Prevalence, predictors, and prognostic implications of residual impairment of functional capacity after transcatheter aortic valve implantation

Background: Patients with degenerative aortic stenosis (AS) referred for transcatheter aortic valve implantation (TAVI) typically have advanced cardiac and vascular adverse remodeling and multiple comorbidities and, therefore, might not recover a normal functional capacity after valve replacement. We sought to investigate the prevalence, the predictors, and the prognostic impact of residual impairment of functional capacity after TAVI. Methods and results: Out of 790 patients undergoing TAVI with impaired functional capacity (NYHA II–IV

Usability of Computerized Lung Auscultation–Sound Software (CLASS) for learning pulmonary auscultation

The mastering of pulmonary auscultation requires complex acoustic skills. Computer-assisted learning tools (CALTs) have potential to enhance the learning of these skills; however, few have been developed for this purpose and do not integrate all the required features. Thus, this study aimed to assess the usability of a new CALT for learning pulmonary auscultation. Computerized Lung Auscultation-Sound Software (CLASS) usability was assessed by eight physiotherapy students using computer screen recordings, think-aloud reports, and facial expressions. Time spent in each task, frequency of messages and facial expressions, number of clicks and problems reported were counted. The timelines of the three methods used were matched/synchronized and analyzed. The tasks exercises and annotation of respiratory sounds were the ones requiring more clicks (median 132, interquartile range [23-157]; 93 [53-155]; 91 [65-104], respectively) and where most errors (19; 37; 15%, respectively) and problems (n = 7; 6; 3, respectively) were reported. Each participant reported a median of 6 problems, with a total of 14 different problems found, mainly related with CLASS functionalities (50%). Smile was the only facial expression presented in all tasks (n = 54). CLASS is the only CALT available that meets all the required features for learning pulmonary auscultation. The combination of the three usability methods identified advantages/disadvantages of CLASS and offered guidance for future developments, namely in annotations and exercises. This will allow the improvement of CLASS and enhance students' activities for learning pulmonary auscultation skills

Valvoplastia mitral percutânea em paciente gestante guiada apenas pelo ecocardiograma transesofágico Percutaneous mitral valvuloplastry in a pregnant woman guided only by the transesophageal echocardiography

A estenose da válvula mitral é a lesão de válvula mais comum durante a gravidez. Apesar de um tratamento clínico eficaz e de uma anatomia valvular favorável, de acordo com o critério de Wilkins e Block [score de Wilkins-Block], a intervenção percutânea em pacientes sintomáticas mostra-se muito importante. Nessas pacientes, recomenda-se evitar ao máximo a exposição aos raios X para proteger o feto dos efeitos deletérios da radiação ionizante. Neste relato de caso, uma paciente de 24 anos, grávida, com grave estenose mitral (área valvular de 0,9 cm²), foi submetida com sucesso a um tratamento percutâneo com ETE-guiado, sem o uso de raios X.<br>Mitral valve stenosis is the most common valve lesion in pregnancy. In spite of an optimized clinical treatment and a favorable valve anatomy according to Wilkins and Block score, in symptomatic patients, percutaneous intervention is shown to be of great importance. In these patients, avoiding x-ray exposure as much as possible is recommended so as to protect the fetus from the deleterious effects of ionizing radiation. In this case report, a 24-year old pregnant patient with severe mitral stenosis (valve area of 0.9 cm²) was successfully submitted to a TEE-guided percutaneous treatment, without the use of x-ray

Morfología externa e interna de la larva de Chiasmocleis leucosticta (Boulenger, 1888) (Amphibia, Anura, Mycrohylidae).

This contribution reports a comprehensive study of the tadpole of Chiasmocleis leucosticta, including external morphology, and, for the first time in the genus, the analysis of the bucco-pharingeal cavity, chondrocranium, visceral skeleton and histology of a peculiar structure of the tail. After the comparisson with other species of the genus and diverse species of the family, some structures are remarcable: (a) The anterior portion of the head bears a symmetrical line, similar in structure to a lateral line and in position to an orbitonasal line or nasolacrimal groove; (b) chondrocranium and visceral skeleton show a mixture of character states reported as typical for Types II and IV larvae; (c) the base of the tail has, as happen in other microhylid tadpoles, a peculiar thickenning, result of a particular development of the caudal dermis; (d) in the buccal cavity, the prenarial papilla is absent, the arena of the buccal roof bears several paillae and the glottis is placed in such a way that the prelingual area is the best developed. As a result, the tadpoles of C. leucosticta resemble more to diverse Asian than to the Neotropical microhylid larvae.Fil: Langone, José A.. Museo Nacional de Historia Natural y Antropología; UruguayFil: Lavilla, Esteban Orlando. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico - Tucumán. Unidad Ejecutora Lillo; ArgentinaFil: Echeverría, Dinorah Diana. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Biodiversidad y Biología Experimental; ArgentinaFil: Mangione, Susana. Universidad Nacional de Tucumán. Facultad de Ciencias Naturales e Instituto Miguel Lillo; ArgentinaFil: Segalla, Magno V.. Instituto Horus; Brasi

Does Age Matter? Association Between Usual Source of Care and Hypertension Control in the US Population: Data From NHANES 2007-2012.

BackgroundThe positive role of having a usual source of care (USOC) on the receipt of preventative services is known. However, associations between USOC and hypertension control and the differential association across age groups is unknown in the US population.MethodsWe used data from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2012. Multivariable logistic regression was used to evaluate the association between having a USOC and hypertension control. The differential effect of USOC on hypertension control by age was assessed using predicted marginal effects across age groups in the multivariable logistic model.ResultsIn adjusted analyses, those with a USOC had higher odds of hypertension control (odds ratio = 3.89, 95% confidence interval (CI): 2.15-6.98). The marginal effect of having a USOC is associated with a 30 percentage point higher probability of controlled blood pressure compared to those without a USOC (marginal probability = 0.30, 95% CI: 0.19-0.41). The marginal effect of USOC on hypertension control varied by age groups, with a statistically significantly lower marginal effect of USOC on hypertension seen among those older than 74 years of age (marginal probability = 0.27, 95% CI: 0.18-0.36) and younger than 35 years of age (marginal probability = 0.23, 95% CI: 0.14-0.33).ConclusionHaving a USOC is significantly associated with improved hypertension control in the US population. The variation in the association across age groups has important implications in targeting age-specific antihypertensive strategies to reduce the burden of hypertension in the US population

Does Age Matter? Association Between Usual Source of Care and Hypertension Control in the US Population: Data From NHANES 2007-2012.

BackgroundThe positive role of having a usual source of care (USOC) on the receipt of preventative services is known. However, associations between USOC and hypertension control and the differential association across age groups is unknown in the US population.MethodsWe used data from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2012. Multivariable logistic regression was used to evaluate the association between having a USOC and hypertension control. The differential effect of USOC on hypertension control by age was assessed using predicted marginal effects across age groups in the multivariable logistic model.ResultsIn adjusted analyses, those with a USOC had higher odds of hypertension control (odds ratio = 3.89, 95% confidence interval (CI): 2.15-6.98). The marginal effect of having a USOC is associated with a 30 percentage point higher probability of controlled blood pressure compared to those without a USOC (marginal probability = 0.30, 95% CI: 0.19-0.41). The marginal effect of USOC on hypertension control varied by age groups, with a statistically significantly lower marginal effect of USOC on hypertension seen among those older than 74 years of age (marginal probability = 0.27, 95% CI: 0.18-0.36) and younger than 35 years of age (marginal probability = 0.23, 95% CI: 0.14-0.33).ConclusionHaving a USOC is significantly associated with improved hypertension control in the US population. The variation in the association across age groups has important implications in targeting age-specific antihypertensive strategies to reduce the burden of hypertension in the US population