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The North Star Ambulatory Assessment measures motor performance in ambulatory boys with Duchenne muscular dystrophy, a hereditary and degenerative muscle disorder. To use the North Star Ambulatory Assessment in Brazilian boys, we performed the cross-cultural adaptation to the Portuguese language spoken in Brazil and evaluated the reliability and validity of the instrument. Cross-cultural adaptation included: independent translations, synthesis, committee review, pre-testing in 12 boys, back-translation and comparison with the original instrument. Thirty-five boys with Duchenne muscular dystrophy and 38 healthy age-matched controls were recruited for further analyses. Reliability was assessed by internal consistency and reproducibility. Validity studies included face, content, construct and known-groups analyses. Cross-cultural adaptation resulted in an adequate instrument. Reliability studies demonstrated high internal consistency (Cronbach's alpha = 0.935) and adequate intra and inter-rater reproducibility (intraclass correlation coefficient = 0.988 and 0.962). Validation analyses indicated satisfactory content, face and convergent construct validities, with positive correlations with the Motor Function Measure total score (r = 0.863) and the 6-minute walk test (r = 0.433). The known group validity was demonstrated by higher scores in younger boys with Duchenne muscular dystrophy (p = 0.005). North Star Ambulatory Assessment in Brazilian Portuguese is a reliable and valid instrument to measure functional capacity in boys with Duchenne muscular dystrophy.

Context Chronic pain is a common complaint among patients with muscular disease. The Wisconsin Brief Pain Questionnaire (WBPQ) has been used to quantify pain severity and pain interference with daily functions. Objectives To translate the WBPQ for use with Brazilian patients and to evaluate the psychometric properties of the adaptation. Methods We conducted a cross-cultural adaptation of the original English version of the WBPQ for use in Brazil (WBPQ-B) and evaluated the psychometric properties of the adapted version. The original questionnaire was translated, evaluated by an expert panel, pilot tested in 40 patients, and back-translated. Subsequently, the tool was administered, in a cross-sectional study, to 100 adult patients who had muscular disease and were being attended to at our university hospital. Results We performed a confirmatory factor analysis and assessed the reliability and validity of the questionnaire (Appendix). The two-factor structure (pain intensity and pain interference) was confirmed satisfactorily. Internal consistency for both scales was adequate (Cronbach's alpha = 0.74 and 0.79, respectively), as was the interrater stability (intraclass correlation coefficients = 0.88 and 0.92, respectively). Convergent validity with the 36-Item Short Form Health Survey was supported by confirmation of a priori hypotheses of negative and satisfactory correlations between the WBPQ-B and some of the 36-Item Short Form Health Survey domains. The pain interference scale correlated higher with the mental summary component. Known-group validity analysis showed that the pain intensity items and scale of the WBPQ-B were higher in the groups where patients with exercise intolerance were concentrated. Conclusion We found the WBPQ-B to be a reliable and valid instrument for pain assessment of Brazilians who have muscular disease. The survey presents similar psychometric properties to the original version.

Although the occurrence of intraoperative cardiac arrest is rare, it is a severe adverse event with a high mortality rate. Trauma patients have additional causes for intraoperative arrest, and we hypothesised that the survival of trauma patients who experienced intraoperative cardiac arrest would be worse than nontrauma patients who experienced intraoperative cardiac arrest.The aim of the present study was to compare the outcomes of trauma and nontrauma patients after intraoperative cardiac arrest.In a tertiary university hospital and trauma centre, the intraoperative cardiac arrest cases were evaluated from January 2007 to December 2009, excluding patients submitted to cardiac surgery. Data were prospectively collected using the Utstein-style. Outcomes among the patients with trauma were compared to the patients without trauma.We collected data from 81 consecutive intraoperative cardiac arrest cases: 32 with trauma and 49 without trauma. Patients in the trauma group were younger than the patients in the nontrauma group (44±23 vs. 63±17, p0.001). Hypovolaemia (63% vs. 35%, p=0.022) and metabolic/hydroelectrolytic disturbances (41% vs. 2%, p0.001) were more likely to cause the cardiac arrest in the trauma group. The first documented arrest rhythm did not differ between the groups, and pulseless electrical activity was the most prevalent rhythm (66% vs. 53%, p=0.698). The return of spontaneous circulation (47% vs. 63%, p=0.146) and survival to discharge with favourable neurological outcome (16% vs. 14%, p=0.869) did not differ between the two groups.The outcomes did not differ between patients with trauma and nontrauma intraoperative cardiac arrest.

Few studies have prospectively addressed the effects of exercise in the inflammatory activity of patients with coronary artery disease (CAD). We sought to evaluate the consequences of an acute bout of exercise on inflammatory markers and BNP in untrained CAD patients before and after randomization to a training program. 34 CAD patients underwent a 50-min acute exercise session on a cycle-ergometer at 65% peak oxygen uptake before and after blood sampling. They were then randomized to a 4-month chronic exercise program (15 patients) or general lifestyle recommendations (19 patients), undergoing a new acute session of exercise after that. In the overall population, acute exercise caused a significant increase in C-reactive protein [CRP; 1.79 (4.49) vs. 1.94 (4.89) mg/L, P

CONTEXT AND OBJECTIVE: Although advances in surgical and anesthetic techniques have reduced perioperative morbidity-mortality, the survival rate following cardiac arrest remains low. The aim of this study was to evaluate, over the course of one year, the prevalence of intraoperative cardiac arrest and the 30-day survival rate after this event in a tertiary teaching hospital. DESIGN AND SETTING: Prospective cohort study in a tertiary teaching hospital. METHODS: Following approval by the institutional ethics committee, anesthetic procedures and cases of intraoperative cardiac arrest between January and December 2007 were evaluated. Patients undergoing cardiac surgery were excluded. The data were gathered prospectively using the modified Utstein model, with evaluation of demographic data, pre-arrest conditions, intraoperative care, care during arrest and postoperative outcome up to the 30th day. The data were recorded by the attending anesthesiologist. RESULTS: During the study period, 40,379 anesthetic procedures were performed, and 52 cases of intraoperative cardiac arrest occurred (frequency of 13:10,000). Among these, 69% presented spontaneous return of circulation after the initial arrest, and only 25% survived for 30 days after the event. The following factors were associated with shorter survival: American Society of Anesthesiologists physical status IV and V, emergency surgery, hemorrhagic events, hypovolemia as the cause of arrest and use of atropine during resuscitation. CONCLUSIONS: Although the frequency of cardiac arrest in the surgical environment has declined and resources to attend to this exist, the survival rate is low. Factors associated with worst prognosis are more frequent in critical patients.