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BACKGROUND: The leadless pacemaker has emerged as a promising alternative for patients requiring artificial cardiac stimulation. Advanced atrioventricular block (AVB) is the primary indication for leadless pacemaker (LP) implantation in patients who have undergone transcatheter aortic valve replacement (TAVR), yet its benefits remain uncertain. This study aimed to assess the efficacy and safety of LPin post-TAVR patients. METHODS: PubMed, Embase, and Cochrane databases were searched for studies evaluating the implantation of leadless pacemakers in post-TAVR patients. Statistical analysis was performed using R version 4.3.2. RESULTS: We included six studies comprising 109 patients, with a mean age of 82 ± 3.21 years, of whom 52% (57 patients) were male. AVB was the primary indication in 55% of cases. Post-procedure complications occurred in 2.32% of patients (95% CI: 0.00 to 8.05%) and heart failure re-hospitalizations in 6.58% (95% CI: 0.00 to 18.00%). The average hospital stay was 9.33 days (95% CI: 8.64 to 10.03), and the mean procedure time was 40.77 minutes (95% CI: 22.32 to 59.23). All-cause mortality rate was 7.20% (95% CI: 0.18 to 14.22%). CONCLUSION: Leadless pacemaker implantation is a feasible option for post-TAVR patients. In terms of safety, outcomes appear to be comparable to data from traditional permanent pacemaker implantation. Additional randomized controlled trials are needed to further explore this issue.

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INTRODUCTION: Brugada syndrome (BrS) is a genetic heart disease that predisposes individuals to malignant ventricular arrhythmias and sudden cardiac death (SCD). Although implantable cardioverter-defibrillators (ICDs) and quinidine are primary treatments, recurrent BrS-triggered cardiac ventricular arrhythmias necessitating ICD therapies can persist. In this setting, epicardial substrate ablation has emerged as a promising alternative for high-risk symptomatic patients. OBJECTIVE:Evaluate the effectiveness and safety of epicardial substrate ablation in patients with BrS. METHODS: In this systematic review and single-arm meta-analysis, we systematically searched PubMed, Embase, and Cochrane databases following PRISMA guidelines for studies including BrS patients who had epicardial substrate ablation. Data was extracted and statistical analysis was performed using random-effects modeling for proportional meta-analysis. Heterogeneity was examined with I² statistics. RESULTS: Seventeen observational cohort studies comprising 695 BrS patients were included. The mean patient age at enrollment was 40.4 ± 14.2 years, 89.9% were males and 77.6% exhibited spontaneous type 1 Brugada ECG pattern. Pooled analysis demonstrated resolution of the type 1 pattern in 89% of cases (95% CI 74-98%; I²=91%) and elimination of abnormal electrograms in 93% (95% CI 84-99%, I²=71%). Post-procedure VF/VT inducibility was 8% (95% CI 1-18%; I²=83%). The overall complication rate was 3% (95% CI 0-8%, I²=78%) with pericarditis being the most common. Rates of recurrent VT/VF and appropriate ICD therapies during post-ablation follow-up were 13% (95% CI 5-23%; I²=87%) and 10% (95% CI 3-21%; I²=87%), respectively. CONCLUSIONS: Epicardial substrate ablation shows promise for BrS patients experiencing recurrent BrS-triggered ventricular arrhythmias, offering demonstrable therapeutic efficacy in eliminating arrhythmogenic substrates with an acceptable safety profile. However, high heterogeneity among studies highlights the need for further research and standardized protocols in this field.

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Transseptal puncture for atrial fibrillation ablation is a safe and common procedure. However, complications, such as cardiac tamponade, may be fatal if not recognized and treated. Our goal is to report a bailout strategy, by which management of an inadvertent puncture of the posterior wall of the left atrium was possible. It was followed by successful pulmonary vein isolation, without the need for subsequent subxiphoid puncture.

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OBJECTIVE: To characterize variables associated with referral to the emergency department following Telemedicine consultation during the COVID-19 pandemic. METHODS: Cross-sectional retrospective study conducted between March and May 2020, with a sample of 500 adult patients. The inclusion criterion was the manifestation of respiratory symptoms, regardless of type. RESULTS: The mean age of patients was 34.7±10.5 years, and 59% were women. Most patients (62.6%) perceived their own health status as malaise and some (41.4%) self-diagnosed COVID-19. Cough (74.4%), rhinorrhea (65.6%), sore throat (38.6%) and sneezing (20.6%) were the most common infection-related symptoms. Overall, 29.4% and 16% of patients reported dyspnea and chest pain, respectively. The Roth score was calculated for a sizeable number of patients (67.6%) and was normal, moderately altered or severely altered in 83.5%, 10.7% and 5.6% of patients, respectively. The percentage of suspected COVID-19 cases was 67.6%. Of these, 75% were managed remotely and only one quarter referred for emergency assessment. CONCLUSION: Telemedicine assessment is associated with reclassification of patient's subjective impression, better inspection of coronavirus disease 2019 and identification of risk patients. Referral is therefore optimized to avoid inappropriate in-person assessment, and low-risk patients can be properly guided. Telemedicine should be implemented in the health care system as a cost-effective strategy for initial assessment of acute patients.

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ABSTRACT Objective: To characterize variables associated with referral to the emergency department following Telemedicine consultation during the COVID-19 pandemic. Methods: Cross-sectional retrospective study conducted between March and May 2020, with a sample of 500 adult patients. The inclusion criterion was the manifestation of respiratory symptoms, regardless of type. Results: The mean age of patients was 34.7±10.5 years, and 59% were women. Most patients (62.6%) perceived their own health status as malaise and some (41.4%) self-diagnosed COVID-19. Cough (74.4%), rhinorrhea (65.6%), sore throat (38.6%) and sneezing (20.6%) were the most common infection-related symptoms. Overall, 29.4% and 16% of patients reported dyspnea and chest pain, respectively. The Roth score was calculated for a sizeable number of patients (67.6%) and was normal, moderately altered or severely altered in 83.5%, 10.7% and 5.6% of patients, respectively. The percentage of suspected COVID-19 cases was 67.6%. Of these, 75% were managed remotely and only one quarter referred for emergency assessment. Conclusion: Telemedicine assessment is associated with reclassification of patient's subjective impression, better inspection of coronavirus disease 2019 and identification of risk patients. Referral is therefore optimized to avoid inappropriate in-person assessment, and low-risk patients can be properly guided. Telemedicine should be implemented in the health care system as a cost-effective strategy for initial assessment of acute patients.

RESUMO Objetivo: Caracterizar as variáveis associadas ao encaminhamento à emergência após consulta de Telemedicina durante a pandemia de COVID-19. Métodos: Estudo transversal e retrospectivo, realizado entre março e maio de 2020, com amostra de 500 pacientes adultos. O critério de inclusão foi apresentação de sintomas respiratórios, independente do tipo. Resultados: A média de idade dos pacientes foi de 34,7±10,5 anos, e 59% eram do sexo feminino. A maioria dos pacientes (62,6%) se classificou subjetivamente como tendo um mal-estar, e alguns (41,4%) autodiagnosticaram COVID-19. Tosse (74,4%), rinorreia (65,6%), dor de garganta (38,6%) e espirros (20,6%) foram os sintomas mais comuns relacionados à infecção. Dispneia e dor torácica foram relatados por 29,4% e 16% dos pacientes, respectivamente. Foi calculado o escore de Roth de um número considerável de pacientes (67,6%), obtendo resultado normal em 83,5%, moderadamente alterado em 10,7% e grave em 5,6%. A percentagem de casos suspeitos de COVID-19 foi de 67,6%, e 75% desses foram gerenciados remotamente, com apenas um quarto sendo encaminhado para avaliação imediata na emergência. Conclusão: A avaliação da Telemedicina está associada à reclassificação da impressão subjetiva do paciente, melhor inspeção da COVI-19 e identificação de pacientes de risco. O encaminhamento é otimizado, para evitar avaliação presencial inadequada, e permite que os pacientes de baixo risco sejam orientados de forma apropriada. A Telemedicina deve ser implementada no sistema de saúde como estratégia com boa relação custo-efetividade para a avaliação inicial de pacientes agudos.

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PURPOSE: To compare differences in the occurrence and changed domains of sexual dysfunction in obese and non-obese Brazilian women. METHODS: Female Sexual Function Index, based on six domains, to investigate 31 sexual dysfunction incidence for obese compared to 32 non-obese women, was used. Statistical analysis using ANOVA and MANOVA were performed to compare total scores of Female Sexual Function Index among groups and to identify the differences among domains, Student t -test was used. Statistical significant level was established for all tests for p<0.05. RESULTS: No difference in female sexual dysfunction frequency between obese (25.8%) and non-obese women (22.5%) was found. However, an important distinction in which aspects of sexual life were affected was found. While the obese group was impaired in three domains of sexual life (desire, orgasm, and arousal), in the control group five aspects were dysfunctional (desire, orgasm, arousal, pain and lubrication). Future research exploring psychological outcomes in obese females, such as body image and measures of positive and negative effect, might better characterize the female sexual dysfunction in this group. CONCLUSIONS: Obesity does not appear to be an independent factor for allow quality of female sexual life. However, disturbance associated to obesity indicates a low frequency of disorder in physical domains, suggesting that psychological factors seem to be mainly involved in the sexual dysfunction in obese women.

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Abstract PURPOSE: To compare differences in the occurrence and changed domains of sexual dysfunction in obese and non-obese Brazilian women. METHODS: Female Sexual Function Index, based on six domains, to investigate 31 sexual dysfunction incidence for obese compared to 32 non-obese women, was used. Statistical analysis using ANOVA and MANOVA were performed to compare total scores of Female Sexual Function Index among groups and to identify the differences among domains, Student t -test was used. Statistical significant level was established for all tests for p<0.05. RESULTS: No difference in female sexual dysfunction frequency between obese (25.8%) and non-obese women (22.5%) was found. However, an important distinction in which aspects of sexual life were affected was found. While the obese group was impaired in three domains of sexual life (desire, orgasm, and arousal), in the control group five aspects were dysfunctional (desire, orgasm, arousal, pain and lubrication). Future research exploring psychological outcomes in obese females, such as body image and measures of positive and negative effect, might better characterize the female sexual dysfunction in this group. CONCLUSIONS: Obesity does not appear to be an independent factor for allow quality of female sexual life. However, disturbance associated to obesity indicates a low frequency of disorder in physical domains, suggesting that psychological factors seem to be mainly involved in the sexual dysfunction in obese women.

Resumo OBJETIVO: Comparar as diferenças na incidência de disfunção sexual nos seis diferentes domínios de mulheres brasileiras obesas e não obesas. MÉTODOS: Foi usado o Female Sexual Function Index , que discrimina seis domínios de disfunção, para investigar a incidência de disfunção sexual em 31 mulheres obesas e 32 mulheres não obesas. Foi realizada análise estatística utilizando ANOVA e MANOVA para comparar os escores totais doFemale Sexual Function Index entre os grupos, bem como empregado o teste t para identificar as diferenças relacionadas aos domínios. O nível de significância estatística estabelecido para todos os testes foi de p<0,05. RESULTADOS: Não foi encontrada diferença significante nas diferentes incidências de disfunção sexual feminina entre o grupo de pacientes obesas (25,8%) e o grupo de não obesas (22,5%). Contudo, foi evidenciada uma importante distinção em quais aspectos da vida sexual foram afetados nos dois grupos. Enquanto as mulheres obesas foram impactadas em apenas três domínios subjetivos do Female Sexual Function Index (desejo, orgasmo e excitação), o grupo controle apresentou disfunção em cinco aspectos (desejo, orgasmo, excitação, dor e lubrificação). Pesquisas futuras explorando aspectos psicológicos em mulheres obesas, como a avaliação da autoimagem corporal e seus aspectos negativos ou positivos sobre as pacientes, deverão auxiliar na melhor caracterização da disfunção sexual feminina neste grupo. CONCLUSÕES: A obesidade não parece constituir um fator de risco independente para uma baixa qualidade de vida sexual feminina. Contudo, as disfunções associadas à obesidade foram menos evidenciadas em domínios fisiológicos, sugerindo que aspectos psicológicos parecem estar primariamente envolvidos na etiologia da disfunção sexual de mulheres obesas.

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PURPOSE: To evaluate if the ileum resection changes the functioning liver cell mass, the hepatic metabolism and the biodistribution of radiopharmaceutical in rats. METHODS: Twelve Wistar rats weighing 285g±34g were randomly divided into the ileum resection group (n = 6) and sham group rats (n = 6). After 30 days, they were anesthetized and 0.1mL of 99m-Tc-phytate (0.66MBq) was injected via femoral vein. After 30 minutes, blood samples were collected for red blood cells radioactive labeling and serum ALT, AST and gammaGT. Liver samples were used for 99m-Tc-phytate percentage of radioactivity/gram of tissue and histopathology. Student 's t test was used with significance 0.05. RESULTS: There was a higher uptake of 99m-Tc-phytate in the liver of sham rats, compared to the ileum resection group (p<0.05). GammaGT, ALT and AST were increased in ileum resection rats compared to sham (p<0.05). The he patocytes count was significantly lower in ileum resection group than in sham (p<0.05). Liver: body mass ratio was lower in experimental animals than in sham group (p<0.05). CONCLUSION: These data support that the ileum has important role in liver function and liver mass regulation, and they have potential clinical implications regarding the pathogenesis of liver injury following lower bowel resection.

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PURPOSE: To evaluate if the ileum resection changes the functioning liver cell mass, the hepatic metabolism and the biodistribution of radiopharmaceutical in rats. METHODS: Twelve Wistar rats weighing 285g±34g were randomly divided into the ileum resection group (n = 6) and sham group rats (n = 6). After 30 days, they were anesthetized and 0.1mL of 99m-Tc-phytate (0.66MBq) was injected via femoral vein. After 30 minutes, blood samples were collected for red blood cells radioactive labeling and serum ALT, AST and gammaGT. Liver samples were used for 99m-Tc-phytate percentage of radioactivity/gram of tissue and histopathology. Student 's t test was used with significance 0.05. RESULTS: There was a higher uptake of 99m-Tc-phytate in the liver of sham rats, compared to the ileum resection group (p<0.05). GammaGT, ALT and AST were increased in ileum resection rats compared to sham (p<0.05). The he patocytes count was significantly lower in ileum resection group than in sham (p<0.05). Liver: body mass ratio was lower in experimental animals than in sham group (p<0.05). CONCLUSION: These data support that the ileum has important role in liver function and liver mass regulation, and they have potential clinical implications regarding the pathogenesis of liver injury following lower bowel resection.

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PURPOSE: To evaluate if the ileum resection changes the functioning liver cell mass, the hepatic metabolism and the biodistribution of radiopharmaceutical in rats. METHODS: Twelve Wistar rats weighing 285g±34g were randomly divided into the ileum resection group (n = 6) and sham group rats (n = 6). After 30 days, they were anesthetized and 0.1mL of 99m-Tc-phytate (0.66MBq) was injected via femoral vein. After 30 minutes, blood samples were collected for red blood cells radioactive labeling and serum ALT, AST and gammaGT. Liver samples were used for 99m-Tc-phytate percentage of radioactivity/gram of tissue and histopathology. Student 's t test was used with significance 0.05. RESULTS: There was a higher uptake of 99m-Tc-phytate in the liver of sham rats, compared to the ileum resection group (p<0.05). GammaGT, ALT and AST were increased in ileum resection rats compared to sham (p<0.05). The he patocytes count was significantly lower in ileum resection group than in sham (p<0.05). Liver: body mass ratio was lower in experimental animals than in sham group (p<0.05). CONCLUSION: These data support that the ileum has important role in liver function and liver mass regulation, and they have potential clinical implications regarding the pathogenesis of liver injury following lower bowel resection.(AU)

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