Tradução e adaptação transcultural do Game Dice Task para população brasileira

OBJECTIVE: The Game Dice Task (GDT) was developed to measure decision making under known risk. The aim of this study was to translate and adapt the GDT to a Brazilian population. METHOD: After the GDT was translated and back-translated to Brazilian Portuguese and evaluated by eight bilingual judges, 175 Brazilian adults were divided into two groups - 160 healthy volunteers and 15 traumatic brain injury (TBI) patients - and had completed the GDT. RESULTS: Differences between genders, but not age, were observed in the healthy volunteer sample. Males more frequently chose a combination of three dice while females preferred four dice. TBI patients were more impulsive than healthy volunteers; they less frequently chose a combination of three dice and made more risky decisions. CONCLUSION: Because of the rigorous process used to translate and adapt the GDT and the differences observed between patients with TBI and healthy volunteers, the Brazilian GDT was considered satisfactory for research purposes.OBJETIVO: O Game Dice Task (GDT) foi desenvolvido para avaliar a tomada de decisão de indivíduos sob situações específicas de risco conhecido. O objetivo deste estudo foi traduzir e adaptar o GDT para a população brasileira. MÉTODOS: Após ter sido traduzido e retrotraduzido para o português e ter sido avaliado por oito juízes bilíngues, 175 adultos brasileiros completaram o GDT - 160 adultos saudáveis e 15 pacientes com traumatismo cranioencefálico (TCE). RESULTADOS: Foram observadas diferenças no desempenho quanto ao gênero, mas não quanto à idade, nos adultos saudáveis. Homens escolheram mais frequentemente a combinação com três dados, enquanto as mulheres preferiram quatro dados. Pacientes com TCE foram mais impulsivos, escolheram com menor frequência a combinação de três dados e tomaram decisões mais arriscadas. CONCLUSÃO: Por causa do rigoroso processo utilizado pra traduzir e adaptar o teste GTD e do poder de discriminação entre as amostras de adultos saudáveis e com TCE, a versão brasileira desse teste foi considerada satisfatória para utilização em pesquisa.Universidade Federal de São Paulo (UNIFESP) Department of PsychobiologyUNIFESP, Department of PsychobiologySciEL

Short and long term follow-up of patients with transient left ventricular apical ballooning

Background: Transient left ventricular apical ballooning (TLVAB) was described in Japan as the syndrome characterized by balloon-like left ventricular wall abnormalities without accompanying coronary atherosclerosis. The aim of the study was to evaluate the short and long-term follow-up of our patients with TLVAB. Methods: The population of 1869 patients with the preliminary diagnosis of acute coronary syndrome was screened. We collected data regarding clinical course, physical or emotional trauma, ECG abnormalities, presence of balloon-like left ventricular abnormality. During follow-up, the data on cardiac events (death, recurrence of chest pain, re-hospitalization) were collected. Serial echocardiographic scans were performed to follow the TLVAB regression. Results: Thirty (1.6%) patients (only women, mean age 72 ± 12 y) showed characteristic left ventricle abnormalities. There was an evidence of significant trauma (40% physical and 60% emotional) in every patient. ECG analysis showed negative T waves in anterior leads in 93% and ST elevation in 7% of the patients. Maximal MB creatine kinase and troponin I levels were 38 ± 12 U/l and 1.12 ± 0.75 ng/dl, respectively. The clinical course during hospitalization was benign in 96% and only in one patient (4%) the pulmonary oedema occurred. During follow-up (6-24 months, mean 12 months), there were two cases of chest pain recurrence, but without clinical features of TLVAB (examined by echo or angiography). Mean time for left ventricular abnormalities regression was 3 ± 1 months. Conclusions: The transient left ventricular apical ballooning is a benign syndrome mimicking acute coronary syndrome with good long term outcome

Kompleksowa diagnostyka chorego w pracowni kardioangiograficznej — FFR v. IVUS czy razem? Czyli kiedy, komu i co można zaproponować w ramach diagnostyki choroby niedokrwiennej serca

In the paper a patient with permanent atrial fibrillation, clinical symptoms difficult for the assessment before test and non-diagnostic result of the non-invasive imaging studies was presented. The coronary angiography showed borderline lesion in the anterior descending artery. Its significance was confirmed by fractional flow reserve. In turn, invasive treatment strategy including stent selection was guided by the result of intravascular ultrasound.W artykule przedstawiono przypadek pacjenta z utrwalonym migotaniem przedsionków, trudnymi do oceny dolegliwościami klinicznymi i niediagnostycznym wynikiem obrazowych badań nieinwazyjnych. W koronarografii znaleziono graniczne zwężenie w zakresie gałęzi przedniej zstępującej, którego istotność czynnościową potwierdzono oceniając cząstkową rezerwę przepływu. W zaplanowania zakresu zabiegu i doboru stentu kierowano się wynikiem ultrasonografii wewnątrznaczyniowej

Memory In Children With Symptomatic Temporal Lobe Epilepsy.

In children with temporal lobe epilepsy (TLE), memory deficit is not so well understood as it is in adults. The aim of this study was to identify and describe memory deficits in children with symptomatic TLE, and to verify the influence of epilepsy variables on memory. We evaluated 25 children with TLE diagnosed on clinical, EEG and MRI findings. Twenty-five normal children were compared with the patients. All children underwent a neuropsychological assessment to estimate intellectual level, attention, visual perception, handedness, and memory processes (verbal and visual: short-term memory, learning, and delayed recall). The results allowed us to conclude: besides memory deficits, other neuropsychological disturbances may be found in children with TLE such as attention, even in the absence of overall cognitive deficit; the earlier onset of epilepsy, the worse verbal stimuli storage; mesial lesions correlate with impairment in memory storage stage while neocortical temporal lesions correlate with retrieval deficits.72184-

Bezpośrednia oraz odległa ocena chorych z przemijającym balotowaniem koniuszka lewej komory

Wstęp: Przemijające balotowanie koniuszka lewej komory (TLVAB) opisano po raz pierwszy w Japonii. W zespole tym występują zaburzenia kurczliwości ściany lewej komory serca współistniejące z prawidłowym obrazem tętnic wieńcowych Metody: Badana populacja składała się z 1869 osób (leczonych w latach 2001-2004), u których rozpoznano początkowo ostry zespół wieńcowy. Zgromadzono dane dotyczące urazów fizycznych i emocjonalnych, nieprawidłowości w badaniach EKG oraz obecności zaburzeń kurczliwości lewej komory o charakterze balotowania (wentrykulografia lub echokardiografia). W czasie obserwacji oceniano występowanie incydentów sercowych (zgon, nawrót bólu w klatce piersiowej, ponowna hospitalizacja) oraz wykonywano badania echokardiograficzne w celu obserwowania regresji TLVAB. Wyniki: W badanej populacji zidentyfikowano 30 (1,6%) osób (wyłącznie kobiety, śr. wieku 72 ± 12 lat), u których wykryto opisywane zaburzenia kurczliwości lewej komory. U wszystkich chorych z badanej grupy wystąpił przed hospitalizacją istotny uraz (u 40% fizyczny, u 60% emocjonalny). W EKG u 93% pacjentów stwierdzono ujemne załamki T w odprowadzeniach przedsercowych, u 7% uniesienia odcinka ST. Najwyższe stężenia izoenzymu MB kinazy kreatynowej oraz troponiny I wynosiły odpowiednio 38 ± 12 j./l oraz 1,12 ± 0,75 ng/dl. Niepowikłany przebieg hospitalizacji charakteryzował 96% osób, jedynie u 1 chorej (4%) rozwinął się obrzęk płuc. W czasie obserwacji (6-24 miesięcy, śr. 12 miesięcy) w 2 przypadkach wystąpił nawrót bólu w klatce piersiowej, jednak bez wykładników klinicznych TLVAB (echokardiografia lub angiografia). Średni czas do ustąpienia zaburzeń lewej komory wynosił 3 ± 1 miesiące. Wnioski: Przemijające balotowanie koniuszka lewej komory jest przebiegającym łagodnie zespołem chorobowym, z korzystnym długoterminowym rokowaniem, naśladującym ostry zespół wieńcowy. Większość przypadków choroby wystąpiła jesienią lub zimą, co pozwala nazwać TLVAB chorobą "sezonową"

Frontal lobe disfunction in children and adolescents with temporal lobe epilepsy and possible correlation with psychiatric disorders

Introduction: There is evidence that individuals with certain types of epilepsy may present cognitive disorders, and that these disorders can be more debilitating than seizures proper. Frontal lobe disorders are reported in adults with temporal lobe epilepsy, carachterized by executive disfunction. Rationale: Literary revision of work concerning the occurence of frontal lobe dysfunction in children and adolescents with temporal lobe epilepsy. Methods: Systematic revision of published literature in PUBMED. Results: Frontal lobe dysfunction has been poorly studied in children with epilepsy, especially in temporal lobe epilepsy. In the only study on the subject, executive deficit was demonstrated. Moreover, children with mesial sclerosis had more deficit in execution/planning than those with frontal or temporal neocortical lesions. Presence of frontal lobe dysfunction, in patients with partial and generalized epilepsy, may corroborate evidence that epilepsy and psychiatric disorders are epiphenomena and not cause effect related phenomena. Conclusion: There are few articles on frontal lobe dysfunction in children with temporal lobe epilepsy. It would be interesting to find out if, and how much this occurs, and if patients with distinct etiologies present different levels of functional disability.Introdução: Há evidências de que pessoas com alguns tipos de epilepsia podem apresentar prejuízos cognitivos, sendo que para alguns pacientes, tais déficits cognitivos podem ser mais debilitantes do que suas crises epilépticas. A disfunção do lobo frontal é relatada em adultos com epilepsia do lobo temporal, caracte­rizada pela disfunção executiva. Objetivo: Rever a literatura sobre a ocorrência de disfunção de lobo frontal em crianças e adolescentes com epilepsia do lobo temporal. Métodos: Revisão sistemática da literatura compulsada no PUBMED. Resultados: A disfunção do lobo frontal tem sido pouco estudada em crianças com epilepsia, em especial com epilepsia do lobo temporal. No único estudo sobre este assunto, demonstrou­se que há um déficit executivo, sendo que as crianças com esclerose mesial têm maiores déficits de execução/ planejamento do que aquelas com lesões neocorticais temporais ou frontais. A presença de uma disfunção do lobo frontal nos pacientes com epilepsia parcial e generalizada pode corroborar as evidências de que epilepsia e transtorno psiquiátrico são epifenômenos e não fenômenos com relação causa efeito. Conclu­sões: Há uma escassez de artigos sobre a disfunção do lobo frontal em crianças com epilepsia do lobo tempo­ral, sendo de interesse saber se esta ocorre e se pacientes com etiologias distintas apresentam diferentes graus de comprometimento destas funções.13113

Status Update and Interim Results from the Asymptomatic Carotid Surgery Trial-2 (ACST-2)

Objectives: ACST-2 is currently the largest trial ever conducted to compare carotid artery stenting (CAS) with carotid endarterectomy (CEA) in patients with severe asymptomatic carotid stenosis requiring revascularization. Methods: Patients are entered into ACST-2 when revascularization is felt to be clearly indicated, when CEA and CAS are both possible, but where there is substantial uncertainty as to which is most appropriate. Trial surgeons and interventionalists are expected to use their usual techniques and CE-approved devices. We report baseline characteristics and blinded combined interim results for 30-day mortality and major morbidity for 986 patients in the ongoing trial up to September 2012. Results: A total of 986 patients (687 men, 299 women), mean age 68.7 years (SD ± 8.1) were randomized equally to CEA or CAS. Most (96%) had ipsilateral stenosis of 70-99% (median 80%) with contralateral stenoses of 50-99% in 30% and contralateral occlusion in 8%. Patients were on appropriate medical treatment. For 691 patients undergoing intervention with at least 1-month follow-up and Rankin scoring at 6 months for any stroke, the overall serious cardiovascular event rate of periprocedural (within 30 days) disabling stroke, fatal myocardial infarction, and death at 30 days was 1.0%. Conclusions: Early ACST-2 results suggest contemporary carotid intervention for asymptomatic stenosis has a low risk of serious morbidity and mortality, on par with other recent trials. The trial continues to recruit, to monitor periprocedural events and all types of stroke, aiming to randomize up to 5,000 patients to determine any differential outcomes between interventions. Clinical trial: ISRCTN21144362. © 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved

Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy

Background: Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods: ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings: Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86–1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91–1·32; p=0·21). Interpretation: Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable. Funding: UK Medical Research Council and Health Technology Assessment Programme