Time in Therapeutic Range With Vitamin K Antagonists in Congenital Heart Disease: A Multicentre Study.

Background: Vitamin K antagonists (VKAs) are frequently prescribed to patients with congenital heart disease (CHD) for atrial arrhythmias or Fontan palliation, but there is a paucity of data regarding time spent in the therapeutic range (TTR). We sought to determine the TTR in patients with CHD and atrial arrhythmias or Fontan palliation prescribed VKAs and explore associations with thromboembolic and bleeding events.

Methods: A multicentre North American cohort study was conducted on patients with CHD who received VKAs for sustained atrial arrhythmia or Fontan palliation.

Cognitive impairment in the HTLV-1 infection: a comparative study associated with functional performance.

Human T cell leukemia virus type-I (HTLV-1) infection courses with a myelopathy, the tropical spastic paraparesis (HAM/TSP). In a case-control study, we compared the neuropsychological profile and functional characteristics in two case HTLV-1-infected groups (asymptomatic and with HAM/TSP) with a control group negative for HTLV-1. Subjects were paired for age, sex, and educational features.

Safety and efficacy of non-vitamin K antagonist oral anticoagulants for prevention of thromboembolism in adults with systemic right ventricle: Results from the NOTE international registry.

Background: Patients with systemic right ventricle (sRV), including transposition of great arteries (TGA) after atrial switch procedure and congenitally corrected transposition of great arteries (ccTGA), may require anticoagulation for thromboembolism (TE) prevention. In the absence of data on non-vitamin K antagonist oral anticoagulants (NOACs), vitamin K antagonists (VKAs) remain the agent of choice. We investigated the safety, efficacy and feasibility of NOACs treatment in adults with sRV in a worldwide study.

Thromboembolic Risk After Atriopulmonary, Lateral Tunnel, and Extracardiac Conduit Fontan Surgery.

Background: Thromboembolic events contribute greatly to morbidity and mortality following Fontan surgery for univentricular hearts.

Objectives: This study sought to evaluate the effect of type of Fontan surgery on thromboembolic risk.

Methods: A North American multicenter retrospective cohort study enrolled 522 patients with Fontan palliation consisting of an atriopulmonary connection (APC) (21.

Variability in the Echocardiographic Evaluation of the Systemic Right Ventricle.

Background: Echocardiographic evaluation of the systemic right ventricle (sRV) remains challenging in patients with transposition of the great arteries (TGA) corrected by an atrial switch (AS) and with congenitally corrected TGA (ccTGA). The aim of this study was to determine the interobserver and intraobserver variability of echocardiographic parameters for sRV size and systolic function.

Methods: Six independent observers retrospectively interpreted 44 previously acquired echocardiograms (25 patients with TGA/AS and 19 patients with ccTGA).

Increasing Prevalence of Atrial Fibrillation and Permanent Atrial Arrhythmias in Congenital Heart Disease.

Background: Atrial arrhythmias are the most common complication encountered in the growing and aging population with congenital heart disease.

Objectives: This study sought to assess the types and patterns of atrial arrhythmias, associated factors, and age-related trends.

Methods: A multicenter cohort study enrolled 482 patients with congenital heart disease and atrial arrhythmias, age 32.

Thromboprophylaxis for atrial arrhythmias in congenital heart disease: A multicenter study.

Background: There is a paucity of data to guide decisions regarding thromboprophylaxis for atrial arrhythmias in congenital heart disease.

Methods: A retrospective multicenter cohort study enrolled patients with documented sustained atrial arrhythmias and congenital heart disease from 12 North American centers to quantify thromboembolic and bleeding rates associated with antiplatelet and anticoagulation therapy, and explore associated factors. A blinded committee adjudicated all qualifying arrhythmias and outcomes.

The impact of exercise on ventricular arrhythmias in adults with tetralogy of Fallot.

Background: Sudden death of presumed arrhythmic etiology is the leading cause of mortality in adults with tetralogy of Fallot.

Objectives: To assess the impact of exercise on ventricular arrhythmias in adults with tetralogy of Fallot.

Methods: Adults with repaired tetralogy of Fallot were randomized in a 2:1 ratio to an open-label trial of standard care versus 12weeks of supervised combined aerobic/resistance training with continuous Holter monitoring.

Teaching transfusion medicine: current situation and proposals for proper medical training.

The current curricula in medical schools and hospital residence worldwide lack exposure to blood transfusion medicine, and require the reformulation of academic programs. In many countries, training in blood transfusion is not currently offered to medical students or during residency. Clinical evidence indicates that blood transfusions occur more frequently than recommended, contributing to increased risk due to this procedure.

Contribution of the Retrovirus Epidemiology Donor Study (REDS) to research on blood transfusion safety in Brazil.

The Retrovirus Epidemiology Donor Study (REDS) program was established in the United States in 1989 with the purpose of increasing blood transfusion safety in the context of the HIV/AIDS and human T-lymphotropic virus epidemics. REDS and its successor, REDS-II were at first conducted in the US, then expanded in 2006 to include international partnerships with Brazil and China. In 2011, a third wave of REDS renamed the Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) was launched.

Aortic coarctation and the retinal microvasculature.

Background: Aortic coarctation has been associated with generalized vascular disease, yet little is known about retinal vascular patterns and their changes over time.

Objectives: The aim of this study is to characterize the nature and extent of retinal vascular disease in adults with aortic coarctation, and explore age-related effects and associations with cardiovascular outcomes.

Methods: A prospective cross-sectional seroepidemiological study was conducted on 60 consecutive adults with repaired aortic coarctation, age 42.

Sickle Cell Disease: quality of life in patients with hemoglobin SS and SC disorders.

Objective: Sickle cell disease comprises chronic, genetically determined disorders, presenting significant morbidity and high prevalence in Brazil. The goal of this study was to evaluate the quality of life of sickle cell disease patients (hemoglobin SS and SC) and their sociodemographic and clinical characteristics.

Methods: Data was collected from clinical records and semi-structured interviews consisting of clinical questionnaires and the World Health Organization Quality of Life-brief questionnaire.

Temporal distribution of blood donations in three Brazilian blood centers and its repercussion on the blood supply.

Background: Seasonal distribution of blood donation hinders efforts to provide a safe and adequate blood supply leading to chronic and persistent shortages. This study examined whether holidays, geographical area and donation type (community versus replacement) has any impact on the fluctuation of donations.

Methods: The numbers of blood donations from 2007 through 2010 in three Brazilian Retrovirus Epidemiological Donor Study II (REDS-II) participating centers were analyzed according to the week of donation.

Evaluation of rapid tests for human immunodeficiency virus as a tool to detect recent seroconversion.

The identification of recent HIV infection is important for epidemiological studies and to monitor the epidemic. The objective of this study was to evaluate two rapid tests that are easily available to the Brazilian scientific community for using as markers of recent HIV infection. The Rapid Test - HIV-1/2 Bio-Manguinhos (Bio-Manguinhos/Fiocruz, Brazil) and the Rapid Check HIV 1&2 (NDI-UFES, Center for Infectious Diseases, Universidade Federal do Espírito Santo) were tested, using 489 samples with HIV positive serology, from blood donors, previously classified as recent or long-term infection by serological testing algorithm for recent HIV seroconversion (STARHS) or LS-HIV Vitros assay methods.

Monitoring the HTLV-1 proviral load in the peripheral blood of asymptomatic carriers and patients with HTLV-associated myelopathy/tropical spastic paraparesis from a Brazilian cohort: ROC curve analysis to establish the threshold for risk disease.

Human T-lymphotropic virus 1 (HTLV-1) infection is associated with HTLV-associated myelopathy/tropical spastic paraparesis (HAM/TSP), which affects approximately 5% of carriers. High proviral load is a risk marker for HAM/TSP, although there is an overlap of proviral load levels in peripheral blood between asymptomatic carriers and HAM/TSP patients. In this study, receiver operating characteristic curve analysis was used to define a set point of HTLV-1 proviral load that better indicates an increased risk for HAM/TSP.

Vasovagal reactions in whole blood donors at three REDS-II blood centers in Brazil.

Background: In Brazil little is known about adverse reactions during donation and the donor characteristics that may be associated with such events. Donors are offered snacks and fluids before donating and are required to consume a light meal after donation. For these reasons the frequency of reactions may be different than those observed in other countries.

Confidential donation confirmation as an alternative to confidential unit exclusion: 15 months experience of the HEMOMINAS foundation.

Background: Confidential unit exclusion remains a controversial strategy to reduce the residual risk of transfusion-transmitted infections.

Objective: This study aimed to analyze confidential unit exclusion from its development in a large institution in light of confidential donation confirmation.

Methods: Data of individuals who donated from October 1, 2008 to December 31, 2009 were analyzed in a case-control study.

Human T cell lymphotropic virus (HTLV-1): when to suspect infection?

Human T-cell lymphotropic virus (HTLV) infections have occurred for thousands of years. However, knowledge about their pathogenesis is recent. The virus is endemic in several regions around the world.

[Spatial-temporal distribution of potential blood donors at the Hemominas Foundation, Belo Horizonte, Minas Gerais State, Brazil, in 1994 and 2004].

The main goal of this study was to describe the spatial and temporal distribution of candidates for blood donation in Belo Horizonte, Minas Gerais State, Brazil, who appeared at the Hemominas Foundation in 1994 and 2004. The study also compared the candidates for age, gender, and clinical approval for blood donation in space and space-time. Data were obtained from a cross-sectional study for 1994 and were randomly selected from all donor candidates for 2004.

HTLV-I/II and blood donors: determinants associated with seropositivity in a low risk population.

Objective: Blood donors in Brazil have been routinely screened for HTLV-I/II since 1993. A study was performed to estimate the prevalence of HTLV-I/II infection in a low risk population and to better understand determinants associated with seropositivity.

Methods: HTLV-I/II seropositive (n=135), indeterminate (n=167) and seronegative blood donors (n=116) were enrolled in an open prevalence prospective cohort study.

Dermatologic lesions in asymptomatic blood donors seropositive for human T cell lymphotropic virus type-1.

Dermatologic manifestations are quite common in patients with adult T cell leukemia/lymphoma and myelopathy/tropical spastic paraparesis associated with infection with human T cell lymphotropic virus type-1 (HTLV-1). In this study, we evaluated the dermatologic lesions of eligible blood donors in the state of Minas Gerais in Brazil who were seropositive but asymptomatic for infection with HTLV-1. The study population was composed of 128 HTLV-1-seropositive individuals and 108 seronegative controls.