Updated cardiovascular prevention guideline of the Brazilian Society of Cardiology: 2019

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Versão brasileira do Body Dysmorphic Disorder Examination

CONTEXT AND OBJECTIVE: Body image improvement is considered to be the main reason for undergoing plastic surgery. The objective was to translate the Body Dysmorphic Disorder Examination (BDDE) into Brazilian Portuguese and to adapt and validate this questionnaire for use in Brazil. DESIGN AND SETTING: Cross-sectional survey, at the Department of Plastic Surgery of Universidade Federal de São Paulo (UNIFESP). METHODS: The BDDE was first translated into Portuguese and then back-translated into English. These translations were then discussed by healthcare professionals in order to establish the final Brazilian version. In a second stage, the validity and reliability of the BDDE were assessed. For this, patients were initially interviewed by two interviewers and subsequently, by only one of these interviewers. On the first occasion, in addition to the BDDE, the body shape questionnaire (BSQ) and the Rosenberg self-esteem scale were also applied. These questionnaires were applied to 90 patients. RESULTS: Six questions were modified during the assessment of cultural equivalence. Cronbach's alpha was 0.89 and the intraclass correlation coefficients for interobserver and test-retest reliability were 0.91 and 0.87, respectively. Pearson's coefficient showed no correlation between the BDDE and the Rosenberg self-esteem scale (0.22), whereas there was a moderate correlation between the BDDE and the BSQ (0.64). CONCLUSIONS: The BDDE was successfully translated and adapted, with good internal consistency, reliability and construct validity.CONTEXTO E OBJETIVO: A busca pela melhoria da imagem corporal é a principal motivação dos pacientes que procuram um cirurgião plástico. O objetivo deste estudo foi traduzir para o português, adaptar à cultura brasileira, testar a validade de construção e a reprodutibilidade do Body Dysmorphic Disorder Examination (BDDE). TIPO DE ESTUDO E LOCAL: Estudo transversal, realizado no Departamento de Cirurgia Plástica da Universidade Federal de São Paulo (UNIFESP). MÉTODOS: O estudo foi realizado em duas fases. Primeiramente, o instrumento foi traduzido e retro-traduzido. Essas traduções foram submetidas à revisão por um comitê multidisciplinar até que se construísse uma versão consensual em Português. Na segunda fase do estudo foram testadas a validade e reprodutibilidade do instrumento. Os pacientes foram entrevistados em duas ocasiões distintas. Na primeira, por dois entrevistadores e na segunda ocasião por apenas um deles. Na primeira ocasião também foram administrados o Body Shape Questionnaire (BSQ) e a Escala de Auto-Estima de Rosenberg. RESULTADOS: Durante a fase de adaptação, seis questões foram modificadas. A consistência interna do instrumento foi de 0,89. O coeficiente de reprodutibilidade inter-observador foi de 0,91 e o intra-observador foi de 0,87. Quanto à validade, pode-se afirmar que os questionários BDDE e Rosenberg não apresentam correlação (0,22), ao passo que entre BDDE e BSQ a associação existente é moderada (0,64). CONCLUSÕES: O BDDE foi traduzido e adaptado com sucesso, demonstrando ser válido e reprodutível.Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Brazilian version of the Body Dysmorphic Disorder Examination

CONTEXT AND OBJECTIVE: Body image improvement is considered to be the main reason for undergoing plastic surgery. The objective was to translate the Body Dysmorphic Disorder Examination (BDDE) into Brazilian Portuguese and to adapt and validate this questionnaire for use in Brazil. DESIGN AND SETTING: Cross-sectional survey, at the Department of Plastic Surgery of Universidade Federal de São Paulo. METHODS: The BDDE was first translated into Portuguese and then back-translated into English. These translations were then discussed by healthcare professionals in order to establish the final Brazilian version. In a second stage, the validity and reliability of the BDDE were assessed. For this, patients were initially interviewed by two interviewers and subsequently, by only one of these interviewers. On the first occasion, in addition to the BDDE, the body shape questionnaire (BSQ) and the Rosenberg self-esteem scale were also applied. These questionnaires were applied to 90 patients. RESULTS: Six questions were modified during the assessment of cultural equivalence. Cronbach's alpha was 0.89 and the intraclass correlation coefficients for interobserver and test-retest reliability were 0.91 and 0.87, respectively. Pearson's coefficient showed no correlation between the BDDE and the Rosenberg self-esteem scale (0.22), whereas there was a moderate correlation between the BDDE and the BSQ (0.64). CONCLUSIONS: The BDDE was successfully translated and adapted, with good internal consistency, reliability and construct validity

Soluble Epoxide Hydrolase Inhibitors are Promising in Pre-clinical and Clinical Studies on Smoking-Mediated Inflamma-tory Lung Diseases and Chronic Obstructive Pulmonary Dis-ease: A Systematic Review with Meta-Analysis

This study aimed to evaluate discrepancies between the effects of epoxide hydrolase inhibition by GSK2256294 in different models of pulmonary inflammation. We performed a secondary study in the scientific databases Medline/PubMed, Web of Science, SciELO, Cochrane Library, Embase, Academic Google, and gray literature. Two independent reviewers performed the searches of records published between 2012 and 2021. The methodological quality and consistency of the evidence were analyzed. Different variables were compared by meta-analysis

Bruch's membrane opening minimum rim width and retinal nerve fiber layer thickness in a Brazilian population of healthy subjects.

OBJECTIVE:To determine Bruch's membrane opening (BMO) minimum rim width (MRW) and peripapillary retinal nerve fiber layer thickness (RNFLT) measurements, acquired with optical coherence tomography (OCT) in healthy Brazilian individuals self-reported as African Descent (AD), European Descent (ED) and Mixed Descent (MD). METHODS:260 healthy individuals (78 AD, 103 ED and 79 MD) were included in this cross-sectional study conducted at the Clinics Hospital of the University of Campinas. We obtained optic nerve head (24 radial B scans) and peripapillary retinal nerve fiber layer (3.5-mm circle scan) images in one randomly selected eye of each subject. RESULTS:After adjustment for BMO area and age, there were no significant differences in mean global MRW (P = 0.63) or RNFLT (P = 0.07) among the three groups. Regionally, there were no significant differences in either MRW or RNFLT in most sectors, except in the superonasal sector, in which both MRW and RNFLT were thinner among ED (P = 0.04, P<0.001, respectively). RNFLT was also thinner in ED in the inferonasal sector (P = 0.009). In all races, global MRW decreased and global RNFLT increased with BMO area. AD subjects had higher rates of global RNFLT decay with age (-0.32 μm/year) compared to ED and MD subjects (-0.10 μm/year and -0.08 μm/year, respectively; P = 0.01 and P = 0.02, respectively). CONCLUSIONS AND RELEVANCE:While we found no significant differences in global MRW and RNFLT among the three races, age-related thinning of the RNFLT was significantly higher in the AD subgroup, which warrants further study

Analysis of CFB (R32Q - rs641153) and CFH (rs1410996) variants as risk factors for age-related macular degeneration in a brazilian population

Age-related macular degeneration (AMD) is a progressive, mutifactorial condition that affects the central retina, and represents an important cause of blindness in the elderly population worldwide. Its pathogenesis is complex, with genetics and environmental factors playing critical roles. The genetic component of AMD has been estimated at 45% to 70%, with at least 34 genomic loci implicated in its etiology. Different variants of complement pathway-associated genes have been associated with the disease, demonstrating the importance of immune pathology and inflammation in the mechanism of AMD. The purpose of this study was to evaluate the role of the variants CFB R32Q (rs641153) and CFH (rs1410996) in the risk of development of AMD in a Brazilian population. This was a case-control study, in which 443 unrelated AMD patients and 471 controls were evaluated for the rs641153 and 451 unrelated AMD patients and 435 controls were evaluated for the rs1410996 SNPs through PCR/direct sequencing. AMD patients were diagnosed according to the International Classification System and subdivided in subgroups: dry and wet; early and advanced disease.Genotype distributions were significantly different when cases and controls were compared. When analyzing rs641153, AG/AA genotypes were more frequent in controls than in cases when compared to GG genotype (p= 0.0008), OR: 0.548 (IC95% 0.385-0.780). When comparing early versus advanced forms, GG genotype was more frequent in patients with advanced AMD (p=0.0006), OR: 1.878 (IC95% 1.081-3.262). No association was observed for the comparison of wet versus dry forms. For rs1410996, GG/AG genotypes were more frequent in cases than controls when compared to AA genotype (p=0.0296), OR: 1.462 (IC95% 1.038-2.059). For the comparison of GG versus AA genotype, OR was 2.030 (IC95% 1.375-2.996) (p=0.0002). No association was observed for the comparisons early versus advanced and dry versus wet AMD.These results are in accordance with the literature and support the role of the A variant of the CFB gene in AMD susceptibility, as a protection factor for the disease and the G variant of the CFH gene as a risk factor for the disease. To our knowledge, this is the first report of the association of these variants with AMD in Brazilians, a highly admixed population61

Fatores associados a atraso no diagnóstico da síndrome de Turner Investigación de factores asociados a retraso en el diagnóstico del síndrome de Turner Variables associated with diagnostic delay in Turner syndrome

OBJETIVO: Investigar as possíveis razões do atraso no diagnóstico da síndrome de Turner (ST), ou seja, aquele realizado após a idade em que se pode estabelecer o atraso puberal. MÉTODOS: Estudo transversal com obtenção de dados dos prontuários de 29 pacientes com ST diagnosticadas com mais de dois anos, entre 2004 e 2007. Foram comparados antecedentes pessoais e familiares e dados de exame físico das pacientes diagnosticadas com menos de 13 anos (limite a partir do qual se pode caracterizar atraso puberal em meninas) com os daquelas diagnosticadas após os 13 anos por meio dos testes t de Student e exato de Fisher. RESULTADOS: Não houve diferenças significativas quanto à estatura materna e da própria paciente, história de afecções associadas (consideradas individualmente), escolaridade dos pais, recorrência familiar de baixa estatura, presença de cada sinal dismórfico isoladamente e total de sinais observados. Os dois grupos diferiram quanto à presença de ao menos uma afecção sugestiva dessa síndrome (associada ao diagnóstico mais precoce) e ao número de irmãos (maior no diagnóstico tardio e associado à menor escolaridade materna). CONCLUSÕES: O diagnóstico precoce relacionou-se mais à presença de alguma das afecções associadas à ST (possivelmente determinando-se encaminhamento a serviços de maior complexidade) do que a sinais dismórficos. Há indicações de que déficit de crescimento menos evidente, dificuldade dos médicos em reconhecer anomalias sugestivas dessa síndrome e determinantes socioeconômicos contribuam para o atraso no diagnóstico. É necessário enfatizar na formação pediátrica o reconhecimento do espectro clínico dessa síndrome e ampliar os serviços públicos de genética.<br>OBJETIVO: Investigar las posibles razones del retraso en el diagnóstico del síndrome de Turner (ST), es decir, aquél realizado después de la edad en que se puede establecer retraso puberal. MÉTODOS: Estudio transversal con obtención de datos de los prontuarios de 29 pacientes diagnosticadas con ST mayores de 2 años de edad entre 2004 y 2007. Se compararon antecedentes personales y familiares y datos de examen físico de las pacientes diagnosticadas a una edad menor de 13 años (límite a partir del cual se puede caracterizar retraso puberal en niñas) con los de aquellas diagnosticadas después de los 13 años mediante las pruebas t y chi-cuadrado. RESULTADOS: No hubo diferencias significativas respecto a la estatura materna y de la paciente misma, historial de afecciones asociadas (consideradas individualmente), escolaridad de los padres; recurrencia familiar de baja estatura, presencia de cada señal dismórfica aislada y total de señales observadas. Los dos grupos difirieron respecto a la presencia de al menos una afección sugestiva de ese síndrome (asociada al diagnóstico más temprano) y al número de hermanos (mayor en el diagnóstico tardío y asociado a la menor escolaridad materna). CONCLUSIONES: El diagnóstico temprano se relacionó más a la presencia de alguna de las afecciones asociadas al ST (posiblemente determinando encaminamiento a servicios de mayor complejidad) que a señales dismórficas. Hay indicaciones de que déficit de crecimiento menos evidente, dificultades de los médicos en reconocer anomalías sugestivas de ese síndrome y factores socioeconómicos contribuyan para el retraso en el diagnóstico. Es necesario enfatizar en la formación pediátrica el reconocimiento del espectro clínico de ese síndrome y ampliar los servicios públicos de genética.<br>OBJECTIVE: To investigate the possible reasons for diagnostic delay in Turner syndrome (TS), i.e., a diagnosis made after the age when pubertal delay may be established. METHODS: Cross-sectional study with data obtained from the records of 29 TS patients aged more than two years who were diagnosed between 2004 and 2007. Data on personal and family history and physical examination from patients diagnosed before 13 years old (age limit from which pubertal delay may be characterized in girls) were compared to those of girls diagnosed after 13 years by Fisher exact test and Student's t-test. RESULTS: No significant differences were noted regarding mothers' and patients' stature, personal history of TS-associated diseases (considered individually), parental schooling, familial recurrence of short stature, presence of each dysmorphic feature considered separately, and total number of dysmorphic features. The two groups differed regarding the presence of at least one TS-associated disease (which was associated to early diagnosis) and number of siblings (which was higher among patients with delayed diagnosis and associated with lower maternal schooling). CONCLUSIONS: Early diagnosis was more associated with the presence of a TS-associated disease (which may have required referral to secondary or tertiary health care services) than with the presence of dysmorphic signs. The results indicate that less evident growth deficit, physicians' inability to recognize abnormalities associated with TS and socioeconomic aspects may contribute to diagnostic delay. Pediatric training should emphasize recognition of the clinical spectrum of TS and public genetic services should be expanded

Genome-wide association study identifies five new susceptibility loci for primary angle closure glaucoma.

Primary angle closure glaucoma (PACG) is a major cause of blindness worldwide. We conducted a genome-wide association study (GWAS) followed by replication in a combined total of 10,503 PACG cases and 29,567 controls drawn from 24 countries across Asia, Australia, Europe, North America, and South America. We observed significant evidence of disease association at five new genetic loci upon meta-analysis of all patient collections. These loci are at EPDR1 rs3816415 (odds ratio (OR) = 1.24, P = 5.94 × 10(-15)), CHAT rs1258267 (OR = 1.22, P = 2.85 × 10(-16)), GLIS3 rs736893 (OR = 1.18, P = 1.43 × 10(-14)), FERMT2 rs7494379 (OR = 1.14, P = 3.43 × 10(-11)), and DPM2-FAM102A rs3739821 (OR = 1.15, P = 8.32 × 10(-12)). We also confirmed significant association at three previously described loci (P < 5 × 10(-8) for each sentinel SNP at PLEKHA7, COL11A1, and PCMTD1-ST18), providing new insights into the biology of PACG

Outcomes in Newly Diagnosed Atrial Fibrillation and History of Acute Coronary Syndromes: Insights from GARFIELD-AF

BACKGROUND: Many patients with atrial fibrillation have concomitant coronary artery disease with or without acute coronary syndromes and are in need of additional antithrombotic therapy. There are few data on the long-term clinical outcome of atrial fibrillation patients with a history of acute coronary syndrome. This is a 2-year study of atrial fibrillation patients with or without a history of acute coronary syndromes

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline