Abstract An athlete’s sporting experience is a factor associated with better-coping strategies and emotional regulation, especially concerning competitive anxiety and its symptoms. To verify whether more experienced athletes have lower rates of negativism and higher levels of self-confidence, we compared the means of these two variables between athletes with more and less experience. A meta-analysis was performed, following the PRISMA model. Seven articles were selected that measured, through the Competitive State Anxiety Inventory - 2 (CSAI-2 or its shortened version, CSAI-2R), the levels of self-confidence and negativism of high-performance athletes with different sports experiences. Significant statistical differences were found regarding the levels of negativism between athletes with more and less experience (p < .001). The same occurred with the levels of self-confidence between athletes with more and less sports experience (< .001). The results align with our initial hypothesis, formulated by Martens et al. (1990), that athletes with more experience would have higher self-confidence and lower negativism averages. One of the reasons may be using more effective coping strategies that are improved during the career years.

Resumo A alta experiência desportiva de um atleta é um fator que está associado a melhores estratégias de coping e regulação emocional, principalmente em relação a ansiedade competitiva e os seus sintomas. Com o intuito de verificar se atletas mais experientes possuem menores índices de negativismo e maiores índices de autoconfiança, comparamos as médias dessas duas variáveis entre atletas com maior e menor experiência. Foi realizada uma meta-análise, seguindo o modelo PRISMA. Foram selecionados 7 artigos que medissem, através do Competitive State Anxiety Inventory - 2 (CSAI-2 ou sua versão reduzida, CSAI-2R), os níveis de autoconfiança e negativismo de atletas de alta performance com diferentes experiências desportivas. Em relação aos níveis de negativismo entre atletas com maior e menor experiência, foram encontradas diferenças estatisticamente significativas (p < .001). O mesmo ocorreu com os níveis de autoconfiança entre atletas com maior e menor experiência desportiva (< .001). Os resultados obtidos vão de encontro com nossa hipótese inicial, formulada por Martens et al. (1990), no sentido de que atletas com maior experiência teriam maiores médias de autoconfiança e menores de negativismo. Um dos motivos pode ser o uso de estratégias mais eficazes de coping que são aprimoradas durante os anos de carreira.

Abstract Introduction and objectives: Myofascial Pain Syndrome (MPS) of the Quadratus Lumborum muscle (QL) is a frequent cause of chronic low back pain. With this study, we aimed to assess the efficacy of ultrasound-guided infiltration with 0.25% levobupivacaine and 40 mg triamcinolone for MPS of the QL. Methods: Observational and retrospective study of participants submitted to ultrasound-guided infiltration of the QL muscle from January 1, 2015 to June 31, 2019. Pain intensity was assessed using the five-point pain Numeric Rating Scale (NRS): pre-intervention, at 72 hours, 1 month, 3 months and 6 months post-intervention. Additional data collected were demographic characteristics, opioid consumption, and adverse effects. Results: We assessed 90 participants with mean age of 55.2 years. Sixty-eight percent of participants were female. Compared to the pre-intervention assessment, there was an improvement in pain at 72 hours (Mean Difference [MD = 3.085]; 95% CI: 2.200-3.970, p < 0.05), at the 1st month (MD = 2.644; 95% CI: 1.667-3.621, p < 0.05), at the 3rdmonth (MD = 2.017; 95% CI: 0.202-2.729, p < 0.05) and at the 6th month (MD = 1.339; 95% CI 0.378-2.300, p < 0.05), post-intervention. No statistically significant differences in opioid consumption were observed. No adverse effects associated with the technique were reported. Conclusions: Ultrasound-guided infiltration of the QL muscle is a safe and effective procedure for the treatment of pain in the QL MPS within 6 months post-intervention.

ABSTRACT Introduction: Antenatal hydronephrosis (ANH) is common in fetal ultrasounds. Though mostly transient, it can be associated with congenital abnormalities and kidney injury. The authors went to assess the evolution of children with ANH and identify risk groups. Methods: Retrospective cohort study of children with ANH from 2013‑2017. Renal pelvis anteroposterior diameter (APD) of 4 and 7mm or more in the second and third trimester, respectively, defined diagnosis of ANH. APD also defined severity stratification. The primary outcomes included occurrence of urinary tract infection (UTI) and congenital anomalies of the kidney and urinary tract (CAKUT). Results: We identified 198 cases, with male predominance (76.8%) and a 2.1% incidence. It resolved antenatally in 12.1%, with a lower mean value of APD in these cases (p=0.017), and persisted in 43.4%. CAKUT were found in 8.6% of the patients. At least 1 episode of UTI occurred in 9.1% of patients during follow‑up. The degree of ANH in the 3rd trimester was related to postnatal persistence and degree (p<0.001) and the postnatal degree was related to the occurrence of UTI (p=0.008). The 3rd trimester and postnatal degree were also associated to the presence of CAKUT (p=0.036; p=0.001), although not with vesicoureteral reflux (VUR). The persistence of ANH through the 2nd and 3rd trimester was related to postnatal persistence (p=0.002) and degree (p=0.007), and the presence of CAKUT excluding VUR (p=0.034). The optimal cut‑off for the APD in the 3rd trimester to predict the occurrence of negative outcomes (CAKUT and/or UTI), through a receiver operating characteristic (ROC) curve, was 8.225mm with 76% sensitivity and 59% specificity. Discussion: ANH is frequent and reflects a wide range of conditions, requiring follow‑up. Most cases resolve spontaneously and require no further intervention other than ultrasounds. 3rd trimester and postnatal degree are related to prognosis, allowing the definition of risk groups and the improvement of patient management.

Introduction: Henoch-Schönlein Purpura is the most common systemic small vessel vasculitis of childhood. It is most frequently a selflimited entity, although some cases with concomitant nephritis may have serious complications. This study aims to analyze the clinical, epidemiologic and prognostic factors of children with this disease. Methods: Observational and retrospective study of children with diagnosis of Henoch-Schönlein Purpura from January 2011 to June 2017. Results: 61 patients were identified, with a median age of 6 years and a slight predominance of females. Purpura was present in all cases; the second most common symptom was arthralgia (75.4%), followed by gastrointestinal (39.3%), renal (31.1%) and scrotal involvement (6.6%). Corticotherapy was used in 12 patients (19.7%). Almost one fourth of the patients had a recurrence, but only 4 had persistent manifestations for longer than 6 months. Abdominal symptoms were found to have a positive correlation with renal involvement and corticotherapy showed no protective long-term effects. Discussion: Henoch-Schönlein Purpura is mostly a self-limited pathology. We found no association between age or sex and a poorer outcome, but a correlation between abdominal and renal involvement was found. We found a negative correlation between joint involvement and recurring episodes, showing that it may be a good prognostics factor. Corticotherapy demonstrated no protective long-term effect, and was on the contrary correlated with hospitalization, recurrence and persistence of signs and/or symptoms. This correlation can be explained by the fact that patients having indication for and receiving corticotherapy had an inherently more severe spectrum of the disease and so were more prone to poorer outcomes.

Resumo Justificativa e objetivo Independente do progresso do tratamento no período perioperatório, o declínio cognitivo no pós-operatório (DCPO) é inequivocamente aceito como uma complicação importante e frequente da cirurgia em pacientes mais velhos. O objetivo deste estudo foi avaliar a incidência de DCPO e sua influência na qualidade de vida três meses após a cirurgia. Métodos Estudo prospectivo observacional conduzido em Sala de Recuperação Pós-anestesia (SRPA) com pacientes de idade superior a 45 anos, após cirurgia eletiva de grande porte. A função cognitiva foi avaliada com o teste de Avaliação Cognitiva de Montreal (MOCA) e a qualidade de vida (QV) com o Questionário sobre Qualidade de Vida (SF-36). As avaliações foram realizadas no pré-operatório (T0) e três meses após a cirurgia (T3). Resultados Foram avaliados 41 pacientes. A incidência de DCPO três meses após a cirurgia foi de 24%. Em T3, os escores MOCA foram menores nos pacientes com DCPO (mediana 20 vs. 25, p = 0,009). Ao comparar as medianas dos escores para cada um dos domínios do SF-36, não observamos diferenças entre os pacientes com e sem DCPO. Ao comparar cada um dos domínios do SF-36 obtidos antes e após três meses de cirurgia, os pacientes com DCPO apresentaram resultados semelhantes para cada uma das oito áreas do SF-36, enquanto pacientes sem DCPO apresentaram resultados melhores em seis domínios. Em T3, os pacientes com DCPO apresentaram níveis mais elevados de dependência na realização de atividades cotidianas. Conclusão Três meses após a cirurgia, os pacientes sem DCPO apresentaram melhora significativa dos escores MOCA. Os pacientes com DCPO não apresentaram aumento dos escores SF-36, mas os pacientes sem DCPO apresentaram melhora em quase todos os domínios do SF-36. Os pacientes com DCPO apresentaram taxas mais elevadas de dependência na realização de atividades cotidianas após a cirurgia.

Abstract Background Regardless the progress in perioperative care postoperative cognitive decline (PCD) has been accepted unequivocally as a significant and frequent complication of surgery in older patients. The aim of this study was to evaluate the incidence of postoperative cognitive decline and its influence on quality of life three months after surgery. Methods Observational, prospective study in a Post-Anesthesia Care Unit (PACU) in patients aged above 45 years, after elective major surgery. Cognitive function was assessed with Montreal Cognitive Assessment (MOCA); Quality of life (QoL) was assessed using SF-36 Health Survey (SF-36). Assessments were performed preoperatively (T0) and 3 months after surgery (T3). Results Forty-one patients were studied. The incidence of PCD 3 months after surgery was 24%. At T3 MOCA scores were lower in patients with PCD (median 20 vs. 25, p = 0.009). When comparing the median scores for each of SF-36 domains, there were no differences between patients with and without PCD. In patients with PCD, and comparing each of SF-36 domains obtained before and three months after surgery, had similar scores for every of the 8 SF-36 areas while patients without PCD had better scores for six domains. At T3 patients with PCD presented with higher levels of dependency in personal activities of daily living (ADL). Conclusion Three months after surgery patients without PCD had significant improvement in MOCA scores. Patients with PCD obtained no increase in SF-36 scores but patients without PCD improved in almost all SF-36 domains. Patients with PCD presented higher rates of dependency in personal ADL after surgery.