ABSTRACT: Considering the increase of water and energy requirements in arid zones, this work combine the presence of the coastal stratocumulus as a potential water resource and the behavior of solar radiation as an energy source. The aim is to know the relationships between attenuation of irradiance by fog typology (orographic or advective) and the yields of associated fog water. September 2013 was analyzed using GOES satellite images, data from the Standard Fog Collector (SFC) and the radiometer located at the Atacama UC Station, Oasis de Niebla Alto Patache (20 ° 49 'S - 70 09'O -800 m a.s.l.). Results show complementarity between the daily cycles of these resources and their productive hours of water and energy (night and day) respectively. This research motivates subsequent studies on fog water and solar energy as complementary resources in line with implementing technologies for wáter treatment, management and distribution, as well as solar panel dust cleaning.

RESUMEN: Considerando los crecientes requerimientos de agua y energía en zonas áridas, se aborda la presencia del estratocúmulo costero como potencial recurso hídrico y el comportamiento de la radiación solar como fuente de energía. Este estudio exploratorio busca conocer las relaciones entre atenuación de la irradiancia por tipología de niebla (orográfica o advectiva) y la producción de agua de niebla asociada. Se analizó septiembre 2013 mediante imágenes satelitales GOES, datos del neblinómetro (SFC) y el radiómetro localizados en la Estación Atacama UC_Oasis Niebla Alto Patache (20° 49' S - 70° 09'O -800 m s.n.m.). Se encontró complementariedad entre los ciclos diarios de estos recursos y sus horarios productivos de agua y energía (noche y día) respectivamente. Esta investigación motiva estudios posteriores sobre agua de niebla y energía solar como recursos complementarios en línea con implementar tecnologías para tratamiento, manejo y distribución del agua, así como limpieza de paneles solares.

Introducción: el aprendizaje de la ventilación mecánica (VM) pediátrica requiere de tiempo y diversas estrategias educativas. En los últimos años se han utilizado los videopodcast para la educación médica. Objetivos: documentación filmográfica de los elementos básicos de la mecánica respiratoria durante la VM en un modelo animal. Creación de un videopodcast para la formación de recursos humanos especializados en VM pediátrica. Metodología: se prepararon diferentes secuencias de VM con ventilador y en forma manual. Se realizó exposición pulmonar mediante toracotomía y VM convencional en un cerdo. Se grabó simultáneamente lo monitorizado por el ventilador y la visualización in vivo del pulmón expuesto ante cada secuencia. Dos especialistas en cuidados intensivos pediátricos analizaron durante la edición las grabaciones y confeccionaron un guión explicativo de lo observado. Resultados: se editó un video con las diferentes secuencias previstas: VM basal, VM sin presión positiva teleespiratoria (PEEP), VM con niveles incrementales de PEEP, VM con bolsa autoinflable, aspiración de sonda endotraqueal con circuito cerrado y abierto durante VM con ventilador y manual con operador. Se editó un videopodcast con leyendas explicativas. Discusión: la utilización de recursos digitales para la enseñanza y divulgación de diversas especialidades médicas es cada vez más frecuente. El videopodcast se ha expandido como una nueva herramienta educativa. Se construyó un modelo para la capacitación de los recursos humanos en VM mediante este formato. La experiencia servirá para construir una videoteca universitaria dirigida a la enseñanza de cuidados críticos del niño y para la divulgación de experimentos biomédicos.

Introduction: learning about mechanical ventilation (MV) in pediatrics requires time and several educational strategies. In recent years, videopodcast has been used for medical training. Objectives: to prepare a filmed documentary of the basic elements in respiratory mechanics during MV in an animal model. To create a videopodcast to train human resources specialized in MV in pediatrics. Material: different sequences of MV with ventilator and manual ventilation were prepared. Lungs were accessed through thoracotomy and MV was started in a pig. Monitored data from the ventilator was simultaneously recorded, the same as the live visualization of the visible lung for each sequence. Two specialists in pediatrics intensive care analysed the recording while it was edited and composed a script explaining what was observed. Results: a video was edited with the different sequences expected: basal MV, MV with zero PEEP, increasing PEEP levels, MV with self-inflating bag, traqueal suction with open and closed traqueal suction systems and manual ventilation with an operator. A videopodcast with explanatory subtitles was edited. Discussion: digital resources are increasingly being used to train physicians and disseminate several medical techniques. Today, videopodcast constitutes a new educational tool. A model was designed to train human resources in MV under this format. This experience will be used to build up a new university video library to assist the training in pediatric critical care and to disseminate biomedical experiments.

The Neuquén Basin represents one of the more significant examples in Argentina where several marine carbonate-evaporite and continental cycles were developed during the Jurassic-Cretaceous. Numerous Ba-Sr stratabound deposits are closely associated with the carbonate and gypsum horizons of several stratigraphic units, as the result of different mineralizing processes: sedimentary-exhalative deposition onto the seafloor, selected replacements of carbonate rocks and gypsum beds with subsequent diagenetic processes and hydrothermal infilling of fractures, voids and vugs. The Ba-Sr mineralizations are mainly epigenetic, and they are related to hydrothermal fluids that occurred in areas with or without igneous rock outcrops.

La Cuenca Neuquina representa unos de los ejemplos más significativos en la Argentina de desarrollo de ciclos carbonáticoevaporíticos marinos y de eventos de sedimentación clástica continental, sucedidos alternadamente durante el lapso Jurásico- Cretácico. Asociado a definidos horizontes estratigráficos de esos ciclos se encuentra un numeroso conjunto de depósitos barítico-celestínicos de carácter estratoligado vinculado a distintos procesos mineralizantes: depositación sedimentario-exhalativa en fondo marino, reemplazo preferencial de rocas carbonáticas y niveles yesíferos con procesos diagenéticos superpuestos y relleno de fracturas y oquedades. Las mineralizaciones de Ba-Sr, mayoritariamente epigenéticas, están vinculadas a la acción de fluidos hidrotermales en áreas con y sin afloramientos de rocas ígneas.

Background and Objectives: We evaluated maintenance of response to atomoxetine during a 25-week, double-blind, placebo-controlled, randomised withdrawal period in adults with attention-deficit/hyperactivity disorder (ADHD) who previously responded to atomoxetine during a 12 week open-label treatment period and maintained that response during a 12-week double-blind maintenance period. Methods: Patients (N = 2017), 18 to 50 years of age, diagnosed with ADHD from 152 outpatient sites in 18 countries received 12 weeks of open-label atomoxetine (40-100 mg/day) followed by 12 weeks of double-blind maintenance (80 or 100 mg/day). Responders were randomized to atomoxetine (N = 266) or placebo (N = 258) for 25-weeks of double-blind treatment. The percentage of patients with a reduction >30% in their baseline Conners' ADHD Rating Scale Investigator-Rated: Screening Version (CAARS-Inv:SV) total score and a score of <3 on the Clinical Global Impression ADHD-Severity (CGI-ADHD-S) after 25 weeks was compared between treatment groups with a Fisher's exact test. Mean changes from baseline in the CAARS-Inv:SV and Adult Attention-Deficit/Hyperactivity Disorder Quality of Life (AAQoL) were analysed. Results: Most patients enrolled (60%) were from Europe. More atomoxetine- than placebo-treated patients maintained a satisfactory response postrandomisation (64.3% vs. 50.0%; p < .001). Time-to-relapse was significantly longer for atomoxetine than placebo (p = .004). Atomoxetine maintained greater improvements in ADHD symptoms compared with placebo (LS mean worsening in the CAARS-Inv:SV total score was 0.9 vs. 4.8 [ p < .001 ] and in the CGI-ADHD-S rating was 0.0 vs. 0.5 [ p < .001 ]). These results were supported by self- or observer-rated measures. Lastly, atomoxetine maintained greater improvements in quality of life compared with placebo (AAQoL total score was 0.4 vs. -4.0; p = .002). Conclusions: This study demonstrated that atomoxetine was superior to placebo in maintaining significantly greater treatment responses for up to 1 year in adults with ADHD.

Background and Objectives: Safety and tolerability of atomoxetine were studied in the largest double-blind, placebo-controlled, randomised withdrawal trial of atomoxetine (80 or 100 mg/day) in adults with attention-deficit/hyperactivity disorder (ADHD). Methods: Patients (N = 2017), 18 to 50 years of age, with ADHD were enrolled from 18 countries. Patients who responded to atomoxetine during a 12-week open-label treatment phase and maintained that response during a 12-week double-blind maintenance phase were randomised to atomoxetine (N = 266) or placebo (N = 258) for 25 weeks of double-blind treatment. Treatment differences were compared for serious adverse events (AEs), treatment-emergent AEs (TEAEs), discontinuation due to AEs, vital signs, body weight, and electrocardiograms. Results: During the 25-week double-blind treatment phase, discontinuations due to AEs were similar between atomoxetine and placebo (3.4% vs. 1.9%; P = .418). The percentage of patients experiencing >1 TEAE(s) was significantly higher for atomoxetine than placebo (47.0% vs. 37.6%; P = .034), but there were no significant differences for any individual TEAE. Diastolic blood pressure (-0.1 vs. -2.3 mmHg), heart rate (-1.4 vs. -5.3 bpm), and weight (-0.2 vs. 1.1 kg) were significantly different between atomoxetine and placebo (P <.001). There were no significant differences between atomoxetine and placebo in the frequencies of patients showing an increase from baseline >30 ms in Fridericia's QT correction (QTcF; 1.4% vs. 2.6%) or Bazett's QT correction (QTcB; 2.8% vs. 2.6%). During the entire study, no patient had a QTcF or QTcB >500 ms, or an increase from baseline >60 ms. Conclusions: This study demonstrated that atomoxetine exhibited an acceptable safety profile in adults with ADHD after 1 year of treatment, and no clinically meaningful safety-related rebound effects were observed following abrupt discontinuation after 24 weeks of treatment.

OBJETIVO: Comparar segurança e eficácia do seguimento a longo prazo da cirurgia de revascularização miocárdica (CRM) com intervenção coronária percutânea (ICP), utilizando stents farmacológicos (SF) em pacientes com lesão de tronco de coronária esquerda não-protegida (TCE). MÉTODOS: MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar e listas de referências artigos relevantes foram escaneados para estudos clínicos que relataram resultados em 5 anos de seguimento após ICP-SF eCRM para o tratamento de lesão de TCE. Cinco estudos (um de ensaio clínico randomizado e quatro estudos observacionais) foram identificados e incluíram um total de 2914 pacientes (1300 para CRM e 1614 para ICP-SF). RESULTADOS: Aos 5 anos de seguimento, não houve diferença significativa entre os grupos CRM e ICP-SF no risco de morte (odds ratio [OR] 1,159, P=0,168) ou desfecho composto de morte, infarto do miocárdio , ou AVC (OR 1,214, P=0,083). O risco de necessidade de nova revascularização foi significativamente menor no grupo CRM em comparação com o grupo de ICP-SF (OR 0,212, P<0,001). O risco de eventos adversos cardíacos maiores e cerebrovasculares (EACMC) foi significativamente menor no grupo CRM em comparação com o grupo de ICP-SF (OR 0,526, P<0,001). Não foi observado viés de publicação sobre os resultados e considerável heterogeneidade dos efeitos sobre EACMC. CONCLUSÃO: CRM continua sendo a melhor opção de tratamento para pacientes com lesão de TCE, com menos necessidade de novas revascularizações e EACMC no seguimento a longo prazo.

OBJECTIVE: To compare the safety and efficacy at long-term follow-up of coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) using drug-eluting stents (DES) in patients with unprotected left main coronary artery (ULMCA) disease. METHODS: MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar and reference lists of relevant articles were searched for clinical studies that reported outcomes at 5-year follow-up after PCI with DES and CABG for the treatment of ULMCA stenosis. Five studies (1 randomized controlled trial and 4 observational studies) were identified and included a total of 2914 patients (1300 for CABG and 1614 for PCI with DES). RESULTS: At 5-year follow-up, there was no significant difference between the CABG and PCI-DES groups in the risk for death (odds ratio [OR] 1.159, P=0.168 for random effect) or the composite endpoint of death, myocardial infarction, or stroke (OR 1.214, P=0.083). The risk for target vessel revascularization (TVR) was significantly lower in the CABG group compared to the PCI-DES group (OR 0.212, P<0.001). The risk of major adverse cardiac and cerebrovascular events (MACCE) was significantly lower in the CABG group compared to the PCI-DES group (OR 0.526, P<0.001). It was observed no publication bias about outcomes and considerably heterogeneity effect about MACCE. CONCLUSION: CABG surgery remains the best option of treatment for patients with ULMCA disease, with less need of TVR and MACCE rates at long-term follow-up.

INTRODUÇÃO: A meta-análise mais recente de estudos randomizados controlados (ERC) mostrou que cirurgia de revascularização (CRM) sem circulação extracorpórea (CEC) reduz a incidência de acidente vascular cerebral em 30% em comparação com CRM com CEC, mas não mostrou diferença em outros resultados. Novos ERCs foram publicados, indicando necessidade de nova meta-análise para investigar resultados agrupados adicionando esses estudos. MÉTODOS: MEDLINE, EMBASE, CENTRAL / CCTR, SciELO, LILACS, Google Scholar e listas de referências de artigos relevantes foram pesquisados para ERCs que compararam os resultados de 30 dias (mortalidade por todas as causas, infarto do miocárdio ou acidente vascular cerebral - AVC) entre CRM com CEC versus sem CEC até maio de 2012. As medidas sumárias principais foram o risco relativo (RR) com intervalo de confiança de 95% (IC) e os valores de P (considerado estatisticamente significativo quando <0,05). Os RR foram combinados entre os estudos usando modelo de efeito randômico de DerSimonian-Laird. Meta-análise e meta-regressão foram concluídas usando o software versão Meta-Análise Abrangente 2 (Biostat Inc., Englewood, Nova Jersey, EUA). RESULTADOS: Quarenta e sete ERCs foram identificados e incluíram 13.524 pacientes (6.758 sem CEC e 6.766 com CEC). Não houve diferença significativa entre CRM com CEC e sem CEC no RR de mortalidade em 30 dias ou infarto do miocárdio, mas houve diferença em favor da CRM sem CEC no desfecho AVC (RR 0,793, IC 95% 0,660-0,920, P = 0,049). Não foi observado importante heterogeneidade dos efeitos sobre qualquer resultado, mas observou-se um viés de publicação sobre o desfecho "AVC". Meta-regressão não demonstrou influência do sexo feminino, o número de pontes ou idade nos resultados. CONCLUSÃO: CRM sem uso da CEC reduz a incidência de acidente vascular cerebral pós-operatória de 20,7% e não tem efeito significativo sobre a mortalidade ou infarto do miocárdio em comparação com CRM com CEC. Sexo do paciente, número de enxertos realizados e idade não parecem explicar o efeito de RM sem CEC sobre a mortalidade, infarto do miocárdio ou acidente vascular cerebral, respectivamente.

BACKGROUND: Most recent published meta-analysis of randomized controlled trials (RCTs) showed that off-pump coronary artery bypass graft surgery (CABG) reduces incidence of stroke by 30% compared with on-pump CABG, but showed no difference in other outcomes. New RCTs were published, indicating need of new meta-analysis to investigate pooled results adding these further studies. METHODS: MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar and reference lists of relevant articles were searched for RCTs that compared outcomes (30-day mortality for all-cause, myocardial infarction or stroke) between off-pump versus on-pump CABG until May 2012. The principal summary measures were relative risk (RR) with 95% Confidence Interval (CI) and P values (considered statistically significant when <0.05). The RR's were combined across studies using DerSimonian-Laird random effects weighted model. Meta-analysis and meta-regression were completed using the software Comprehensive Meta-Analysis version 2 (Biostat Inc., Englewood, New Jersey, USA). RESULTS: Forty-seven RCTs were identified and included 13,524 patients (6,758 for off-pump and 6,766 for on-pump CABG). There was no significant difference between off-pump and on-pump CABG groups in RR for 30-day mortality or myocardial infarction, but there was difference about stroke in favor to off-pump CABG (RR 0.793, 95% CI 0.660-0.920, P=0.049). It was observed no important heterogeneity of effects about any outcome, but it was observed publication bias about outcome "stroke". Meta-regression did not demonstrate influence of female gender, number of grafts or age in outcomes. CONCLUSION: Off-pump CABG reduces the incidence of post-operative stroke by 20.7% and has no substantial effect on mortality or myocardial infarction in comparison to on-pump CABG. Patient gender, number of grafts performed and age do not seem to explain the effect of off-pump CABG on mortality, myocardial infarction or stroke, respectively.

OBJETIVO: Investigar fatores de risco para óbito intra-hospitalar em diabéticos submetidos à cirurgia de revascularização miocárdica isolada. MÉTODOS: Estudo retrospectivo de 305 pacientes. Foram avaliadas média de idade, taxa de mortalidade intra-hospitalar, uso de circulação extracorpórea, débito cardíaco no período pós-operatório e uso da artéria torácica interna. Análise univariada para variáveis categóricas foi executada com teste qui-quadrado de Pearson ou exato de Fisher, conforme apropriado. Potenciais fatores de risco com valor de P <0,05 na análise univariada foram incluídos na análise multivariada, que foi realizada por regressão logística backward. Valores de P <0,05 foram considerados estatisticamente significativos. RESULTADOS: A população estudada apresentou média de idade de 61,44 anos (±9,81), sendo 65,6% (n=200) do sexo masculino. A taxa de mortalidade intra-hospitalar foi de 11,8% (n=36). Os fatores de risco independentes para óbito mostraram: uso de circulação extracorpórea OR 6,15; IC 95% 1,57-24,03; P=0,009 e baixo débito cardíaco no período pós-operatório com OR 34,17; IC 95% 10,46-111,62; P<0,001. O uso de artéria torácica interna foi fator protetor independente para óbito com OR 0,27; IC 95% 0,08-0,093; P=0,038. CONCLUSÃO: Este estudo identificou como fatores de risco independentes para óbito após a operação o uso de circulação extracorpórea e síndrome de baixo débito cardíaco. O uso da artéria torácica inerna foi fator protetor independente.

OBJECTIVE: To investigate the risk factors for in-hospital death in diabetic patients undergoing isolated Coronary Artery Bypass Grafting (CABG). METHODS: We conducted a retrospective study with 305 consecutive diabetic patients undergoing CABG in the Division of Cardiovascular Surgery of our institution from April 2004 to April 2010. Univariate analysis for categorical variables was performed with the chi-square or Fisher's exact test, as appropriate. Potential risk factors with p <0.05 in the univariate analysis were included in the multivariate analysis, which was performed by backward logistic regression. Values of p <0.05 were considered statistically significant. RESULTS: The study population had a mean age of 61.44 years (± 9.81) and 65.6% (n=200) were male. The in-hospital mortality rate was 11.8% (n=36). The following independent risk factors for death were identified: on-pump CABG (OR 6.15, 95% CI 1.57 to 24.03, P=0.009) and low cardiac output in the postoperative period (OR 34.17, 95% CI 10.46 to 111.62, P <0.001). The use of internal thoracic artery (ITA) was an independent protective factor for death (OR 0.27, 95% CI 0.08 to 0.093, P=0.038). CONCLUSION: This study identified the following independent risk factors for death after CABG: on-pump CABG and low cardiac output syndrome. The use of ITA was an independent protective factor.

OBJETIVOS: Encontrar preditores de hemotransfusão pode facilitar a abordagem mais eficiente para utilização de serviços de banco de sangue em CRM. O objetivo deste estudo é identificar as características dos pacientes pré- e intraoperatórios que predizem necessidade de hemotransfusão durante ou após a revascularização miocárdica. MÉTODOS: 435 pacientes submetidos à CRM isolada pela primeira vez, foram revisados para suas variáveis pré e intra-operatórias e analisados os dados pós-operatórios. Foram 255 homens e 180 mulheres, com idade média 62,01 ± 10,13 anos. Análise de regressão logística foi utilizada para identificar os preditores perioperatórios de hemotransfusão. RESULTADOS: A hemotransfusão foi executada em 263 pacientes (60,5%). O número médio de unidades de hemoderivados por paciente foi de 2,27 ± 3,07 (0-23) unidades. O número total de unidades de hemoderivados foi de 983. A análise univariada identificou idade> 65 anos, peso <70 kg, IMC <25 kg/m2, hemoglobina < 13 mg/dl, hematócrito < 40% e fração de ejeção <50%, uso de circulação extracorpórea (CEC), não usar a artéria torácica interna como bypass, e múltiplos bypasses como preditores significativos. Os preditores mais fortes por meio de análise multivariada foram hematócrito < 40% (OR 2,58; IC 1,62-4,15; P<0,001), o uso da CEC (OR 2,00; IC 1,27-3,17; P=0,003) e múltiplos bypasses (OR 2,31; IC 1,31-4,08; P=0,036). CONCLUSÕES: A identificação desses fatores de risco leva a uma melhor identificação de pacientes com uma probabilidade maior de usar sangue, melhor alocação dos recursos do banco de sangue e o uso custo-efetivo dos hemoderivados.

OBJECTIVES: Finding predictors of blood transfusion may facilitate the most efficient approach for the use of blood bank services in coronary artery bypass grafting procedures. The aim of this retrospective study is to identify preoperative and intraoperative patient characteristics predicting the need for blood transfusion during or after CABG in our local cardiac surgical service. METHODS: 435 patients undergoing isolated first-time CABG were reviewed for their preoperative and intraoperative variables and analyzed postoperative data. Patients were 255 males and 180 females, with mean age 62.01 ± 10.13 years. Regression logistic analysis was used for identifying the strongest perioperative predictors of blood transfusion. RESULTS: Blood transfusion was used in 263 patients (60.5%). The mean number of transfused blood products units per patient was 2.27 ± 3.07 (0-23) units. The total number of transfused units of blood products was 983. Univariate analysis identified age >65 years, weight <70 Kg, body mass index <25 Kg/m2, hemoglobin <13mg/dL, hematocrit < 40% and ejection fraction <50%, use of cardiopulmonary bypass (CPB), not using an internal thoracic artery as a bypass, and multiple bypasses as significant predictors. The strongest predictors using multivariate analysis were hematocrit < 40% (OR 2.58; CI 1.62-4.15; P<0.001), CPB use (OR 2.00; CI 1.27-3.17; P=0.003) and multiple bypasses (OR 2.31; CI 1.31-4.08; P=0.036). CONCLUSIONS: The identification of these risk factors leads to better identification of patients with a grater probability of using blood, allocation blood bank resources and cost-effectiveness use of blood products.

OBJETIVO: O objetivo deste estudo é avaliar a aplicabilidade de um novo escore de predição de mediastinite - MagedanzSCORE - em pacientes submetidos à cirurgia de revascularização miocárdica (CRM) na Divisão de Cirurgia Cardiovascular do Pronto Socorro Cardiológico de Pernambuco - PROCAPE. MÉTODOS: Estudo retrospectivo envolvendo 500 pacientes operados entre maio/2007 e abril/2010. Os registros continham todas as informações utilizadas para calcular o MagedanzSCORE. O desfecho de interesse foi mediastinite. Foram calculados sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo, concordância e acurácia. A acurácia do modelo foi avaliada pelo ROC (receiver operating characteristic curve). RESULTADOS: A incidência de mediastinite foi de 5,6%, com uma taxa de letalidade de 32,1%. Na análise univariada, as cinco variáveis do MagedanzSCORE foram preditoras de mediastinite no pós-operatório: doença pulmonar obstrutiva crônica (OR 6,42; IC 95,0% 2,76-14,96; P<0,001), obesidade (OR 3,06; IC 95,0% 1,32-7,09; P=0,009), reintervenção cirúrgica (OR 82,40; IC 95,0% 30,40-223,30; p<0,001), transfusões múltiplas (OR 3,33; IC 95,0% 1,52-7,29; P=0,003) e angina estável classe IV ou instável (OR 2,59; IC 95,0% 1,19-7,64; P=0,016) de acordo com a Sociedade Canadense de Cardiologia. O escore teve uma sensibilidade de 96,4%, especificidade de 90,0%, valor preditivo positivo de 36,5%, valor preditivo negativo de 99,8% e 90,4% de concordância. A acurácia medida pela área sob a curva ROC foi 96,2% (IC 95,0% 94,5%-97,9%). CONCLUSÕES: O MagedanzSCORE provou ser um índice simples e objetivo, revelando-se um preditor satisfatório de desenvolvimento de mediastinite no pós-operatório de pacientes submetidos à CRM em nossa instituição

OBJECTIVE: The aim of this study is to evaluate the applicability of a new score for predicting mediastinitis - MagedanzSCORE - in patients undergoing coronary artery bypass graft (CABG) surgery in the Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE. METHODS: Retrospective study involving 500 patients operated between May/2007 and April/2010. The registers contained all the information used to calculate the MagedanzSCORE. The outcome of interest was mediastinitis. We calculated sensitivity, specificity, positive predictive value, negative predictive value, concordance and accuracy. The accuracy of the model was evaluated by ROC (receiver operating characteristic) curve. RESULTS: The incidence of mediastinitis was 5.6%, with a lethality rate of 32.1%. In univariate analysis, the five variables of the MagedanzSCORE were predictors of postoperative mediastinitis: chronic obstructive pulmonary disease (OR 6.42; 95.0% CI 2.76-14.96; P<0.001), obesity (OR 3.06; 95.0% CI 1.32-7.09; P=0.009), surgical reintervention (OR 82.40; 95.0% CI 30.40-223.30; P<0.001), multiple transfusion (OR 3.33; 95.0% CI 1.52-7.29; P=0.003) and stable angina class IV or unstable (OR 2.59; 95.0% CI 1.19-7.64; P=0.016) according to Canadian Cardiovascular Society. The score had a sensitivity of 96.4%, specificity of 90.0%, positive predictive value of 36.5%, negative predictive value of 99.8% and 90.4% concordance. The accuracy measured by the area under the ROC curve was 96.2% (95.0% CI 94.5%-97.9%). CONCLUSIONS: The MagedanzSCORE proved to be a simple and objective index, revealing a satisfactory predictor of development of postoperative mediastinitis in patients undergoing CABG surgery at our institution

O uso de stents intravasculares em crianças com cardiopatia congênita é procedimento bem estabelecido, porém a indicação de paliação por meio de procedimentos percutâneos ao invés da cirurgia convencional permanece incerta. Neste relato são apresentados três casos de obstrução crítica de via de saída do ventrículo direito (VSVD), submetidos a ampliação da VSVD com implante de stent. O implante foi realizado com sucesso nos três casos, permitindo restabelecer o fluxo pulmonar para a árvore pulmonar e melhorar a saturação de oxigênio.

The use of intravascular stents in children with congenital heart disease is well established, however the use of palliative percutaneous therapy instead of a conventional surgery remains uncertain. We present three cases of critical right ventricular outflow tract (RVOT) obstruction treated with stenting to expand the RVOT. Stenting was successful in all three cases, reestablishing pulmonary flow into the pulmonary arteries and improving oxygen saturation.

INTRODUÇÃO: Mediastinite é uma complicação séria da esternotomia mediana e está associada a significativa morbidade e mortalidade. Diabetes é um temido fator de risco para mediastinite, visto com cautela pelos cirurgiões cardiovasculares. OBJETIVO: Identificar fatores de risco para mediastinite em diabéticos submetidos à CRM com uso unilateral da ATI na Divisão de Cirurgia Cardiovascular do Pronto Socorro Cardiológico de Pernambuco - PROCAPE. MÉTODOS: Estudo retrospectivo de 157 pacientes diabéticos operados entre maio de 2007 e abril de 2010. Nove variáveis pré-operatórias, cinco variáveis intraoperatórias e sete variáveis pós-operatórias possivelmente envolvidas no desenvolvimento de mediastinite foram avaliadas. Análises univariada e multivariada por regressão logística foram aplicadas. RESULTADOS: A incidência de mediastinite foi de 7% (n=11), com taxa de letalidade de 36,1% (n=4). Variáveis associadas com maior risco de mediastinite foram: uso de ATI pediculada (OR 8,25, IC 95% 2,03-66,10, P=0,016), complicações renais (OR 5,10, IC 95% 1,03-25,62, P = 0,049) e reoperação (OR 7,45, IC 95% 1,24-42,17, P=0,023). Na análise multivariada por regressão logística, apenas uma variável permaneceu como fator independente de risco: uso ATI pediculada (OR 7,64, IC 95% 1,95-61,6, P = 0,048), em comparação à ATI esqueletizada. CONCLUSÕES: Sugerimos que diabéticos devem ser considerados para estratégias de minimização do risco de infecção. Nos diabéticos que recebem ATI unilateral, o problema parece estar relacionado à forma como a ATI é dissecada. Diabéticos devem sempre ser considerados para utilização da ATI esqueletizada.

BACKGROUND: Mediastinitis is a serious complication of median sternotomy and is associated to significant morbidity and mortality. Diabetes is a feared risk factor for mediastinitis and viewed with caution by cardiovascular surgeons. OBJECTIVE: To identify risk factors for mediastinitis in diabetics undergoing CABG surgery with use of unilateral ITA in the Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE. METHODS: Retrospective study of 157 diabetics operated between May 2007 and April 2010. Nine preoperative variables, five intraoperative variables and seven postoperative variables possibly involved in the development of postoperative mediastinitis were evaluated. Univariate and multivariate logistic regression analyses were applied. RESULTS: The incidence of mediastinitis was 7% (n=11), with a lethality rate of 36.1% (n=4). Variables associated with increased risk of mediastinitis were: use of pedicled ITA (OR 8.25, 95% CI 2.03 to 66.10, P=0.016), postoperative renal complications (OR 5.10, 95% CI 1.03 to 25.62, P=0.049) and re-operation (OR 7.45, 95% CI 1.24 to 42.17, P=0.023). In multivariate analysis using backward logistic regression, only one variable remained as independent risk factor: use of pedicled ITA (OR 7.64, 95% CI 1.95 to 61.6, P=0.048), in comparison to skeletonized ITA. CONCLUSIONS: We suggest that diabetics should be considered for strategies to minimize risk of infection. In diabetics that undergo unilateral ITA, the problem seems to be related to how ITA is harvested. Diabetics should always be considered for use of skeletonized ITA.

OBJETIVO: A mediastinite é uma complicação grave da esternotomia mediana, estando associada a significativa morbidade e mortalidade. O objetivo deste estudo é identificar fatores de risco para mediastinite em pacientes submetidos à cirurgia de revascularização miocárdica (CRM), sem o uso bilateral da artéria torácica interna (ATI), na Divisão de Cirurgia Cardiovascular do Pronto Socorro Cardiológico de Pernambuco - PROCAPE. MÉTODOS: Estudo retrospectivo compreendendo 500 pacientes consecutivos operados entre maio de 2007 e abril de 2010. Avaliaram-se 10 variáveis pré-operatórias, sete variáveis intraoperatórias e sete variáveis pós-operatórias possivelmente implicadas no desenvolvimento de mediastinite. Aplicaram-se análises univariada e multivariada por regressão logística. RESULTADOS: A incidência de mediastinite foi de 5,6% (n = 28), com taxa de letalidade de 32,1% (n = 9). Na análise multivariada por regressão logística, cinco variáveis permaneceram como fatores de risco independentes: obesidade (OR 2,60; IC 95% 1,1-6,68), diabetes (OR 2,71; IC 95% 1,18-6,65), tabagismo (OR 2,10; IC 95% 1,12-4,67), uso de ATI pediculada (OR 5,17; IC 95% 1,45-18,42) e CRM com circulação extracorpórea (OR 2,26, IC 95% 1,14-5,85). CONCLUSÕES: Este estudo identificou os seguintes fatores de risco independentes para mediastinite após CRM: obesidade, diabetes, tabagismo, uso de ATI pediculada e CRM com circulação extracorpórea.

OBJECTIVE: Mediastinitis is a serious complication of median sternotomy and is associated to significant morbidity and mortality. The aim of this study is to identify risk factors for mediastinitis in patients undergoing coronary artery bypass grafting (CABG), without the use of bilateral internal thoracic artery (ITA), at the Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE. METHODS: A retrospective study of 500 consecutive patients operated on between May 2007 and April 2010. Ten preoperative variables, seven intraoperative variables and seven postoperative variables possibly involved in the development of postoperative mediastinitis were evaluated. Univariate and multivariate logistic regression analyses were performed. RESULTS: The incidence of mediastinitis was 5.6% (n=28), with a lethality rate of 32.1% (n=9). In multivariate analysis using logistic regression, five variables remained as independent risk factors: obesity (OR 2.60, 95% CI 1.11 to 6.68), diabetes (OR 2.71, 95% CI 1.18 to 6.65), smoking (OR 2.10, 95% CI 1.12 to 4.67), use of pedicled internal thoracic artery (OR 5.17, 95% CI 1.45 to 18.42) and on-pump CABG (OR 2.26, 95% CI 1.14 to 5.85). CONCLUSION: This study identified the following independent risk factors for mediastinitis after CABG: obesity, diabetes, smoking, use of pedicled ITA and on-pump CABG.

Muchas veces nos encontramos con problemas de combinatoria difíciles de resolver. Estos problemas aparecen comúnmente no solo en el ámbito académico (por ejemplo en los dominios de la inteligencia artificial, bases de datos, investigación operativa, etc.), sino también en el ámbito de nuestra vida cotidiana (por ejemplo en las áreas de planificación, programación de actividades, asignación de recursos, etc.). Programando con restricciones es posible en muchos casos encontrar, de manera altamente eficiente, soluciones a muchos de estos problemas manejando su complejidad de manera simple e, incluso, elegante. Este artículo es una introducción a la programación con restricciones. Describe de manera sencilla una buena parte de las técnicas y conceptos fundamentales que la sustentan a través de ejemplos abordados de manera clara y concisa. Finaliza con un ejemplo práctico y concreto, mostrando la resolución de un problema clásico usando C++.

Hard combinatorial problems are ubiquitous in our society. They arise in many application domains (e.g., artificial intelligence, data bases, operations research, etc.) and diverse real life settings (e.g., scheduling, timetabling, resource allocation, etc.). Constraint Programming is a technique that manages the complexity of these problems in a simple and even elegant manner. It usually allows us to highly efficiently find solutions to many hard combinatorial problems. This article is an introduction to Constraint Programming. It describes many of its fundamental concepts and techniques through clear and concise examples. It finishes with a practical example, solving a classical problem, using C++.

OBJETIVOS: O objetivo desse estudo foi avaliar a aplicabilidade do EuroSCORE em pacientes submetidos à cirurgia de revascularização miocárdica na Divisão de Cirurgia Cardiovascular do Pronto Socorro Cardiológico de Pernambuco - PROCAPE. MÉTODOS: Estudo retrospectivo envolvendo 500 pacientes operados entre maio de 2007 a abril de 2010. Os registros continham todas as informações utilizadas para calcular o EuroSCORE. O desfecho de interesse foi óbito. Análises univariada e multivariada por regressão logística backward foram aplicadas para verificar associação entre cada variável do EuroSCORE e ocorrência de óbito. Foram calculadas medidas de sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo. O poder de concordância do EuroSCORE entre mortalidade prevista e observada foi mensurado por meio do índice Kappa. A acurácia do modelo foi avaliada por meio da curva ROC (receiver operating characteristic). RESULTADOS: A ocorrência de morte foi de 13% (n=65). Na análise multivariada, nove fatores permaneceram como preditores independentes de morte: doença pulmonar obstrutiva crônica, creatinina >2,3mg/dL, endocardite ativa, estado crítico no pré-operatório, angina instável, fração de ejeção de 30%-50%, infarto agudo do miocárdio <90 dias, cirurgia de emergência e cirurgia adicional. O escore obteve sensibilidade de 88,4%, especificidade de 79,3%, valor preditivo positivo de 40,7%, valor preditivo negativo de 97,7% e 80,6% de concordância. A acurácia mensurada pela área sob a curva ROC foi de 0,892 (IC 95% 0,862-0,922). CONCLUSÕES: O EuroSCORE mostrou-se um índice simples e objetivo, revelando-se um discriminador satisfatório de evolução pós-operatória em pacientes submetidos à cirurgia de revascularização miocárdica em nossa instituição.

OBJECTIVE: The aim of this study is to evaluate the applicability of EuroSCORE in patients undergoing coronary artery bypass graft (CABG) surgery at the Division of Cardiovascular Surgery of Pernambuco Cardiologic Emergency Medical Services - PROCAPE. METHODS: A retrospective study involving 500 patients operated between May 2007 and April 2010. The registers contained all the information used to calculate the EuroSCORE. The outcome of interest was death. Univariate analysis and multivariate analysis by backward logistic regression were applied to assess the association between each variable in the EuroSCORE and deaths. The following parameters were calculated: sensitivity, specificity, positive predictive value, and negative predictive value. The power of concordance between the predicted mortality by the EuroSCORE and the observed mortality was measured using the Kappa coefficient. The accuracy of the model was evaluated by the ROC (receiver operating characteristic) curve. RESULTS: The incidence of death was 13%. In multivariate analysis, nine variables remained independent predictors of death: chronic obstructive pulmonary disease, creatinine >2,3mg/dL, active endocarditis, preoperative critical state, unstable angina, ejection fraction 30% to 50%, acute myocardial infarction < 90 days, emergency surgery and additional surgery. The score had a sensitivity of 88.4%, specificity of 79.3%, positive predictive value of 40.7%, negative predictive value of 97.7% and 80.6% concordance. The accuracy measured by the area under the ROC curve was 0.892 (95% CI 0.862-0.922). CONCLUSIONS: The EuroSCORE proved to be a simple and objective index, revealing a satisfactory discriminator of postoperative evolution in patients undergoing CABG surgery at our institution.