BackgroundDelirium is a common complication after cardiac surgery in older adult patients. However, risk factors and the influence of delirium on patient outcomes are not well established. We aimed to determine the incidence, predisposing and triggering factors of delirium following cardiac surgery.MethodsOne hundred seventy-three consecutive patients aged ≥60 years were studied. Patients’ characteristics and two cognitive function assessment tests were recorded preoperatively. Perioperative variables were blood transfusion, orotracheal intubation time (OIT), renal dysfunction, and hypoxemia. Delirium was assessed using the Confusion Assessment Method for the Intensive Care Unit. The composite outcome consisted of death, infection, and perioperative myocardial infarction until hospital discharge or 30 days after surgery, and for up to 18 months.ResultsOne hundred six patients (61.27%) were men and the age was 69.5 ± 5.8 years. EuroSCORE II index was 4.06 ± 3.86. Hypertension was present in 75.14%, diabetes in 39.88%, and 30.06% were illiterate. Delirium occurred in 59 patients (34.1%). Education level (OR 0.81, 0.71–0.92), hypertension (OR 2.73, 1.16–6.40), and mitral valve disease (OR 2.93, 1.32–6.50) were independent predisposing factors for delirium, and atrial fibrillation after surgery (OR 2.49, 1.20–5.20) represented the potential triggering factor. Delirium (OR 2.35, 1.20–4.58) and OIT ≥ 900 min (OR 2.50; 1.30–4.80) were independently associated with the composite outcome.ConclusionsIn older adult patients submitted to cardiac surgery, delirium is a frequent complication that is associated with worst outcome. Independent risk factors for delirium included education level, hypertension, mitral valve disease, and atrial fibrillation after cardiac surgery.

When present, the left atrial oblique vein can be easily recognized, adjacent to the Vieussens valve. The mean distance between the coronary sinus opening and left atrial oblique vein ostium was around 30 mm, independently of the heart weight and the presence of cardiomegaly.

BackgroundThe positive health impact of physical activity (PA) is well known, yet a large proportion of the world’s population remains sedentary. General PA programs are common as health promotion initiatives. However, effectiveness evaluations of such PA programs on individual and organizational aspects, which could inform the decision-making process of public health bodies are still lacking, particularly in the most socially disadvantaged areas, where health promotion schemes are particularly needed. The aim of this study was to assess the effectiveness of a Guided Walking Program in a high social vulnerability context.MethodsA quasi-experimental, mixed methods study was conducted. The program had a duration of 6 months and a 6-month follow-up period after the intervention. Session frequency was five times a week, where sessions consisted of supervised PA combined with educational sessions. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework was followed to assess the program. The International Physical Activity Questionnaire (IPAQ) and accelerometers were used to measure levels of PA. Focus groups were conducted to gain a comprehensive insight on the implementation domain.ResultsMost subjects in the intervention (IG) (n = 74) and control (CG) (n = 74) groups were female (IG:90.5%; CG:95.9%), aged 18–49 years (IG:44.6%; CG:43.2%), received less than 1 minimum wage (IG:74.3%; CG:83.7%) and had 0–4 years of formal education (IG:52.1%; CG:46.1%). The reach of the intervention was 0.3%. The IG showed increased levels of PA at post-intervention and 6-month follow-up. However, the difference between groups was not statistically significant. Adoption data revealed that 89.5% of the professionals in the Primary Health Care Center (health center) team perceived the benefits of the program for the population. The program was independently promoted by the health center team for a further 4 months post-intervention. The qualitative data revealed that the program was discontinued due to participants’ low adherence and human resource limitations in the unit’s operational dynamics.ConclusionsA health promotion intervention in a socially deprived setting faces challenges but can be effective and feasible to implement. The present study informs the development of future health promotion initiatives in this context.Trial registration NCT02857127. Registered: 30 July 2016 (retrospectively registered).

ABSTRACT ABSTRACTObjective Objective Objective Objective Objective: To evaluate the use of polyester resin in preserving anatomical specimens for the study of human anatomy. Methods Methods Methods Methods Methods: We used 150 anatomical specimens, comprised of unfixed (fresh), fixed in 10% formalin and vascular casts of organs injected with vinyl acetate and polyester resin. The solution used consisted of polyester resin with the diluent styrene monomer and catalyst (peroxol). After embedding in this solution, models in transparent resin were obtained, allowing full observation of structures and conservation of the specimens used. Results Results ResultsResults Results: upon evaluation of the specimens, we observed a high degree of transparency, which promoted a complete visualization of structures with perfect preservation of the anatomy. The average time for the completion of the embedding was 48 hours. Only 14 specimens (9.3%) were lost during the preparation. Conclusion Conclusion Conclusion Conclusion Conclusion: Polyester resin can be used for preserving anatomical specimens for teaching human anatomy in a practical, aesthetic and durable way.

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Systemic arterial hypertension is the most prevalent chronic noncommunicable disease among older people. This study aimed to estimate the prevalence of hypertension in the elderly and to analyze factors associated with diagnosed, undiagnosed, and uncontrolled hypertension. This is a cross-sectional study of data from the SABE study—Health, Well-Being, and Aging Survey—a multiple-cohort study, obtained in 2010, composed of a probabilistic sample representative of the population of the São Paulo city aged ≥60 years. Hypertension was self‐reported or defined by increased blood pressure. Multinomial regression assessed factors associated with diagnosis and lack of diagnosis of hypertension (reference: no hypertension), and logistic regression assessed factors associated with uncontrolled hypertension (reference: controlled). The prevalence of hypertension was 79.5%, and in 51% of individuals with the condition, hypertension was uncontrolled. Undiagnosed hypertension was associated with nonwhite skin color (OR: 1.89, CI: 1.11–3.19), being uninsured (OR: 1.77, CI: 1.04–3.03), overweight (OR: 2.38, CI: 1.09–5.19), higher education (OR: 0.46, CI: 0.22–1.94), and ≥1 chronic disease (OR: 0.28; CI: 0.13–0.58). Diagnosed hypertension was associated with age between 70 and 79 years (OR: 2.02, CI: 1.34–3.05), age ≥80 (OR: 2.73, CI: 1.72–4.31), nonwhite skin color (OR: 1.48, CI: 1.01–2.18), being uninsured (OR: 1.70, CI: 1.18–2.47), at least one medical consultation in the last year (OR: 1.86, CI: 1.06–3.25), obesity (OR: 2.50, CI: 1.61–3.88), and ≥1 chronic disease (OR: 2.81, CI: 1.94–4.08). Among those with hypertension, being uncontrolled was associated with widowhood (OR: 1.73, CI: 1.23–2.43), being uninsured (OR: 1.38, CI: 1.02–1.87), and female gender (OR: 0.61, CI: 0.43–0.87). The prevalence of hypertension was high in this population, and its diagnosis and control were associated with socioeconomic, demographic, and healthcare access factors.

ResumoCoração entrecruzado (criss-cross heart) é uma anomalia extremamente rara, caracterizada por rotação anormal da massa ventricular ao longo do seu eixo maior e pode estar associada com qualquer malformação dos segmentos e das conexões entre as câmaras cardíacas. Devido às alterações estruturais complexas e à raridade da anomalia, essa anomalia de rotação é muitas vezes mal diagnosticada. Neste trabalho são relatados dois casos de coração entrecruzado com ênfase no diagnóstico morfológico e nas técnicas cirúrgicas utilizadas. Foi também realizada revisão da literatura sobre o assunto, que, embora escassa, foi enfatizada quanto à morfologia, diagnóstico, abordagem cirúrgica e possíveis complicações.Descritores: Anormalidades congênitas. Procedimentos cirúrgicos cardíacos. Coração entrecruzado. AbstractCriss-cross heart is an extremely rare anomaly, characterized by an abnormal rotation of the ventricular mass along its major axis. It may be associated with any malformation of the heart segments and connections. Due to the complex structural changes and rarity of the anomaly, the rotation of ventricular axis is often misdiagnosed. In this paper, two cases of criss-cross heart are reported, with emphasis on diagnostic and surgical techniques used to corrected the main defects. A literature review on the subject is also presented which, although sparse, emphasized on the morphologic, diagnostic and surgical aspects of the anomaly.Descriptors: Congenital abnormalities. Cardiac surgical procedures. Crisscross heart. REVIEW ARTICLE 94Rev Bras Cir Cardiovasc 2013;28(1):93-102 Oliveira IM, et al. -Criss-cross heart: Report of two cases, anatomic and surgical description and literature review

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