Abstract Background: Some evidence suggests an association between gut dysbiosis and cirrhosis progression. The authors investigated Gut Microbiome (GM) influence on 90-day mortality and hospitalization/rehospitalization rates in cirrhotic patients. Methods: Compensated/decompensated outpatients and decompensated inpatients were prospectively included and compared to healthy controls. Clinical, laboratory, GM, and two ratios between phyla were evaluated. Patients were followed up for 90 days for hospitalization/rehospitalization and mortality. Results: 165 individuals were included (50 compensated, 49 decompensated outpatients; 36 decompensated inpatients; 30 healthy), 48.5 % female, mean age was 61, main cirrhosis etiology was hepatitis C (27.3 %), and mostly Child-Pugh (CP) B patients, median MELD of 13. As liver disease progressed, microbiota diversity decreased between the groups (p = 0.05; p < 0.004). There were 9 deaths and 22 hospitalizations or rehospitalizations. GM composition had correlation with norfloxacin (p = 0.36, p = 0.04), encephalopathy (p = 0.31, p = 0.01), lactulose (p = 0.26, p = 0.01), 90-day mortality (p = 0.22, p = 0.04), CP (p = 0.17, p = 0.01), previous 6-month antibiotic use (p = 0.16, p = 0.01), MELD (p = 0.145, p = 0.01), ALBI (p = 0.1, p = 0.04) and 90-day hospitalization/rehospitalization (p = 0.08, p = 0.03). Firmicutes/Bacteroidetes (F/B) and Firmicutes/Proteobacteria (F/P) ratios were progressively lower and more significant and had an association with 90-day mortality (p < 0.001). Three MELD set-points (≥ 15, 18 and 20) were significantly associated with both ratios, with similar accuracies. Conclusions: GM dysbiosis was associated with higher CP, MELD, 90-day mortality and hospitalization/rehospitalization. F/B and F/P ratios were associated with 90-day mortality. Background progression (GM 90day day hospitalizationrehospitalization hospitalization rehospitalization patients Methods Compensateddecompensated Compensated controls Clinical laboratory evaluated Results 16 50 (5 compensated 4 3 healthy, , healthy) 485 48 5 48. female 61 27.3 273 27 (27. %, %) ChildPugh Child Pugh (CP 13 progressed 0.05 005 0 05 0.004. 0004 0.004 . 004 0.004) 2 rehospitalizations 036 0.36 0.04, 0.04 04 031 31 0.31 0.01, 001 0.01 01 0.01) 026 26 0.26 022 0.22 017 17 0.17 6month month 6 016 0.16 0145 145 0.145 1 0.1 008 08 0.08 0.03. 003 0.03 03 0.03) FirmicutesBacteroidetes Firmicutes Bacteroidetes FB F (F/B FirmicutesProteobacteria Proteobacteria FP P (F/P 0.001. 0001 0.001 0.001) setpoints set points ≥ ( 15 20 accuracies Conclusions 27. (27 0.0 00 000 0.00 0.3 02 0.2 014 14 0.14 0. (2

CONTEXTO E OBJETIVO: A ocorrência de fibrilação atrial (FA) assintomática é comum. A identificação da FA é importante e está associada com maior morbimortalidade. O Holter de 24 horas vem sendo utilizado para a detecção de FA paroxística (FAP). O objetivo desse estudo é investigar a relação entre a ocorrência de FAP no Holter de 24 horas e os sintomas na população estudada.TIPO DE ESTUDO E LOCAL: Estudo transversal realizado em um hospital de cardiologia.MÉTODOS: Análise de 11.321 exames consecutivos de Holter de 24 horas realizados em serviço de referência. Foram excluídos pacientes com marcapasso e aqueles com FA durante toda a gravação.RESULTADOS: Foram identificados 75 (0,67%) exames apresentando FAP. A idade média foi de 67 ± 13 anos e 45% eram do sexo feminino. A frequência cardíaca (FC) encontrada nas 24 horas foi mínima de 45 ± 8 bpm, média de 74 ± 17 bpm e máxima de 151 ± 32 bpm. Entre os exames apresentando FAP, apenas 26% apresentaram sintomas. O único fator testado que evidenciou correlação com FA sintomática foi a FC máxima (165 ± 34 versus 147 ± 30 bpm) (P = 0,03). O uso de betabloqueadores teve efeito protetor para ocorrência de sintomas na FA (odds ratio: 0.24, P = 0.031).CONCLUSÕES: A FAP é um evento raro em Holter de 24 horas. A FC máxima nas 24 horas foi o único fator relacionado com FA sintomática e o uso de betabloqueadores teve efeito protetor para ocorrência de sintomas na FA.

CONTEXT AND OBJECTIVE: Occurrences of asymptomatic atrial fibrillation (AF) are common. It is important to identify AF because it increases morbidity and mortality. 24-hour Holter has been used to detect paroxysmal AF (PAF). The objective of this study was to investigate the relationship between occurrence of PAF in 24-hour Holter and the symptoms of the population studied.DESIGN AND SETTING: Cross-sectional study conducted at a cardiology hospital.METHODS: 11,321 consecutive 24-hour Holter tests performed at a referral service were analyzed. Patients with pacemakers or with AF throughout the recording were excluded.RESULTS: There were 75 tests (0.67%) with PAF. The mean age was 67 ± 13 years and 45% were female. The heart rate (HR) over the 24 hours was a minimum of 45 ± 8 bpm, mean of 74 ± 17 bpm and maximum of 151 ± 32 bpm. Among the tests showing PAF, only 26% had symptoms. The only factor tested that showed a correlation with symptomatic AF was maximum HR (165 ± 34 versus 147 ± 30 bpm) (P = 0.03). Use of beta blockers had a protective effect against occurrence of PAF symptoms (odds ratio: 0.24, P = 0.031).CONCLUSIONS: PAF is a rare event in 24-hour Holter. The maximum HR during the 24 hours was the only factor correlated with symptomatic AF, and use of beta blockers had a protective effect against AF symptom occurrence.

FUNDAMENTO: No atendimento ao episódio sincopal é necessário estratificar o risco para melhor diferenciar pacientes que necessitam de internação hospitalar daqueles que podem ser liberados. Os critérios utilizados pelos médicos avaliadores desses pacientes em emergências cardiológicas em nosso meio são desconhecidos. OBJETIVOS: Analisar quais os critérios adotados para internação hospitalar, diferenciá-los dos utilizados nos pacientes liberados e compará-los com os preditores de alto risco definidos pelo escore de OESIL já validado para esse fim. MÉTODOS: Estudo transversal em pacientes diagnosticados com síncope na emergência em nossa instituição no ano de 2011. RESULTADOS: Dos 46.476 atendimentos realizados naquele ano, 216 foram descritos como síncope. Dos 216 pacientes analisados, 39% foram internados, sendo que as principais variáveis associadas à admissão foram síncope prévia, doença cardíaca conhecida, história negativa para acidente vascular encefálico no passado, ECG alterado e possuir plano de súde. Na comparação internação contra não internação, os escores OESIL 0-1 foram associados a maior chance de liberação hospitalar; os escores 2-3 apresentaram maior associação com internação. Um escore OESIL >2 demonstrou razão de chances 7,8 vezes maior de internação comparado com o escore 0 (p < 0,001; IC95%: 4,03-15,11). Aproximadamente 39% dos pacientes não tiveram definição etiológica e em 18% foi identificada uma causa cardiológica. CONCLUSÕES: Fatores como doença cardiovascular conhecida, história sincopal prévia, ausência de AVC prévio, possuir seguro de saúde e eletrocardiograma alterado foram os critérios utilizados pelos médicos em emergência para indicar internação hospitalar. Houve boa correlação entre os critérios clínicos e os critérios de risco do OESIL descritos na literatura.

BACKGROUND: Risk stratification of a syncopal episode is necessary to better differentiate patients needing hospitalization of those who can be safely set home from the emergency department. Currently there are no strict guidelines from our Brazilian medical societies to guide the cardiologist that evaluate patients in an emergency setting. OBJECTIVES: To analyze the criteria adopted for defining the need for hospitalization and compare them with the predictors of high risk for adverse outcome defined by the OESIL score that is already validated in the medical literature for assessing syncope. METHODS: A cross-sectional study of patients diagnosed with syncope during emergency department evaluation at our institution in the year 2011. RESULTS: Of the 46,476 emergency visits made in that year, 216 were due to syncope. Of the 216 patients analyzed, 39% were hospitalized. The variables associated with the need of hospital admission were - having health care insurance, previous known cardiovascular disease, no history of prior stroke, previous syncope and abnormal electrocardiograms during the presentation. In comparison with those not admitted OESIL scores of 0-1 were associated with a greater chance of emergency discharge; 2-3 scores showed greater association with the need of hospitalization. A score > 2 OESIL provided an odds ratio 7.8 times higher for hospitalization compared to score 0 (p <0.001, 95% CI:4,03-15,11). In approximately 39% no etiological cause for syncope was found and in 18% cardiac cause was identified. CONCLUSIONS: Factors such as cardiovascular disease, prior history of syncope, health insurance, no previous stroke and abnormal electrocardiograms, were the criteria used by doctors to indicate hospital admission. There was a good correlation between the clinical judgment and the OESIL criteria for high risk described in literature.