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BACKGROUND: There are few retrospective and prospective studies on implantable cardioverter-defibrillators (ICD) in primary and secondary prevention of sudden death in chronic Chagas heart disease (CCHD). OBJECTIVES: To describe the long-term evolution of patients with CCHD and ICD and to identify and analyze predictors of mortality and appropriate device therapy in this population. METHODS: This was a historical prospective study with 117 patients with ICD and CCHD. Devices were implanted from January 2003 to December 2021. Predictors of appropriate therapies and long-term mortality were identified and analyzed. The level of statistical significance was p < 0.05. RESULTS: Patients (n = 117) had a median follow-up of 61 months (25 to 121 months); they were predominantly male (74%), with a median age of 55 years (48 to 64 years). There were 43.6% appropriate shocks, 26.5% antitachycardia pacing (ATP), and 51% appropriate therapies. During follow-up, 46 patients (39.7%) died. Mortality was 6.2% person-years (95% confidence interval [CI]: 4.6 to 8.3), with 2 sudden deaths during follow-up. Secondary prevention (hazard ratio [HR] 2.1; 95% CI: 1.1 to 4.3; p = 0.029) and ejection fraction less than 30% (HR 1.8; 95% CI: 1.1 to 3.1; p < 0.05) were predictors of appropriate therapies. Intermediate Rassi score showed a strong association with the occurrence of ATP alone (p = 0.015). Functional class IV (p = 0.007), left ventricular ejection fraction < 30 (p = 0.010), and age above 75 years (p = 0.042) were predictors of total mortality. CONCLUSION: ICDs in CCHD showed a high incidence of appropriate activation, especially in patients with secondary prevention, low left ventricular ejection fraction, and intermediate Rassi score. Patients with congestive heart failure, elevated functional class, and age over 75 years showed elevated mortality. Survival function of patients with implantable cardioverter-defibrillators and chronic Chagas heart disease. A - According to New York Heart Association functional class; B - According to left ventricular ejection fraction; C - According to Rassi score. D - According to age. CCHD: chronic Chagas heart disease; HR: hazard ratio; ICD: implantable cardioverter-defibrillator.

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BACKGROUND AND PURPOSE: Assessing lower limb strength, balance, and fall risk are crucial components of rehabilitation, especially for the older adult population. With the growing interest in telehealth, teleassessment has been investigated as an alternative when in-person assessments are not possible. The Five Times Sit-to-Stand test (5TSTS) provides a quick measure of balance during chair transfers, muscle power, endurance, and the hability to change and maintain body position, and is highly recommended by guidelines. However, the literature is unclear about the viability and safety of teleassessment using the 5TSTS in older adults with and without Parkinson's disease (PD). This study aimed to evaluate the reliability of teleassessment using the 5TSTS and to determine its feasibility and safety for older adults with and without PD. METHODS: This cross-sectional study included older adults with and without PD who were evaluated remotely through a videoconference platform. To ensure effective and comprehensive instructions for the test, we developed a guideline called OMPEPE (an acronym for: Objective; Materials; Position-Start; Execution; Position-End; Environment). We assessed the 5TSTS intra- and inter-rater reliability by comparing scores obtained from the same examiner and from different examiners, respectively. Participants and examiners completed online surveys to provide information about feasibility and safety. RESULTS: Twelve older adults with PD and 17 older adults without PD were included in this study (mean ages 69.0 and 67.6 years, respectively). Based on the participants' perspectives and the absence of adverse effects, teleassessment using the 5TSTS is feasible and safe for older adults with and without PD. Excellent intra- and inter-rater reliability (intraclass correlation coefficient >0.90) was found for all measurements of the 5TSTS. DISCUSSION: This study demonstrated the feasibility, safety, and reliability of teleassessment using the 5TSTS. The guidelines developed may help health professionals minimize barriers and safely conduct an online assessment that includes a physical test such as the 5TSTS in older adults with or without PD. In addition to addressing technological barriers, the OMPEPE guideline might ensure the optimal execution of evaluations. CONCLUSION: Teleassessment using the 5TSTS for older adults with and without PD is feasible and safe. Both synchronous (i.e., live) and asynchronous (i.e., recorded) online 5TSTS tests demonstrate excellent intra- and inter-rate reliability.

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Resumo Fundamento: Existem poucos estudos retrospectivos e prospectivos sobre cardiodesfibrilador implantável (CDI) na prevenção primária e secundária de morte súbita na cardiopatia chagásica crônica (CCC). Objetivos: Descrever a evolução a longo prazo dos portadores de CCC com CDI e identificar e analisar os preditores de mortalidade e de terapia apropriada do dispositivo nessa população. Métodos: Trata-se de um estudo prospectivo histórico com 117 pacientes portadores de CDI e CCC. Dispositivos foram implantados de janeiro de 2003 a dezembro de 2021. Fatores preditores de terapias apropriadas e mortalidade a longo prazo foram identificados e analisados. O nível de significância estatística é de p < 0,05. Resultados: Pacientes (n = 117) tiveram mediana de seguimento de 61 meses (25 a 121 meses), sendo o gênero masculino (74%) predominante e a mediana de idade de 55 anos (48 a 64 anos). Houve 43,6% de choques apropriados, 26,5% de estimulação cardíaca antitaquicardia (ATP) e 51% de terapias apropriadas. Durante o seguimento, 46 pacientes (39,7%) foram a óbito. A mortalidade foi de 6,2% pessoas-ano (intervalo de confiança [IC] 95%: 4,6 a 8,3), com 2 mortes súbitas durante o seguimento. A prevenção secundária (hazard ratio [HR] 2.1; IC 95%: 1,1 a 4,3; p = 0,029) e a fração de ejeção menor que 30% (HR 1.8; IC 95%: 1,1 a 3,1; p < 0,05) foram preditores de terapias apropriadas. Escore de Rassi intermediário apresentou uma forte associação com ocorrência de ATP isoladamente (p = 0,015). A classe funcional IV (p = 0,007), fração de ejeção do ventrículo esquerdo < 30 (p = 0,010) e a idade maior que 75 anos (p = 0,042) foram preditores de mortalidade total. Conclusão: Os desfibriladores na CCC apresentaram elevada incidência de acionamento apropriado especialmente naqueles pacientes de prevenção secundária, fração de ejeção do ventrículo esquerdo baixa e escore de Rassi intermediário. Os pacientes com insuficiência cardíaca congestiva, classe funcional avançada e idade maior que 75 anos apresentaram elevada mortalidade.

Abstract Background: There are few retrospective and prospective studies on implantable cardioverter-defibrillators (ICD) in primary and secondary prevention of sudden death in chronic Chagas heart disease (CCHD). Objectives: To describe the long-term evolution of patients with CCHD and ICD and to identify and analyze predictors of mortality and appropriate device therapy in this population. Methods: This was a historical prospective study with 117 patients with ICD and CCHD. Devices were implanted from January 2003 to December 2021. Predictors of appropriate therapies and long-term mortality were identified and analyzed. The level of statistical significance was p < 0.05. Results: Patients (n = 117) had a median follow-up of 61 months (25 to 121 months); they were predominantly male (74%), with a median age of 55 years (48 to 64 years). There were 43.6% appropriate shocks, 26.5% antitachycardia pacing (ATP), and 51% appropriate therapies. During follow-up, 46 patients (39.7%) died. Mortality was 6.2% person-years (95% confidence interval [CI]: 4.6 to 8.3), with 2 sudden deaths during follow-up. Secondary prevention (hazard ratio [HR] 2.1; 95% CI: 1.1 to 4.3; p = 0.029) and ejection fraction less than 30% (HR 1.8; 95% CI: 1.1 to 3.1; p < 0.05) were predictors of appropriate therapies. Intermediate Rassi score showed a strong association with the occurrence of ATP alone (p = 0.015). Functional class IV (p = 0.007), left ventricular ejection fraction < 30 (p = 0.010), and age above 75 years (p = 0.042) were predictors of total mortality. Conclusion: ICDs in CCHD showed a high incidence of appropriate activation, especially in patients with secondary prevention, low left ventricular ejection fraction, and intermediate Rassi score. Patients with congestive heart failure, elevated functional class, and age over 75 years showed elevated mortality.

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This work adopted a green synthesis route using cashew tree gum as a mediating agent to obtain Ni-doped ZnO nanoparticles through the sol-gel method. Structural analysis confirmed the formation of the hexagonal wurtzite phase and distortions in the crystal lattice due to the inclusion of Ni cations, which increased the average crystallite size from 61.9 nm to 81.6 nm. These distortions resulted in the growth of point defects in the structure, which influenced the samples' optical properties, causing slight reductions in the band gaps and significant increases in the Urbach energy. The fitting of the photoluminescence spectra confirmed an increase in the concentration of zinc vacancy defects (VZn) and monovacancies (Vo) as Zn cations were replaced by Ni cations in the ZnO structure. The percentage of VZn defects for the pure compound was 11%, increasing to 40% and 47% for the samples doped with 1% and 3% of Ni cations, respectively. In contrast, the highest percentage of VO defects is recorded for the material with the lowest Ni ions concentration, comprising about 60%. The influence of dopant concentration was also reflected in the photocatalytic performance. Among the samples tested, the Zn0.99Ni0.01O compound presented the best result in MB degradation, reaching an efficiency of 98.4%. Thus, the recovered material underwent reuse tests, revealing an efficiency of 98.2% in dye degradation, confirming the stability of the photocatalyst. Furthermore, the use of different inhibitors indicated that •OH radicals are the main ones involved in removing the pollutant. This work is valuable because it presents an ecological synthesis using cashew gum, a natural polysaccharide that has been little explored in the literature.

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The Amazon Forest, the largest contiguous tropical forest in the world, stores a significant fraction of the carbon on land. Changes in climate and land use affect total carbon stocks, making it critical to continuously update and revise the best estimates for the region, particularly considering changes in forest dynamics. Forest inventory data cover only a tiny fraction of the Amazon region, and the coverage is not sufficient to ensure reliable data interpolation and validation. This paper presents a new forest above-ground biomass map for the Brazilian Amazon and the associated uncertainty both with a resolution of 250 meters and baseline for the satellite dataset the year of 2016 (i.e., the year of the satellite observation). A significant increase in data availability from forest inventories and remote sensing has enabled progress towards high-resolution biomass estimates. This work uses the largest airborne LiDAR database ever collected in the Amazon, mapping 360,000 km2 through transects distributed in all vegetation categories in the region. The map uses airborne laser scanning (ALS) data calibrated by field forest inventories that are extrapolated to the region using a machine learning approach with inputs from Synthetic Aperture Radar (PALSAR), vegetation indices obtained from the Moderate-Resolution Imaging Spectroradiometer (MODIS) satellite, and precipitation information from the Tropical Rainfall Measuring Mission (TRMM). A total of 174 field inventories geolocated using a Differential Global Positioning System (DGPS) were used to validate the biomass estimations. The experimental design allowed for a comprehensive representation of several vegetation types, producing an above-ground biomass map varying from a maximum value of 518 Mg ha-1, a mean of 174 Mg ha-1, and a standard deviation of 102 Mg ha-1. This unique dataset enabled a better representation of the regional distribution of the forest biomass and structure, providing further studies and critical information for decision-making concerning forest conservation, planning, carbon emissions estimate, and mechanisms for supporting carbon emissions reductions.

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OBJETIVO: Identificar e mapear as tecnologias desenvolvidas e/ou validadas para incentivar e auxiliar na adesão ao tratamento da tuberculose na Atenção Primária à Saúde. MÉTODO: Trata-se de uma scoping review, seguindo as orientações do Joanna Briggs Institute (JBI) Reviewer's Manual, com a seguinte pergunta de pesquisa: "Quais as tecnologias têm sido desenvolvidas e/ou validadas para incentivar e auxiliar na adesão ao tratamento da tuberculose na Atenção Primária à Saúde?" Serão incluídos artigos, teses e dissertações a partir de buscas nas bases: Medical Literature Analysis and Retrieval System Online (Medline/PubMed), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS)/Biblioteca Virtual de Saúde (BVS), Cumulative Index to Nursing and Allied Health (CINAHL), Web of Science (WOS), Scopus, Excerpta Medica Database (Embase) e literatura cinzenta. A busca, avaliação, seleção e extração dos dados serão realizadas de forma cega entre pares; quando houver divergências, um terceiro revisor será consultado. Os resultados serão descritos na íntegra, utilizando-se de narrativa e diagramas, de forma que estejam alinhados com o objetivo e a questão norteadora desta revisão. Protocolo registrado na Open Science Framework (OSF): 10.17605/OSF.IO/PKWTC.

OBJECTIVE: To identify and map technologies developed and/or validated to promote and support adherence to tuberculosis treatment in primary health care settings. METHOD: This is a scoping review, following the guidelines of the Joanna Briggs Institute (JBI) Reviewer's Manual, with the following research question: "What technologies have been developed and/or validated to promote and support adherence to tuberculosis treatment in primary health care?". Articles, theses, and dissertations will be included by searching the following databases Medical Literature Analysis and Retrieval System Online (Medline/PubMed), Latin American and Caribbean Health Sciences Literature (LILACS)/Virtual Health Library (VHL), Cumulative Index to Nursing and Allied Health (CINAHL), Web of Science (WOS), Scopus, Excerpta Medica Database (Embase), and gray literature. The search, assessment, selection, and data extraction will be performed in a blinded manner between peers; in case of disagreement, a third reviewer will be consulted. The results will be fully described using narratives and graphs to align with the objective and guiding question of this review. Protocol registered with the Open Science Framework (OSF): 10.17605/OSF.IO/PKWTC.

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RESUMO Objetivo avaliar a efetividade de intervenção educativa utilizando o jogo sério AleitaGame como recurso educacional no ensino sobre lesões mamilares. Método estudo quase experimental, do tipo grupo único, antes e depois, não randomizado, desenvolvido entre agosto e outubro de 2021. A intervenção foi realizada com 43 profissionais atuantes em um hospital do Rio Grande do Norte. Os dados foram analisados a partir de estatística descritiva e inferencial. Resultados o recurso educacional apresentou efeito positivo, com aumento significativo no conhecimento dos participantes da intervenção educativa (p<0,05). No que concerne à avaliação da satisfação dos participantes quanto ao AleitaGame como recurso educativo, a maioria dos participantes consideraram ótimos todos os itens das categorias "conteúdo", "linguagem", "organização e layout", "motivação e aprendizagem". Conclusão e implicações para a prática os resultados do estudo são critérios convidativos para docentes da área passarem a incorporar o AleitaGame em suas salas de aula, bem como para utilização do recurso como estratégia para educação permanente dos profissionais nos serviços de saúde. O jogo sério está disponível através do link: <https://aleitagame.github.io/>.

RESUMEN Objetivo evaluar la efectividad de una intervención educativa utilizando el juego serio AleitaGame como recurso educativo en la enseñanza de las lesiones en los pezones. Método estudio cuasi-experimental, del tipo grupo único, antes y después, no aleatorizado, desarrollado entre agosto y octubre de 2021. La intervención fue realizada con 43 profesionales que actúan en un hospital de Rio Grande do Norte. Los datos se analizaron mediante estadística descriptiva e inferencial. Resultados el recurso educativo tuvo un efecto positivo, con un aumento significativo en el conocimiento de los participantes de la intervención educativa (p<0,05). En cuanto a la evaluación de la satisfacción de los participantes con AleitaGame como recurso educativo, la mayoría consideró excelentes todos los ítems en las categorías "contenido", "lenguaje", "organización y diseño", "motivación y aprendizaje". Conclusión e implicaciones para la práctica los resultados del estudio son criterios atractivos para que los profesores del área pasen a incorporar el AleitaGame en sus clases, así como a utilizar el recurso como estrategia para la formación continua de los profesionales de los servicios de salud. El juego serio está disponible a través del link: <https://aleitagame.github.io/>.

ABSTRACT Objective to evaluate the effectiveness of an educational intervention using the serious game AleitaGame as an educational resource in teaching about mammillary injuries. Method a quasi-experimental, single group, before and after, non-randomized study, developed between August and October 2021. The intervention was carried out with 43 professionals working in a hospital in Rio Grande do Norte. Data were analyzed using descriptive and inferential statistics. Results the educational resource had a positive effect, with a significant increase in the knowledge of the participants of the educational intervention (p<0.05). Regarding the evaluation of participants' satisfaction about AleitaGame as an educational resource, most participants considered all items in the "content", "language", "organization and layout", "motivation and learning" categories to be excellent. Conclusion and implications for practice the results of the study are inviting criteria for professors in the area to start incorporating AleitaGame in their classrooms, as well as for using the resource as a strategy for the continuing education of professionals in health services. The serious game is available on the link: <https://aleitagame.github.io/>.

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Several decomposed body parts were received for examination by the Forensic Anthropology section of the Medico-legal Institute of João Pessoa, Paraíba, Brazil. The portions of the lower and upper limbs, ribs, vertebrae, and a skull were thoroughly examined. The biological profile indicated a male individual with an estimated age range between 23 and 57 years and a mean age of 35.2 years (SD = 9.4; phase IV, Suchey-Brooks). The skeleton showed injuries caused by sharp force and sharp-blunt force trauma that affected all body segments. Macroscopically, the lesions are mainly in the diaphyseal segments of the long bones, sacrum, pelvis, mandible, maxilla, scapulae, sternum, vertebrae, the distal epiphysis of the left fibula, and the distal epiphysis of the left tibia displayed characteristics compatible with injuries produced perimortem. It was not possible to determine the cause of death. DNA analysis resulted in a positive identification. Because of common difficulties faced in forensic practice, it is often not possible for forensic anthropologists to go to the crime scene, X-ray or body scanners are frequently unavailable, and the victim's medical and/or dental records are sometimes absent. These difficulties make identification ultimately depend on genetic analysis, which is more time-consuming than other identification methods. Despite this, bone fragment examination in dismemberment cases is a complex task. Forensic Anthropology can shed light on cases involving the identification of dismembered remains, which are challenging because of the number of traumatic injuries, as well as different injury patterns, on bones.

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Background: The remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) has become a common method of in-home monitoring and follow-up in high-income countries given its effectiveness, safety, convenience, and the possibility of early intervention. However, in Brazil, RM is still underutilized. Objectives: This observational study aims to demonstrate our experience of using RM in Brazil and the predictive factors of RM of CIED follow-up in Brazil. Methods: This was a prospective cohort study of patients with a CIED. Event rates are reported and clinical responses to those findings and outcomes based on the detection of RM. A logistic regression model was performed to identify predictors of more events, with P < .05 for statistical significance. Results: This study evaluated consecutive 119 patients: 30.2% with pacemakers, 42.8% with implantable cardioverter-defibrillator, 22.7% with cardiac resynchronization therapy (CRT) with defibrillator, and 3.3% with CRT with pacemaker. Events were detected in 63.9% of the cases in 29.5 ± 23 months of follow-up. The outcomes found were that 44.5% needed elective evaluation in medical treatment and 23.5% needed immediate evaluation in therapy. Logistic regression analysis showed that the groups with CRT or CRT with defibrillator (75.0%), reduced ejection fraction (76.5%), and New York Heart Association functional class ≥II (75.0%) had the highest RM event rates. Conclusions: RM proved to be effective and safe in the follow-up of patients with CIEDs in Brazil, allowing early interventions and facilitating therapeutic management.

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Este estudo objetivou avaliar a inserção da disciplina de Pacientes com Necessidades Especiais (PNE)na estrutura curriculardos cursos de Odontologia em funcionamento no estado do Rio Grande do Norte (RN). Trata-se de estudo transversal, exploratório e descritivo com abordagem quantitativa. As informações foram coletadas nos sítios web dos cursos. Foram encontrados dez cursos em funcionamento e cinco deles ofertavam a disciplina, sendo apenas um em modo optativo. A nomenclatura da disciplina e o semestre de oferta variou entre as instituições. Dois cursos possuem uma abordagem teórico/prática, um deles clínica e o restante teórica. Conclui-se que apenas as quatro instituições privadas oferecem de forma obrigatória o componente curricular relacionados a PNE durante a graduação, enquanto entre as públicas apenas umaoferta a disciplina, porém, de maneira optativa. Assim, éevidente a necessidade da inserção de conteúdos relacionados à assistência de pacientes especiais nos cursos de graduação emOdontologia do RN, atendendo às DiretrizesCurriculares Nacionais no tangente à formação de um profissional generalista (AU).

This study aimed to evaluate the insertion of the Patients with Special Needs (PSN) discipline in the syllabus of Dentistry courses in operation in the state of Rio Grande do Norte (RN). This is a cross-sectional, exploratory and descriptive study with a quantitative approach. The information was collected from the courses' websites. There were ten courses in operation, with five of them offering the discipline, only one in optional mode. The nomenclature of the discipline and the semester of offer varied among the institutions. Two courses have a theoretical/practical approach, one of them clinical and the remaining theoretical. Only the four private institutions offer compulsorily the curricular component related to PSN during graduation, while the only one public institution offers the discipline, but in an optional way. Thus, it is evident the need for the insertionof contents related to the care of special patients in undergraduate Dentistry courses in RN, meeting the National Curriculum Guidelines concerning the training of a generalist professional (AU).

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Introdução: A violência intrafamiliar é amplamente identificada como negligência e abuso de crianças e adolescentes; violência doméstica contra mulheres, maus-tratos de idosos e de pessoas portadoras de deficiência. É dever ético-legal dos cirurgiões-dentistas realizarem a notificação compulsória frente a esses casos. Objetivo: Verificar o conhecimento e a conduta dos cirurgiões-dentistas sobre a violência intrafamiliar no município de Caicó-RN, Brasil. Material e Métodos: Estudo descritivo, transversal, e com abordagem quantitativa. A amostra do estudo foi constituída por 66 cirurgiões-dentistas do município de Caicó-RN. A coleta dos dados foi realizada através da aplicação do questionário adaptado já validado por Mythri (2015). A análise dos dados se deu por estatística descritiva. Resultados: 53% (n=35) dos cirurgiões-dentistas afirmaram ter atendido vítimas de violência intrafamiliar. Dentre os quais, apenas 37,9% questionaram aos seus pacientes sobre os motivos da violência. A conduta do cirurgião-dentista mais citada frente à casos de violência, foi aconselhamento. Pode-se apontar que 87,9% dos profissionais afirmaram conhecer os sinais, sintomas e lesões orofaciais decorrentes da violência intrafamiliar e o mais relatado foi o hematoma. Os profissionais demonstraram ser cientes da localização anatômica das agressões da violência intrafamiliar na região de atuação do profissional da Odontologia. Conclusão: Os cirurgiões-dentistas possuem conhecimento satisfatório no que diz respeito ao reconhecimento dos sinais e sintomas decorrentes das lesões orofaciais causadas pela violência intrafamiliar. Porém, no que se referem a como proceder diante dos casos, as suas condutas se mostram insuficientes e contraditórias.

Introduction: Intrafamily violence widely identified as the neglect and the abuse of children and adolescents, domestic violence against women, abuse of the elderly and people with disabilities. It is the ethical-legal duty of the dentists to carry out compulsory notification in these cases. Objective: To verify the knowledge and the conduct of dentists about intrafamily violence in the municipality of Caicó-RN, Brazil. Material and Methods: cross-seccional, descriptive study with a quantitative approach. The study's sample consisted og 66 dentists from the municipality of Caicó-RN. Data collection took place through the application of questions adapted from the validated questionnaire by Mythri (205). Data analysis was performed using descriptive statistics. Results: 53% of dentists said they had seen victims of intrafamily violence whose only 37.9% asked their patients about the reasons for the violence. The dentist's most cited conduct, face of a violence case was the counseling. It can be pointed out that 87.9% of the professionals claimed to know the signs, symptoms and orofacial injuries resulting from intrafamily violence and most of them reported it was the hematoma. The professionals demonstrated to be aware about the anatomic location of the aggressions of intrafamily violence that it was in the region where Dentistry professionals work. Conclusion: Dentists have satisfactory knowledge regarding the recognition of signs and symptoms resulting from orofacial injuries caused by intrafamily violence. However, regarding how to proceed in that cases, their conduct was insufficient and contradictory.

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INTRODUCTION: It is challenging to diagnose syncope in patients with pacemakers. Because these patients have increased morbidity and mortality risks, they require immediate attention to determine the causes in order to provide appropriate treatment. This study aimed to investigate the causes and predictive factors of syncope as well as the methods used to diagnose syncope in cardiac pacemaker patients. METHODS: Patients with pacemakers implanted owing to sinus node disease or atrioventricular block were evaluated with standardized questionnaires, endocavitary electrograms, and other tests based on the suspected causes of syncope. Mann- Whitney U tests were used to analyze continuous variables and Chi-squared or Fisher's exact tests were used for categorical variables. Logistic regression was used for multivariate analyses. Statistical significance was P<0.05. RESULTS: The study included 95 patients with pacemakers: 47 experienced syncope in the last 12 months and 48 did not. Of the 100 documented episodes of syncope, 48.9% were vasovagal syncopes, 17% had cardiac-related causes, 10.6% had unknown causes, and 8.5% had pacemaker failure. The multivariate analysis showed that a New York Heart Association (NYHA) Functional Class II was a significant factor for developing syncope (P<0.01). CONCLUSION: While the most common type of syncope in pacemaker patients was neurally mediated, it is important to perform detailed evaluations in this population as the causes of syncope can be life-threatening. The best diagnostic methods were stored electrogram analysis and the tilt table test. NYHA Functional Class II patients were found to have a higher risk for syncope.

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Abstract Introduction: It is challenging to diagnose syncope in patients with pacemakers. Because these patients have increased morbidity and mortality risks, they require immediate attention to determine the causes in order to provide appropriate treatment. This study aimed to investigate the causes and predictive factors of syncope as well as the methods used to diagnose syncope in cardiac pacemaker patients. Methods: Patients with pacemakers implanted owing to sinus node disease or atrioventricular block were evaluated with standardized questionnaires, endocavitary electrograms, and other tests based on the suspected causes of syncope. Mann-Whitney U tests were used to analyze continuous variables and Chi-squared or Fisher's exact tests were used for categorical variables. Logistic regression was used for multivariate analyses. Statistical significance was P<0.05. Results: The study included 95 patients with pacemakers: 47 experienced syncope in the last 12 months and 48 did not. Of the 100 documented episodes of syncope, 48.9% were vasovagal syncopes, 17% had cardiac-related causes, 10.6% had unknown causes, and 8.5% had pacemaker failure. The multivariate analysis showed that a New York Heart Association (NYHA) Functional Class II was a significant factor for developing syncope (P<0.01). Conclusion: While the most common type of syncope in pacemaker patients was neurally mediated, it is important to perform detailed evaluations in this population as the causes of syncope can be life-threatening. The best diagnostic methods were stored electrogram analysis and the tilt table test. NYHA Functional Class II patients were found to have a higher risk for syncope.

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Tall trees are key drivers of ecosystem processes in tropical forest, but the controls on the distribution of the very tallest trees remain poorly understood. The recent discovery of grove of giant trees over 80 meters tall in the Amazon forest requires a reevaluation of current thinking. We used high-resolution airborne laser surveys to measure canopy height across 282,750 ha of old-growth and second-growth forests randomly sampling the entire Brazilian Amazon. We investigated how resources and disturbances shape the maximum height distribution across the Brazilian Amazon through the relations between the occurrence of giant trees and environmental factors. Common drivers of height development are fundamentally different from those influencing the occurrence of giant trees. We found that changes in wind and light availability drive giant tree distribution as much as precipitation and temperature, together shaping the forest structure of the Brazilian Amazon. The location of giant trees should be carefully considered by policymakers when identifying important hot spots for the conservation of biodiversity in the Amazon.

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Os gessos odontológicos são usados desde a antiguidade e ainda hoje estão presentes principalmente na odontologia e na prótese. Constituem parte da documentação do paciente e são usados durante o tratamento cínico para diagnóstico, plano de tratamento e confecção dos trabalhos protéticos. Como é um material de uso comum em várias áreas da odontologia, os gessos passaram por uma evolução quanto ao grau de expansão, tempo de trabalho, tempo de presa e dureza. è um material acessível e comum em clínicas e laboratórios e empregados em diversos trabalhos com diferentes finalidades (AU).

Dental plasters have been used since ancient times and are still present today mainly in dentristry and prosthesis. They are part of the patient documentation and are used duringclinical treatment for diagnosis, treatment plan and manufacturing of prosthetic work. As they are a commonly used material in several areas of dentistry, they underwent an evolution in the expansion degree, working time, prey time and hardness. They are accesible and common materials in clinics and laboratories and they are employed in many kinds of work for different purposes (AU).

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A cardiomiopatia induzida pelo marcapasso é uma cardiomiopatia que ocorre em pacientes expostos a estimulação ventricular direita, sendo definida pela piora da função sistólica do ventrículo esquerdo na ausência de outras etiologias possíveis, com ou sem evidência de insuficiência cardíaca. Sua incidência varia de 9% a 26%, dependendo da população estudada e do período de acompanhamento. Relata-se o caso de uma criança submetida a implante de marcapasso ventricular por bloqueio atrioventricular total, que evoluiu com disfunção ventricular grave e insuficiência cardíaca 14 meses após o implante. Após realização de terapia de ressincronização cardíaca, a criança evoluiu com melhora clínica e remodelamento reverso do ventrículo esquerdo

Pacing-induced cardiomyopathy is observed in patients exposed to right ventricular pacing and is defined as worsening of left ventricular systolic function in the absence of alternative causes, with or without clinical evidence of heart failure. Incidence ranges from 9% to 26%, depending on the study population and the length of follow-up. This is a case report of a child with univentricular pacemaker for total atrioventricular block that evolved into severe ventricular dysfunction and heart failure after implant. Cardiac resynchronization was performed and the child evolved with clinical improvement and reverse left ventricular remodeling

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Fundamento: Pacientes submetidos à ressincronização cardíaca podem evoluir com padrões de resposta acima do esperado, com normalização dos parâmetros clínicos e ecocardiográficos. Objetivo: Analisar as características clínicas e ecocardiográficas desta população de super-respondedores, comparando-as com os demais pacientes submetidos à terapia de ressincronização cardíaca. Métodos: Estudo de coorte observacional, prospectivo, envolvendo 146 pacientes, consecutivamente submetidos a implantes de ressincronizador cardíaco. Para comparação das variáveis, foram realizados o teste exato de Fisher e o teste de Mann-Whitney. Foram considerados super-respondedores os pacientes com fração de ejeção > 50 % e classe funcional I/II (New York Heart Association) após 6 meses da terapia de ressincronização cardíaca. Resultados: A idade média foi de 64,8 ± 11,1 anos, sendo 69,8% do sexo masculino, com mediana da fração de ejeção de 29%, sendo 71,5% com bloqueio de ramo esquerdo, 12% com bloqueio de ramo direito associado a bloqueios divisionais; 16,3% com marca-passo cardíaco definitivo, 29,3% com miocardiopatia isquêmica, 59,4% com miocardiopatia dilatada e 11,2% com miocardiopatia chagásica. Foram observados 24 (16,4%) superrespondedores, sendo que 13 (8,9%) apresentaram normalização da fração de ejeção, dos diâmetros diastólicos do ventrículo esquerdo e da classe funcional. Quando comparados com os pacientes não super-respondedores, em relação às características pré-implante, os super-respondedores apresentaram-se mais no sexo feminino (58,3% vs. 22,8%; p = 0,002), maior índice de massa corporal (26,8 vs. 25,5; p = 0,013), maior fração de ejeção basal (31,0 vs. 26,9; p = 0,0003) e menores diâmetros diastólicos do ventrículo esquerdo (65,9 mm vs. 72,6 mm; p = 0,0032). Dez pacientes (41,6% dos super-respondedores) com bloqueio de ramo direito e bloqueio divisional evoluíram como super-respondedores, entretanto apenas um paciente com doença de Chagas e apenas na primeira avaliação. Conclusões: Os super-respondedores apresentaram cardiopatia de base menos avançada e sem diferenças em relação ao tipo de distúrbio de condução basal. Pacientes com bloqueio de ramo direito e bloqueio divisional, mas sem cardiopatia chagásica podem também evoluir como super-respondedores

Background: Patients submitted to cardiac resynchronization may develop response patterns that are higher than expected, with normalization of clinical and echocardiographic parameters. Objective: To analyze the clinical and echocardiographic characteristics of this population of super-responders, comparing them with the other patients submitted to cardiac resynchronization therapy. Methods: A prospective, observational cohort study involving 146 patients consecutively submitted to cardiac resynchronization implants. Fisher's exact test and Mann-Whitney test were performed to compare the variables. Patients with ejection fraction > 50% and functional class I/II (New York Heart Association) were considered super-responders after 6 months of cardiac resynchronization therapy. Results: Mean age was 64.8 ± 11.1 years, with 69.8% of males, with a median ejection fraction of 29%, 71.5% with left bundle-branch block, 12% with right bundle-branch block associated with hemiblocks; 16.3% wearing a definitive cardiac pacemaker, 29.3% with ischemic cardiomyopathy, 59.4% with dilated cardiomyopathy, and 11.2% with Chagasic cardiomyopathy. Twenty-four (16.4%) super-responders were observed, and 13 (8.9%) showed normalization of the ejection fraction, left ventricular diastolic diameters and functional class. When compared to the non-super-responder patients, in relation to the pre-implantation characteristics, the super-responders were more often females (58.3% vs. 22.8%, p = .002), had higher body mass index (26.8 vs. 25.5, p = 0.013), higher baseline ejection fraction (31.0 vs. 26.9, p = 0.0003), and lower left ventricular diastolic diameters (65.9 mm vs. 72.6 mm, p = 0.0032). Ten patients (41.6% of super-responders) with right bundle-branch block and hemiblock progressed to super-responders, although there was only one patient with Chagas' disease among them, and only at the first assessment. Conclusions: Super-responders had less advanced heart disease at baseline and no differences regarding the type of conduction disorder at baseline. Patients with right bundle-branch block and hemiblock, but without Chagasic heart disease may also progress as super-responders

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Abstract Background: The outcome of Chagas disease patients after receiving implantable cardioverter defibrillator (ICD) is still controversial. Objective: To compare clinical outcomes after ICD implantation in patients with chronic Chagas cardiomyopathy (CCC) and ischemic heart disease (IHD). Methods: Prospective study of a population of 153 patients receiving ICD (65 with CCC and 88 with IHD). The devices were implanted between 2003 and 2011. Survival rates and event-free survival were compared. Results: The groups were similar regarding sex, functional class and ejection fraction. Ischemic patients were, on average, 10 years older than CCC patients (p < 0.05). Patients with CCC had lower schooling and monthly income than IHD patients (p < 0.05). The number of appropriate therapies was 2.07 higher in CCC patients, who had a greater incidence of appropriate shock (p < 0.05). Annual mortality rate and electrical storm incidence were similar in both groups. There was no sudden death in CCC patients, and only one in IHD patients. Neither survival time (p = 0.720) nor event-free survival (p = 0.143) significantly differed between the groups. Conclusion: CCC doubles the risk of receiving appropriate therapies as compared to IHD, showing the greater complexity of arrhythmias in Chagas patients.

Resumo Fundamento: A evolução do paciente chagásico após implante de cardiodesfibrilador implantável (CDI) é tema ainda controverso. Objetivo: Comparar a evolução clínica pós-implante do CDI em pacientes com cardiopatia chagásica crônica (CCC) e cardiopatia isquêmica (CI). Métodos: Trata-se de um estudo prospectivo histórico de uma população de 153 pacientes portadores de CDI, sendo 65 com CCC e 88 com CI. Os dispositivos foram implantados entre janeiro de 2003 e novembro de 2011, tendo-se comparado a taxa de sobrevida e a sobrevida livre de eventos entre essas populações. Resultados: Os grupos foram similares na predominância do sexo masculino, classe funcional e fração de ejeção. Os pacientes isquêmicos são em média 10 anos mais velhos que os chagásicos (p < 0,05). Os pacientes chagásicos apresentavam escolaridade e renda mensal mais baixa do que os isquêmicos (p < 0,05). Foi demonstrado que o número de terapias apropriadas nos pacientes com CCC é 2,07 vezes maior do que naqueles com CI. A incidência de choque apropriado é maior na CCC (p < 0,05). As taxas de mortalidade anual nos dois grupos foram similares, assim como a incidência de tempestade elétrica. Não houve nenhuma morte súbita nos pacientes com CCC e apenas uma nos pacientes com CI. Não houve diferença estatisticamente significativa no tempo de sobrevida entre os dois grupos (p = 0,720) nem na sobrevida livre de eventos (p = 0,143). Conclusão: A CCC duplica o risco de receber terapias apropriadas em relação à CI, mostrando assim maior complexidade das arritmias nos pacientes chagásicos.

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