrônicos Ltda., Brasil), método tradicional de se medir a radiodensidade, e pela análise digital indireta utilizando o program Adobe Phostoshop 6.0 , o qual mede a radiodensidade convertendo-a em 256 graus de cinza. Para verificar a correlação entre os métodos, foi utilizada uma regressão polinomial, sendo constatado que os níveis de radiopacidade medidos pelos dois métodos foram positivamente correlacionados (R2=0,00). Os dados da radiodensidade das resinas compostas foram analisadas pelo ANOVA e o teste de Tukey com 5%. Houve diferença estatisticamente significante entre todos os materiais testados. Os resultados mostraram, também, que houve influência da espessura...

The purpose was to evaluate the accuracy of indirect digital image using scanner (scan Maker II Microtek International INc.Hsinnchu 300, Taiwan ROC) and the software Adobe Photoshop 6.0 comparing with digital densitometer. Using these methods, the radiopacity of five different types of compsite resin (hybrid, condensable, flow, indirect resin and microfill) was determined. To complement this study was also evaluated the influence of material thickness and exposition time time and the dental transposition in resin composite radiopacity results. Samples eith resin composite and amalgam was made with. Teflon matrix with 5 mm internal diameter and thickness of 2, 4, 6 mm, radiographed in Insight films (Kodak Co., Rochester, NY, USA) with a dental structure disk and a aluminum step-wedge, as ISO 4049 recommendation, to evaluate the radiopacity of resin composites. The exposition time used was 0.4 and 0.8 seconds. Theses films were manual processed with time/temperature technique in 24% C in fresh solutions, mixed according manufacturers recommendation. Radiographic images were analyzed by Photodensitometer (MRA), tradicional method to measure radiodensity and by indirect digital analysis using the software Adobe Photoshop 6.0, that converts in 256 degrees of gary. To verify the correlation between methods was used polynomial regression. It showed that the radiopacity levels measured by twomethods were positive correlated (R=0,99). The radiodensity data of resin composite were analyzed by ANOVA and Tukey test with =5%. were obseved. The results also showed the influence of thicness, time of exposition of radiographic film, in radiopacity values in different types of resin composite. The dental transposition showed a positive influence of different values of radiodensity of resin composite...