Abstract Introduction: The Technical Performance Score (TPS) was developed and subsequently refined at the Boston Children's Hospital. Our objective was to translate and validate its application in a developing country. Methods: The score was translated into the Portuguese language and approved by the TPS authors. Subsequently, we studied 1,030 surgeries from June 2018 to October 2020. TPS could not be assigned in 58 surgeries, and these were excluded. Surgical risk score was evaluated using Risk Adjustment in Congenital Heart Surgery (or RACHS-1). The impact of TPS on outcomes was studied using multivariable linear and logistic regression adjusting for important perioperative covariates. Results: Median age and weight were 2.2 (interquartile range [IQR] = 0.5-13) years and 10.8 (IQR = 5.6-40) kilograms, respectively. In-hospital mortality was 6.58% (n=64), and postoperative complications occurred in 19.7% (n=192) of the cases. TPS was categorized as 1 in 359 cases (37%), 2 in 464 (47.7%), and 3 in 149 (15.3%). Multivariable analysis identified TPS class 3 as a predictor of longer hospital stay (coefficient: 6.6; standard error: 2.2; P=0.003), higher number of complications (odds ratio [OR]: 1.84; 95% confidence interval [CI]: 1.1-3; P=0.01), and higher mortality (OR: 3.2; 95% CI: 1.4-7; P=0.004). Conclusion: TPS translated into the Portuguese language was validated and showed to be able to predict higher mortality, complication rate, and prolonged postoperative hospital stay in a high-volume Latin-American congenital heart surgery program. TPS is generalizable and can be used as an outcome assessment tool in resource diverse settings.

Abstract Introduction: Elevated neutrophil-lymphocyte ratio (NLR) has been associated with poorer outcomes in cyanotic patients undergoing single ventricle palliation. Little is known about this biomarker on patients with tetralogy of Fallot (TOF), the most common cyanotic congenital heart disease. Our objective is to study the impact of preoperative NLR on outcomes of TOF patients undergoing total repair. Methods: This retrospective study included 116 consecutive patients between January 2014 and December 2018. Preoperative NLR was measured from the last complete blood count test before the surgery. Using the cutoff value of 0.80, according to the receiver-operating characteristic (ROC) curve, the sample was divided into two groups (NLR < 0.80 and ≥ 0.80). The primary endpoint was hospital length of stay (LOS). Results: ROC curves showed that higher preoperative NLR was associated with longer hospital LOS, with an area under the curve of 0.801±0.040 (95% confidence interval 0.722 - 0.879; P<0.001). High preoperative NLR was also associated with long intensive care unit (ICU) LOS (P=0.035). Preoperative NLR predicted longer hospital LOS with a sensitivity of 63% and a specificity of 81.4%. Conclusion: Higher preoperative NLR was associated with long ICU and hospital LOS in patients undergoing TOF repair.

Abstract Since the beginning of the coronavirus disease (COVID-19) pandemic, in March 2020, the number of people infected with COVID-19 worldwide increases continuously. Brazil is being followed with great concern in the international media, as it can, very soon, be the epicenter of the pandemic. Initial surgical data suggest that patients who acquire COVID-19 in the perioperative period are prone to a higher morbidity and mortality, however, evidence in cardiac surgery is still scarce. This article aims to aggregate to the growing evidence suggesting that perioperative infection with severe acute respiratory syndrome coronavirus 2 contributes to a more morbid evolution of the case.

A calagem do cafeeiro é realizada com base em resultados da análise de solo de amostras coletadas na projeção da copa, a parte mais acidificada do terreno devido à aplicação de adubos nitrogenados. Isso tem suscitado dúvidas, por existirem partes da área do solo menos ácidas em cafezais, mormente nas entrelinhas, onde ocorre o acúmulo de bases em vista da arruação. Outro problema da cafeicultura é o uso rotineiro de fórmulas com altos teores de N e de K, sem atentar para as reais necessidades da cultura. Neste trabalho, estudaram-se a calagem e as adubações nitrogenada e potássica, em dois cafezais em produção, os quais vinham sendo normalmente calcariados e adubados. Os dois ensaios foram desenvolvidos em solo podzolizado-de-Lins-e-marïlia do município de Garça (SP) entre 1987 e 1992. Utilizou-se um delineamento fatorial fracionado 1/2 (4 x 4 x 4), com as seguintes doses: calcário - 400, 1.600, 3.600 e 6.400 kg/ha; nitrogênio - 64, 121, 196 e 289 g/cova; potássio (K2O) - 36, 81, 144 e 225 g/cova. Constatou-se efeito maior de nitrogênio e menor de calcário; o potássio não afetou as produções. A saturação por bases, na projeção da copa, foi bem inferior aos 70% preconizados como meta de calagem para o cafeeiro. 0 efeito de N nas produções, não muito acentuado, foi coerente com os teores altos nas folhas. 0 solo continha teores médios a altos de potássio na camada de 0-20 cm e médios nas camadas de 20-40 e 40-60 cm de profundidade, o que explica a ausência de resposta ao nutriente. Pode-se concluir que é necessário rever a meta de saturação por bases para a calagem do cafeeiro, que a adubação nitrogenada pode ser monitorada pela análise foliar e a adubação potássica, pela análise de solo.

Liming of coffee crop is based on soil analysis of samples from the projection of the crown, which is the most acidic part of the soil due to nitrogen fertilization. This procedure is doubt ful since there are less acidic areas of the soil, mainly in the mid rows, due to the accumulation of bases promoted by squaring. Another problem of coffee management is the routine use of NPK formulas with high N and K contents, independently of the actual need of the crop. In this paper the effects of liming, nitrogen and potassium fertilization were studied in two plantations that had received normal application of these insumes. A fractional factorial design 1/2 (4 x 4 x 4) was used, with the following amounts of applied treatments: limestone - 400, 1,600, 3,600 and 6,400 kg/ha; nitrogen - 64, 121, 196 and 289 g/hole; potassium (K2O) - 36, 81, 144 and 225 g/hole. The experiments were performed in Garça, State of São Paulo, Brazil, on a lins-and-marília-podzolized soil. Five crops were recorded from 1987 to 1992. Nitrogen produced the largest yield increases, although not very high, followed by liming; potassium did not affect yields. In the case of liming, low responses were obtained in spite of the fact that the observed base saturation values were much lower than the recommended 70%. Leaf nitrogen contents were rather high, which explained the fair response of the coffee tree to nitrogen fertilization. Medium to high levels of potassium were found in the 0-20 cm soil layer and medium contents in the 20-40 and 40-60 layers, which explained the lack of response to this nutrient. It can be concluded that it is necessary to review the actual base saturation needs for liming coffee. Nitrogen fertilization can be based on leaf and potassium on soil analyses.