Peptídeo natriurético cerebral (BNP) e troponinas como biomarcadores de estresse do miocárdio em ciclistas: uma revisão narrativa

Cycling is an old sport that has attracted many fans around the world. Cycling requires major neuroimmunoendocrine and cardiovascular adaptations, in such a way that the body maintains homeostasis. In this context, myocardial stress biomarkers may change secondary to the cyclist's physical effort. The objective of this study was to evaluate, in cyclists, the values of BNP, NT-proBNP and ultrasensitive Troponin, relating the changes in these biomarkers to the presence of myocardial lesions in long-term exercise. A narrative review was carried out, which executed an active search in the Bireme, Pubmed, MedLine, SciELO and LILACS databases. Seven articles that meet the study methodological criteria were published. Studies demonstrate that cycling athletes are predisposed to higher values of BNP, NT-proBNP and ultrasensitive troponin during exercise than individuals who do not practice resistance exercise, however, there is no evidence of short-term changes in the cardiac muscle.El ciclismo es un deporte que ha atraído a muchos aficionados en todo el mundo. La práctica del ciclismo requiere importantes adaptaciones neuroinmunoendocrinas y cardiovasculares, para que el organismo mantenga la homeostasis. En este contexto, los biomarcadores de estrés miocárdico parecen sufrir alteraciones secundarias al esfuerzo físico del ciclista. El objetivo de este estudio fue evaluar, en ciclistas, los valores de BNP, NT-proBNP y troponina ultrasensible, relacionando cambios en estos biomarcadores con la presencia de daño miocárdico en ejercicio de larga duración. Se realizó una revisión narrativa, mediante una búsqueda activa en las bases de datos Bireme, Pubmed, MedLine, SciELO y LILACS. Se analizaron siete artículos que cumplieron con los criterios metodológicos del estudio. Los estudios demuestran que los ciclistas están predispuestos a valores más altos de BNP, NT-proBNP y troponina ultrasensible durante el ejercicio que los que hacen ejercicio sin resistencia; sin embargo, no hay evidencia de cambios a corto plazo en el músculo cardíaco.O ciclismo é um esporte que tem atraído vários adeptos pelo mundo. A prática do ciclismo exige grandes adaptações neuroimunoendócrinas e cardiovasculares, de tal modo que o corpo mantenha a homeostase. Nesse contexto, biomarcadores de estresse miocárdico parecem sofrer alterações secundárias ao esforço físico do ciclista. O objetivo desse trabalho foi avaliar, em ciclistas, os valores de BNP, NT-proBNP e Troponina ultrassensível, relacionando alterações nesses biomarcadores à presença de lesões miocárdicas em exercícios de longa duração. Realizou-se uma revisão narrativa, que realizou busca ativa nas bases de dados Bireme, Pubmed, MedLine, SciELO e LILACS. Foram analisados 7 artigos que atenderam aos critérios metodológicos do estudo. Os estudos demonstram que os atletas de ciclismo estão predispostos a valores mais elevados de BNP, NT-proBNP e Troponina ultrassensível durante o exercício que os indivíduos não praticantes de exercícios de resistência; contudo, não se evidenciam alterações no músculo cardíaco em curto prazo

First-year experience of a Brazilian tertiary medical center in supporting severely ill patients using extracorporeal membrane oxygenation

OBJECTIVES: The aim of this manuscript is to describe the first year of our experience using extracorporeal membrane oxygenation support. METHODS: Ten patients with severe refractory hypoxemia, two with associated severe cardiovascular failure, were supported using venous-venous extracorporeal membrane oxygenation (eight patients) or veno-arterial extracorporeal membrane oxygenation (two patients). RESULTS: The median age of the patients was 31 yr (range 14-71 yr). Their median simplified acute physiological score three (SAPS3) was 94 (range 84-118), and they had a median expected mortality of 95% (range 87-99%). Community-acquired pneumonia was the most common diagnosis (50%), followed by P. jiroveci pneumonia in two patients with AIDS (20%). Six patients were transferred from other ICUs during extracorporeal membrane oxygenation support, three of whom were transferred between ICUs within the hospital (30%), two by ambulance (20%) and one by helicopter (10%). Only one patient (10%) was anticoagulated with heparin throughout extracorporeal membrane oxygenation support. Eighty percent of patients required continuous venous-venous hemofiltration. Three patients (30%) developed persistent hypoxemia, which was corrected using higher positive end-expiratory pressure, higher inspired oxygen fractions, recruitment maneuvers, and nitric oxide. The median time on extracorporeal membrane oxygenation support was five (range 3-32) days. The median length of the hospital stay was 31 (range 3-97) days. Four patients (40%) survived to 60 days, and they were free from renal replacement therapy and oxygen support. CONCLUSIONS: The use of extracorporeal membrane oxygenation support in severely ill patients is possible in the presence of a structured team. Efforts must be made to recognize the necessity of extracorporeal respiratory support at an early stage and to prompt activation of the extracorporeal membrane oxygenation team

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Finger prosthesis: the art of reconstruction

Hand deformities affect aesthetics function of hand severely compromised and also cause psychological disturbances. This report describes the fabrication of a silicone finger prosthesis for a patient after an accident at work. The finger prosthesis was retained by a vacuum effect on the stump. The silicone material Silastic-MDX 44210 was used to provide function and aesthetics. The finger prosthesis offered psychological, functional and rehabilitative advantages for the patient. Restoring the natural appearance with the prosthesis eliminated the trauma generated by the dysfunction and represented an efficient psychological therapy

All-oral direct antiviral treatment for hepatitis C chronic infection in a real-life cohort: The role of cirrhosis and comorbidities in treatment response.

BACKGROUND:Hepatitis C virus (HCV) infection is the major cause of end-stage liver disease (LD) worldwide. The aim of this study was to assess sustained virological response (SVR) rates in a real-world cohort of patients with HCV infection treated with interferon-free direct antiviral agents (DAA). PATIENTS AND METHODS:All patients with genotypes 1, 2 or 3 HCV infection who started interferon-free treatment at a university hospital from December 2015 through July 2017 were included. The primary outcome was SVR at post-treatment week 12 by intention-to-treat (ITT) and modified ITT (mITT) analysis. RESULTS:Five hundred twenty seven patients were enrolled, 51.6% with cirrhosis. Most patients received sofosbuvir + daclatasvir + ribavirin (60.7%) and sofosbuvir + simeprevir (25.6%). Overall SVR rates were 90.5% for ITT and 96% for mITT. SVR rates were higher in non-cirrhotic (94.2% in ITT and 96.8% in mITT) versus cirrhotic patients (87.1% in ITT and 95.2% in mITT). In ITT and mITT assessments, SVR rates were higher in patients with Child-Pugh A (n = 222, 88.7% and 95.7%, respectively) versus Child-Pugh B or C (n = 40, 80% and 90%, respectively); SVR rates were higher in patients with genotype 1 (n = 405, 92.1% and 98.2%), followed by genotype 2 (n = 13, 84.6% and 92.7%) and genotype 3 (n = 109, 84.4% and 88.4%). Lower comorbidity index (p = 0.0014) and absence of cirrhosis (p = 0.0071) were associated with SVR. Among cirrhotic patients, lower Model for End-Stage Liver Disease (p = 0.0258), higher albumin (p = 0.0015), and higher glomerular filtration rate (p = 0.0366) were related to SVR. Twenty-two cirrhotic patients (8%) had clinical liver decompensation during treatment. Complications of advanced LD were responsible for discontinuation of treatment and death in 12 and 7 patients, respectively. CONCLUSION:Treatment with all-oral DAA achieved high SVR rates, particularly in patients without cirrhosis and few comorbidities. Advanced LD is associated to poor outcome, such as treatment failure and death

SALLUSTIUS MARIUS-PORTRÉJA

Additional file 1. Table 1S: Brasilian patients transported on ECMO support in Hospital das ClĂ­nicas

MOESM2 of Transportation of patients on extracorporeal membrane oxygenation: a tertiary medical center experience and systematic review of the literature

Additional file 2. Figure 1S: Flow diagram of the systematic review according to the PRISMA statement

MOESM3 of Transportation of patients on extracorporeal membrane oxygenation: a tertiary medical center experience and systematic review of the literature

Additional file 3. Table 3S: Quality evaluation of the manuscripts retrieved in accordance with our predefined score

Baseline characteristics associated with sustained virological response.

<p>Baseline characteristics associated with sustained virological response.</p