Resumo Fundamento A fibrilação atrial (FA) afeta de 0,5% a 2,0% da população geral e geralmente está associada a doenças estruturais cardíacas, comprometimento hemodinâmico e complicações tromboembólicas. A anticoagulação oral previne eventos tromboembólicos e é monitorada pela razão normalizada internacional (RNI). Objetivos Avaliar a estabilidade do RNI em pacientes com FA não valvar tratados com anticoagulante varfarina, avaliar complicações tromboembólicas ou hemorrágicas e identificar o grupo com risco mais alto de eventos tromboembólicos ou hemorrágicos. Métodos Dados de prontuários médicos de 203 pacientes atendidos em um hospital terciário no Brasil foram analisados e o tempo de intervalo terapêutico (TTR) foi calculado usando-se o método Rosendaal. Em seguida possíveis fatores que influenciam o TTR foram analisados e a relação entre TTR e eventos tromboembólicos ou hemorrágicos foi calculada. O nível de significância foi 5%. Resultados O TTR médio foi 52,2%. Pacientes com instabilidade de RNI na fase de adaptação tinham um TTR médio mais baixo (46,8%) do que aqueles sem instabilidade (53,9%). Entre os pacientes estudados, 6,9% sofreram eventos hemorrágicos e 8,4% tiveram um acidente vascular cerebral. O grupo com risco mais alto de acidente vascular cerebral e sangramento era composto de pacientes com instabilidade de RNI na fase de adaptação. Conclusões A qualidade da anticoagulação nesse hospital terciário no Brasil é semelhante à de centros de países em desenvolvimento. Pacientes com instabilidade de RNI maior na fase de adaptação evoluíram para um TTR médio mais baixo durante o acompanhamento, tinham uma chance de acidente vascular cerebral 4,94 vezes maior e uma chance de sangramento 3,35 vezes maior. Portanto, para esse grupo de pacientes, individualizar a escolha de tratamento anticoagulante seria recomendado, considerando-se a relação custo-benefício.

Abstract Background Atrial fibrillation (AF) affects 0.5% to 2.0% of the general population and is usually associated with cardiac structural diseases, hemodynamic damage, and thromboembolic complications. Oral anticoagulation prevents thromboembolic events and is monitored by the international normalized ratio (INR). Objectives To evaluate INR stability in nonvalvular AF patients treated with warfarin anticoagulation, to evaluate thromboembolic or hemorrhagic complications, and to identify the group at higher risk for thromboembolic or hemorrhagic events. Methods Data from the medical records of 203 patients who received medical care at a tertiary hospital in Brazil were reviewed, and the time in therapeutic range (TTR) was calculated using the Rosendaal method. The possible TTR influencing factors were then analyzed, and the relationship between the TTR and thromboembolic or hemorrhagic events was calculated. The level of significance was 5%. Results The mean TTR was 52.2%. Patients with INR instability in the adaptation phase had a lower mean TTR (46.8%) than those without instability (53.9%). Among the studied patients, 6.9% suffered hemorrhagic events, and 8.4% had a stroke. The higher risk group for stroke and bleeding consisted of patients with INR instability in the adaptation phase. Conclusions The quality of anticoagulation in this tertiary hospital in Brazil is similar to that in centers in developing countries. Patients with greater INR instability in the adaptation phase evolved to a lower mean TTR during follow-up, had a 4.94-fold greater chance of stroke, and had a 3.35-fold greater chance of bleeding. Thus, for this patient group, individualizing the choice of anticoagulation therapy would be advised, considering the cost-benefit ratio.

OBJECTIVES: Coronary artery disease is the primary cause of death and is responsible for a high number of hospitalizations worldwide. Ventricular remodeling is associated with worse prognosis following ST-segment elevation myocardial infarction (STEMI) and is a risk factor for ventricular dysfunction and heart failure. This study aimed to identify the predictors of ventricular remodeling following STEMI. Additionally, we evaluated the clinical, laboratory, and echocardiographic characteristics of patients with anterior wall STEMI who underwent primary percutaneous intervention in the acute phase and at 6 months after the infarction. METHODS: This prospective, observational, and longitudinal study included 50 patients with anterior wall STEMI who were admitted to the coronary care unit (CCU) of a tertiary hospital in Brazil between July 2017 and August 2018. During the CCU stay, patients were evaluated daily and underwent echocardiogram within the first three days following STEMI. After six months, the patients underwent clinical evaluation and echocardiogram according to the local protocol. RESULTS: Differences were noted between those who developed ventricular remodeling and those who did not in the mean±standard deviation levels of creatine phosphokinase MB isoenzyme (CKMB) peak (no remodeling group: 323.7±228.2 U/L; remodeling group: 522.4±201.6 U/L; p=0.008) and the median and interquartile range of E/E’ ratio (no remodeling group: 9.20 [8.50-11.25] and remodeling group: 12.60 [10.74-14.40]; p=0.004). This difference was also observed in multivariate logistic regression. CONCLUSIONS: Diastolic dysfunction and CKMB peak in the acute phase of STEMI can be predictors of ventricular remodeling following STEMI.

TEMA: vários autores têm apontado a urgência de se intensificar pesquisas e ações voltadas ao professor, na escola, de caráter preventivo e de promoção de saúde vocal, que se volta para a melhoria das condições de trabalho e do ambiente no qual ocorre a docência. Assim sendo, o objetivo deste estudo foi: analisar as queixas, os sintomas laríngeos, hábitos relacionados ao desempenho vocal e o tipo de voz de professores de uma escola da rede pública de ensino antes e após a participação em grupos de vivência de voz. MÉTODO: o estudo foi dividido em etapas com professores de uma escola pública: 1ª Etapa: entrevista, avaliação laringológica e perceptivo-auditiva da qual participaram 42 professores; 2ª Etapa: grupos de vivência de voz e 3ª Etapa: reavaliação perceptivo-auditiva - das quais participaram 13 professores. RESULTADOS: 73% dos sujeitos apresentaram queixas vocais; 57,14% apresentaram rouquidão de grau leve e moderado, 78,57% apresentaram soprosidade e 52,38% apresentaram tensão na voz. Ao exame laringológico, 75,86% apresentaram fendas glóticas e 34,48% espessamento mucoso. Após a vivência de voz houve diferença significativa no grau de tensão, tanto na análise da vogal /e/ como na análise da fala espontânea (p = 0,0277 para p > 0,05 para ambas). Houve melhora dos cuidados com a voz e a compreensão dos fatores intervenientes e determinantes das alterações vocais, presentes nas condições e organização do trabalho docente. CONCLUSÃO: ações educativas processuais, como os grupos de vivência de voz, se caracterizam como importantes espaços de reflexão e de mudança das relações entre trabalho e saúde do professor.

BACKGROUND: several authors have pointed to the urgent need of researches and actions involving teachers, in the school environment, that have a preventive and vocal health promotion character with the purpose of improving work conditions. AIM: to analyze the vocal complaints, laryngeal symptoms, vocal habits and vocal profile of teachers of a public school before and after their participation in voice workshops. METHOD: the study was divided in different steps: 1st step - closed interview, larynx and perceptive-auditory assessment in which 42 teachers were evaluated; 2nd step - voice workshops; 3rd step - perceptive-auditory reassessment in which 13 teachers were evaluated. RESULTS: 73% of the subjects presented vocal complaints; 57.14% presented mild to moderate hoarseness, 78.57% presented breathiness and 52.38% vocal tension. Evaluation of the larynx indicated that 75.86% of the subjects presented glottal gaps and 34.48% mucous thickening. After the voice workshops a significant difference was observed in the level of vocal tension, both in the analysis of the /e/ vowel and in the analysis of Spontaneous Speech (p = 0.0277 for p > 0.05 for both). Improvement was observed in vocal care and in the understanding of intervening and determinant factors for vocal alterations, which are present in the teaching environment. CONCLUSION: health actions, such as voice workshops, are important to trigger changes in the work environment as well as in the health of teachers.