Nevin Manimala

Arq Bras Cardiol. 2021 May;116(5):928-937. doi: 10.36660/abc.20190356.

ABSTRACT

BACKGROUND: Although non-ischemic troponin elevation is frequently seen in patients admitted to the emergency department (ED), consensus regarding its management is lacking.

OBJECTIVES: This study aimed to characterize patients admitted to the ED with non-ischemic troponin elevation and to identify potential mortality predictors in this population.

METHODS: This retrospective observational study included ED patients with a positive troponin test result between June and July of 2015. Patients with a clinical diagnosis of acute coronary syndrome (ACS) were excluded. Data on patient demographics and clinical and laboratory variables were extracted from medical records. Follow-up data were obtained for 16 months or until death occurred. The statistical significance level was 5%.

RESULTS: Troponin elevation without ACS was found in 153 ED patients. The median (IQR) patient age was 78 (19) years, 80 (52.3%) were female and 59(38.6%) died during follow-up. The median (IQR) follow-up period was 477(316) days. Survivors were significantly younger 76 (24) vs. 84 (13) years; p=0.004) and featured a higher proportion of isolated troponin elevation (without creatine kinase or myoglobin elevation) in two consecutive evaluations: 48 (53.9%) vs. 8 (17.4%), p<0.001. Survivors also presented a lower rate of antiplatelet treatment and same-day hospitalization. In the multivariate logistic regression with adjustment for significant variables in the univariate analysis, isolated troponin elevation in two consecutive evaluations showed a hazard ratio= 0.43 (95%CI 0.17-0.96, p=0.039); hospitalization, previous antiplatelet treatment and age remained independently associated with mortality.

CONCLUSIONS: Isolated troponin elevation in two consecutive measurements was a strong predictor of survival in ED patients with troponin elevation but without ACS.

PMID:34008817 | DOI:10.36660/abc.20190356

Arq Bras Cardiol. 2021 May;116(5):908-916. doi: 10.36660/abc.20190726.

ABSTRACT

BACKGROUND: In the last decade, the number of cardiac electronic devices has risen considerably and consequently the occasional need for their removal. Concurrently, the transvenous lead removal became a safe procedure that could prevent open-heart surgery.

OBJECTIVE: The primary objective of this study was to describe the successful performance and the complication rates of pacemaker removals in a Brazilian public hospital. Our secondary aim was to describe the variables associated to successes and complications.

METHODS: A retrospective case series was conducted in patients submitted to pacemaker removal in a Brazilian public hospital from January 2013 to June 2018. Removal, explant, extraction, success and complication rates were defined by the 2017 Heart Rhythm Society Guideline. Categorical variables were compared using x2 or Fisher’s tests, while continuous variables were compared by unpaired tests. A p-value of 0.05 was considered statistically significant.

RESULTS: Cardiac device removals were performed in 61 patients, of which 51 were submitted to lead extractions and 10 to lead explants. In total, 128 leads were removed. Our clinical success rate was 100% in the explant group and 90.2% in the extraction one (p=0.58). Major complications were observed in 6.6% patients. Procedure failure was associated to older right ventricle (p=0.05) and atrial leads (p=0,04). Procedure duration (p=0.003) and need for blood transfusion (p<0,001) were associated to more complications.

CONCLUSION: Complications and clinical success were observed in 11.5% and 91.8% of the population, respectively. Removal of older atrial and ventricular leads were associated with lower success rates. Longer procedures and blood transfusions were associated with complications.

PMID:34008813 | DOI:10.36660/abc.20190726

Arq Bras Cardiol. 2021 May;116(5):879-886. doi: 10.36660/abc.20200231.

ABSTRACT

BACKGROUND: Body mass index (BMI) is the most commonly used index to categorize a person as obese or non-obese, which is subject to important limitations.

OBJECTIVE: To evaluate the direct effect of BMI on cardiovascular outcomes among participants without central obesity.

METHODS: This analysis included 14,983 males and females aged 45-75 years from the Atherosclerosis Risk in Communities Study (ARIC). BMI was measured as general obesity, and waist circumference (WC), waist-to-hip ratio (WHR) and hip circumference as central obesity. Targeted maximum likelihood estimation (TMLE) was used to estimate the total effects (TEs) and the controlled direct effects (CDEs). The proportion of TE that would be eliminated if all participants were non-obese regarding central obesity was computed using the proportion eliminated (PE) index. P <0.05 was considered statistically significant. Analyses were performed in the TMLE R package.

RESULTS: The risk of cardiovascular outcomes attributed to BMI was significantly reversed by eliminating WHR obesity (p<0.001). The proportion eliminated of BMI effects was more tangible for non-obese participants regarding WC (PE=127%; 95%CI (126,128)) and WHR (PE=97%; 95%CI (96,98)) for coronary heart disease (CHD), and WHR (PE=92%; 95%CI (91,94)) for stroke, respectively. With respect to sex, the proportion eliminated of BMI effects was more tangible for non-obese participants regarding WHR (PE=428%; 95%CI (408,439)) for CHD in males, and WC (PE=99%; 95%CI (89,111)) for stroke in females, respectively.

CONCLUSION: These results indicate different potential effects of eliminating central obesity on the association between BMI and cardiovascular outcomes for males and females. (Arq Bras Cardiol. 2021; 116(5):879-886).

PMID:34008807 | DOI:10.36660/abc.20200231

Arq Bras Cardiol. 2021 May;116(5):867-876. doi: 10.36660/abc.20190739.

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).

PMID:34008805 | DOI:10.36660/abc.20190739

J Appl Oral Sci. 2021 May 17;29:e20200787. doi: 10.1590/1678-7757-2020-0787. eCollection 2021.

ABSTRACT

OBJECTIVE: To define the subgingival microbial profile associated with Stage II generalized periodontitis using next-generation sequencing and to determine the relative abundance of novel periodontal pathogens and bacterial complexes.

METHODOLOGY: Subgingival biofilm samples were collected from 80 subjects diagnosed with Stage II generalized periodontitis. Bacterial DNA was extracted, and 16S rRNA-based bacterial profiling via next-generation sequencing was carried out. The bacterial composition and diversity of microbial communities based on the age and sex of the patients were analyzed. The bacterial species were organized into groups: bacterial complexes (red, orange, purple, yellow, and green), novel periodontal pathogens, periodontal health-related species, and unclassified periodontal species. The results were analyzed and statistically evaluated.

RESULTS: The highest number of bacteria belonged to the phylum Bacteroidetes and Firmicutes. In terms of relative abundance, the orange complex represented 18.99%, novel bacterial species (Fretibacterium spp. and Saccharibacteria spp.) comprised 17.34%, periodontal health-related species accounted for 16.75% and unclassified periodontal species represented (Leptotrichia spp. and Selenomonas spp.) 15.61%. Novel periodontal pathogens had outweighed the periodontal disease-related red complex (5.3%). The one-sample z-test performed was statistically significant at p<0.05. The Beta diversity based on the unweighted UniFrac distance at the species level demonstrated a total variance of 15.77% based on age and 39.19% on sex, which was not statistically significant.

CONCLUSION: The bacterial species corresponding to the disease-related orange complex and novel periodontal pathogens are predominant in Stage II generalized periodontitis.

PMID:34008792 | DOI:10.1590/1678-7757-2020-0787

Cad Saude Publica. 2021 May 17;37(5):e00169020. doi: 10.1590/0102-311X00169020. eCollection 2021.

ABSTRACT

The Satisfaction with Life Scale (SWLS) was originally proposed in the English language to measure the individual’s overall perception in relation to life. The study aims to evaluate the psychometric properties of SWLS when applied to young adults and estimate the influence of demographic characteristics on life satisfaction, in a non-probabilistic sample of young adult individuals (18 to 35 years) of both sexes in Araraquara, São Paulo State, Brazil. We assessed the fit of SWLS to the data by confirmatory analysis, using the comparative fit index (CFI), Tucker-Lewis index (TLI), and standardized root mean square residual (SRMR). Reliability was estimated by the alpha ordinal coefficient and omega. Factor invariance was estimated by multigroup analysis, with CFI test of statistical difference (ΔCFI). Comparison of the mean scores on satisfaction with life according to sex, age, economic stratum, and employment status was performed with analysis of variance (ANOVA). Participation included 2,170 individuals (females: 67.8%; age: 22.09 years). The model’s fit to the different samples was adequate (CFI = 0.981-0.998; TLI = 0.962-0.996; SRMR = 0.026-0.040; omega = 0.842-0.869; alpha = 0.862-0.889). Strict invariance was seen for the target variables. Life satisfaction was greater among individuals in higher economic strata. The data obtained with SWLS were valid, reliable, and invariant between samples with different sex, age, economic strata, and employment status. Life satisfaction was greater among individuals from higher economic strata and did not differ by sex, age, or employment status.

PMID:34008787 | DOI:10.1590/0102-311X00169020

Rev Saude Publica. 2021 May 17;55:21. doi: 10.11606/s1518-8787.2021055002134. eCollection 2021.

ABSTRACT

OBJECTIVE: To characterize breastfeeding patterns in the first six months of life and factors associated with early weaning in a birth-cohort in Rio Branco, state of Acre.

METHODS: This is a prospective study with all babies born between April and June 2015. The mothers were interviewed soon after birth and between 6 and 15 months postpartum. At hospital discharge, breastfeeding was defined as exclusively (EBF), and breastfeeding (BF). In the follow-up, breastfeeding patterns were exclusive breastfeeding (EBF), predominant breastfeeding (PBF), and breastfeeding (BF). The interruption of breastfeeding in the first six months was classified as early weaning. The Kaplan Meier method (log-rank: 95%) was used to estimate the conditional probability of change in breastfeeding pattern, and early weaning risk. Crude and adjusted proportional Cox regression models, and their respective 95% confidence intervals (95%CI), were used to analyze the factors associated with early weaning.

RESULTS: The study included 833 infants in EBF (95.4%) and BF (4.6%) at hospital discharge. During the first six months of life, the infant likely discharged in EBF remaining in EBF, becoming PBF, and BF, were respectively 16.4%, 32.3%, and 56.5%. The weaning likely at six months was statistically higher for infants discharged in BF (47.4%) when compared with those discharged in EBF (26%). Factors associated with early weaning were BF at hospital discharge (HR = 1.82; 95%CI 1.06-3.11), no mother cross-breastfeeding (HR = 2.50; 95%CI 1.59-3.94), pacifier use (HR = 6.23; 95%CI 4.52-8.60), less than six months of breastfeeding intention (HR = 1.93; 95%CI 1.25-2.98), lack of breastfeeding in the first hour of life (HR = 1.45; 95%CI 1.10-1.92), and pregnancy alcohol consumption (HR = 1.88; 95%CI 1.34-2.90).

CONCLUSION: Compared to infants in EBF, those in BF at hospital discharge were more likely to wean. Public health efforts should prioritize EBF at hospital discharge, promote breastfeeding in the first hour of life, and prevent alcohol consumption risks during pregnancy, cross-breastfeeding and pacifier use.

PMID:34008778 | DOI:10.11606/s1518-8787.2021055002134

Codas. 2021 May 14;33(2):e20190219. doi: 10.1590/2317-1782/20202019219. eCollection 2021.

ABSTRACT

PURPOSE: Adapt and validate the content and appearance of the Expanded Protocol of Orofacial Myofunctional Evaluation with Scores (OMES-E) for nursing infants aged 6 to 24 months.

METHODS: This is a validation study. The parameters were based on the literature on orofacial motor development, the authors’ experience, and on a committee of ten members. Data analysis was performed using descriptive statistics, content validity index, and agreement among experts.

RESULTS: The protocol was organized into functional blocks after maintenance, exclusion, modification, and addition of items, and was adapted according to the age group. A high level of agreement between experts was obtained for 90% of the items. The final version of the protocol includes new items such as history of feeding, orofacial parafunctional habits, facial mobility, dentition, oral breathing mode, swallowing of pasty food, and details specific for the age group. An operational manual and a table for recording the scores were also included.

CONCLUSIONS: The OMES-E Infants protocol was validated for its content and appearance, and may contribute to orofacial myofunctional diagnosis in the 6 to 24-month age group.

PMID:34008774 | DOI:10.1590/2317-1782/20202019219

Codas. 2021 May 14;33(3):e20190218. doi: 10.1590/2317-1782/20202019218. eCollection 2021.

ABSTRACT

PURPOSE: The aim of the study was to investigate the electroneurophysiological aspects of volunteers with temporomandibular disorders before and after performing isotonic exercises for pain relief and self-care guidelines.

METHODS: The study was a parallel controlled randomized controlled trial under protocol 1,680,920. The inclusion criteria were age between 18 and 60 years, muscle temporomandibular dysfunction with or without limitation of mouth opening and self-reported pain with scores between 4 and 10. The individuals were randomized into experimental group and control. Twenty-three volunteers participated in the study, most of then were female. Control group had 11 and experimental group 12 individuals. Dropouts occurred in both groups, two in the experimental group and three in the control group. Since there were an intergroup imbalance the power density was analysed just in experimental group. Electroencephalographic recording was performed before and after the interventions, using the 32-channel apparatus, with sample frequency of 600 Hz and impedance of 5 kΩ. The data were processed through the MATLAB computer program. The individual records filtered off-line, using bandpass between 0.5 and 50 Hz. Epochs of 1,710 ms were created and the calculation of the absolute power density calculated by means of the fast Fourier transform. The statistical approach was inferential and quantitative.

RESULTS: The alpha power density analyzed presented a difference, but not significant, when compared in the two moments.

CONCLUSION: According to this study, isotonic exercises performed to reduce pain provided a small increase in alpha power density in the left temporal, parietal and occipital regions.

PMID:34008769 | DOI:10.1590/2317-1782/20202019218

An Acad Bras Cienc. 2021 May 17;93(suppl 1):e20200883. doi: 10.1590/0001-3765202120200883. eCollection 2021.

ABSTRACT

Gamma-ray bursts (GRBs) are the most energetic and mysterious events in the Universe, which are observed in all ranges of electromagnetic spectrum. Most valuable results about physics of GRB are obtained by optical observations. GRBs are initially detected in gamma-rays with poor localization accuracy, and an optical counterpart should be found. The faster the counterpart is found, the more it can give to physics. This first phase, as a rule, corresponds to an early afterglow. The next phases of the observations are multicolor photometry, polarimetry, spectroscopy, and few days later the search for a supernova or kilonova associated with the GRB, and finally, observations of the host galaxy. To manage the problem of fast optical observations, telescopes with a small aperture are suitable. They can have a large field of view, which is necessary to cover initial localizations of GRBs. The sensitivity of the telescope+detector may be sufficient to record statistically significant light curve with fine time resolution. We describe one of the networks of telescopes with a small aperture IKI-GRB FuN, and present the results of early optical observation of GRB sources, and discuss the design requirements of the optical observations for effective GRB research in the next decade.

PMID:34008766 | DOI:10.1590/0001-3765202120200883