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Resumo Fundamento O choque cardiogênico (CC) refratário está associado com altas taxas de mortalidade, e o uso de oxigenação por membrana extracorpórea venoarterial (VA-ECMO, do inglês venoarterial extracorporeal membrane oxygenation) como uma opção terapêutica tem gerado discussões. Nesse sentido, sua custo-efetividade, principalmente em países de baixa e média renda como o Brasil, continua incerto.Objetivos: Conduzir uma análise de custo-efetividade na perspectiva do Sistema Único de Saúde (SUS) para avaliar a custo-efetividade de VA-ECMO combinado com o tratamento padrão em comparação ao tratamento padrão isolado em pacientes adultos com CC refratário. Métodos Acompanhamos uma coorte de pacientes com CC refratário tratados com VA-ECMO em centros de assistência terciária do sul brasileiro. Coletamos dados de desfechos e custos hospitalares. Realizamos uma revisão sistemática para complementar nossos dados e usamos o modelo de Markov para estimar a razão de custo-efetividade incremental (RCEI) por ano de vida ajustado pela qualidade (QALY) e por ano de vida ganho. Resultados Na análise do caso-base, a VA-ECMO gerou uma RCEI de Int$ 37 491 por QALY. Análises de sensibilidade identificaram o custo de internação, o risco relativo de sobrevida, e a sobrevida do grupo submetido à VA-ECMO como principais variáveis influenciando os resultados. A análise de sensibilidade probabilística mostrou um benefício do uso de VA-ECMO, com uma probabilidade de 78% de custo-efetividade no limiar recomendado de disposição a pagar. Conclusões Nosso estudo sugere que, dentro do SUS, VA-ECMO pode ser uma terapia custo-efetiva para o CC refratário. Contudo, a escassez de dados sobre a eficácia e de ensaios clínicos recentes que abordem seus benefícios em subgrupos específicos de pacientes destaca a necessidade de mais pesquisas. Ensaios clínicos rigorosos, incluindo perfis diversos de pacientes, são essenciais para confirmar a custo-efetividade com uso de VA-ECMO e assegurar acesso igualitário a intervenções médicas avançadas dentro dos sistemas de saúde, especialmente em países com desigualdades socioeconômicas como o Brasil. (CC mortalidade VAECMO, VAECMO VA ECMO, ECMO (VA-ECMO oxygenation discussões sentido custoefetividade, custoefetividade efetividade, efetividade Brasil incerto.Objetivos incertoObjetivos incerto Objetivos SUS (SUS brasileiro hospitalares (RCEI QALY (QALY ganho casobase, casobase caso base, base caso-base Int 3 49 internação resultados 78 pagar custoefetiva efetiva Contudo pesquisas rigorosos saúde 4 7

Abstract Background Refractory cardiogenic shock (CS) is associated with high mortality rates, and the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a therapeutic option has generated discussions. Therefore, its cost-effectiveness, especially in low- and middle-income countries like Brazil, remains uncertain.Objectives: To conduct a cost-utility analysis from the Brazilian Unified Health System perspective to assess the cost-effectiveness of VA-ECMO combined with standard care compared to standard care alone in adult refractory CS patients. Methods We followed a cohort of refractory CS patients treated with VA-ECMO in tertiary care centers located in Southern Brazilian. We collected data on hospital outcomes and costs. We conducted a systematic review to supplement our data and utilized a Markov model to estimate incremental cost-effectiveness ratios (ICERs) per quality-adjusted life year (QALY) and per life-year gained. Results In the base-case analysis, VA-ECMO yielded an ICER of Int$ 37,491 per QALY. Sensitivity analyses identified hospitalization cost, relative risk of survival, and VA-ECMO group survival as key drivers of results. Probabilistic sensitivity analysis favored VA-ECMO, with a 78% probability of cost-effectiveness at the recommended willingness-to-pay threshold. Conclusions Our study suggests that, within the Brazilian Health System framework, VA-ECMO may be a cost-effective therapy for refractory CS. However, limited efficacy data and recent trials questioning its benefit in specific patient subsets highlight the need for further research. Rigorous clinical trials, encompassing diverse patient profiles, are essential to confirm cost-effectiveness and ensure equitable access to advanced medical interventions within healthcare systems, particularly in socio-economically diverse countries like Brazil. (CS rates VAECMO VA ECMO (VA-ECMO discussions Therefore costeffectiveness, costeffectiveness cost effectiveness, effectiveness low middleincome middle income Brazil uncertain.Objectives uncertainObjectives uncertain Objectives costutility utility costs ICERs (ICERs qualityadjusted quality adjusted QALY (QALY lifeyear gained basecase base case Int 37491 37 491 37,49 results VAECMO, ECMO, 78 willingnesstopay willingness pay threshold that framework costeffective effective However research profiles systems socioeconomically socio economically 3749 3 49 37,4 7 374 4 37,

https://doi.org/10.36660/abc.20230672

[SciELO Preprints] - Guidelines on the Diagnosis and Treatment of Hypertrophic Cardiomyopathy – 2024
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Fernandes, Fabio Simões, Marcus V. Correia, Edileide de Barros Marcondes-Braga, Fabiana G. Coelho-Filho, Otavio Rizzi Mesquita, Cláudio Tinoco Mathias-Junior, Wilson Rochitte, Carlos Eduardo Ramires, Felix José Alvarez Alves, Silvia Marinho Martins Montera, Marcelo Westerlund Lopes, Renato Delascio Oliveira-Junior, Mucio Tavares Scolari, Fernando L. Avila, Walkiria Samuel Canesin, Manoel Fernandes Bacal, Fernando Bocchi, Edimar Alcides Moura, Lídia Ana Zytynski Saad, Eduardo Benchimol Scanavacca, Mauricio I. Valdigem, Bruno Pereira Cano , Manuel Nicolas Abizaid , Alexandre Ribeiro, Henrique Barbosa Lemos-Neto, Pedro Alves Ribeiro, Gustavo Calado de Aguiar Jatene, Fabio Biscegli Dias, Ricardo Ribeiro Beck-da-Silva, Luis Rohde, Luis Eduardo P. Bittencourt, Marcelo Imbroinise Pereira, Alexandre Krieger, José Eduardo Villacorta, Humberto Martins, Wolney de Andrade Figueiredo-Neto, José Albuquerque de Cardoso , Juliano Novaes Pastore, Carlos Alberto Jatene, Ieda Biscegli Tanaka, Ana Cristina Sayuri Hotta, Viviane Tiemi Romano, Minna Moreira Dias Albuquerque, Denilson Campos de Mourilhe-Rocha, Ricardo Hajjar, Ludhmila Abrahão Brito, Fabio Sandoli de Caramelli , Bruno Calderaro, Daniela Farsky, Pedro Silvio Colafranceschi , Alexandre Siciliano Pinto, Ibraim Masciarelli Vieira , Marcelo Luiz Campos Danzmann, Luiz Claudio Barberato , Silvio Henrique Mady, Charles Martinelli-Filho, Martino Torbey , Ana Flavia Malheiros Schwartzmann, Pedro Vellosa Macedo, Ariane Vieira Scarlatelli Ferreira , Silvia Moreira Ayub Schmidt, Andre Melo , Marcelo Dantas Tavares de Lima-Filho, Moysés Oliveira Sposito, Andrei C. Brito, Flavio de Souza Biolo, Andreia Madrini-Junior, Vagner Rizk, Stéphanie Itala Mesquita, Evandro Tinoco

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Publication date: 2024-04-08

Abstract: Pt Es En

A cardiomiopatia hipertrófica (CMH) é uma forma de doença do músculo cardíaco de causa genética, caracterizada pela hipertrofia das paredes ventriculares. O diagnóstico requer detecção por métodos de imagem (Ecocardiograma ou Ressonância Magnética Cardíaca) de qualquer segmento da parede do ventrículo esquerdo com espessura > 15 mm, sem outra causa provável. A análise genética permite identificar mutações de genes codificantes de diferentes estruturas do sarcômero responsáveis pelo desenvolvimento da CMH em cerca de 60% dos casos, permitindo o rastreio de familiares e aconselhamento genético, como parte importante do manejo dos pacientes e familiares. Vários conceitos sobre a CMH foram recentemente revistos, incluindo sua prevalência de 1 em 250 indivíduos, não sendo, portanto, uma doença rara, mas subdiagnosticada. A vasta maioria dos pacientes é assintomática. Naqueles sintomáticos, a obstrução do trato de saída do ventrículo esquerdo (OTSVE) é o principal distúrbio responsável pelos sintomas, devendo-se investigar a sua presença em todos os casos. Naqueles em que o ecocardiograma em repouso ou com Manobra de Valsalva não detecta gradiente intraventricular significativo (> 30 mmHg), devem ser submetidos à ecocardiografia com esforço físico para detecção da OTSVE.   Pacientes com sintomas limitantes e grave OTSVE, refratários ao uso de betabloqueadores e verapamil, devem receber terapias de redução septal ou uso de novas drogas inibidoras da miosina cardíaca. Por fim, os pacientes adequadamente identificados com risco aumentado de morta súbita podem receber medida profilática com implante de cardiodesfibrilador implantável (CDI).

La miocardiopatía hipertrófica (MCH) es una forma de enfermedad cardíaca de origen genético, caracterizada por el engrosamiento de las paredes ventriculares. El diagnóstico requiere la detección mediante métodos de imagen (Ecocardiograma o Resonancia Magnética Cardíaca) que muestren algún segmento de la pared ventricular izquierda con un grosor > 15 mm, sin otra causa probable. El análisis genético permite identificar mutaciones en genes que codifican diferentes estructuras del sarcómero responsables del desarrollo de la MCH en aproximadamente el 60% de los casos, lo que permite el tamizaje de familiares y el asesoramiento genético, como parte importante del manejo de pacientes y familiares. Varios conceptos sobre la MCH han sido revisados recientemente, incluida su prevalencia de 1 entre 250 individuos, por lo tanto, no es una enfermedad rara, sino subdiagnosticada. La gran mayoría de los pacientes son asintomáticos. En los casos sintomáticos, la obstrucción del tracto de salida ventricular izquierdo (TSVI) es el trastorno principal responsable de los síntomas, y su presencia debe investigarse en todos los casos. En aquellos en los que el ecocardiograma en reposo o la maniobra de Valsalva no detecta un gradiente intraventricular significativo (> 30 mmHg), deben someterse a ecocardiografía de esfuerzo para detectar la obstrucción del TSVI. Los pacientes con síntomas limitantes y obstrucción grave del TSVI, refractarios al uso de betabloqueantes y verapamilo, deben recibir terapias de reducción septal o usar nuevos medicamentos inhibidores de la miosina cardíaca. Finalmente, los pacientes adecuadamente identificados con un riesgo aumentado de muerte súbita pueden recibir medidas profilácticas con el implante de un cardioversor-desfibrilador implantable (CDI).

Hypertrophic cardiomyopathy (HCM) is a form of genetically caused heart muscle disease, characterized by the thickening of the ventricular walls. Diagnosis requires detection through imaging methods (Echocardiogram or Cardiac Magnetic Resonance) showing any segment of the left ventricular wall with a thickness > 15 mm, without any other probable cause. Genetic analysis allows the identification of mutations in genes encoding different structures of the sarcomere responsible for the development of HCM in about 60% of cases, enabling screening of family members and genetic counseling, as an important part of patient and family management. Several concepts about HCM have recently been reviewed, including its prevalence of 1 in 250 individuals, hence not a rare but rather underdiagnosed disease. The vast majority of patients are asymptomatic. In symptomatic cases, obstruction of the left ventricular outflow tract (LVOT) is the primary disorder responsible for symptoms, and its presence should be investigated in all cases. In those where resting echocardiogram or Valsalva maneuver does not detect significant intraventricular gradient (> 30 mmHg), they should undergo stress echocardiography to detect LVOT obstruction. Patients with limiting symptoms and severe LVOT obstruction, refractory to beta-blockers and verapamil, should receive septal reduction therapies or use new drugs inhibiting cardiac myosin. Finally, appropriately identified patients at increased risk of sudden death may receive prophylactic measure with implantable cardioverter-defibrillator (ICD) implantation.

https://doi.org/10.1590/SciELOPreprints.8394

Attention-deficit/hyperactivity disorder in Mozambique: an epidemiological investigation in a primary school sample Attentiondeficit/hyperactivity Attentiondeficithyperactivity Attention deficit/hyperactivity deficit hyperactivity Mozambique Attentiondeficit deficithyperactivity
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Daniel, Helena Mutede Cutótua

; Duarte, Igor

; Caye, Arthur

; Suleman, Antonio

; Fumo, Wilza

; Rohde, Luis Augusto

Brazilian Journal of Psychiatry

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2024, Volume 46 elocation e20233343

Abstract: En | Text: En | PDF: En

Objective: To evaluate the prevalence of attention-deficit/hyperactivity disorder (ADHD), comorbidity rates with disruptive behavior disorders and main negative outcomes in primary school students in Nampula, Mozambique. Methods: We selected a random sample of 748 students for ADHD screening from a population of around 43,000 primary school students. The Swanson, Nolan, and Pelham Rating Scale version IV was applied to both parents and teachers. All students who screened positive (n=76) and a propensity score-matched random subset of students who screened negative (n=76) were assessed by a child psychiatrist. Results: The prevalence of ADHD was estimated at 13.4% (95%CI 11.5-19.2), and 30.6% of those with ADHD presented comorbid disruptive behavior disorders. Students with ADHD (n=36) had significantly higher rates of both substance use (alcohol, marijuana) (p < 0.001), and school failures than controls (n=96; p < 0.001). Comorbidity between ADHD and disruptive behavior disorders increased the chance of substance use (p < 0.001). Secondary analyses with more restrictive ADHD diagnostic criteria revealed a lower prevalence rate (6.7%; 95%CI 5.2-12.9) with similar patterns of associated factors and negative outcomes. Conclusion: Our findings demonstrated that ADHD is a prevalent mental disorder in Mozambique, and it is associated with similar comorbid profiles, predisposing factors, and negative outcomes, as in other cultures. Objective attentiondeficit/hyperactivity attentiondeficithyperactivity attention deficit/hyperactivity deficit hyperactivity ADHD, , (ADHD) Nampula Mozambique Methods 74 43000 43 000 43,00 Swanson Nolan teachers n=76 n76 n 76 (n=76 scorematched score matched psychiatrist Results 134 13 4 13.4 95CI CI 95 11.519.2, 115192 11.5 19.2 11 5 19 2 11.5-19.2) 306 30 6 30.6 n=36 n36 36 (n=36 alcohol, alcohol (alcohol marijuana 0.001, 0001 0.001 0 001 0.001) n=96 n96 96 (n=96 0.001. . 6.7% 67 7 (6.7% 5.212.9 52129 5.2 12.9 12 9 5.2-12.9 Conclusion profiles cultures attentiondeficit deficithyperactivity (ADHD 4300 00 43,0 n=7 n7 (n=7 1 13. 519 11.519.2 11519 115 11. 192 19. 11.5-19.2 3 30. n=3 n3 (n=3 0.00 n=9 n9 (n=9 6.7 (6.7 212 5.212. 5212 52 5. 129 12. 5.2-12. 430 43, n= (n= 51 11.519. 1151 11.5-19. 0.0 6. (6. 21 5.212 521 5.2-12 (n 11.519 11.5-19 0. (6 5.21 5.2-1 11.51 11.5-1 ( 5.2- 11.5-

https://doi.org/10.47626/1516-4446-2023-3343

Diretriz sobre Diagnóstico e Tratamento da Cardiomiopatia Hipertrófica – 2024 202 20 2
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Fernandes, Fabio

; Simões, Marcus V.

; Correia, Edileide de Barros

; Marcondes-Braga, Fabiana Goulart

; Coelho-Filho, Otavio Rizzi

; Mesquita, Cláudio Tinoco

; Mathias Junior, Wilson

; Antunes, Murillo de Oliveira

; Arteaga-Fernández, Edmundo

; Rochitte, Carlos Eduardo

; Ramires, Felix José Alvarez

; Alves, Silvia Marinho Martins

; Montera, Marcelo Westerlund

; Lopes, Renato Delascio

; Oliveira Junior, Mucio Tavares de

; Scolari, Fernando Luis

; Avila, Walkiria Samuel

; Canesin, Manoel Fernandes

; Bocchi, Edimar Alcides

; Bacal, Fernando

; Moura, Lidia Zytynski

; Saad, Eduardo Benchimol

; Scanavacca, Mauricio Ibrahim

; Valdigem, Bruno Pereira

; Cano, Manuel Nicolas

; Abizaid, Alexandre Antonio Cunha

; Ribeiro, Henrique Barbosa

; Lemos Neto, Pedro Alves

; Ribeiro, Gustavo Calado de Aguiar

; Jatene, Fabio Biscegli

; Dias, Ricardo Ribeiro

; Beck-da-Silva, Luis

; Rohde, Luis Eduardo Paim

; Bittencourt, Marcelo Imbroinise

; Pereira, Alexandre da Costa

; Krieger, José Eduardo

; Villacorta Junior, Humberto

; Martins, Wolney de Andrade

; Figueiredo Neto, José Albuquerque de

; Cardoso, Juliano Novaes

; Pastore, Carlos Alberto

; Jatene, Ieda Biscegli

; Tanaka, Ana Cristina Sayuri

; Hotta, Viviane Tiemi

; Romano, Minna Moreira Dias

; Albuquerque, Denilson Campos de

; Mourilhe-Rocha, Ricardo

; Hajjar, Ludhmila Abrahão

; Brito Junior, Fabio Sandoli de

; Caramelli, Bruno

; Calderaro, Daniela

; Farsky, Pedro Silvio

; Colafranceschi, Alexandre Siciliano

; Pinto, Ibraim Masciarelli Francisco

; Vieira, Marcelo Luiz Campos

; Danzmann, Luiz Claudio

; Barberato, Silvio Henrique

; Mady, Charles

; Martinelli Filho, Martino

; Torbey, Ana Flavia Malheiros

; Schwartzmann, Pedro Vellosa

; Macedo, Ariane Vieira Scarlatelli

; Ferreira, Silvia Moreira Ayub

; Schmidt, Andre

; Melo, Marcelo Dantas Tavares de

; Lima Filho, Moysés Oliveira

; Sposito, Andrei C.

; Brito, Flávio de Souza

; Biolo, Andreia

; Madrini Junior, Vagner

; Rizk, Stephanie Itala

; Mesquita, Evandro Tinoco

Arquivos Brasileiros de Cardiologia

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2024, Volume 121 N. 7 elocation e202400415

Abstract: Pt | Text: Pt | PDF: Pt

https://doi.org/10.36660/abc.20240415

When should a university student be allowed academic accommodations for attention-deficit/hyperactivity disorder? A position statement for a unified procedure for use in Brazil attentiondeficit/hyperactivity attentiondeficithyperactivity attention deficit/hyperactivity deficit hyperactivity disorder attentiondeficit deficithyperactivity
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Lisboa, Bernardo Oppermann

; Caye, Arthur

; Hernandes, Angelo Masson

; da Silva, Antonio Geraldo

; Rieder, Carlos Roberto M.

; Sonuga-Barke, Edmund

; Kestelman, Iane

; Nelson, Jason M.

; Castanho, Marisa Irene Siqueira

; Fonseca, Rochele Paz

; Hinshaw, Stephen P.

; Rohde, Luis Augusto

Brazilian Journal of Psychiatry

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aug 2023, Volume 45 N. 4 Pages 373 - 378

Abstract: En | Text: En | PDF: En

In higher education, reasonable accommodations are increasingly made for students with a wide range of disabilities. However, rigorous assessment is paramount to ensure these students are supported while preventing ineligible students from gaining unfair advantages. In this context, we sought to identify under which circumstances a university student should be allowed academic accommodation for attention-deficit/hyperactivity disorder (ADHD) and to outline an evidence-based policy for use in Brazil based on the global experience. We reviewed the literature to acquire information on what documents are commonly required by disability services before accommodations for ADHD are provided (including detection of malingering) and scrutinized the eligibility criteria of leading universities worldwide. Finally, renowned experts in the field and national stakeholders were consulted. Despite an exhaustive search, we found no international standard for the assessment of students with ADHD who request academic accommodation; even renowned institutions worldwide differ in their approaches to granting accommodations on the grounds of ADHD. Therefore, we propose a unified set of nationwide criteria for Brazilian universities, which could be generalized internationally. Higher education institutions in Brazil and beyond may benefit from adoption of such criteria. disabilities However advantages context attentiondeficit/hyperactivity attentiondeficithyperactivity attention deficit/hyperactivity deficit hyperactivity (ADHD evidencebased evidence experience including malingering Finally consulted search Therefore internationally attentiondeficit deficithyperactivity

https://doi.org/10.47626/1516-4446-2022-2999

Papel Incremental da Classificação da New York Heart Association e dos Índices do Teste de Exercício Cardiopulmonar para Prognóstico na Insuficiência Cardíaca: um Estudo de Coorte Cardíaca
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Engster, Pedro Henrique de Borba

; Zimerman, André

; Schaan, Thomas

; Borges, Marina S.

; Souza, Gabriel

; Costa, Giovanni Donelli

; Rohde, Luis Eduardo

; Silveira, Anderson Donelli da

Arquivos Brasileiros de Cardiologia

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2023, Volume 120 N. 11 elocation e20230077

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Fundamento A precisão da classificação da New York Heart Association (NYHA) para avaliar o prognóstico pode ser limitada em comparação com os parâmetros objetivos do teste de exercício cardiopulmonar (TECP) na insuficiência cardíaca (IC). Objetivo Investigar o valor prognóstico da classificação da NYHA e da classe Weber. Métodos Foram incluídos pacientes ambulatoriais adultos com IC submetidos a TECP em um centro terciário brasileiro. A classe NYHA atribuída pelo médico e a classe Weber derivada do TECP foram estratificadas como “favorável” (NYHA I ou II com Weber A ou B) ou “adversa” (NYHA III ou IV com Weber C ou D). Pacientes com uma classe favorável e uma classe adversa foram definidos como “discordantes”. O desfecho primário foi o tempo para mortalidade por todas as causas. Um valor de p bilateral < 0,05 foi considerado estatisticamente significativo. Resultados Foram incluídos 834 pacientes. A mediana de idade foi de 57 anos; 42% (351) eram do sexo feminino e a mediana da fração de ejeção do ventrículo esquerdo foi de 32%. Entre os pacientes com classes NYHA e Weber concordantes, aqueles com classes NYHA e Weber adversas tiveram mortalidade por todas as causas significativamente maior em comparação com aqueles com classes favoráveis ( hazard ratio [HR]: 5,65; intervalo de confiança de 95%: 3,38 a 9,42). Entre os pacientes com classes discordantes, não houve diferença significativa na mortalidade por todas as causas (HR: 1,38; intervalo de confiança de 95%: 0,82 a 2,34). No modelo multivariado, incrementos na classe NYHA (HR: 1,55 por aumento na classe; intervalo de confiança de 95%: 1,26 a 1,92) e reduções no VO 2 pico (HR: 1,47 por diminuição de 3 ml/kg/min; intervalo de confiança de 95%: 1,28 a 1,70) previu significativamente a mortalidade. Conclusões A classe NYHA atribuída pelo médico e as medidas objetivas do TECP fornecem informações prognósticas complementares para pacientes com IC. (TECP . (IC) brasileiro “favorável B “adversa D. D D) discordantes. discordantes “discordantes” 005 0 05 0,0 significativo 83 5 anos 42 351 (351 32 32% concordantes HR [HR] 5,65 565 65 95% 95 338 38 3,3 9,42. 942 9,42 9 9,42) (HR 1,38 138 1 082 82 0,8 2,34. 234 2,34 34 2,34) multivariado 155 55 1,5 126 26 1,2 1,92 192 92 147 47 1,4 ml/kg/min mlkgmin ml kg min 128 28 1,70 170 70 (IC “discordantes 00 0, 8 4 35 (35 [HR 5,6 56 6 33 3, 94 9,4 1,3 13 08 23 2,3 15 1, 12 1,9 19 14 1,7 17 7 (3 5, 9, 2,

Abstract Background The accuracy of the New York Heart Association (NYHA) classification to assess prognosis may be limited compared with objective cardiopulmonary exercise test (CPET) parameters in heart failure (HF). Objective To investigate the prognostic value of the NYHA classification in addition to Weber class. Methods Adult outpatients with HF undergoing CPET in a Brazilian tertiary care center were included. The physician-assigned NYHA class and the CPET-derived Weber class were stratified into “favorable” (NYHA I or II; Weber A or B) or “adverse” (NYHA III or IV; Weber C or D). Patients with one favorable class and one adverse class were defined as “discordant.” The primary endpoint was time to all-cause mortality. A 2-sided p value < 0.05 was considered statistically significant. Results A total of 834 patients were included. Median age was 57 years; 42% (351) were female, and median left ventricular ejection fraction was 32%. Among patients with concordant NYHA and Weber classes, those with adverse NYHA and Weber classes had significantly higher all-cause mortality compared to those with favorable classes (hazard ratio [HR]: 5.65; 95% confidence interval [CI]: 3.38 to 9.42). Among patients with discordant classes, there was no significant difference in all-cause mortality (HR: 1.38; 95% CI: 0.82 to 2.34). In the multivariable model, increments in NYHA class (HR: 1.55 per class increase; 95% CI: 1.26 to 1.92) and reductions in peak VO 2 (HR: 1.47 per 3 ml/kg/min decrease; 95% CI: 1.28 to 1.70) significantly predicted mortality. Conclusions Physician-assigned NYHA class and objective CPET measures provide complementary prognostic information for patients with HF. (CPET . (HF) included physicianassigned physician assigned CPETderived derived “favorable II B “adverse IV D. D D) discordant. “discordant. allcause all cause 2sided sided 005 0 05 0.0 83 5 years 42 351 (351 female 32 32% hazard HR [HR] 5.65 565 65 95 CI [CI] 338 38 3.3 9.42. 942 9.42 9 9.42) (HR 1.38 138 1 082 82 0.8 2.34. 234 2.34 34 2.34) model 155 55 1.5 increase 126 26 1.2 1.92 192 92 147 47 1.4 mlkgmin ml kg min decrease 128 28 1.70 170 70 Physicianassigned Physician (HF “discordant 00 0. 8 4 35 (35 [HR 5.6 56 6 [CI 33 3. 94 9.4 1.3 13 08 23 2.3 15 1. 12 1.9 19 14 1.7 17 7 (3 5. 9. 2. (

https://doi.org/10.36660/abc.20230077

Identifying Depression Early in Adolescence: assessing the performance of a risk score for future onset of depression in an independent Brazilian sample Adolescence
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Cunha, Graccielle R.

; Caye, Arthur

; Pan, Pedro

; Fisher, Helen L.

; Pereira, Rivka

; Ziebold, Carolina

; Bressan, Rodrigo

; Miguel, Eurípedes Constantino

; Salum, Giovanni A.

; Rohde, Luis Augusto

; Kohrt, Brandon A.

; Mondelli, Valeria

; Kieling, Christian

; Gadelha, Ary

Brazilian Journal of Psychiatry

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2023, Volume 45 N. 3 Pages 242 - 248

Abstract: En | Text: En | PDF: En

Objective: The Identifying Depression Early in Adolescence Risk Score (IDEA-RS) was recently developed in Brazil using data from the Pelotas 1993 Birth Cohort to estimate the individualized probability of developing depression in adolescence. This model includes 11 sociodemographic variables and has been assessed in longitudinal studies from four other countries. We aimed to test the performance of IDEA-RS in an independent, community-based, school-attending sample within the same country: the Brazilian High-Risk Cohort. Methods: Standard external validation, refitted, and case mix-corrected models were used to predict depression among 1442 youth followed from a mean age of 13.5 years at baseline to 17.7 years at follow-up, using probabilities calculated with IDEA-RS coefficients. Results: The area under the curve was 0.65 for standard external validation, 0.70 for the case mix-corrected model, and 0.69 for the refitted model, with discrimination consistently above chance for predicting depression in the new dataset. There was some degree of miscalibration, corrected by model refitting (calibration-in-the-large reduced from 0.77 to 0). Conclusion: IDEA-RS was able to parse individuals with higher or lower probability of developing depression beyond chance in an independent Brazilian sample. Further steps should include model improvements and additional studies in populations with high levels of subclinical symptoms to improve clinical decision making. Objective IDEARS IDEA RS (IDEA-RS 199 adolescence 1 countries communitybased, communitybased community based, based community-based schoolattending school attending country HighRisk High Methods validation mixcorrected mix 144 135 13 5 13. 177 17 7 17. followup, followup follow up, up follow-up coefficients Results 065 0 65 0.6 070 70 0.7 069 69 dataset miscalibration calibrationinthelarge calibration large 077 77 0. . 0) Conclusion making 19 14 06 6 07

https://doi.org/10.47626/1516-4446-2022-2775

Inattention symptoms in early pregnancy predict parenting skills and infant maltreatment during the first year of life
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Oliveira, Jordana Verano de

; Fatori, Daniel

; Shephard, Elizabeth

; Xavier Neto, Mauro

; Matijasevich, Alicia

; Ferraro, Alexandre Archanjo

; Rohde, Luis Augusto

; Chiesa, Anna Maria

; Miguel, Euripedes Constantino

; Polanczyk, Guilherme V.

Brazilian Journal of Psychiatry

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aug 2022, Volume 44 N. 4 Pages 388 - 400

Abstract: En | Text: En | PDF: En

Objective: Maternal attention-deficit/hyperactivity disorder has not been investigated in relation to parenting skills in adolescent mothers. This study investigated whether maternal inattention and hyperactivity/impulsivity symptoms early in pregnancy predict poorer parenting skills and infant maltreatment during the first year of life in adolescent mothers living in adverse environmental conditions. Methods: The participants in this study were 80 adolescent mothers aged 14-19 years and their babies who were taking part in a randomized controlled trial on the effects of a home-visiting program on infant development. Symptoms of maternal attention-deficit/hyperactivity disorder were assessed in the first trimester of pregnancy. Parenting skills (maternal competence, attachment to the baby, home environment) and child maltreatment were assessed when the infants were aged 6 and 12 months. Multilevel linear regression models were constructed to test the extent to which prenatal maternal inattention and hyperactivity/impulsivity symptoms predicted these parenting variables during the first year of the infant’s life. Results: Prenatal inattention symptoms significantly predicted lower maternal competence and attachment, a poorer home environment, and greater maltreatment during the first year of life. Hyperactivity did not significantly predict parenting skills or maltreatment. Conclusions: Our findings suggest that inattention symptoms may interfere with parenting abilities in adolescent mothers and should be considered in early intervention programs.

https://doi.org/10.47626/1516-4446-2021-2045

Desempenho em Aritmética de Estudantes com e sem Sintomas de TDAH
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Sperafico, Yasmini Lais Spindler

; Pisacco, Nelba Maria Teixeira

; Rohde, Luis Augusto Paim

; Nogues, Camila Peres

; Dorneles, Beatriz Vargas

Psico-USF

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oct 2021, Volume 26 N. 4 Pages 645 - 657

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

Resumo O Transtorno de Déficit de Atenção/Hiperatividade (TDAH) é um transtorno que frequentemente acarreta prejuízos ao desempenho acadêmico. O presente estudo teve como objetivo verificar a extensão desses prejuízos no desempenho aritmético, comparando estudantes com sintomas de TDAH com o de seus pares sem TDAH. O desempenho aritmético de 93 estudantes com sintomas de TDAH e 447 estudantes sem TDAH, entre 7 e 16 anos, de escolas públicas de Porto Alegre (3º a 9º ano), foi avaliado pelo Subteste de Aritmética do TDE. Estudantes com sintomas de TDAH apresentaram escores mais baixos e uma quantidade maior de erros de procedimento do que os estudantes sem o transtorno. Os resultados sugerem que sintomas frequentes de TDAH têm relação com maior ocorrência de erros no desempenho em aritmética dos estudantes avaliados neste estudo.

Abstract Attention-Deficit/Hyperactivity Disorder (ADHD) is a highly prevalent disorder that often impairs academic performance. The present study aimed to verify the extent of these impairments in arithmetic performance by comparing the performance of students with and without ADHD symptoms. The arithmetic performance of 93 students with ADHD symptoms and 447 students without ADHD was evaluated by the Arithmetical Subtest of the School Performance Test. Participants were attending public elementary schools in the municipality of Porto Alegre (3rd to 9th grades) and their age range was 7 to 16 years old. Those with ADHD symptoms had lower scores and a higher number of procedural errors than those without ADHD. The results suggest that frequent symptoms of ADHD are related to a higher frequency of errors in the arithmetic performance of the students assessed in this study.

Resumen El Trastorno por Déficit de Atención/Hiperactividad (TDAH) es un trastorno que frecuentemente acarrea perjuicios al desempeño académico. El presente estudio tuvo como objetivo verificar la extensión de las deficiencias en el desempeño aritmético, comparando el rendimiento de estudiantes con y sin síntomas de TDAH. El desempeño aritmético de 93 estudiantes con síntomas de TDAH y 447 estudiantes sin TDAH provenientes de escuelas públicas de Porto Alegre (del 3º al 9º año) y con edades entre los 7 y los 16 años, fueron evaluados por el Subtest de Aritmética del Test de Rendimiento Escolar. Los estudiantes con síntomas de TDAH presentaron puntuaciones más bajas y una mayor cantidad de errores de procedimiento que los estudiantes sin el trastorno. Los resultados sugieren que, en los estudiantes evaluados en este estudio, los síntomas frecuentes del TDAH se relacionan con una mayor frecuencia de errores en el desempeño en aritmética.

https://doi.org/10.1590/1413-82712021260404

10.

Preditores de Mortalidade Total e Eventos Arrítmicos Graves em Pacientes com Insuficiência Cardíaca Não Isquêmica: O Papel da Galectina-3
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Kochi, Adriano Nunes

; Pimentel, Mauricio

; Andrades, Michael

; Zimerman, Tiago

; Zimerman, Leandro Ioschpe

; Rohde, Luis Eduardo

Arquivos Brasileiros de Cardiologia

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sep 2021, Volume 117 N. 3 Pages 531 - 541

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Fundamento: A estratificação de risco continua sendo clinicamente desafiadora em pacientes com insuficiência cardíaca (IC) de etiologia não isquêmica. A galectina-3 é um marcador sérico de fibrose que pode ajudar no prognóstico. Objetivo: Determinar o papel da galectina-3 como preditora de eventos arrítmicos graves e mortalidade total. Métodos: Este é um estudo de coorte prospectivo que incluiu 148 pacientes com IC não isquêmica. Todos os pacientes foram submetidos a uma avaliação clínica e laboratorial abrangente para coleta de dados de referência, incluindo níveis de galectina-3 sérica. O desfecho primário foi a ocorrência de síncope arrítmica, intervenções apropriadas do cardioversor desfibrilador implantável, taquicardia ventricular sustentada ou morte súbita cardíaca. O desfecho secundário foi a morte por todas as causas. Para todos os testes estatísticos, considerou-se significativo o valor p<0,05 (bicaudal). Resultados: Em seguimento mediano de 941 dias, os desfechos primário e secundário ocorreram em 26 (17,5%) e 30 (20%) pacientes, respectivamente. A galectina-3 sérica>22,5 ng/mL (quartil mais alto) não foi preditora de eventos arrítmicos graves (HR: 1,98; p=0,152). Os preditores independentes do desfecho primário foram diâmetro diastólico final do ventrículo esquerdo (DDFVE)>73 mm (HR: 3,70; p=0,001), ventilação periódica durante o exercício (VPE) no teste de esforço cardiopulmonar (HR: 2,67; p=0,01) e taquicardia ventricular não sustentada (TVNS)>8 batimentos na monitorização por Holter (HR: 3,47; p=0,027). Os preditores de morte por todas as causas foram: galectina-3>22,5 ng/mL (HR: 3,69; p=0,001), DDFVE>73 mm (HR: 3,35; p=0,003), VPE (HR: 3,06; p=0,006) e TVNS>8 batimentos (HR: 3,95; p=0,007). A ausência de todos os preditores de risco foi associada a um valor preditivo negativo de 91,1% para o desfecho primário e 96,6% para a mortalidade total. Conclusões: Em pacientes com IC não isquêmica, níveis elevados de galectina-3 não foram preditores de eventos arrítmicos graves, mas foram associados à mortalidade total. A ausência de preditores de risco revelou um subgrupo prevalente de pacientes com IC com excelente prognóstico.

Abstract Background: Risk stratification remains clinically challenging in patients with heart failure (HF) of non-ischemic etiology. Galectin-3 is a serum marker of fibrosis that might help in prognostication. Objective: To determine the role of galectin-3 as a predictor of major arrhythmic events and overall mortality. Methods: We conducted a prospective cohort study that enrolled 148 non-ischemic HF patients. All patients underwent a comprehensive baseline clinical and laboratory assessment, including levels of serum galectin-3. The primary outcome was the occurrence of arrhythmic syncope, appropriate implantable cardioverter defibrillator therapy, sustained ventricular tachycardia, or sudden cardiac death. The secondary outcome was all-cause death. For all statistical tests, a two-tailed p-value<0.05 was considered significant. Results: In a median follow-up of 941 days, the primary and secondary outcomes occurred in 26 (17.5%) and 30 (20%) patients, respectively. Serum galectin-3>22.5 ng/mL (highest quartile) did not predict serious arrhythmic events (HR: 1.98, p=0.152). Independent predictors of the primary outcome were left ventricular end-diastolic diameter (LVEDD)>73mm (HR: 3.70, p=0.001), exercise periodic breathing (EPB) on cardiopulmonary exercise testing (HR: 2.67, p=0.01), and non-sustained ventricular tachycardia (NSVT)>8 beats on Holter monitoring (HR: 3.47, p=0.027). Predictors of all-cause death were galectin-3>22.5 ng/mL (HR: 3.69, p=0.001), LVEDD>73mm (HR: 3.35, p=0.003), EPB (HR: 3.06, p=0.006), and NSVT>8 beats (HR: 3.95, p=0.007). The absence of all risk predictors was associated with a 91.1% negative predictive value for the primary outcome and 96.6% for total mortality. Conclusions: In non-ischemic HF patients, elevated galectin-3 levels did not predict major arrhythmic events but were associated with total mortality. Absence of risk predictors revealed a prevalent subgroup of HF patients with an excellent prognosis.

https://doi.org/10.36660/abc.20200353 98 downloads

11.

Disability in children and adolescents: the extent of the impact on psychiatric disorders and educational deficits
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Zaqueu, Livia

; Teixeira, Maria Crista Triguero Veloz

; Lowenthal, Rosane

; Mari, Jair J.

; Miguel, Eurípedes Constantino

; Rohde, Luís Augusto

; Paula, Cristiane Silvestre

Trends in Psychiatry and Psychotherapy

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sep 2021, Volume 43 N. 3 Pages 235 - 239

Abstract: En | Text: En | PDF: En

Abstract Introduction Most children/adolescents with disability live in low and middle-income countries and, worldwide, they are more likely to have mental health problems and achieve worse academic performance compared to those with typical development. Objective To assess whether Brazilian children/adolescents with four types of disabilities are more likely to have psychiatric disorders and educational deficits than children/adolescents with typical development. Method A multicenter cross-sectional study involving a school-based probabilistic sample of second to sixth graders (N = 1,674) from public schools in four Brazilian regions. The four types of disabilities (intellectual, visual, hearing, and motor) were assessed using the Ten Questions Questionnaire. Psychiatric disorders were measured with the Schedule for Affective Disorders/Schizophrenia for School-Age Children (K-SADS-PL), and academic performance was evaluated using the Teste de Desempenho Acadêmico – TDE (the academic performance test). Results A logistic regression model with cluster-robust errors identified the following statistically significant associations with three of the four types of disability (the exception was hearing). Intellectual disability was associated with anxiety (p < 0.01), depression (p < 0.01), attention deficit hyperactivity disorder (ADHD) (p < 0.001), school failure (p < 0.01), and poor academic performance (p < 0.01). Visual disability was associated with depression (p < 0.01). Motor disability was marginally associated with ADHD (p = 0.08). Conclusions Presence of disabilities (intellectual, visual, and motor) in children/adolescents was associated with psychiatric disorders, school failure, and academic performance. It is therefore important to identify presence of disabilities and plan and deliver specific interventions and specialized educational care for the needs presented by these children/adolescents. This is particularly important in low and middle-income countries, where these disabilities are frequent among children/adolescents.

https://doi.org/10.47626/2237-6089-2020-0059 136 downloads

12.

Posicionamento sobre Diagnóstico e Tratamento da Amiloidose Cardíaca – 2021
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Simões, Marcus V.

; Fernandes, Fabio

; Marcondes-Braga, Fabiana G.

; Scheinberg, Philip

; Correia, Edileide de Barros

; Rohde, Luis Eduardo P.

; Bacal, Fernando

; Alves, Silvia Marinho Martins

; Mangini, Sandrigo

; Biolo, Andréia

; Beck-da-Silva, Luis

; Szor, Roberta Shcolnik

; Marques Junior, Wilson

; Oliveira, Acary Souza Bulle

; Cruz, Márcia Waddington

; Bueno, Bruno Vaz Kerges

; Hajjar, Ludhmila Abrahão

; Issa, Aurora Felice Castro

; Ramires, Felix José Alvarez

; Coelho Filho, Otavio Rizzi

; Schmidt, André

; Pinto, Ibraim Masciarelli Francisco

; Rochitte, Carlos Eduardo

; Valicelli, Flávio Henrique

; Vieira, Marcelo Luiz Campos

; Mesquita, Cláudio Tinoco

; Ramos, Celso Dario

; Soares-Junior, José

; Romano, Minna Moreira Dias

; Mathias Junior, Wilson

; Garcia Junior, Marcelo Iório

; Montera, Marcelo Westerlund

; Melo, Marcelo Dantas Tavares de

; Silva, Sandra Marques e

; Garibaldi, Pedro Manoel Marques

; Alencar Neto, Aristóteles Comte de

; Lopes, Renato Delascio

; Ávila, Diane Xavier de

; Viana, Denizar

; Saraiva, José Francisco Kerr

; Canesin, Manoel Fernandes

; Oliveira, Glaucia Maria Moraes de

; Mesquita, Evandro Tinoco

Arquivos Brasileiros de Cardiologia

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sep 2021, Volume 117 N. 3 Pages 561 - 598

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36660/abc.20210718 330 downloads

13.

Predictors of gaming disorder in children and adolescents: a school-based study
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Ferreira, Felipe de M.

; Bambini, Beatriz B.

; Tonsig, Gabriela K.

; Fonseca, Lais

; Picon, Felipe A.

; Pan, Pedro M.

; Salum, Giovanni A.

; Jackowski, Andrea

; Miguel, Eurípedes C.

; Rohde, Luis A.

; Bressan, Rodrigo A.

; Gadelha, Ary

Brazilian Journal of Psychiatry

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jun 2021, Volume 43 N. 3 Pages 289 - 292

Abstract: En | Text: En | PDF: En

Objective: To determine whether psychiatric and gaming pattern variables are associated with gaming disorder in a school-based sample. Methods: We analyzed data from the Brazilian High-Risk Cohort for Psychiatric Disorders, a community sample aged 10 to 18, using questionnaires on gaming use patterns. We applied the Gaming Addiction Scale to diagnose gaming disorder and the Development and Well-Being Behavior Assessment for other diagnoses. Results: Out of 407 subjects, 83 (20.4%) fulfilled the criteria for gaming disorder. More role-playing game players were diagnosed with gaming disorder that any other genre. Gaming disorder rates increased proportionally to the number of genres played. Playing online, being diagnosed with a mental disorder, and more hours of non-stop gaming were associated with higher rates of gaming disorder. When all variables (including age and gender) were considered in a logistic regression model, the number of genres played, the number of non-stop hours, the proportion of online games, and having a diagnosed mental disorder emerged as significant predictors of gaming disorder. Conclusion: Each variable seems to add further risk of gaming disorder among children and adolescents. Monitoring the length of gaming sessions, the number and type of genres played, time spent gaming online, and behavior changes may help parents or guardians identify unhealthy patterns of gaming behavior.

https://doi.org/10.1590/1516-4446-2020-0964 336 downloads

14.

Atualização de Tópicos Emergentes da Diretriz Brasileira de Insuficiência Cardíaca – 2021
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Marcondes-Braga, Fabiana G.

; Moura, Lídia Ana Zytynski

; Issa, Victor Sarli

; Vieira, Jefferson Luis

; Rohde, Luis Eduardo

; Simões, Marcus Vinícius

; Fernandes-Silva, Miguel Morita

; Rassi, Salvador

; Alves, Silvia Marinho Martins

; Albuquerque, Denilson Campos de

; Almeida, Dirceu Rodrigues de

; Bocchi, Edimar Alcides

; Ramires, Felix José Alvarez

; Bacal, Fernando

; Rossi Neto, João Manoel

; Danzmann, Luiz Claudio

; Montera, Marcelo Westerlund

; Oliveira Junior, Mucio Tavares de

; Clausell, Nadine

; Silvestre, Odilson Marcos

; Bestetti, Reinaldo Bulgarelli

; Bernadez-Pereira, Sabrina

; Freitas Jr, Aguinaldo F.

; Biolo, Andréia

; Barretto, Antonio Carlos Pereira

; Jorge, Antônio José Lagoeiro

; Biselli, Bruno

; Montenegro, Carlos Eduardo Lucena

; Santos Júnior, Edval Gomes dos

; Figueiredo, Estêvão Lanna

; Fernandes, Fábio

; Silveira, Fabio Serra

; Atik, Fernando Antibas

; Brito, Flávio de Souza

; Souza, Germano Emílio Conceição

; Ribeiro, Gustavo Calado de Aguiar

; Villacorta, Humberto

; Souza Neto, João David de

; Goldraich, Livia Adams

; Beck-da-Silva, Luís

; Canesin, Manoel Fernandes

; Bittencourt, Marcelo Imbroinise

; Bonatto, Marcely Gimenes

; Moreira, Maria da Consolação Vieira

; Avila, Mônica Samuel

; Coelho Filho, Otavio Rizzi

; Schwartzmann, Pedro Vellosa

; Mourilhe-Rocha, Ricardo

; Mangini, Sandrigo

; Ferreira, Silvia Moreira Ayub

; Figueiredo Neto, José Albuquerque de

; Mesquita, Evandro Tinoco

Arquivos Brasileiros de Cardiologia

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jun 2021, Volume 116 N. 6 Pages 1174 - 1212

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36660/abc.20210367 3168 downloads

15.

Exploring the association between attention-deficit/hyperactivity disorder and entrepreneurship attentiondeficit/hyperactivity attentiondeficithyperactivity attention deficit/hyperactivity deficit hyperactivity attentiondeficit deficithyperactivity
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Sônego, Márcio

; Meller, Martin

; Massuti, Rafael

; Campani, Fausto

; Amaro, Julia

; Barbosa, Christian

; Rohde, Luis A.

Brazilian Journal of Psychiatry

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apr 2021, Volume 43 N. 2 Pages 174 - 180

Abstract: En | Text: En | PDF: En

Objective: To investigate the association between attention-deficit/hyperactivity disorder (ADHD) symptoms and entrepreneurial profiles and the effects of entrepreneurial characteristics in individuals who screen positive for ADHD and self-identify as entrepreneurs. Methods: We sent 4,341 questionnaires by e-mail to applicants for a career development course for entrepreneurs. We used the propensity score covariate adjustment to balance differences between included and excluded individuals. ADHD symptoms were evaluated with the Adult ADHD Self-Report Scale. The Individual Entrepreneurial Orientation scale was used to assess the entrepreneurial profile of the participants. Impairment from ADHD symptoms was assessed with the Barkley Functional Impairment Scale. Results: Those who screened positive for ADHD had higher risk-taking scores (p-value = 0.016) and lower proactivity (p-value = 0.001) than those who screened negative. Higher inattention scores were related to lower proactivity (p-value < 0.001), while higher hyperactive symptom scores were related to a more generalized entrepreneurial profile (p-value = 0.033). Among ADHD-positive participants, entrepreneurial profile scores were not significantly associated with company profits or impairment. Conclusions: Inattention symptoms were related to less proactivity, whereas hyperactive symptoms were positively associated with a general entrepreneurial orientation. ADHD-positive individuals had a higher risk-taking profile, and these characteristics did not negatively impact their lives. Objective attentiondeficit/hyperactivity attentiondeficithyperactivity attention deficit/hyperactivity deficit hyperactivity (ADHD selfidentify self identify entrepreneurs Methods 4341 4 341 4,34 email e mail SelfReport Self Report Scale participants Results risktaking risk taking pvalue p value 0.016 0016 0 016 0.001 0001 001 negative 0.001, , 0.033. 0033 0.033 . 033 0.033) ADHDpositive impairment Conclusions orientation lives attentiondeficit deficithyperactivity 434 34 4,3 0.01 01 0.00 000 00 003 0.03 03 43 3 4, 0.0 0.

https://doi.org/10.1590/1516-4446-2020-0898 356 downloads

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