New spirometry recommendations from the Brazilian Thoracic Association - 2024 update.

The latest pulmonary function guideline from the Brazilian Thoracic Association was published in 2002, since which there have been updates to international guidelines (mainly those from the European Respiratory Society and the American Thoracic Society), as well as new national and international publications on various aspects of the performance, interpretation, and clinical implications of spirometry. Despite those updates, a careful analysis of what applies to the reality in Brazil is essential, because there have been studies that evaluated individuals who are representative of our population and who could show responses different from those of individuals in other regions of the world. This document is the result of the work of a group of specialists in pulmonary function who evaluated relevant scientific articles that could be applicable to the population of Brazil.

Beyond sleep: Rest and activity rhythm as a marker of preclinical and mild dementia in older adults with less education.

Background: Although sleep duration and sleep-related breathing disorders were associated with dementia previously, few studies examined the association between circadian rhythm association and cognitive status.

Objective: We aimed to investigate the association of rest and activity rhythm with cognitive performance in older people with cognitive complaints and less education.

Methods: Activity rhythm was evaluated with wrist actigraphy in 109 community-dwelling older people with cognitive complaints without diagnosed dementia.

A Bayesian Interpretation of CABANA and Other Randomized Controlled Trials for Catheter Ablation in Patients With Atrial Fibrillation.

Background: Catheter ablation improves symptoms and quality of life in atrial fibrillation patients, but its effect on adverse cardiovascular outcomes and mortality remains uncertain. Bayesian analysis of randomized controlled trials offers a deeper understanding of treatment effects beyond conventional p-value thresholds.

Methods: We conducted a post hoc Bayesian reanalysis of CABANA and four similar trials to estimate catheter ablation's effect on cardiovascular and survival outcomes.

Hyperintense lesions of the middle cerebellar peduncle and beyond: a pictorial essay.

The middle cerebellar peduncle (MCP) is the largest afferent system of the cerebellum and consists of fibres from the cortico-ponto-cerebellar tract. Specifically, several relevant diseases can present with hyperintensity in the MCP on T2-weighted/fluid-attenuated inversion recovery (T2/FLAIR) magnetic resonance imaging sequences, including multiple sclerosis; acute disseminated encephalomyelitis; neuromyelitis optica spectrum disorder; progressive multifocal leucoencephalopathy; hepatic encephalopathy; osmotic demyelination syndrome; multiple system atrophy; fragile X-associated tremor/ataxia syndrome; megalencephalic leucoencephalopathy with subcortical cysts; spinocerebellar ataxias; hemi-pontine infarct with trans-axonal degeneration; and diffuse midline glioma with the histone H3K27M mutation. The aim of this pictorial review is to discuss the imaging findings that are relevant for the differential diagnosis of diseases presenting with MCP hyperintensity on T2/FLAIR sequences.

TREATMENT OF ADHESIVE CAPSULITIS WITH THE TRIPLE PROCEDURE: INTRA-ARTICULAR INJECTION WITH CORTICOSTEROIDS, HYDRODILATION AND SHOULDER MANIPULATION UNDER SEDATION.

Objective: There are several conservative treatment options for adhesive capsulitis (AC), but no previous study combines hydrodilation, corticosteroid injection and joint manipulation under sedation (triple procedure), followed by daily home exercises.

Methods: Patients included were evaluated before the procedure, at 30 days, 3, 6 and 12 months after treatment in prospective cohort. The outcomes used were the ASES, UCLA, SANE, VAS scales and passive range of motion (ROM).

Clinical impact of healthcare-associated infections in Brazilian ICUs: a multicenter prospective cohort.

Background: Limited data is available to evaluate the burden of device associated healthcare infections (HAI) [central line associated bloodstream infection (CLABSI), catheter associated urinary tract infection (CAUTI), and ventilator associated pneumonia (VAP)] in low and-middle-income countries. Our aim is to investigate the population attributable mortality fraction and the absolute mortality difference of HAI in a broad population of critically ill patients from Brazil.

Methods: Multicenter cohort study from September 2019 to December 2023 with prospective individual patient data collection.

Hemodynamic effects of slower versus faster intravenous fluid bolus rates in critically ill patients: An observational study.

Purpose: We compared the immediate and sustained effects of 500 mL of crystalloid administered at slow (333 mL/h) versus fast rates (999 mL/h) on mean arterial pressure (MAP) in critically ill patients.

Materials And Methods: Hemodynamic variables were collected immediately before and every 30 min up to 60 min after the end of the infusion. The primary outcome was the adjusted difference in MAP.

Seven versus 14 days of antimicrobial therapy for severe multidrug-resistant Gram-negative bacterial infections in intensive care unit patients (OPTIMISE): a randomised, open-label, non-inferiority clinical trial.

Background: Shorter courses of antimicrobial therapy have been shown to be non-inferior to longer durations for the management of several infections. However, data on critically ill patients with severe infections by multidrug-resistant Gram-negative bacteria (MDR-GNB) are scarce. In the duratiOn of theraPy in severe infecTIons by MultIdrug-reSistant gram-nEgative bacteria (OPTIMISE) trial, we assessed the non-inferiority of 7-day versus 14-day antimicrobial therapy for patients with intensive care unit (ICU)-acquired severe infections by MDR-GNB.

Myocardial Infarction with ST Elevation and Reperfusion Therapy in Brazil: Data from the ACCEPT Registry.

Background: There is a lack of information from Brazil regarding therapies used and outcomes in patients with acute coronary syndrome with ST elevation (STEMI).

Objectives: To evaluate evidence-based therapies, occurrence of outcomes, reperfusion use, and predictors of not receiving reperfusion in patients with STEMI in a national multicenter registry.

Methods: Patients with STEMI from the ACCEPT registry, with up to 12 hours of symptoms, were followed for 1 year for the occurrence of major adverse cardiovascular events.

High-Flow Nasal Oxygen vs Noninvasive Ventilation in Patients With Acute Respiratory Failure: The RENOVATE Randomized Clinical Trial.

Importance: High-flow nasal oxygen (HFNO) and noninvasive ventilation (NIV) are commonly used respiratory support therapies for patients with acute respiratory failure (ARF).

Objective: To assess whether HFNO is noninferior to NIV on the rates of endotracheal intubation or death at 7 days in 5 patient groups with ARF.

Design, Setting, And Participants: This noninferiority, randomized clinical trial enrolled hospitalized adults (aged ≥18 years; classified as 5 patient groups with ARF: nonimmunocompromised with hypoxemia, immunocompromised with hypoxemia, chronic obstructive pulmonary disease [COPD] exacerbation with respiratory acidosis, acute cardiogenic pulmonary edema [ACPE], or hypoxemic COVID-19, which was added as a separate group on June 26, 2023) at 33 hospitals in Brazil between November 2019 and November 2023 (final follow-up: April 26, 2024).

Early Diagnostic Prediction of Infective Endocarditis: Development and Validation of EndoPredict-Dx.

Background: Infective endocarditis is a life-threatening disease with diverse clinical presentations, making diagnosis challenging and requiring a range of complementary tests. The level of suspicion, based on clinical judgment, guides decisions regarding the initiation of empirical treatment and the selection of appropriate diagnostic tools. This study aimed to develop and validate the EndoPredict-Dx score for early prediction of infective endocarditis diagnosis.

Effect of a driving pressure-limiting strategy for patients with acute respiratory distress syndrome secondary to community-acquired pneumonia: the STAMINA randomised clinical trial.

Background: This study aimed to assess whether a driving pressure-limiting strategy based on positive end-expiratory pressure (PEEP) titration according to best respiratory system compliance and tidal volume adjustment increases the number of ventilator-free days within 28 days in patients with moderate to severe acute respiratory distress syndrome (ARDS).

Methods: This is a multi-centre, randomised trial, enrolling adults with moderate to severe ARDS secondary to community-acquired pneumonia. Patients were randomised to a driving pressure-limiting strategy or low PEEP strategy based on a PEEP:FiO table.

Association between vaccination and persistent COVID-19-related symptoms among patients with mild Omicron infection: A prospective cohort study.

Background: While COVID-19 vaccination has been shown to reduce the risk of severe illness, its impact on the occurrence of persistent symptoms in patients with mild Omicron infection remains uncertain. Our objective was to investigate whether COVID-19 vaccination reduces the occurrence of persistent COVID-19-related symptoms 3 months after mild Omicron infection.

Methods: Multicenter prospective cohort study was conducted in Brazil between January 2022 and June 2023 when Omicron was predominant.

Patients submitted to re-revision ACL reconstruction present more knee laxity, more complications, and a higher failure rate than patients submitted to the first revision ACL reconstruction.

Background: Few comparative studies have evaluated patients who underwent two revision anterior cruciate ligament reconstruction (ACLR) and patients who underwent one revision ACLR, and many of them have a short postoperative follow-up and a relatively small number of patients. The objective of this study is to evaluate the functional results, complications, and failure rates of patients who underwent one revision ACLR and patients who underwent two revision ACLRs.

Methods: This is a retrospective study comparing patients who underwent one revision ACLR (Group 1) with patients who underwent a re-revision ACLR (Group 2).

Proactive therapeutic drug monitoring of biologic drugs in patients with inflammatory bowel disease, inflammatory arthritis, and psoriasis: systematic review and meta-analysis.

Objective: To address the efficacy and safety of proactive therapeutic drug monitoring of biologic drugs for patients with inflammatory bowel disease, inflammatory arthritis, and psoriasis.

Design: Systematic review and meta-analysis.

Data Sources: Medline, Embase, Central, and CINAHL, from database inception to 23 May 2024.

The second Latin American catheter ablation registry ("II LAHRS EP registry").

Background: Patient's clinical characteristics, technical resources, center and operator volume, and operator experience and training are known variables impacting outcomes. Although international standards have been agreed to maximize the benefits of this therapy, regional and global differences still exist. Latin American information has not been updated in the last 10 years.

Latarjet procedure: open with screws or arthroscopic with cortical buttons? A retrospective cohort comparison of outcomes and complications.

Background: The original Latarjet-Patte procedure is a reliable technique to treat traumatic anterior shoulder instability. However, attempts to reduce possible complications have led to the emergence of modified techniques. More prominent among them are the arthroscopic approach and the use of cortical buttons for coracoid fixation.

Microfragmented Adipose Tissue Associated With Collagen Membrane in the Treatment of Focal Knee Cartilage Defect.

Focal articular cartilage defects are an important factor that leads to dysfunction of the knee joint. Several different surgical approaches have been tried, most of them showing poor results in the long term. The use of orthobiologics in the context of focal chondral lesion has emerged as a potential tool in the treatment of this condition.