Tendência temporal, distribuição regional e perfil da morbimortalidade por queimadura na infância em Santa Catarina: Um estudo ecológico / Temporal trend, regional distribution and profile of morbidity and mortality due to childhood burns in Santa Catarina: An ecological study

Introdução: As queimaduras são um desafio da saúde pública devido à alta morbimortalidade e prejuízo na qualidade de vida da vítima. Elas afetam desproporcionalmente as populações de menor nível socioeconômico, resultando em elevados custos para saúde. Método: Estudo ecológico, retrospectivo, observacional, com abordagem quantitativa e análise de tendência temporal da morbimortalidade por queimadura em Santa Catarina, com dados obtidos dos Sistemas de Informações Hospitalar e de mortalidade disponibilizados pelo Departamento de Informática do Sistema Único de Saúde. Análise temporal pelo Teste de Correlação de Spearman. Resultados: Verificada tendência de crescimento na taxa geral de internação (Spearman=0,806; p<0,005) por queimaduras no estado no período analisado. Maior prevalência no sexo masculino (RP 1,68), na população de 0 a 4 anos (RP 3,08) e na região da Grande Florianópolis (taxa média 23,22%). Predominou o grupo classificado como médio queimado (taxa média 25,67%) e as internações de 0 a 3 dias (taxa média 50,25%). Queimaduras em cabeça, pescoço e tronco (taxa média 32,25%) foram as mais prevalentes. Conclusão: Identificada tendência de crescimento na taxa de internação por queimaduras em crianças no estado. Maior prevalência de internação no sexo masculino, em crianças de 0 a 4 anos e na região da Grande Florianópolis. Predomínio de médio queimados e de queimaduras em cabeça, pescoço e tronco, com maior taxa de internações de curta duração.

Introduction: Burns is a public health challenge due to high morbidity and mortality and impairment of the victim's quality of life. They disproportionately affect populations of lower socioeconomic status, resulting in high health costs. Method: Ecological, retrospective, observational study, with a quantitative approach and temporal trend analysis of morbidity and mortality due to burns in Santa Catarina, with data obtained from the Hospital and Mortality Information Systems made available by the Information Technology Department of the Unified Health System. Temporal analysis by Spearman Correlation Test. Results: There was a growing trend in the general hospitalization rate (Spearman=0.806; p<0.005) for burns in the state in the period analyzed. Higher prevalence in males (RP 1.68), in the population aged 0 to 4 years (RP 3.08), and in the Greater Florianópolis region (mean rate 23.22%). The group classified as medium burn predominated (mean rate 25.67%) and hospitalizations of 0 to 3 days (mean rate 50.25%). Burns to the head, neck, and trunk (mean rate 32.25%) were the most prevalent. Conclusion: A growth trend was identified in the hospitalization rate for burns in children in the state. Higher prevalence of hospitalization in males, in children aged 0 to 4 years, and in the Greater Florianópolis region. Predominance of moderate burns and burns to the head, neck, and trunk, with a higher rate of short-term hospitalizations.

Prediction of fat-free mass from body surface area in young basketball players.

BACKGROUND: Fat Free Mass (FFM) is an important and essential indicator in various sports populations, since greater muscle and bone mass generates greater strength, endurance and speed in athletes. OBJECTIVE: The purpose of the study was to validate Body Surface Area (BSA) as an anthropometric indicator to estimate FFM in young basketball players. METHODS: A descriptive cross-sectional study was carried out in 105 male basketball players of the Brazilian Basketball Confederation of Sao Paulo (Campinas), Brazil. The age range was 11 to 15 years. Weight and height were evaluated. BSA, body mass index (BMI) and maturity status (MS) were calculated. Total body scanning was performed by dual X-ray absorptiometry (DXA). The components were extracted: Fat mass (FM), Fat free mass (FFM), percentage of fat mass (%FM) and bone mass (BM). The data were analyzed using the correlation coefficient of concordance (CCC) in terms of precision and accuracy. RESULTS: Three regression equations were generated: equation 1 had age and body weight as predictors [FFM= -30.059+(2.926*age)+(0.625*Weight)] (R2 = 92%, precision = 0.96 and accuracy = 0.99), equation 2 used age and BSA [FFM=-45.719+(1.934*age)+(39.388*BSA)] (R2 = 94%, precision = 0.97 and accuracy = 0.99) and equation 3 was based on APHV and BSA [FFM=-15.284+(1.765*APHV)+(37.610*(BSA)] (R2 = 94%, precision = 0.96 and accuracy = 0.99). CONCLUSIONS: The results suggest the use of anthropometric equation using decimal age and BSA to estimate FFM in young basketball players. This new method developed can be used to design, evaluate and control training programs and monitor the weight status of athletes.

Mapeamento do Potencial da Superfície Corporal durante a Despolarização Ventricular em Atletas com Intervalo PQ Prolongado após Exercício / Body Surface Potential Mapping during Ventricular Depolarization in Athletes with Prolonged PQ Interval after Exercise

Resumo Fundamento: O prolongamento do intervalo PQ, geralmente associado a um atraso na condução atrioventricular, pode estar relacionado a alterações na propagação do impulso intraventricular. Objetivo: Avaliar, por meio do mapeamento do potencial de superfície corporal (BSPM), o processo de despolarização ventricular em atletas com intervalos PQ prolongados em repouso e após o exercício. Métodos: O estudo incluiu 7 esquiadores cross-country com intervalo PQ superior a 200 ms (grupo PQ Prolongado) e 7 com intervalo PQ inferior a 200 ms (grupo PQ Normal). O BSPM de 64 derivações unipolares do tronco foi realizado antes (Pré-Ex) e após o teste ergométrico de bicicleta (Pós-Ex). Mapas equipotenciais da superfície corporal foram analisados durante a despolarização ventricular. O nível de significância foi de 5%. Resultados: Comparado com atletas com PQ Normal, o primeiro e o segundo períodos de posição estável dos potenciais cardíacos na superfície do tronco foram mais longos, e a formação da distribuição de potencial "sela" ocorreu mais tarde, no Pré-Ex, nos atletas com PQ Prolongado. No Pós-Ex, o grupo PQ Prolongado apresentou um encurtamento do primeiro e segundo períodos de distribuições de potencial estáveis e uma diminuição no tempo de aparecimento do fenômeno "sela" em relação ao Pré-Ex (para valores próximos aos do Normal -Grupo PQ). Além disso, no Pós-Ex, a primeira inversão das distribuições de potencial e a duração total da despolarização ventricular em atletas com PQ Prolongado diminuíram em comparação com o Pré-Ex e com valores semelhantes em atletas com PQ Normal. Em comparação com atletas com PQ Normal, a segunda inversão foi mais longa no Pré-Ex e Pós-Ex em atletas com PQ Prolongado. Conclusão: Atletas com PQ prolongado apresentaram diferenças significativas nas características temporais do BSPM durante a despolarização ventricular, tanto em repouso quanto após o exercício, em comparação com atletas com PQ normal.

Abstract Background: Prolongation of the PQ interval, generally associated with an atrioventricular conduction delay, may be related to changes in intraventricular impulse spreading. Objective: To assess, using body surface potential mapping (BSPM), the process of ventricular depolarization in athletes with prolonged PQ intervals at rest and after exercise. Methods: The study included 7 cross-country skiers with a PQ interval of more than 200 ms (Prolonged-PQ group) and 7 with a PQ interval of less than 200 ms (Normal-PQ group). The BSPM from 64 unipolar torso leads was performed before (Pre-Ex) and after the bicycle exercise test (Post-Ex). Body surface equipotential maps were analyzed during ventricular depolarization. The significance level was 5%. Results: Compared to Normal-PQ athletes, the first and second periods of the stable position of cardiac potentials on the torso surface were longer, and the formation of the "saddle" potential distribution occurred later, at Pre-Ex, in Prolonged-PQ athletes. At Post-Ex, the Prolonged-PQ group showed a shortening of the first and second periods of stable potential distributions and a decrease in appearance time of the "saddle" phenomenon relative to Pre-Ex (to the values near to those of the Normal-PQ group). Additionally, at Post-Ex, the first inversion of potential distributions and the total duration of ventricular depolarization in Prolonged-PQ athletes decreased compared to Pre-Ex and with similar values in Normal-PQ athletes. Compared to Normal-PQ athletes, the second inversion was longer at Pre-Ex and Post-Ex in Prolonged-PQ athletes. Conclusion: Prolonged-PQ athletes had significant differences in the temporal characteristics of BSPM during ventricular depolarization both at rest and after exercise as compared to Normal-PQ athletes.

Liver Size and its Correlation with Anthropometric Parameters and Age / El Tamaño del Hígado y su Correlación con los Parámetros Antropométricos y la Edad

SUMMARY: The liver has over 500 physiological and biochemical roles in our organism so checking of liver size and function is a part of every clinical examination. Aim of our research was to estimate liver size on computed tomography (CT) of the abdomen images and to determinate relations between liver dimensions and anthropometric parameters. The research included 99 patients, 49 men and 50 women, who were referred for CT of abdomen. We measured body height (BH) and body mass (BM), and calculated body mass index (BMI) and body surface area (BSA). Also, on CT images we measured anteroposterior (AP), laterolateral (LL) and two craniocaudal liver diameters (one at the level of midclavicular line - CCmcl, and the other was maximal - CCmax). Liver volume (LV) was calculated with formula. Our results showed that AP diameter positively correlated with BSA (r=0.30) in women. LL diameter positively correlated with BH (r=0.43), and BSA (0.31) in men. CCmcl diameter positively correlated with BH (r=0.33), BM (r=0.31), and BSA (r=0.34) in men, while in women it correlated only with BH (r=0.38). CCmax diameter positively correlated with BH (r=0.33) and BSA (r=0.33) in men. LV positively correlated with BH and BSA in both men (r=0.36, r=0.33, respectively) and women (r=0.42, r=0.31, respectively), and in men also with BM (r=0.34). LL, CCmcl, CCmax, and LV negatively correlated with aging in both sexes After the age of 60, there was a decrease in size of LL, CC diameters, as well as in LV. We concluded that liver dimensions decrease with aging, regardless of sex at the expanse of LL and CC diameters which are related to the size of body parameters, so that for a precise evaluation of liver size all three diameters should be measured, LV as well as BH, BM, and BSA.

El hígado desempeña más de 500 funciones fisiológicas y bioquímicas en nuestro organismo, por lo que comprobar el tamaño y la función de este órgano es parte de cada examen clínico. El objetivo de nuestra investigación fue estimar el tamaño del hígado mediante tomografía computarizada (TC) de imágenes del abdomen y determinar las relaciones entre las dimensiones del hígado y los parámetros antropométricos. La investigación incluyó a 99 pacientes, 49 hombres y 50 mujeres, que fueron remitidos para TC de abdomen. Medimos la altura corporal (BH) y la masa corporal (BM), y calculamos el índice de masa corporal (IMC) y el área de superficie corporal (BSA). Además, en las imágenes de TC medimos los diámetros hepáticos anteroposterior (AP), laterolateral (LL) y dos craneocaudales (uno a nivel de la línea medioclavicular - CCmcl, y el diámetro máximo - CCmax). El volumen del hígado (VI) se calculó con una fórmula. Nuestros resultados mostraron que el diámetro AP se correlacionó positivamente con BSA (r = 0,30) en mujeres. El diámetro de LL se correlacionó positivamente con BH (r=0,43) y BSA (0,31) en hombres. El diámetro CCmcl se correlacionó positivamente con BH (r=0,33), BM (r=0,31) y BSA (r=0,34) en hombres, mientras que en mujeres se correlacionó solo con BH (r=0,38). El diámetro CCmax se correlacionó positivamente con BH (r=0,33) y BSA (r=0,33) en hombres. El VI se correlacionó positivamente con BH y BSA tanto en hombres (r=0,36, r=0,33, respectivamente) como en mujeres (r=0,42, r=0,31, respectivamente), y en hombres también con BM (r=0,34). LL, CCmcl, CCmax y LV se correlacionaron negativamente con el envejecimiento en ambos sexos. Después de los 60 años, hubo una disminución en el tamaño de los diámetros LL, CC y LV. Concluimos que las dimensiones del hígado disminuyen con la edad, independientemente del sexo, en la extensión de los diámetros LL y CC que están relacionados con el tamaño de los parámetros corporales, por lo que para una evaluación precisa del tamaño del hígado se debe medir LV como BH, BM y BSA.

HAS-BLED Score for Prediction of Bleeding and Mortality After Transcatheter Aortic Valve Replacement

ABSTRACT Introduction: Bleeding after transcatheter aortic valve replacement (TAVR) is associated with increased mortality. The predictive value of the HAS-BLED score in TAVR patients is still to be evaluated. We assessed the value of the HAS-BLED score to predict in-hospital bleeding and mortality after TAVR and the impact of diferent renal impairment definitions on the predictive value of the score system. Methods: We retrospectively included 574 patients who underwent TAVR at a single center. Study outcomes were 30-day mortality and the composite endpoint of major and life-threatening bleeding as defined by The Valve Academic Research Consortium-2. The predictive value of the HAS-BLED score was calculated and compared to a modified model. The performance of the score was compared using two definitions of renal impairment. Model discrimination was tested using C-statistic and the Net Reclassification Index. Results: Bleeding occurred in 78 patients (13.59%). HAS-BLED category 3 was a significant predictor of bleeding (OR: 1.99 ]1.18- 3.37], C-index: 0.56, P=0.01). C-index increased to 0.64 after adding body surface area and extracardiac arteriopathy to the model. The Net Reclassification Index showed an increase in the predic tive value of the model by 11.4% (P=0.002). The C-index increased to 0.61 using renal impairment definition based on creatinine clearance. Operative mortality was significantly associated with the HAS-BLED score (OR: 7.54 [95% CI: 2.73- 20.82], C-index: 0.73, P<0.001). Conclusion: The HAS-BLED score could be a good predictor of in-hospital mortality after TAVR. Its predictive value for bleeding was poor but improved by adding procedure-specific factors and using creatinine clearance to define renal impairment.

Risk Factors of Thrombocytopenia After Cardiac Surgery with Cardiopulmonary Bypass.

INTRODUCTION: Postoperative thrombocytopenia is common in cardiac surgery with cardiopulmonary bypass, and its risk factors are unclear. METHODS: This retrospective study enrolled 3,175 adult patients undergoing valve surgeries with cardiopulmonary bypass from January 1, 2017 to December 30, 2018 in our institute. Postoperative thrombocytopenia was defined as the first postoperative platelet count below the 10th quantile in all the enrolled patients. Outcomes between patients with and without postoperative thrombocytopenia were compared. The primary outcome was in-hospital mortality. Risk factors of postoperative thrombocytopenia were assessed by logistic regression analysis. RESULTS: The 10th quantile of all enrolled patients (75×109/L) was defined as the threshold for postoperative thrombocytopenia. In-hospital mortality was comparable between thrombocytopenia and non-thrombocytopenia groups (0.9% vs. 0.6%, P=0.434). Patients in the thrombocytopenia group had higher rate of postoperative blood transfusion (5.9% vs. 3.2%, P=0.014), more chest drainage volume (735 [550-1080] vs. 560 [430-730] ml, P<0.001), and higher incidence of acute kidney injury (12.3% vs. 4.2%, P<0.001). Age > 60 years (odds ratio [OR] 2.25, 95% confidence interval [CI] 1.345-3.765, P=0.002], preoperative thrombocytopenia (OR 18.671, 95% CI 13.649-25.542, P<0.001), and cardiopulmonary bypass time (OR 1.088, 95% CI 1.059-1.117, P<0.001) were positively independently associated with postoperative thrombocytopenia. Body surface area (BSA) (OR 0.247, 95% CI 0.114-0.538, P<0.001) and isolated mitral valve surgery (OR 0.475, 95% CI 0.294-0.77) were negatively independently associated with postoperative thrombocytopenia. CONCLUSION: Positive predictors for thrombocytopenia after valve surgery included age > 60 years, small BSA, preoperative thrombocytopenia, and cardiopulmonary bypass time. BSA and isolated mitral valve surgery were negative predictors.

Chemotherapy and Anticancer Drugs Adjustment in Obesity: A Narrative Review.

BACKGROUND: Obese individuals have higher rates of cancer incidence and cancer- related mortality. The worse chemotherapy outcomes observed in this subset of patients are multifactorial, including the altered physiology in obesity and its impact on pharmacokinetics, the possible increased risk of underdosing, and treatment-related toxicity. AIMS: The present review aimed to discuss recent data on physiology, providing just an overall perspective and pharmacokinetic alterations in obesity concerning chemotherapy. We also reviewed the controversies of dosing adjustment strategies in adult and pediatric patients, mainly addressing the use of actual total body weight and ideal body weight. METHODS: This narrative review tried to provide the best evidence to support antineoplastic drug dosing strategies in children, adolescents, and adults. RESULTS: Cardiovascular, hepatic, and renal alterations of obesity can affect the distribution, metabolism, and clearance of drugs. Anticancer drugs have a narrow therapeutic range, and variations in dosing may result in either toxicity or underdosing. Obese patients are underrepresented in clinical trials that focus on determining recommendations for chemotherapy dosing and administration in clinical practice. After considering associated comorbidities, the guidelines recommend that chemotherapy should be dosed according to body surface area (BSA) calculated with actual total body weight, not an estimate or ideal weight, especially when the intention of therapy is the cure. CONCLUSION: The actual total body weight dosing appears to be a better approach to dosing anticancer drugs in both adults and children when aiming for curative results, showing no difference in toxicity and no limitation in treatment outcomes compared to adjusted doses.

HAS-BLED Score for Prediction of Bleeding and Mortality After Transcatheter Aortic Valve Replacement.

INTRODUCTION: Bleeding after transcatheter aortic valve replacement (TAVR) is associated with increased mortality. The predictive value of the HAS-BLED score in TAVR patients is still to be evaluated. We assessed the value of the HAS-BLED score to predict in-hospital bleeding and mortality after TAVR and the impact of diferent renal impairment definitions on the predictive value of the score system. METHODS: We retrospectively included 574 patients who underwent TAVR at a single center. Study outcomes were 30-day mortality and the composite endpoint of major and life-threatening bleeding as defined by The Valve Academic Research Consortium-2. The predictive value of the HAS-BLED score was calculated and compared to a modified model. The performance of the score was compared using two definitions of renal impairment. Model discrimination was tested using C-statistic and the Net Reclassification Index. RESULTS: Bleeding occurred in 78 patients (13.59%). HAS-BLED category 3 was a significant predictor of bleeding (OR: 1.99 ]1.18- 3.37], C-index: 0.56, P=0.01). C-index increased to 0.64 after adding body surface area and extracardiac arteriopathy to the model. The Net Reclassification Index showed an increase in the predic tive value of the model by 11.4% (P=0.002). The C-index increased to 0.61 using renal impairment definition based on creatinine clearance. Operative mortality was significantly associated with the HAS-BLED score (OR: 7.54 [95% CI: 2.73- 20.82], C-index: 0.73, P<0.001). CONCLUSION: The HAS-BLED score could be a good predictor of in-hospital mortality after TAVR. Its predictive value for bleeding was poor but improved by adding procedure-specific factors and using creatinine clearance to define renal impairment.

Risk Factors of Thrombocytopenia After Cardiac Surgery with Cardiopulmonary Bypass

ABSTRACT Introduction: Postoperative thrombocytopenia is common in cardiac surgery with cardiopulmonary bypass, and its risk factors are unclear. Methods: This retrospective study enrolled 3,175 adult patients undergoing valve surgeries with cardiopulmonary bypass from January 1, 2017 to December 30, 2018 in our institute. Postoperative thrombocytopenia was defined as the first postoperative platelet count below the 10th quantile in all the enrolled patients. Outcomes between patients with and without postoperative thrombocytopenia were compared. The primary outcome was in-hospital mortality. Risk factors of postoperative thrombocytopenia were assessed by logistic regression analysis. Results: The 10th quantile of all enrolled patients (75×109/L) was defined as the threshold for postoperative thrombocytopenia. In-hospital mortality was comparable between thrombocytopenia and non-thrombocytopenia groups (0.9% vs. 0.6%, P=0.434). Patients in the thrombocytopenia group had higher rate of postoperative blood transfusion (5.9% vs. 3.2%, P=0.014), more chest drainage volume (735 [550-1080] vs. 560 [430-730] ml, P<0.001), and higher incidence of acute kidney injury (12.3% vs. 4.2%, P<0.001). Age > 60 years (odds ratio [OR] 2.25, 95% confidence interval [CI] 1.345-3.765, P=0.002], preoperative thrombocytopenia (OR 18.671, 95% CI 13.649-25.542, P<0.001), and cardiopulmonary bypass time (OR 1.088, 95% CI 1.059-1.117, P<0.001) were positively independently associated with postoperative thrombocytopenia. Body surface area (BSA) (OR 0.247, 95% CI 0.114-0.538, P<0.001) and isolated mitral valve surgery (OR 0.475, 95% CI 0.294-0.77) were negatively independently associated with postoperative thrombocytopenia. Conclusion: Positive predictors for thrombocytopenia after valve surgery included age > 60 years, small BSA, preoperative thrombocytopenia, and cardiopulmonary bypass time. BSA and isolated mitral valve surgery were negative predictors.

Mapeamento Potencial de Superfície Corporal durante a Despolarização Ventricular em Ratos Após Exercício Exaustivo Agudo / Body Surface Potential Mapping during Ventricular Depolarization in Rats after Acute Exhaustive Exercise

Resumo Fundamento O exercício físico exaustivo pode causar alterações significantes nas propriedades elétricas do miocárdio. Objetivo Avaliar, através do mapeamento potencial de superfície corporal, a atividade elétrica do coração de ratos durante a despolarização ventricular após exercício exaustivo agudo. Métodos Ratos machos com doze semanas de idade foram submetidos a exercício agudo em esteira a 36 m/min até a exaustão. Eletrocardiogramas unipolares (ECGs) da superfície do tronco foram registrados em ratos anestesiados com zoletil três a cinco dias antes (Pré-Ex), 5 e 10 minutos após exercício exaustivo (Pós-Ex 5 e Pós-Ex 10, respectivamente) simultaneamente com ECGs nas derivações dos membros. Os mapas potenciais de superfície corporal instantâneos (BSPMs, body surface potential maps ) foram analisados durante a despolarização ventricular. Os valores de p <0,05 foram considerados estatisticamente significantes. Resultados Comparado com o Pré-Ex, uma conclusão precoce da segunda inversão de distribuições de potencial, uma conclusão precoce da despolarização ventricular, bem como uma diminuição na duração da fase média e a duração total da despolarização ventricular nos BSPMs foram reveladas no Pós-Ex5. Além disso, em comparação com o Pré-Ex, um aumento na amplitude do extremo negativo do BSPM no pico da onda R no ECG na derivação II (pico RII) e uma diminuição na amplitude do extremo negativo do BSPM a 3 e 4 ms após o pico RII foram demonstrados no Pós-Ex 5. No Pós-Ex 10, os parâmetros dos BSPMs não diferiram daqueles do Pré-Ex. Conclusão Em ratos, o exercício exaustivo agudo causa alterações reversíveis nas características temporais e de amplitude dos BSPMs durante a despolarização ventricular, provavelmente relacionadas a alterações na excitação da massa principal do miocárdio ventricular.

Abstract Background Exhaustive physical exercise can cause substantial changes in the electrical properties of the myocardium. Objective To evaluate, using body surface potential mapping, the electrical activity of the heart in rats during ventricular depolarization after acute exhaustive exercise. Methods Twelve-week-old male rats were submitted to acute treadmill exercise at 36 m/min until exhaustion. Unipolar electrocardiograms (ECGs) from the torso surface were recorded in zoletil-anesthetized rats three to five days before (Pre-Ex), 5 and 10 minutes after exhaustive exercise (Post-Ex 5 and Post-Ex 10, respectively) simultaneously with ECGs in limb leads. The instantaneous body surface potential maps (BSPMs) were analyzed during ventricular depolarization. P values <0.05 were considered statistically significant. Results Compared with Pre-Ex, an early completion of the second inversion of potential distributions, an early completion of ventricular depolarization, as well as a decrease in the duration of the middle phase and the total duration of ventricular depolarization on BSPMs were revealed at Post-Ex 5. Also, compared with Pre-Ex, an increase in the amplitude of negative BSPM extremum at the R-wave peak on the ECG in lead II (RII-peak) and a decrease in the amplitude of negative BSPM extremum at 3 and 4 ms after RII-peak were showed at Post-Ex 5. At Post-Ex 10, parameters of BSPMs did not differ from those at Pre-Ex. Conclusion In rats, acute exhaustive exercise causes reversible changes in the temporal and amplitude characteristics of BSPMs during ventricular depolarization, most likely related to alterations in the excitation of the main mass of the ventricular myocardium.

Precisão de réguas endodônticas milimetradas e orifício calibrador, e avaliação da regularidade da superfície do orifício calibrador / Accuracy of endodontic millimeter rulers and calibrator hole, and evaluation of the regularity of the calibrator hole surface

Objetivo: O objetivo desse artigo foi avaliar a precisão das porções milimetrada e calibradora das réguas endodônticas, e avaliar a regularidade da superfície dos orifícios calibradores. Métodos: A porção milimetrada das réguas Angelus, Maillefer, Maquira, Microdont e Prisma foi avaliada com paquímetro eletrônico digital. Os orifícios calibradores da Maillefer, Prisma e Angelus foram medidos com um projetor de perfil. A regularidade da superfície dos orifícios calibradores foi classificada em S1 ­ sem irregularidades ou S2 ­ com regularidades. A análise de precisão das porções milimetrada e calibradora foi realizada com o teste t (p=0,05); e as frequências dos tipos de superfície, com o teste do qui-quadrado (p<0,05). Resultados: A Maillefer foi a única régua endodôntica com precisão em todos os comprimentos e orifícios. A Prisma apresentou estatisticamente mais orifícios do tipo S2, quando comparada com outras réguas endodônticas avaliadas (p<0,05). Não houve diferença estatisticamente significativa entre Angelus e Maillefer (p>0,05). Conclusão: A Maillefer apresentou precisão nas porções milimetrada e calibradora. As réguas endodônticas da Angelus não foram precisas em nenhum comprimento da parte milimetrada e não foram precisas na maioria dos orifícios calibradores. A régua endodôntica Prisma mostrou significativamente mais orifícios calibradores com irregularidades na superfície do que Angelus e Maillefer. Destaca-se a necessidade de controle de qualidade e padrões específicos para fabricação das réguas endodônticas (AU).

Objective: The aim was to evaluate the accuracy of the millimeter and calibration portion and evaluate the regularity of the calibrator orifice surfaces of the endodontic rulers. Methods: The millimeter portion of the Angelus, Maillefer, Maquira, Microdont and Prisma rulers was evaluated with an electronic digital caliper. The calibration holes of the Maillefer, Prisma and Angelus were measured with Profile Projector. The surface regularity of calibration holes was evaluated and classified in S1- without irregularities and S2- with irregularities. The accuracy analysis of the millimeter and calibration was performed with T-Test (p=0.05) and the frequencies of the surface types with Chi-square (p<0.05). Results: The Maillefer was the only rulers with accuracy in all lengths and holes. Prisma presented statistically more S2 type holes when compared with other endodontic rulers evaluated (p <0.05). There was no statistically significant difference between Angelus and Maillefer (p> 0.05). Conclusion: The Maillefer presented accuracy in the millimeter and calibration portion. Angelus endodontic rulers were not accurate at any rated length of the millimeter portion and it was not accurate in most calibration holes evaluated. Prisma endodontic ruler showed significantly more calibration holes with irregular surfaces than Angelus and Maillefer. We emphasize the need for quality control and specific standards for endodontic rulers manufacturing (AU).

Comparison of dialysis dose through real-time Kt/V by ultraviolet absorbance of spent dialysate, single-pool Daugirdas II, and Kt/BSA according to sex and age / Comparação da dose de diálise através do Kt/V em tempo real pela absorbância ultravioleta do dialisato gasto, Daugirdas II de pool único e Kt/BSA de acordo com sexo e idade

ABSTRACT Background: Kt/V OnLine (Kt/VOL) avoids inaccuracies associated with the estimation of urea volume distribution (V). The study aimed to compare Kt/VOL, Kt/V Daugirdas II, and Kt/BSA according to sex and age. Methods: Urea volume distribution and body surface area were obtained by Watson and Haycock formulas in 47 patients. V/BSA was considered as a conversion factor from Kt/V to Kt/BSA. Dry weight was determined before the study. Kt/VOL was obtained on DIALOG machines. Results: Pearson correlation between Kt/VOL vs Kt/VII and Kt/VOL vs Kt/BSA was significant for males (r = 0.446, P = 0.012 and r = -0.476 P = 0.007) and individuals < 65 years (0.457, P = 0.019 and -0.549 P = 0.004), but not for females and individuals ≥ 65 years. V/BSA between individuals < 65 and individuals ≥ 65 years were 18.28 ± 0.15 and 18.18 ± 0.16 P = 0.000). No agreement between Kt/VII vs Kt/BSA. Men and individuals > 65 years received a larger dialysis dose than, respectively, females and individuals < 65 years, in the comparison between Kt/VOL versus Kt/VII. V/BSA ratios among men and women were respectively 18.29 ± 0.13 and 18.12 ± 0.15 P = 0.000. Conclusions: Kt/VOL allows recognition of real-time dose regardless of sex and age.

RESUMO Introdução: O Kt/V OnLine (Kt/VOL) evita imprecisões associadas à estimativa da distribuição do volume de uréia (V). O estudo teve como objetivo comparar Kt/VOL, Kt/V Daugirdas II e Kt/BSA de acordo com sexo e idade. Métodos: A distribuição do volume de uréia e área de superfície corporal foram obtidas pelas fórmulas de Watson e Haycock em 47 pacientes. V/BSA foi considerado um fator de conversão de Kt/V para Kt/BSA. O peso seco foi determinado antes do estudo. Kt/VOL foi obtido através de máquinas DIALOG. Resultados: A correlação de Pearson entre Kt/VOL vs Kt/VII e Kt/VOL vs Kt/BSA foi significativa para os homens (r = 0,446, P = 0,012 e r = -0,476 P = 0,007) e indivíduos < 65 anos (0,457, P = 0,019 e -0,549 P = 0,004), mas não para mulheres e indivíduos ≥ 65 anos. A V/BSA entre indivíduos <65 e indivíduos ≥ 65 anos foi 18,28 ± 0,15 e 18,18 ± 0,16 P = 0,000). Sem concordância entre Kt/VII vs Kt/BSA. Homens e indivíduos > 65 anos receberam maior dose de diálise do que, mulheres e indivíduos <65 anos, respectivamente, na comparação entre Kt/VOL versus Kt/VII. As razões V/BSA entre homens e mulheres foram, respectivamente, 18,29 ± 0,13 e 18,12 ± 0,15 P = 0,000. Conclusões: Kt/VOL permite o reconhecimento da dose em tempo real, independentemente do sexo e idade.

Early hemodynamic profile after aortic valve replacement - a comparison between three mechanical valves

Abstract Introduction: There are scarce data comparing different mechanical valves in the aortic position. The objective of this study was to compare the early hemodynamic changes after aortic valve replacement between ATS, Bicarbon, and On-X mechanical valves. Methods: We included 99 patients who underwent aortic valve replacement with mechanical valves between 2017 and 2019. Three types of mechanical valves were used, On-X valve (n=45), ATS AP360 (n=32), and Bicarbon (n=22). The mean prosthetic valve gradient was measured postoperatively and after six months. Results: Preoperative data were comparable between groups, and there were no differences in preoperative echocardiographic data. Pre-discharge echocardiography showed no difference between groups in the ejection fraction (P=0.748), end-systolic (P=0.764) and end-diastolic (P=0.723) diameters, left ventricular mass index (P=0.348), aortic prosthetic mean pressure gradient (P=0.454), and indexed aortic prosthetic orifice area (P=0.576). There was no difference in the postoperative aortic prosthetic mean pressure gradient between groups when stratified by valve size. The changes in the aortic prosthetic mean pressure gradient of the intraoperative period, at pre-discharge, and at six months were comparable between the three prostheses (P=0.08). Multivariable regression analysis revealed that female gender (beta coefficient -0.242, P=0.027), body surface area (beta coefficient 0.334, P<0.001), and aortic prosthetic size (beta coefficient -0.547, P<0.001), but not the prosthesis type, were independent predictors of postoperative aortic prosthetic mean pressure gradient. Conclusion: The three bileaflet mechanical aortic prostheses (On-X, Bicarbon, and ATS) provide satisfactory early hemodynamics, which are comparable between the three valve types and among different valve sizes.

Early Hemodynamic Profile after Aortic Valve Replacement - A Comparison between Three Mechanical Valves.

INTRODUCTION: There are scarce data comparing different mechanical valves in the aortic position. The objective of this study was to compare the early hemodynamic changes after aortic valve replacement between ATS, Bicarbon, and On-X mechanical valves. METHODS: We included 99 patients who underwent aortic valve replacement with mechanical valves between 2017 and 2019. Three types of mechanical valves were used, On-X valve (n=45), ATS AP360 (n=32), and Bicarbon (n=22). The mean prosthetic valve gradient was measured postoperatively and after six months. RESULTS: Preoperative data were comparable between groups, and there were no differences in preoperative echocardiographic data. Pre-discharge echocardiography showed no difference between groups in the ejection fraction (P=0.748), end-systolic (P=0.764) and end-diastolic (P=0.723) diameters, left ventricular mass index (P=0.348), aortic prosthetic mean pressure gradient (P=0.454), and indexed aortic prosthetic orifice area (P=0.576). There was no difference in the postoperative aortic prosthetic mean pressure gradient between groups when stratified by valve size. The changes in the aortic prosthetic mean pressure gradient of the intraoperative period, at pre-discharge, and at six months were comparable between the three prostheses (P=0.08). Multivariable regression analysis revealed that female gender (beta coefficient -0.242, P=0.027), body surface area (beta coefficient 0.334, P<0.001), and aortic prosthetic size (beta coefficient -0.547, P<0.001), but not the prosthesis type, were independent predictors of postoperative aortic prosthetic mean pressure gradient. CONCLUSION: The three bileaflet mechanical aortic prostheses (On-X, Bicarbon, and ATS) provide satisfactory early hemodynamics, which are comparable between the three valve types and among different valve sizes.

Performance of Glomerular Filtration Rate Estimating Equations Before and After Bariatric Surgery.

RATIONALE & OBJECTIVE: Evaluation of glomerular filtration rate (GFR) is challenging in adults undergoing bariatric surgery because creatinine and cystatin C levels are influenced by changes in muscle and fat mass. Additionally, indexing of GFR by body surface area (BSA) may by affected by decreases in BSA. STUDY DESIGN: Prospective observational study. SETTING & PARTICIPANTS: 27 adults with body mass index (BMI) ≥ 35 kg/m2 who underwent measurement of GFR before and after bariatric surgery. OUTCOMES: Indexed and nonindexed GFRs measured (mGFRs) using plasma iohexol clearance, indexed and nonindexed estimated GFR (eGFR) based on levels of creatinine, cystatin C, or both from Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. ANALYTIC APPROACH: Bias and percent of estimates within 20% and 30% of mGFR (P20 and P30) for estimating equations were examined. RESULTS: Mean presurgery BMI was 49.5 (SD, 9.4) kg/m2, BSA was 2.42 (SD, 0.27) m2, nonindexed mGFR was 117.3 (SD, 34.1) mL/min, and indexed mGFR was 84.1 (SD, 22.0) mL/min/1.73 m2. After 6 months, mean BMI changed by -13.8 (95% CI, -15.9 to -11.8) kg/m2, BSA by -0.30 (95% CI, -0.33 to -0.27) m2, and nonindexed mGFR by -9.2 (95% CI, -17.2 to -1.1) mL/min, while indexed mGFR was unchanged at 5.1 (95% CI, -0.1 to 10.4) mL/min/1.73 m2. Nonindexed eGFRcr was unbiased (median bias, 5.0 [95% CI, -4.3 to 11.6] mL/min) before surgery, but overestimated mGFR (8.8 [95% CI, 1.8 to 16.9] mL/min) after surgery. Nonindexed eGFRcys underestimated mGFR before (median bias, -12.1 [95% CI, -21.4 to -1.2] mL/min) and after surgery (-11.2 [95% CI, -21.8 to -7.3] mL/min). Nonindexed eGFRcr-cys was unbiased before (median bias, -6.0 [95% CI, -11.0 to 1.0] mL/min) and after surgery (-2.0 [95% CI, -8.8 to 4.9] mL/min). Findings were similar for indexed eGFR compared with indexed mGFR. LIMITATIONS: Small, mostly white sample. CONCLUSIONS: Changes in indexed and nonindexed GFRs may be discordant after bariatric surgery in adults because of decreases in BSA. Indexed and nonindexed eGFRcr-cys may be less biased than indexed or nonindexed eGFRcr or eGFRcys because of opposite biases in estimating mGFR.

Cálculo de la superficie corporal quemada ¿Es correcta la estimación que realizamos? / Calculating total body surface area burned: Is the estimate we use correct?

La correcta evaluación de la extensión de las quemaduras influye directamente en la terapéutica inicial instituida y la referencia al centro especializado. El objetivo de este trabajo ha sido cuantificar las diferencias de los porcentajes de superficie corporal quemada (%SCQ) estimados entre los hospitales de derivación y la Unidad de Quemados del Hospital de Pediatría Juan P. Garrahan, correspondientes a los niños internados entre los años 2014 y 2019. Se realizó una revisión retrospectiva de 221 historias clínicas digitalizadas, siendo que 154 de ellas contaban con estimaciones de %SCQ de los hospitales de derivación. Se compararon dichas estimaciones con las reales de la Unidad de Quemados con un nivel de exactitud del 100% y, además, las diferencias se expresaron como un porcentual del %SCQ real como subestimado (<20%), satisfactorio (<20 a 20%) y sobrestimado (>20%). Las variables secundarias (edad, mortalidad y estancia hospitalaria) fueron evaluadas en cada grupo. De los 154 pacientes estudiados, 36 fueron subestimados, 32 estimados satisfactoriamente y 86 fueron sobrestimados, al considerar un nivel de exactitud del 100%. La relación entre sobrestimación y estimación satisfactoria fue de 2.6:1 mientras que la subestimación y estimación satisfactoria fue 1.1:1. La relación entre sobrestimación y subestimación fue de 2.4:1. Se constató una diferencia global significativa de 5% ±10.87 DS (IC95% 3.06­6.96) entre las estimaciones de los hospitales de derivación y la Unidad de Quemados (p<0.00001), con notable inclinación a la sobrestimación. No hubo diferencias estadísticas entre las variables secundarias según los grupos (AU)

Adequate evaluation of the extent of burn wounds directly influences the initial management of the patient and the referral to a specialized center. The aim of this study was to quantify the differences in the estimated percent total body surface area (%TBSA) affected by the burns between the referring hospitals and the Burn Unit at Hospital de Pediatría Juan P. Garrahan of children admitted between 2014 and 2019. A retrospective review of 221 electronic records was conducted, in 154 of whom %TBSA was estimated at the referring hospitals. These estimates were compared with those performed at the Burn Unit with an accuracy level of 100%. In addition, the differences were expressed as a percentage of the actual %TBSA as underestimated (<20%), satisfactory (<20 to 20%), overestimated (>20%). Secondary variables (age, mortality, and hospital stay) were evaluated in each group. Of the 154 patients, %TBSA was underestimated in 36, estimated satisfactorily in 32, and overestimated in 86, considering a 100% level of accuracy. The ratio of overestimation to satisfactory estimation was 2.6:1, while the ratio of underestimation to satisfactory estimation was 1.1:1. The ratio of overestimation to underestimation was 2.4:1. A significant overall difference of 5% ±10.87 SD (95% CI 3.06­6.96) was found between the estimates of referring hospitals and the Burn Unit (p<0.00001), with a marked proclivity to overestimation. No statistical differences were found in secondary variables between the groups (AU)

Fluidoterapia y electrolitos parenterales en pediatría / Fluid therapy and electrolytes in pediatrics

RESUMEN La administración de líquidos y electrolitos parenterales es una terapia fundamental de soporte en niños agudamente enfermos si la vía oral no permite la administración de la cantidad o composición requeridas de fluidos, por ejemplo en enfermedades de tipo gastrointestinal, respiratorio, neurológico, o en el período transoperatorio. Al momento de planificar la administración de líquidos y electrolitos parenterales en niños a partir del mes de edad, se debe considerar componentes relacionados con la cantidad de líquidos a infundir considerando los requerimientos secundarios a pérdidas hídricas habituales o requerimientos para reacciones metabólicas, evaluar el grado de deshidratación para la administración de líquidos que complementen el déficit, corregir las pérdidas que se han producido secundarios a una noxa externa (enfermedad, procedimiento quirúrgico, trauma, etc.) y finalmente aportar la cantidad adecuada de fluido que permita re-establecer la perfusión tisular. Es necesario conocer los cambios instaurados basados en la evidencia actual con la finalidad de incorporar a el manejo frecuente de los pacientes considerando también la toxicidad ya sean cualitativos o cuantitativos de esta terapéutica tan necesaria en el manejo del paciente pediátrico

ABSTRACT The administration of parenteral fluids and electrolytes is a fundamental support therapy in acutely ill children if the oral route does not allow the ad-ministration of the required amount or composition of fluids, for example in gastrointestinal, respiratory, neurological, or transoperative diseas-es. When planning the administration of parenteral fluids and electrolytes in children from one month of age onwards, components related to the amount of fluids to be infused should be considered, taking into account the requirements secondary to habitual water loss or requirements for meta-bolic reactions, evaluating the degree of dehydration for the administration of fluids to supplement the deficit, correcting the losses that have oc-curred secondary to an external noxa (illness, surgical procedure, trauma, etc.) and finally providing the adequate amount of fluid to allow re-es-tablishment of tissue perfusion. It is necessary to know the changes established based on current evidence in order to incorporate to the frequent management of patients, also considering the toxicity, either qualitative or quantitative, of this therapy, so necessary in the management of the pediatric patient.

Characterization of atrial arrhythmias in body surface potential mapping: A computational study.

PURPOSE: Atrial tachycardia (AT), flutter (AFL) and fibrillation (AF) are very common cardiac arrhythmias and are driven by localized sources that can be ablation targets. Non-invasive body surface potential mapping (BSPM) can be useful for early diagnosis and ablation planning. We aimed to characterize and differentiate the arrhythmic mechanisms behind AT, AFL and AF from the BSPM perspective using basic features reflecting their electrophysiology. METHODS: 19 simulations of 567-lead BSPMs were used to obtain dominant frequency (DF) maps and estimate the atrial driving frequencies using the highest DF (HDF). Regions with |DF-HDF|≤1Hz were segmented and characterized (size, area); the spatial distribution of the differences |DF-atrialHDFestimate| was qualitatively analyzed. Phase singularity points (SPs) were detected on maps generated with Hilbert transform after band-pass filtering around the HDF (±1Hz). Connected SPs along time (filaments) and their histogram (heatmaps) were used for rotational activity characterization (duration, spatiotemporal stability). Results were reproduced in clinical layouts (252 to 12 leads) and with different rotations and translations of the atria within the torso, and compared with the original 567-lead outcomes using structural similarity index (SSIM) between maps, sensitivity and precision in SP detection and direct feature comparison. Random forest and least-square based algorithms were used to classify the arrhythmias and their mechanisms' location, respectively, based on the obtained features. RESULTS: Frequency and phase analyses revealed distinct behavior between arrhythmias. AT and AFL presented uniform DF maps with low variance, while AF maps were more heterogeneous. Lower differences from the atrial HDF regions correlated with the driver location. Rotational activity was most stable in AFL, followed by AT and AF. Features were robust to lower spatial resolution layouts and modifications in the atrial geometry; DF and heatmaps presented decreasing SSIM along the layouts. The classification of the arrhythmias and their mechanisms' location achieved balanced accuracy of 72.0% and 73.9%, respectively. CONCLUSION: Non-invasive characterization of AT, AFL and AF based on realistic models highlights intrinsic differences between the arrhythmias, enhancing the BSPM utility as an auxiliary clinical tool.