Alexandre Negrão Pantaleão

Transcatheter Aortic Valve Implantation (TAVI) or Replacement (TARV) is a widely established treatment for symptomatic severe aortic stenosis (AS) in patients with high or intermediate surgical risk. Diabetes mellitus (DM) is prevalent in TAVR patients and is associated with an increased risk of cardiovascular events, which may elevate procedural risks. A systematic review and meta‐analysis were conducted following PRISMA guidelines. PubMed, Web of Science, and Cochrane databases were searched. A random‐effects model was applied, with 95% confidence intervals (CIs) and a 5% significance level. Statistical analyses were performed using RStudio version 4.4.1. Twelve studies with 214,444 patients were included, comprising 74,294 diabetic and 140,150 nondiabetic individuals. The analysis revealed no significant differences in all‐cause mortality, procedure mortality, 30‐day mortality, or complications such as bleeding, myocardial infarction, and major complications. However, 1‐year mortality was significantly higher in the diabetic group (RR: 1.51, 95% CI: 1.08–2.13). Diabetic patients were at higher risk for renal injury (RR: 1.46, 95% CI: 1.40–1.51) and lower risk of stroke (RR: 0.91, 95% CI: 0.83–0.99). The length of hospital stay and other major complications showed no significant differences. There was an increased risk of 1‐year mortality and renal injury in diabetic patients undergoing TAVI compared to non‐diabetics. Surprisingly, the risk for developing stroke in the diabetic group was significantly lower. In any case, the study emphasizes the need for tighter DM control to decrease the risk of such complications in the future.

Background: Rheumatic heart disease (RHD) is the leading cause of cardiac death in children, with over 300,000 annual fatalities. Immunological, genetic, and environmental factors contribute to an increased risk of RHD. It remains unclear whether first-degree relatives have a higher RHD prevalence than the regional average. Methods: We performed a systematic review and meta-analysis of echocardiographic screening studies reporting the prevalence of RHD in family members of individuals with RHD or acute rheumatic fever. PubMed, Embase, Cochrane, and Lilacs databases were searched. Finding Forrester RHD was classified as per the 2012 World Heart Federation criteria. Random-effects models assessed definite RHD prevalence in study groups. Results: Four of the 1160 studies were included, with 776 first-degree relatives screened. Two studies were from Africa, one from South America, and one from Oceania. In the first-degree relatives of index cases, the prevalence of RHD was 7% (95% confidence interval [CI] 3.7-13). The control group, individuals screened with no known RHD cases in their family, had a lower prevalence than first-degree relatives (risk ratio [RR] 0.44, 95% CI 0.26-0.75). There was no difference in the prevalence of RHD among siblings and parents of cases. Conclusion: RHD prevalence in first-degree relatives of index cases was more significant than the There is an overall prevalence of non-relatives from the respective region, which suggests that genetic predisposition may play a role. In future studies of RHD, the systematic screening of first-degree relatives should be considered with a better control group—socioeconomic, region, age, and sex-matched.

Resumo Fundamento A febre reumática aguda (FRA) ainda representa um grande desafio de saúde pública, principalmente em países de baixa e média renda. Afeta desproporcionalmente populações não brancas em regiões menos favorecidas e pode evoluir para cardiopatia reumática (CR), associada à alta morbidade e mortalidade. Objetivos Analisar internações e óbitos relacionados à FRA no Brasil entre 2008 e 2022, destacando desigualdades regionais e demográficas. Métodos Estudo transversal baseado em dados de internação e mortalidade por FRA, coletados pelo Sistema de Informações Hospitalares (SIH/SUS). Dados estratificados por características demográficas, região e tipo de visita hospitalar foram analisados utilizando modelos de regressão linear de média móvel para avaliar o impacto de idade, sexo e raça. A significância estatística foi estabelecida em p < 0,05. Resultados Foram registradas 11.061 internações e 65 óbitos por FRA; 53% dos hospitalizados eram homens e 16% eram brancos. A faixa etária de 10 a 14 anos apresentou as maiores taxas de internação, enquanto a de 15 a 19 anos apresentou mais óbitos. As internações foram mais frequentes entre indivíduos não-brancos, concentrando-se no Nordeste do Brasil. Ao longo do tempo, as internações pela FRA diminuíram em todas as demografias, com convergência gradual entre as taxas de homens e mulheres até 2022. Conclusões O estudo revela um declínio nas internações por FRA em todas as regiões e demografias, embora ainda persistam disparidades. Não houve diferença significativa nos casos entre homens e mulheres. Evidência é uma evidência entre fatores socioeconômicos e a carga de doença, afetando mais grupos de baixa renda.

Background Acute rheumatic fever (ARF) remains a significant public health challenge, especially in low- and middle-income countries. It disproportionately affects non-white populations in underprivileged regions and may lead to rheumatic heart disease (RHD), which has high morbidity and mortality. Objectives Analyze hospitalizations and deaths related to ARF in Brazil between 2008 and 2022, highlighting regional and demographic inequalities. Methods We conducted a cross-sectional study analyzing hospitalization and mortality data caused by ARF from 2008 to 2022 in Brazil, collected through the Hospital Information System (SIH/SUS). Data were stratified by demographics, region, and hospital visit type (urgent or elective) and analyzed using generalized linear autoregressive moving average models to assess the impact of age, sex, and race. Statistical significance was set at p < 0.05. Results Of 11,061 hospitalizations and 65 deaths from ARF, 53% were male and 16% were white. The 10–14-year-old age group had the highest hospitalization rates, while the 15–19-year-old group had more deaths. Hospitalizations were higher among non-white individuals and concentrated in Brazil’s Northeast. Over time, ARF-related hospitalizations declined across all demographics, with a gradual convergence between male and female rates by 2022. Conclusion Our findings highlight a decline in ARF-related hospitalizations across regions and demographics, though disparities remain. There is no significant difference in ARF cases between men and women. The study highlights a correlation between socioeconomic factors and disease burden, with low-income groups experiencing a higher rate of ARF hospitalizations.

Background: The efficacy and safety of adjunctive low‐voltage area (LVA) ablation on outcomes of catheter ablation (CA) for atrial fibrillation (AF) remains uncertain.Methods: PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were searched for randomized controlled trials (RCTs) comparing CA with versus without LVA ablation for patients with AF. Risk ratios (RR) with 95% confidence intervals (CI) were pooled with a random‐effects model. Our primary endpoint was recurrence of atrial tachyarrhythmia (ATA), including AF, atrial flutter, or atrial tachycardia. We used R version 4.3.1 for all statistical analyses.Results: Our meta‐analysis included 10 RCTs encompassing 1780 patients, of whom 890 (50%) were randomized to LVA ablation. Adjunctive LVA ablation significantly reduced recurrence of ATA (RR 0.76; 95% CI 0.67−0.88; p < .01) and reduced the number of redo ablation procedures (RR 0.54; 95% CI 0.35−0.85; p < .01), as compared with conventional ablation. Among 691 (43%) patients with documented LVAs on baseline substrate mapping, adjunctive LVA ablation substantially reduced ATA recurrences (RR 0.57; 95% CI 0.38−0.86; p < .01). There was no significant difference between groups in terms of periprocedural adverse events (RR 0.78; 95% CI 0.39−1.56; p = .49).Conclusions: Adjunctive LVA ablation is an effective and safe strategy for reducing recurrences of ATA among patients who undergo CA for AF.

Objectives: Digital health (DH) is a revolution driven by digital technologies to improve health. Despite the importance of DH, curricular updates in healthcare university programs are scarce, and DH remains undervalued. Therefore, this report describes the first Junior Scientific Committee (JSC) focusing on DH at a nationwide congress, with the aim of affirming its importance for promoting DH in universities.Methods: The scientific committee of the Brazilian Congress of Health Informatics (CBIS) extended invitations to students engaged in health-related fields, who were tasked with organizing a warm-up event and a 4-hour session at CBIS. Additionally, they were encouraged to take an active role in a workshop alongside distinguished experts to map out the current state of DH in Brazil.Results: The warm-up event focused on the topic “Artificial intelligence in healthcare: is a new concept of health about to arise?” and featured remote discussions by three professionals from diverse disciplines. At CBIS, the JSC’s inaugural presentation concentrated on delineating the present state of DH education in Brazil, while the second presentation offered strategies to advance DH, incorporating viewpoints from within and beyond the academic sphere. During the workshop, participants deliberated on the most crucial competencies for future professionals in the DH domain.Conclusions: Forming a JSC proved to be a valuable tool to foster DH, particularly due to the valuable interactions it facilitated between esteemed professionals and students. It also supports the cultivation of leadership skills in DH, a field that has not yet received the recognition it deserves.

Acute rheumatic fever (ARF) is a complex disease with several clinical manifestations. Its most significant long-term complication is valvular heart damage, commonly referred to as chronic rheumatic heart disease. The risk of ARF varies globally, with over 80% of cases occurring in low- and middle-income countries, highlighting the role of socioeconomic factors. A comprehensive understanding of the risk factors associated with ARF and its clinical, genetic, and sociodemographic mediators can help clinicians identify high-risk individuals, develop effective management strategies, enhance target screening and active case-finding initiatives, and ultimately improve patient outcomes. This review aimed to provide an overview of ARF and its global burden, focusing on the established and potential risk factors associated with its development.

Paget-Schroetter Syndrome (PSS) is a rare condition characterized by spontaneous thrombosis of the axillary-subclavian vein that occurs predominantly in young athletes engaged in repetitive overhead upper extremity motion, for instance, weightlifting, swimming, baseball, and tennis. PSS is usually a consequence of chronic repetitive microtrauma to the vein intima due to compression of the axillary-subclavian vein by the thoracic outlet structures. This chronic injury can then be acutely exacerbated by vigorous exercise done over a brief period, accelerating thrombus formation. Lack of PSS awareness leads to underdiagnosis, misdiagnosis, or late diagnosis, which can pose life-threatening risks to patients, including pulmonary embolism (PE) and recurrent thrombosis. This case report of a 20-year-old male college athlete exposes a PE caused by PSS, potentially worsened by a delay in diagnosis. Early suspicion and proper management are crucial for optimizing long-term outcomes and facilitating limb rehabilitation. The recommended approach involves early catheter-directed thrombolysis followed by thoracic outlet decompression.

Background: Solitary functioning kidney (SFK) is a subgroup of the Congenital Anomalies of the Kidneys and Urinary Tract (CAKUT). Although the prognosis of these patients was considered good in the past, numerous studies have shown different levels of kidney damage associated with this condition. Serum creatinine measurement is still the most used marker to assess renal function, even though the limitations are widely known. Objective: The present review aims to summarize and update the scientific literature on congenital SFK, discussing its pathophysiology, diagnosis, complications, prognosis, role of novel urinary biomarkers, treatment, and follow-up. Results: The natural history of congenital SFK is still an unresolved issue due to several factors. Although it has not yet been proven in humans, Brenner’s hyperfiltration hypothesis is the most concrete theory to explain the poor renal outcomes of patients born with one functioning kidney. The search for novel urinary biomarkers capable of assessing renal function and predicting renal outcomes has already started, but there are still few studies on this specific population. Among the most studied markers, Cystatin C, EGF and NGAL have shown potential usefulness for the follow-up of these patients. The treatment still relies on the search for kidney injury and general renoprotective measures. Conclusion: Further research with a longer follow-up duration is needed to better understand the natural course of congenital SFK and the role of novel urinary biomarkers in this specific population. Thus, it will be possible to improve the prognosis of these patients.