Introduction: Mitral valve prolapse and aortic root dilatation are reported in association with hypermobile Ehlers–Danlos syndrome (hEDS), but the full phenotypic spectrum of cardiovascular complications in this condition has not been studied in the aftermath of updated nosology and diagnostic criteria. Methods: We performed a retrospective review of 258 patients (> 94% adults) referred to a multidisciplinary clinic for evaluation of joint hypermobility between January 2017 and December 2020 and diagnosed with hEDS or a hypermobility spectrum disorder (HSD) to determine the incidence and spectrum of cardiovascular involvement. Results: Mitral valve prolapse was present in 7.5% and thoracic aortic dilatation in 15.2%. Aortic dilatation was more frequent in individuals with hEDS (20.7%) than with HSD (7.7%) and similarly prevalent between males and females, although was mild in > 90% of females and moderate-to-severe in 50% of males. Five individuals (1.9%) with hEDS/HSD had extra-aortic arterial involvement, including cervical artery dissection (CeAD, n = 2), spontaneous coronary artery dissection (SCAD, n = 2), and SCAD plus celiac artery pseudoaneurysm ( n = 1). This is the first series to report the prevalence of CeAD and SCAD in hEDS/HSD. Conclusions: Cardiovascular manifestations in adults with hEDS/HSD, especially females, are typically mild and readily assessed by echocardiography. Since the risk of progression has not yet been defined, adults with hEDS/HSD who are found to have aortic dilatation at baseline should continue ongoing surveillance to monitor for progressive dilatation. Cardiovascular medicine specialists, neurologists, and neurosurgeons should consider hEDS/HSD on the differential for patients with CeAD or SCAD who also have joint hypermobility.

OBJECTIVES:The goal of this study is to determine the incidence, predictors, and outcomes of atrial fibrillation (AF) or atrial flutter (AFL) in patients hospitalized with coronavirus disease-2019 (COVID-19). BACKGROUND:COVID-19 results in increased inflammatory markers previously associated with atrial arrhythmias. However, little is known about their incidence or specificity in COVID-19 or their association with outcomes. METHODS:This is a retrospective analysis of 3,970 patients admitted with polymerase chain reaction-positive COVID-19 between February 4 and April 22, 2020, with manual review performed of 1,110. The comparator arm included 1,420 patients with influenza hospitalized between January 1, 2017, and January 1, 2020. RESULTS:Among 3,970 inpatients with COVID-19, the incidence of AF/AFL was 10% (n = 375) and in patients without a history of atrial arrhythmias it was 4% (n = 146). Patients with new-onset AF/AFL were older with increased inflammatory markers including interleukin 6 (93 vs. 68 pg/ml; p < 0.01), and more myocardial injury (troponin-I: 0.2 vs. 0.06 ng/ml; p < 0.01). AF and AFL were associated with increased mortality (46% vs. 26%; p < 0.01). Manual review captured a somewhat higher incidence of AF/AFL (13%, n = 140). Compared to inpatients with COVID-19, patients with influenza (n = 1,420) had similar rates of AF/AFL (12%, n = 163) but lower mortality. The presence of AF/AFL correlated with similarly increased mortality in both COVID-19 (relative risk: 1.77) and influenza (relative risk: 1.78). CONCLUSIONS:AF/AFL occurs in a subset of patients hospitalized with either COVID-19 or influenza and is associated with inflammation and disease severity in both infections. The incidence and associated increase in mortality in both cohorts suggests that AF/AFL is not specific to COVID-19, but is rather a generalized response to the systemic inflammation of severe viral illnesses.

Dysautonomia is a recognized manifestation in patients with joint hypermobility (JH) disorders. Symptoms can be highly debilitating and commonly include physical deconditioning and poor aerobic fitness. In this study, the prevalence of dysautonomia, range of associated symptoms, patient-reported physical activity levels, and echocardiographic features were assessed retrospectively in a cohort of 144 patients (94% female) with hypermobile Ehlers-Danlos syndrome (hEDS) or hypermobility spectrum disorder (HSD). Echocardiographic parameters of left ventricular size and function were compared between patients with and without dysautonomia as well as to reported values from healthy controls. Dysautonomia was identified in 65% of female and 44% of male subjects and was associated with a high burden of symptomatology, most commonly exercise intolerance (78%). Exercise capacity was limited by dysautonomia, often postural symptoms, in half of all patients. We observed a reduction in physical activity following the onset or significant flare of hEDS/HSD, most strikingly noting the proportion of dysautonomic patients with sedentary lifestyle, which increased from 44% to 85%. JH-related dysautonomia was associated with smaller cardiac chamber sizes, consistent with the previous reports in positional orthostatic tachycardia syndrome. Dysautonomia is prevalent in patients with hEDS/HSD, and exercise intolerance is a key feature and leads to drastic decline in physical activity. Unfavorable cardiac geometry may underlie dysautonomia symptoms and may be due to cardiac atrophy in the setting of aerobic deconditioning.

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Headache and neck pain (cervicalgia) are frequently reported among patients with joint hypermobility but the prevalence and scope of these symptoms has not been studied in the era of contemporary Ehlers-Danlos and hypermobility disorder nosology. We performed a single-center retrospective study on the incidence of head and neck symptoms in 140 patients with hypermobility disorders over a 2-year period. Overall, 93 patients (66%) reported either headache or neck pain with 49 of those (53%) reporting both. Migraine (83%) was the most common headache type among those with headache disorders and cervical spondylosis (61%) the most common pathology among those with neck symptoms. Fifty-nine percent of spondylosis patients who underwent cervical facet procedures reported significant improvement in neck and head symptoms. Of patients with both head and neck complaints, 82% had both migraine and spondylosis, which, when combined with the high response rate to injections raises the possibility of cervicogenic headache. In this large multidisciplinary retrospective study of patients with hypermobility disorders, head and neck symptoms were highly prevalent, with migraine and cervical spondylosis common, often coexisting, and frequently responsive to targeted therapy for the cervical spine suggesting that degenerative spinal pathology may cause or contribute to headache symptoms in some patients with hypermobility disorders.

We present a case of azathioprine hypersensitivity presenting as sepsis with elevated procalcitonin in a 68-year-old man with myasthenia gravis. The patient presented with fever, chills, nausea, vomiting, and headache. He developed numerous 1 cm erythematous papules over his upper torso. Infectious workup including bacteriological tests and microbial cultures was negative and a skin biopsy was performed which revealed suppurative folliculitis with eosinophils, consistent with drug hypersensitivity. Notably, acute phase reactants including C-reactive protein and procalcitonin were elevated upon presentation, likely secondary to drug hypersensitivity.

Cardiac amyloidosis is an acquired heart disease secondary to the deposition of β-pleated amyloid proteins in heart tissue. Amyloid light chain (AL) amyloidosis is usually secondary to multiple myeloma and can rapidly deteriorate cardiac function, with high mortality. Up to 50% of AL patients have cardiac involvement presenting as heart failure, conduction abnormalities, and cardiomyopathies. One of the rare presentations is the likely simulation of disease with hypertrophic cardiomyopathies like left ventricular outflow tract (LVOT) obstruction due to the systolic anterior motion of the mitral valve and irregular septal hypertrophy secondary to amyloid deposits. We present a case of cardiac amyloidosis secondary to multiple myeloma who presented with dynamic LVOT obstruction resembling hypertrophic obstructive cardiomyopathy and complicated by acute pulmonary edema. These complicated cases can be initially treated for pulmonary edema with an elevation of the head of the bed, furosemide, and nitroglycerin intravenously. For multiple myeloma, chemotherapy was continued. Beta-blockers, calcium channel blockers and angiotensin-converting enzyme inhibitors, and aldosterone receptor blocker were avoided due to poor tolerability. After symptomatic control, the patient can likely be scheduled for septal myotomy and the placement of a pacemaker or implantable cardiac defibrillator to prevent any arrhythmias causing sudden cardiac death in these subsets of patients.

Chronic kidney disease (CKD) is a predictor of post-surgical mortality. Between November 2013 and June 2016, 5,241 patients underwent transcatheter mitral valve repair with data in the STS/ACC Transcatheter Valve Therapy registry. The primary outcome was a composite of all-cause mortality, stroke,

Abstract Introduction: Back pain has become a serious public health problem. Objective: To determine the prevalence of back pain in a population-based sample of subjects over 20 years old living in the city of Bauru (São Paulo, Brazil) and to analyze the associations to variables- sociodemographic, ergonomic and lifestyle-related - and to morbidity. Methods: a cross-sectional study which evaluated 600 adults over 20 years old, both gender and living in the city. We used a structured protocol and the Nordic questionnaire. Also, we developed a descriptive analysis, bivariate and multivariate by binary logistic regression. Results: The prevalence of back pain was of 50.3% (CI 46.3 to 54.3), since 42.3% (CI 36.9 to 48.0) in men and 57.6% (CI 51.9 to 63.0) in women, with statistical significant difference (p = 0.001). Different variables remained in final models when assessed by gender. For male to be widowed and divorced and smoking habits and, for women to be widowed and divorced, to work in seated position and to perform occupational activities that demand carrying and lifting weight. Conclusion: We verified high prevalence in back pain in the population of Bauru and high association to widowed/divorced in both gender, with women performing occupational activities usually or always in seated position, those who carry or lift weight in work and men who smoke.

Population ageing, Brazilian demographic facts in recent decades, became of the utmost importance for the social planning that emerges in this century with this new profile. Differences in survival in observed cohorts of older people according to some variables are referred in the literature. Then, the aim of this work was to develop more general parametric models to estimate survival time for grouped and censored data including covariates and apply them to data from the cohort of older people, considering as outcomes the death from all causes and some specific. A population survey was carried out in Botucatu, SãoPaulo, Brazil, in the years of 2003, 2006 and 2010, in order to evaluate the survival time of these people. The sample size was calculated in 365 older people considering the quality of life as unknown (50%), 5% of margin error and 95% of reliability. It was observed the risks were not proportional. Then these new models (Generalized Log-Normal and Generalized Weibull) were used to estimate the survival time rather than Cox model that could not be appropriate for these data. Including covariates, it was found the age more than 60 years, diabetes mellitus, another income and cardiovascular disease were risk factor for survival. Already, social relationship was protective factor for survival, when including some aspects of quality of life. As a conclusion, the use of these models has become an interesting alternative to the Cox proportional hazard model and they seem more realistic with the factors involving survival time for older people.

El objetivo de este estudio fue verificar el nivel de calidad de vida relacionada a la salud (QVRS) en una muestra de base poblacional de adultos de 20 anos o mas, residentes de la ciudad de Bauru, Sao Paulo, y su asociacion con la cantidad de morbilidades referidas. Se realizo una encuesta poblacional mediante una muestra compleja en dos estadios, con un total de 600 participantes de la zona urbana de Bauru. Para la recoleccion de datos se utilizo los siguientes instrumentos: 1. caracterizacion de los participantes (aspectos demograficos, socioeconomicos, nivel de actividad fisica y habito de fumar); 2. morbilidades (referida mediante la pregunta: el ultimo ano, usted ha recibido el diagnostico medico de alguna enfermedad?); 3. calidad de vida (utilizando el cuestionario Medical Outcomes Study 36 - Item Short-Form Health Survey - SF-36). Se realizo analisis descriptivos y bivariados, mediante la prueba T de Student y Anova. Se observo que 70,5% presentaron por lo menos una enfermedad, y las principales referidas fueron la hipertension, la artrosis, la depresion y la diabetes. En relacion a la asociacion entre los numeros de enfermedades, las personas mayores y las que refirieron tres o mas enfermedades presentaron peores scores de QVRS en todos los dominios fisicos y en las limitaciones por aspectos sociales y emocionales. El mayor numero de morbilidades se asocio a los menores scores de calidad de vida relacionada a la salud.

RESUMO O objetivo deste trabalho foi verificar o nível de qualidade de vida relacionada à saúde (QVRS) em uma amostra de base populacional de adultos de 20 anos ou mais, residentes na cidade de Bauru, São Paulo, e sua associação com a quantidade de morbidades referidas. Foi realizado um inquérito populacional, por meio de uma amostragem complexa em dois estágios, totalizando 600 participantes da zona urbana de Bauru. Para a coleta de dados foram utilizados os seguintes instrumentos: 1. caracterização dos participantes (aspectos demográficos, socioeconômicos, nível de atividade física e hábito de fumar); 2. morbidade (referida por meio da pergunta: "No último ano, o (a) sr. (a) recebeu diagnóstico médico de alguma doença?"); 3. qualidade de vida (utilizando o questionário Medical Outcomes Study 36 - Item Short-Form Health Survey - SF-36). Foram realizadas análises descritiva e bivariada, por meio do teste t de Student e ANOVA. Observou-se que 70,5% apresentaram pelo menos uma doença, e as principais referidas foram a hipertensão, as artroses, a depressão e o diabetes. Quanto à associação entre os números de doenças, as pessoas mais idosas e as que referiram três ou mais doenças apresentaram piores escores de QVRS em todos os domínios físicos e nas limitações por aspectos sociais e emocionais. O maior número de morbidades associou-se aos menores escores de qualidade de vida relacionada à saúde.

Background: African swine fever (ASF) is a viral infectious disease of domestic and wild suids of all breeds and ages, causing a wide range of hemorrhagic syndromes and frequently characterized by high mortality. The disease is endemic in Sub-Saharan Africa and Sardinia. Since 2007, it has also been present in different countries of Eastern Europe, where control measures have not been effective so far. The continued spread poses a serious threat to the swine industry worldwide. In the absence of vaccine, early detection of infected animals is of paramount importance for control of the outbreak, to prevent the transmission of the virus to healthy animals and subsequent spreading of the disease. Current laboratory diagnosis is mainly based on virological methods (antigen and genome detection) and serodiagnosis.Results: In the present work, a Lateral Flow Assay (LFA) for antigen detection has been developed and evaluated. The test is based on the use of a MAb against VP72 protein of ASFV, the major viral capsid protein and highly immunogenic. First experiments using VP72 viral and recombinant protein or inactivated culture virus showed promising results with a sensitivity similar to that of a commercially available Antigen-ELISA. Moreover, these strips were tested with blood from experimentally infected pigs and field animals and the results compared with those of PCR and Antigen-ELISA. For the experimentally infected samples, there was an excellent correlation between the LFA and the ELISA, while the PCR always showed to be more sensitive (38 % positive samples by PCR versus 27 % by LFA). The LFA was demonstrated to be positive for animals with circulating virus levels exceeding 104 HAU. With the field samples, once again, the PCR detected more positives than either the Antigen-ELISA or LFA, although here the number of positive samples scored by the LFA exceeded the values obtained with the Antigen-ELISA, showing 60 % positivity vs 48 % for the ELISA. For the two groups of sera, the specificity was close to 100 % indicating that hardly any false positive samples were found.Conclusions: The newly developed LFA allows rapid and reliable detection of ASFV, at field and laboratory level, providing a new useful tool for control programs and in situations where laboratory support and skilled personnel are limited.

Mailing address: Alberto De Vitta – Rua Ir. Arminda, 10-50, Jd. Brasil – Bauru (SP), Brasil – CEP: 17011-160 – Phone: (14) 2107-7112 – E-mail: albvitta@yahoo.com.br. Financing source: Fundação de Amparo à Pesquisa do Estado de São Paulo (2011/20123-4); Conselho Nacional de Desenvolvimento Científico e Tecnológico (478188/2011-0) – Conflict of interest: Nothing to declare – Presentation: Apr. 2915 – Accepted for publication: Feb. 2016 – Approved by Ethics Committee no 251/97. DOI: 10.1590/1809-2950/14817923012016

Objetivo: Estudar a associacao entre qualidade de vida autoavaliada e tempo de sobrevivencia, entre idosos residentes no municipio de Botucatu/SP. Metodos: Foi realizado estudo de coorte, com tempo de seguimento de sete anos. A qualidade de vida foi mensurada pela escala de Flanagan. Os obitos foram identificados no Sistema de Informacao sobre Mortalidade. Associacoes foram estimadas por meio do teste de log-rank. Calcularam-se Hazard Ratio (HR) e respectivos intervalos de confianca de 95% (IC 95%) por meio da regressao de Cox. Resultados: Foram avaliados365 idosos. A qualidade de vida dos idosos foi avaliada como positiva (mediana: 75 pontos; variacao 31-97). Na analise ajustada, apenas o dominio de “bem-estar” da qualidade de vida permaneceu associado a sobrevivencia (HR =1,5 IC95%1,0 – 2,3).Conclusao: Destaca-se o papel da qualidade de vida como preditor de mortalidade, por meio do dominio “bem estar”.

Objetivo: avaliar o efeito de um Programa de Educação em Gerontologia desenvolvido à Agentes Comunitários de Saúde. Métodos: estudo de intervenção (comparação antes e depois) com participação de 111 agentes comunitários, com perda de 25 (22,5%), atuantes nas 12 unidades de saúde da família de um município do interior paulista, em 2012. Os dados foram coletados por meio de questionário sociodemográfico, instrumento de avaliação do contato dos agentes comunitários com idosos e questionário para avaliação de conhecimentos gerontológicos (Questionário Palmore-Neri-Cachioni). Foi desenvolvido um Programa de Educação em Gerontologia junto aos agentes comunitários, no período de 5 dias: encontros com duração de 90 minutos cada um, abordando temas relacionados à velhice e envelhecimento. Para análise dos dados, foi utilizado o programa SAS versão 9.2 para Windows. Resultados: prevaleceram entre os agentes os adultos jovens, do sexo feminino, casados, com ensino médio completo e inseridos na atividade há mais de dois anos e meio. A maioria dos agentes expôs sempre ter contato com idosos, cultivado em âmbito do trabalho e intrafamiliar e relatou experiência com a população dessa faixa etária, mais da metade referiu ter participado de educação gerontológica. O maior número de acertos ao questionário de avaliação sobre conhecimentos gerontológicos, aplicado antes, imediatamente após e depois de três meses ao desenvolvimento do Programa de Educação em Gerontologia, demonstrou melhor desempenho dos agentes na segunda e terceira aplicações desse instrumento realizadas após o programa, tornando evidente a importância de educação em gerontologia para esse público. Conclusão: promover educação em gerontologia para agentes comunitários de saúde é fundamental, pois providos de conhecimentos podem reforçar seu papel mediante a equipe de saúde e população, dentre ela, os idosos.