Abstract INTRODUCTION We aimed to describe the sociodemographic, epidemiological, and clinical characteristics of patients with chronic Chagas disease (CD) at an infectious disease referral center. Changes in patient profiles over time were also evaluated. METHODS This retrospective study included patients with CD from November 1986-December 2019. All patients underwent an evaluation protocol that included sociodemographic profile; epidemiological history; anamnesis; and physical, cardiologic, and digestive examinations. Trend differences for each 5-year period from 1986 to 2019 were tested using a nonparametric trend test for continuous and generalized linear models with binomial distribution for categorical variables. RESULTS A total of 2,168 patients (52.2% women) were included, with a mean age of 47.8 years old. White patients with low levels of education predominated. The reported transmission mode was vectorial in 90.2% of cases. The majority came from areas with a high prevalence (52.2%) and morbidity (67.8%) of CD. The most common clinical presentation was the indeterminate form (44.9%). The number of patients referred gradually decreased and the age at admission increased during the study period, as did the patients’ levels of education. CONCLUSIONS The clinical profile of CD is characterized by a predominance of the indeterminate form of the disease. Regarding the patients who were followed up at the referral center, there was a progressive increase in the mean age and a concomitant decrease in the number of new patients. This reflects the successful control of vector and transfusion transmission in Brazil as well as the aging population of patients with CD.

RESUMO Entre todos os subtipos de AVC isquêmico, os eventos cardioembólicos (CE) apresentam os piores prognósticos. Determinamos a incidência de AVC isquêmico CE, associada ou não à fibrilação atrial (FA), o uso prévio de anticoagulantes e os desfechos funcionais em Joinville, Brasil. Utilizando múltiplas e sobrepostas fontes de informação, registramos todos os primeiros eventos CE ocorridos em 2015. Entre 374 eventos isquêmicos, 23% (84) foram CE. A incidência ajustada, para qualquer fonte cardioembólica, foi 0.14 (0.11–0.17) por 1000 pessoas-ano. Entre 26 pacientes com FA previamente conhecida, 73% (19) não estavam anticoagulados, 77% (20) tinham ≥ 3 pontos na escala CHA2DS2VASc e 81 % (21) < 3 pontos na escala HAS-BLED. Após 3 meses, um terço destes 26 pacientes morreram ou ficaram dependentes. A incidência de AVC I CE em Joinville é menor do que em outros estudos de base populacional. Um terço dos casos de AVC I CE com FA previamente conhecida perderam a oportunidade de anticoagulação.

ABSTRACT Among ischemic strokes, cardioembolic (CE) stroke has the worst outcome. We measured the incidence of atrial fibrillation (AF) and non-AF related CE strokes, previous anticoagulant use, and the 90-day functional outcome. Using multiple overlapping sources, we included all CE strokes that occurred in 2015 in Joinville, Brazil. Of the 374 ischemic strokes, 23% (84) were CE. The CE age-adjusted incidence, per 1,000 person-years, was 0.14 (0.11–0.17). Of the 26 patients with known prior AF, 73% (19) were not anticoagulated, 77% (20) had a CHA2DS2VASc score ≥ 3 and 81% (21) had a HAS-BLED score < 3. After three months, approximately one third of those 26 patients died or became disabled. The incidence of CE stroke in our sample was lower than in other population-based studies. The opportunity for anticoagulation was missed in one third of cases.

A dissecção das artérias cervicais é uma emergência médica. Embora de forma relativamente rara, certas atividades descritas como esportes e recreação podem ser a causa de dissecção arterial independentemente de trauma de crânio ou cervical. O propósito do presente estudo é apresentar uma série de casos de dissecção de artérias cérebro-cervicais em indivíduos durante ou logo após a prática destas atividades desportivas. Métodos Dados retrospectivos de pacientes com dissecção arterial relacionada à prática de esportes e recreação. Resultados Quarenta e um casos foram identificados. A artéria mais frequentemente afetada foi a vertebral. Uma grande variedade de atividades teve relação temporal com a dissecção arterial, sendo a corrida a mais frequente delas. Esta é a maior série de casos da literatura. Conclusão Dissecção arterial pode ser uma complicação da prática de esportes.

Dissection of cervical arteries constitutes a medical emergency. Although relatively rarely, activities classified as sports and recreation may be a cause of arterial dissection independently of neck or head trauma. The purpose of the present paper was to present a series of cases of cerebrum-cervical arterial dissection in individuals during or soon after the practice of these sports activities. Methods Retrospective data on patients with arterial dissection related to sports and recreation. Results Forty-one cases were identified. The most frequently affected vessel was the vertebral artery. A large variety of activities had a temporal relationship to arterial dissection, and jogging was the most frequent of these. This is the largest case series in the literature. Conclusion Arterial dissection may be a complication from practicing sports.

Cross-sectional study conducted among workers of the Family Health Strategy Montes Claros. Objective: to investigate the report of vaccination against Hepatitis B, verification of immunization and the factors associated with dosages of anti-HBs. Method: we collected blood samples from those reported that they had one or more doses of the vaccine. We evaluated the association of the dosage of anti- HBs with sociodemographic conditions, occupational and behavioral. The associations were verified by Mann Whitney and Kruskal Wallis and correlation Spermann by linear regression using SPSS® 17.0. Results: among the 761 respondents, 504 (66.1%) were vaccinated, 52.5 % received three doses, 30.4 % verified immunization. Of the 397 evaluated for the determination of anti-Hbs, 16.4% were immune. Conclusion: it was found that longer duration of work was associated with higher levels of anti-HBs, while levels of smoking were inversely associated with anti-HBs. These workers need for vaccination campaigns.

Estudio transversal realizado entre trabajadores de la Estrategia Salud de la Familia Montes Claros. Objetivo: investigar el informe de la vacunación contra la hepatitis B, la verificación de la inmunización y los factores asociados con la dosis de anti-HBs. Método: se recogieron muestras de sangre de los que informaron que tenían una o más dosis de la vacuna. Se evaluó la asociación entre la dosis de anti- HBs con las condiciones sociodemográficas, laborales y de comportamiento. Las asociaciones fueron verificadas por Mann Whitney y Kruskal Wallis y Spermann correlación seguida por regresión lineal utilizando el programa SPSS® 17.0. Resultado: entre los 761 encuestados, 504 (66,1%) fueron vacunados, el 52,5 % recibió tres dosis de vacunación, 30,4% verificado. De los 397 evaluados para la determinación de anticuerpos anti-HBs, 16,4 % eran inmunes. Conclusión: se encontró que la mayor duración de la obra se asoció con mayores niveles de anti- HBs, mientras que los niveles de tabaquismo se asoció inversamente con el anti- HBs. La necesidad de campañas de vacunación entre los trabajadores.

Estudo transversal conduzido entre trabalhadores da Estratégia Saúde da Família de Montes Claros. Objetivo: investigar o relato de vacinação contra Hepatite B, a verificação da imunização e os fatores associados às dosagens de anti-HBs. Método: coletaram-se amostras de sangue daqueles que relataram ter recebido uma ou mais doses da vacina. Avaliou-se a associação da dosagem de anti-HBs com condições sociodemográficas, ocupacionais e comportamentais. As associações foram verificadas pelos testes Mann Whitney e Kruskal Wallis e correlação de Spermann seguida pela regressão linear, utilizou-se o SPSS® 17.0. Resultados: dentre os 761 entrevistados, 504 (66,1%) foram vacinados, 52,5% tomaram três doses, 30,4% verificaram a imunização. Dos 397 avaliados quanto à dosagem de anti-HBs, 16,4% estavam imunes. Conclusão: constatou-se que o maior tempo de trabalho foi associado a níveis mais elevados de anti-HBs, enquanto os níveis de tabagismo foram inversamente associados ao anti-HBs. Há necessidade de campanhas de vacinação entre esses trabalhadores.

Estudo transversal conduzido entre trabalhadores da Estratégia Saúde da Família de Montes Claros. Objetivo: investigar o relato de vacinação contra Hepatite B, a verificação da imunização e os fatores associados às dosagens de anti-HBs. Método: coletaram-se amostras de sangue daqueles que relataram ter recebido uma ou mais doses da vacina. Avaliou-se a associação da dosagem de anti-HBs com condições sociodemográficas, ocupacionais e comportamentais. As associações foram verificadas pelos testes Mann Whitney e Kruskal Wallis e correlação de Spermann seguida pela regressão linear, utilizou-se o SPSS® 17.0. Resultados: dentre os 761 entrevistados, 504 (66,1%) foram vacinados, 52,5% tomaram três doses, 30,4% verificaram a imunização. Dos 397 avaliados quanto à dosagem de anti-HBs, 16,4% estavam imunes. Conclusão: constatou-se que o maior tempo de trabalho foi associado a níveis mais elevados de anti-HBs, enquanto os níveis de tabagismo foram inversamente associados ao anti-HBs. Há necessidade de campanhas de vacinação entre esses trabalhadores.

Cross-sectional study conducted among workers of the Family Health Strategy Montes Claros. Objective: to investigate the report of vaccination against Hepatitis B, verification of immunization and the factors associated with dosages of anti-HBs. Method: we collected blood samples from those reported that they had one or more doses of the vaccine. We evaluated the association of the dosage of anti- HBs with sociodemographic conditions, occupational and behavioral. The associations were verified by Mann Whitney and Kruskal Wallis and correlation Spermann by linear regression using SPSS® 17.0. Results: among the 761 respondents, 504 (66.1%) were vaccinated, 52.5 % received three doses, 30.4 % verified immunization. Of the 397 evaluated for the determination of anti-Hbs, 16.4% were immune. Conclusion: it was found that longer duration of work was associated with higher levels of anti-HBs, while levels of smoking were inversely associated with anti-HBs. These workers need for vaccination campaigns.

Estudio transversal realizado entre trabajadores de la Estrategia Salud de la Familia Montes Claros. Objetivo: investigar el informe de la vacunación contra la hepatitis B, la verificación de la inmunización y los factores asociados con la dosis de anti-HBs. Método: se recogieron muestras de sangre de los que informaron que tenían una o más dosis de la vacuna. Se evaluó la asociación entre la dosis de anti- HBs con las condiciones sociodemográficas, laborales y de comportamiento. Las asociaciones fueron verificadas por Mann Whitney y Kruskal Wallis y Spermann correlación seguida por regresión lineal utilizando el programa SPSS® 17.0. Resultado: entre los 761 encuestados, 504 (66,1%) fueron vacunados, el 52,5 % recibió tres dosis de vacunación, 30,4% verificado. De los 397 evaluados para la determinación de anticuerpos anti-HBs, 16,4 % eran inmunes. Conclusión: se encontró que la mayor duración de la obra se asoció con mayores niveles de anti- HBs, mientras que los niveles de tabaquismo se asoció inversamente con el anti- HBs. La necesidad de campañas de vacunación entre los trabajadores.

Fundamento: A reserva de velocidade de fluxo coronariano (RVFC) ≥ 2 é adequada para inferir bom prognóstico ou ausência de coronariopatia importante. Objetivo: Identificar parâmetros relevantes na obtenção da RVFC (adequada ou inadequada) na descendente anterior (ADA), durante o ecocardiograma sob estresse com dobutamina (EED). Métodos: Avaliação de 100 pacientes encaminhados para pesquisa de isquemia miocárdica através do EED, orientados para suspender o betabloqueador 72 horas antes do exame. Calculou-se a RVFC pela divisão do pico de velocidade (cm/s) diastólica (PVD) verificado no EED (PVD-EED) pelo de repouso (PVD-REP). No grupo I, a RVFC < 2 e no grupo II a RVFC ≥ 2. Foram utilizados o teste t de Student e o exato de Fisher. Significância estatística quando p < 0,05. Resultados: Em repouso, o tempo (segundos) para obter o Doppler na ADA nos grupos I e II não diferiu (53 ± 31 vs. 45 ± 32; p = 0,23). No EED, registrou-se a ADA em 92 pacientes. O grupo I evidenciou pacientes mais velhos (65,9 ± 9,3 vs. 61,2 ± 10,8 anos; p = 0,04), menor fração de ejeção (61 ± 10 vs. 66 ± 6%; p = 0,005), maior PVD-REP (36,81 ± 08 vs. 25,63 ± 06 cm/s; p < 0,0001) e menor RVFC (1,67 ± 0,24 vs. 2,53 ± 0,57; p < 0,0001), entretanto o PVD-EED não diferiu (61,40 ± 16 vs. 64,23 ± 16 cm/s; p = 0,42). A suspensão do betabloqueador associou-se à chance 4 vezes maior de ocorrer RVFC < 2 (OR = 4; 95% IC [1,171 - 13,63], p = 0,027). Conclusão: O PVD-REP foi o principal parâmetro para determinar uma RVFC adequada. A suspensão do betabloqueador associou-se significativamente com RVFC inadequada. A elevada exequibilidade e o tempo para registro da ADA favorecem a utilização dessa metodologia.

Background: A coronary flow velocity reserve (CFVR) ≥ 2 is adequate to infer a favorable prognosis or the absence of significant coronary artery disease. Objective: To identify parameters which are relevant to obtain CFVR (adequate or inadequate) in the left anterior descending coronary artery (LAD) during dobutamine stress echocardiography (DSE). Methods: 100 patients referred for detection of myocardial ischemia by DSE were evaluated; they were instructed to discontinue the use of β-blockers 72 hours prior to the test. CFVR was calculated as a ratio of the diastolic peak velocity (cm/s) (DPV) on DSE (DPV-DSE) to baseline DPV at rest (DPV-Rest). In group I, CFVR was < 2 and, in group II, CFVR was ≥ 2. The Fisher's exact test and Student's t test were used for the statistical analyses. P values < 0.05 were considered statistically significant. Results: At rest, the time (in seconds) to obtain Doppler in LAD in groups I and II was not different (53±31 vs. 45±32; p=0.23). During DSE, LAD was recorded in 92 patients. Group I patients were older (65.9±9.3 vs. 61.2±10.8 years; p=0.04), had lower ejection fraction (61±10 vs. 66±6%; p=0.005), higher DPV-Rest (36.81±08 vs. 25.63 ± 06cm/s; p<0.0001) and lower CFVR (1.67 ± 0.24 vs. 2.53 ± 0.57; p<0.0001), but no difference was observed regarding DPVDSE (61.40±16 vs. 64.23±16cm/s; p=0.42). β-blocker discontinuation was associated with a 4-fold higher chance of a CFVR < 2 (OR= 4; 95% CI [1.171-13.63], p=0.027). Conclusion: DPV-Rest was the main parameter to determine an adequate CFVR. β-blocker discontinuation was significantly associated with inadequate CFVR. The high feasibility and the time to record the LAD corroborate the use of this methodology.

The aim of the present study was to evaluate which material and technique were the best for bonding 3x3 lingual retainer. One hundred and five bovine mandibular incisors were used, to which contention bars with a standardized size of 7 mm were bonded to the lingual surface. Initially all teeth received prophylaxis with pumice stone and water. After this they were randomly divided into seven groups, denominated and characterized as follows: Group (1) bars bonded with Transbond XT in accordance with the manufacturer's instructions; (2) Tooth surface etching with self-etching agent Transbond (SEPT) followed by bonding with Transbond XT; (3) Bonding with Transbond Plus Color Change (TPCC) without adhesive; (4) Bonding with TPCC + SEPT; (5) Bonding with restorative composite Z100 + adhesive Prime Bond, (6) Z100 without adhesive and (7) Z100 + SEPT. Before bonding in Groups 1, 3, 5 and 6 the lingual surface was etched with 37% phosphoric acid for 20 seconds, followed by washing and drying. After bonding the mechanical tests were performed in a Universal mechanical test machine. The values obtained were submitted to the analysis of variance (ANOVA) and afterwards to the Tukey test (p<0.05). We observed absence of statistical differences among Groups 1, 2, 5 and 7 and among Groups 3, 4, 5 and 6 (p<0.05). Group 1 presented the highest bond strength value and Group 6 the lowest. It could be concluded that where bonding of lingual retainer is concerned; the best material to use is Transbond XT irrespective of the etching method, followed by composite Z100 etched with SEPT.

El objetivo fue evaluar cuáles materiales y técnicas eran mejores para la adhesión del retenedor lingual 3x3. Se utilizaron 105 incisivos mandibulares bovinos, a los que se adhirieron barras de contención con un tamaño estándar de 7 mm en la superficie lingual . Inicialmente todos los dientes recibieron profilaxis con piedra pómez y agua. Luego, se dividieron aleatoriamente en siete grupos, denominados y caracterizados como: Grupo (1) con barras unidas con Transbond XT de acuerdo con las instrucciones del fabricante , (2) Con la superficie del diente grabada con el agente de auto- grabado Transbond (SEPT), seguido por la adhesión con Transbond XT, (3) Adhesión con Transbond Plus Color Change (TPCC ) sin adhesivo, (4) Adhesión con TPCC + SEPT, (5) Adhesión con la resina restauradora Z100 + adhesivo Prime Bond, (6) Adhesión con Z100 sin adhesivo y (7) Z100 + SEPT. Previo a la adhesión en los Grupos 1, 3, 5 y 6 la superficie lingual fue grabada con ácido fosfórico al 37% durante 20 segundos, lavado y secado. Se realizaron los ensayos con una máquina de ensayo mecánico universal. Los valores obtenidos fueron sometidos al análisis de varianza (ANOVA ) y a la prueba de Tukey ( p < 0,05). No hubo diferencias estadísticas entre los grupos 1, 2, 5 y 7 y entre los Grupos 3, 4, 5 y 6 (p < 0,05 ). El grupo 1 presentó el mayor valor de resistencia de adhesión y el Grupo 6 el menor. Se podría concluir que cuando se trata de la adhesión de un retenedor lingual, el mejor material para usar es Transbond XT independiente del método de grabado, seguido de la resina Z100 grabada con SEPT.