ABSTRACT Introduction: COVID-19 disease presentation is heterogeneous, from asymptomatic up to severe life-threatening forms. Getting further insights into patients with specific diseases is of particular interest. We aimed to identify profiles of hematology patients hospitalized with COVID-19 that would be associated with survival and to assess the differences between cohorts Methods: A binational cohort of 263 patients with COVID-19 and hematological disease was studied in Paris, France and São Paulo, Brazil. Patient profiles were based on age, comorbidities, biological measurements, COVID-19 symptoms and hematological disease characteristics. A semi-supervised learning method with a survival endpoint was first used, following which, a classifier was identified to allow the classification of patients using only baseline information Main results: Two profiles of patients were identified, one being young patients with few comorbidities and low C-reactive protein (CRP), D-dimers, lactate dehydrogenase (LDH) and creatinine levels, and the other, older patients, with several comorbidities and high levels of the 4 biology markers. The profiles were strongly associated with survival (p < 0.0001), even after adjusting for age (p = 0.0002). The 30-day survival rate was 77.1% in the first profiles, versus 46.7% in the second. The Brazilian analysis emphasized the importance of age, while the French focused on the comorbidities Conclusion: This analysis showed the importance of CRP, LHD and creatinine in the COVID-19 presentation and prognosis, whatever the geographic origin of the patients.

RESUMEN Objetivo. Evaluar el tamizaje de muestras de sangre en las que se analizan marcadores de enfermedades infecciosas en laboratorios y bancos de sangre de América Latina según los resultados de un programa de evaluación externa de la calidad (EQAP, por su sigla en inglés). Métodos. Este análisis cualitativo utilizó datos del EQAP —coordinado por la Fundação Pro Sangue Hemocentro de São Paulo con el apoyo de la Organización Panamericana de la Salud— para evaluar la eficacia del tamizaje sanguíneo para la detección de enfermedades infecciosas que se realizó entre el 2014 y el 2018 en América Latina. Cada laboratorio o banco de sangre participante recibió un panel idéntico para análisis a ciegas compuesto por 24 muestras de sangre con reactividad variable para todos los parámetros del tamizaje. Los paneles se procesaron en cada establecimiento participante y los resultados se enviaron a la Fundação Pro Sangue Hemocentro de São Paulo donde se realizaron análisis individuales y conjuntos. Había dos tipos de resultados discrepantes que eran posibles fallas del tamizaje: los positivos falsos (PF) y los negativos falsos (NF). Resultados. En total se evaluaron 23 136 muestras. Las tasas generales de PF, NF y resultados concordantes fueron, respectivamente, del 0,3%, 1,0% y 98,7%. Se obtuvieron siete NF en casos de HBsAg (1,0%), 12 en casos de sífilis (2,6%) y 21 en casos de enfermedad de Chagas (2,9%). No se obtuvieron NF en casos de infección por virus del VIH, el VHC o el VLTH. La precisión promedio de todos los laboratorios y bancos de sangre participantes en el EQAP durante el periodo de estudio fue del 99,5% (desviación típica: 0,5%). Conclusión. Los resultados de este análisis cualitativo son positivos en lo referente a la seguridad sanguínea en América Latina, con una precisión promedio del 99,5% entre los laboratorios y bancos de sangre participantes. Este informe refleja la considerable mejora del tamizaje serológico que se realiza en los bancos de sangre, en comparación con los resultados del informe del EQAP que contó con el apoyo de la OPS y se publicó en el 2003.

ABSTRACT Objective. To evaluate the screening of blood samples for infectious disease markers at laboratories and blood banks in Latin America per the findings of an External Quality Assessment Program (EQAP). Methods. This qualitative analysis used data from the EQAP coordinated by the Fundação Pro Sangue Hemocentro de São Paulo with the support of the Pan American Health Organization to assess the performance of blood screening for infectious diseases from 2014 to 2018 in Latin America. Each participating laboratory or blood bank received an identical blind panel with 24 blood samples with variable reactivity for all the screening parameters. Panels were processed at each participating facility and results were returned to the Fundação Pro Sangue Hemocentro de São Paulo for individual and joint analyses. Two types of discrepant results were potential failures: false positive results (FPRs) and false nonreactive results (FNRRs). Results. A total of 23 136 samples were evaluated. Global rates of FPR, FNRR, and concordant results were 0.3%, 1.0% and 98.7%, respectively. Seven FNRRs were found for HBsAg (1.0%), 12 for syphilis (2.6%), and 21 for Chagas disease (2.9%). No FNRRs were found for the HIV, HCV, and HTLV viruses. The average accuracy of all the laboratories and blood banks participating in the EQAP during the study period was 99.5% (standard deviation, 0.5%). Conclusion. The findings of this qualitative analysis are positive for blood safety in Latin America, with an average accuracy of 99.5% among the participating laboratories and blood banks. This report reflects an important improvement in blood bank serological screening EQAP-PAHO report since the 2003.

RESUMO Objetivo. Avaliar a triagem de marcadores de doenças infecciosas em amostras de sangue realizada em laboratórios e bancos de sangue da América Latina de acordo com os resultados de um Programa Externo de Avaliação de Qualidade (EQAP, na sigla em inglês). Métodos. Esta análise qualitativa usou dados do EQAP coordenado pela Fundação Pró-Sangue Hemocentro de São Paulo, com o apoio da Organização Pan-Americana da Saúde, para avaliar o desempenho da triagem de sangue quanto a doenças infecciosas no período de 2014 a 2018 na América Latina. Cada laboratório ou banco de sangue participante recebeu um painel cego idêntico com 24 amostras de sangue de reatividade variável para todos os parâmetros de triagem. Os painéis foram processados em cada estabelecimento participante e os resultados foram devolvidos à Fundação Pró-Sangue Hemocentro de São Paulo para análises individuais e conjuntas. Dois tipos de resultados discrepantes representavam falhas em potencial: resultados falso-positivos e resultados falso-negativos (não reativos). Resultados. Foram avaliadas 23.136 amostras. As taxas globais de resultados falso-positivos, falso-negativos e concordantes foram de 0,3%, 1,0% e 98,7%, respectivamente. Foram encontrados sete resultados falso-negativos para HBsAg (1,0%), 12 para sífilis (2,6%) e 21 para doença de Chagas (2,9%). Não houve resultados falso-negativos para os vírus HIV, HCV e HTLV. A acurácia média de todos os laboratórios e bancos de sangue que participaram do EQAP durante o período do estudo foi de 99,5% (desvio padrão de 0,5%). Conclusões. Os resultados desta análise qualitativa são positivos para a segurança do sangue na América Latina, com uma acurácia média de 99,5% entre os laboratórios e bancos de sangue participantes. Este relatório reflete uma melhoria importante na triagem sorológica dos bancos de sangue em relação aos resultados do relatório do EQAP apoiado pela OPAS que foi publicado em 2003.

ABSTRACT Background: Transfusion of ABO-compatible non-identical platelets (PTLs), fresh plasma (FP) and red blood cells (RBCs) has been associated with increased morbidity and mortality of recipients. Trauma victims are frequently exposed to ABO non-identical products, given the need for emergency transfusions. Our goal was to evaluate the impact of the transfusion of ABO non-identical blood products on the severity and all-cause 30-day mortality of trauma patients. Methods: This was a retrospective single-center cohort, which included trauma patients who received emergency transfusions in the first 24 h of hospitalization. Patients were divided in two groups according to the use of <3 or ≥3 ABO non-identical blood products. The patient severity, measured by the Acute Physiology and Chronic Health Evaluation (APACHEII) score at ICU admission, and the 30-day mortality were compared between groups. Results: Two hundred and sixteen trauma patients were enrolled. Of these, 21.3% received ≥3 ABO non-identical blood products (RBCs, PLTs and FP or cryoprecipitate). The transfusion of ≥3 ABO non-identical blood products in the first 24 h of hospitalization was independently associated with a higher APACHEII score at ICU admission (OR = 3.28 and CI95% = 1.48–7.16). Transfusion of at least one unit of ABO non-identical PTLs was also associated with severity (OR = 10.89 and CI95% = 3.38–38.49). Transfusion of ABO non-identical blood products was not associated with a higher 30-day mortality in the studied cohort. Conclusion: The transfusion of ABO non-identical blood products and, especially, of ABO non-identical PLTs may be associated with the greater severity of trauma patients at ICU admission. The transfusion of ABO non-identical blood products in the trauma setting is not without risks.

Abstract Background With the growth of the elderly population in Brazil and the increasing impact of depression and anxiety, the importance of preventing these disorders has been highlighted. Studies have shown an inverse relationship between rates of depression/anxiety and physical activity, pointing out its role as a possible protective factor. Objectives To conduct a randomized study with elderly adults in the community, who present with subsyndromal depression and anxiety, that will evaluate the effectiveness of physical activity with a collaborative stepped-care strategy; and to compare the effectiveness of physical activity in preventing subsyndromal depression and anxiety, with regard to the usual care group. Methods The article contains the methodological description of an arm of a large study entitled “Prevention and Treatment of Depression in Elderly”, in which 2,566 Brazilian older adults were screened to identify clinically significant depressive and anxiety symptoms. Those with clinically significant depressive or anxiety symptoms, not meeting criteria for depressive or anxiety disorder, will be invited to participate in a randomized clinical trial with 2 intervention groups: a step-by-step preventive care programme using physical activity, and usual care. The effectiveness of physical activity in the prevention of depressive and anxiety disorders will be evaluated. Discussion New health policies could be implemented, aiming to reduce the number of elderly people with depression and anxiety in primary care. In addition, training may be implemented for family health teams so that screening tools could be used to make an early identification of individuals with (or at risk of developing) mental disorders.

Resumo Fundamento: Estudos demonstraram o impacto da fibrilação atrial (FA) na qualidade de vida dos pacientes. Questionários específicos permitem avaliar manifestações pertinentes. Desenvolvemos anteriormente questionário de qualidade de vida para FA (QVFA versão 1) e, neste estudo, apresentamos reanálise e adições de novos domínios. Objetivo: Demonstrar a reprodutibilidade do QVFA na versão 2 (QVFA v.2) com a inclusão dos domínios fadiga, percepção da doença e bem-estar. Métodos: Foram aplicados 160 questionários (QVFA v.2 e SF-36) em 40 pacientes com intervalos de 15 dias para mensuração da reprodutibilidade inter- e intra-observador. A análise de estabilidade da qualidade de vida foi determinada pelo teste-reteste, aplicando o coeficiente de correlação intraclasse (CCI) de Bartko. A consistência interna foi avaliada pelo teste alfa de Cronbach. Resultados: O escore total do teste-reteste (n=40) apresentou CCI de 0,98 no QVFA v.2 e de 0,94 no SF36. Na avaliação intra-observador e inter-observador do QVFA v.2, a confiabilidade do CCI foi de 0,98 e 0,97, respectivamente. Para a análise da consistência interna, obteve-se um coeficiente alfa de Cronbach de 0,82, compatível com boa concordância do QFVA v.2. Conclusão: O QVFA v.2 apresentou melhor desempenho em relação à versão anterior. No mesmo sentido, os domínios acrescentados contribuíram para torná-lo mais abrangente e robusto para avaliar a qualidade de vida de pacientes com FA.

Abstract Background: Studies have shown the impact of atrial fibrillation (AF) on the patients' quality of life. Specific questionnaires enable the evaluation of relevant events. We previously developed a questionnaire to assess the quality of life of patients with AF (AFQLQ version 1), which was reviewed in this study, and new domains were added. Objective: To demonstrate the reproducibility of the AFQLQ version 2 (AFQLQ v.2), which included the domains of fatigue, illness perception and well-being. Methods: We applied 160 questionnaires (AFQLQ v.2 and SF-36) to 40 patients, at baseline and 15 days after, to measure inter- and intraobserver reproducibility. The analysis of quality of life stability was determined by test-retest, applying the Bartko intraclass correlation coefficient (ICC). Internal consistency was assessed by Cronbach's alpha test. Results: The total score of the test-retest (n = 40) had an ICC of 0.98 in the AFQLQ v.2, and of 0.94 in the SF36. In assessing the intra- and interobserver reproducibility of the AFQLQ v.2, the ICC reliability was 0.98 and 0.97, respectively. The internal consistency had a Cronbach's alpha coefficient of 0.82, compatible with good agreement of the AFQLQ v.2. Conclusion: The AFQLQ v.2 performed better than its previous version. Similarly, the domains added contributed to make it more comprehensive and robust to assess the quality of life of patients with AF.

Objective To assess the cross-cultural adaptation to Brazilian Portuguese of two instruments for the measurement of family-centered care, one for parents and one for healthcare professionals. Methods Methodological study of cross-cultural adaptation following the phases of translation, back-translation, analysis by experts, pre-test, test-retest and psychometric analysis after the application of the instrument to 100 parents of hospitalized children and 100 professionals from pediatric units of a teaching hospital. Results The evaluation of experts in both instruments showed a Kappa of 0.85 and 0.93 respectively. At pretest, participants suggested no changes. Test-retest reliability was good for both stability indexes. Factor analysis explained 43.9% of the total variance in the parents instrument and 43.4% in the staff instrument. Cronbach's alpha coefficient was 0.723 for the parents instrument and 0.781 for the staff instrument. Conclusion The instruments adapted to the Brazilian culture presented reliability, stability and good internal consistency, with potential to be used in the pediatric clinical practice.

Objetivo Realizar a adaptação transcultural para a língua portuguesa brasileira de dois instrumentos de medida do cuidado centrado na família, um para pais e outro para profissionais da equipe de saúde. Métodos Estudo metodológico de adaptação transcultural seguindo as etapas de tradução, retrotradução, análise de especialistas, pré-teste, teste-reteste e análise psicométrica após aplicação do instrumento com 100 pais de crianças hospitalizadas e 100 profissionais de unidades pediátricas de um hospital universitário. Resultados A avaliação por especialistas de ambos os instrumentos apresentaram Kappa de 0,85 e 0,93 respectivamente. No pré-teste, os participantes não sugeriram alterações. No teste-reteste houve bons índices de estabilidade em ambos. A análise fatorial explicou 43,9% da variância total no instrumento pais e 43,4% no instrumento equipe. O coeficiente Alpha de Cronbach foi 0,723 no instrumento pais e 0,781 no instrumento equipe. Conclusão Os instrumentos adaptados para a cultura brasileira apresentaram confiabilidade, estabilidade e boa consistência interna com potencial para ser utilizado na pratica clinica pediátrica.

Objetivo Realizar a adaptação transcultural para a língua portuguesa brasileira de dois instrumentos de medida do cuidado centrado na família, um para pais e outro para profissionais da equipe de saúde. Métodos Estudo metodológico de adaptação transcultural seguindo as etapas de tradução, retrotradução, análise de especialistas, pré-teste, teste-reteste e análise psicométrica após aplicação do instrumento com 100 pais de crianças hospitalizadas e 100 profissionais de unidades pediátricas de um hospital universitário. Resultados A avaliação por especialistas de ambos os instrumentos apresentaram Kappa de 0,85 e 0,93 respectivamente. No pré-teste, os participantes não sugeriram alterações. No teste-reteste houve bons índices de estabilidade em ambos. A análise fatorial explicou 43,9% da variância total no instrumento pais e 43,4% no instrumento equipe. O coeficiente Alpha de Cronbach foi 0,723 no instrumento pais e 0,781 no instrumento equipe. Conclusão Os instrumentos adaptados para a cultura brasileira apresentaram confiabilidade, estabilidade e boa consistência interna com potencial para ser utilizado na pratica clinica pediátrica.

Objective To assess the cross-cultural adaptation to Brazilian Portuguese of two instruments for the measurement of family-centered care, one for parents and one for healthcare professionals. Methods Methodological study of cross-cultural adaptation following the phases of translation, back-translation, analysis by experts, pre-test, test-retest and psychometric analysis after the application of the instrument to 100 parents of hospitalized children and 100 professionals from pediatric units of a teaching hospital. Results The evaluation of experts in both instruments showed a Kappa of 0.85 and 0.93 respectively. At pretest, participants suggested no changes. Test-retest reliability was good for both stability indexes. Factor analysis explained 43.9% of the total variance in the parents instrument and 43.4% in the staff instrument. Cronbach's alpha coefficient was 0.723 for the parents instrument and 0.781 for the staff instrument. Conclusion The instruments adapted to the Brazilian culture presented reliability, stability and good internal consistency, with potential to be used in the pediatric clinical practice.

Fundamento:O bloqueio atrioventricular congênito isolado (BAVCi) é raro e tem múltiplas apresentações clínicas. O remodelamento ventricular pode ocorrer em cerca de 10% dos indivíduos após o implante de marca-passo.Objetivos:Avaliar a capacidade funcional de crianças e adultos jovens com BAVCi e estimulação crônica no ventrículo direito (VD) e pesquisar sua associação com fatores preditores de remodelamento ventricular.Métodos:Estudo transversal em coorte de indivíduos com BAVCi e estimulação no VD há mais de um ano. Os indivíduos foram submetidos a avaliação clínica e ecocardiográfica. A capacidade funcional foi avaliada pelo teste de caminhada de seis minutos. Foram empregados os testes qui-quadrado, exato de Fisher e coeficiente de correlação de Pearson, considerando o nível de significância de 5%.Resultados:De março de 2010 a dezembro de 2013, foram avaliados 61 indivíduos, 67,2% do sexo feminino, com 7-41 anos de idade e uso de MP há 13,5 ± 6,3 anos. O percentual de estimulação ventricular era 97,9 ± 4,1% e a duração do complexo QRS estimulado era de 153,7 ± 19,1 ms. A maioria (95,1%) era assintomática e não utilizava medicamentos. A distância média percorrida de 546,9 ± 76,2 m teve forte correlação com a distância predita (r = 0,907; p = 0,001) e não se associou com os fatores de risco de remodelamento estudados.Conclusões:A capacidade funcional de portadores de BAVTCi com estimulação crônica no VD foi satisfatória e não se correlacionou com os fatores de risco para remodelamento ventricular.

Background:Isolated congenital atrioventricular block (CAVB) is a rare condition with multiple clinical outcomes. Ventricular remodeling can occur in approximately 10% of the patients after pacemaker (PM) implantation.Objectives:To assess the functional capacity of children and young adults with isolated CAVB and chronic pacing of the right ventricle (RV) and evaluate its correlation with predictors of ventricular remodeling.Methods:This cross-sectional study used a cohort of patients with isolated CAVB and RV pacing for over a year. The subjects underwent clinical and echocardiographic evaluation. Functional capacity was assessed using the six-minute walk test. Chi-square test, Fisher's exact test, and Pearson correlation coefficient were used, considering a significance level of 5%.Results:A total of 61 individuals were evaluated between March 2010 and December 2013, of which 67.2% were women, aged between 7 and 41 years, who were using PMs for 13.5 ± 6.3 years. The percentage of ventricular pacing was 97.9 ± 4.1%, and the duration of the paced QRS complex was 153.7 ± 19.1 ms. Majority of the subjects (95.1%) were asymptomatic and did not use any medication. The mean distance walked was 546.9 ± 76.2 meters and was strongly correlated with the predicted distance (r = 0.907, p = 0.001) but not with risk factors for ventricular remodeling. (Arq Bras Cardiol. 2014; [online].ahead print, PP.0-0)Conclusions:The functional capacity of isolated CAVB patients with chronic RV pacing was satisfactory but did not correlate with risk factors for ventricular remodeling.