Na era dos primeiros antimicrobianos disponíveis, os pacientes eram jovens e apresentavam relativamente poucas comorbidades, como cardiopatias reumática ou congênita. Recentemente, em um momento de antimicrobianos de amplo espectro e potencial bactericida mais robusto, o paciente que se apresenta tem outro perfil, sendo mais idoso, com múltiplas comorbidades e clinicamente mais instável.3 também destaca a mudança do perfil clínico epidemiológico e das cepas microbiológicas envolvidas, situação que está intimamente relacionada ao perfil do paciente, muitas vezes institucionalizado. O que antes tinha como um grande protagonista o Streptococcus, os dados contemporâneos apontam para a maior prevalência do Staphylococcus como agente causador da endocardite infecciosa.5Ao observar o comportamento evolutivo dos pacientes analisados, Jorge MS et al.,7Embora tenha sido, até o momento, pouco abordado de forma ampla a irrestrita, as mudanças no manejo da profilaxia antibiótica para prevenção da endocardite infecciosa também podem ter impactado essa evolução ao longo dos últimos 30 anos, em que cada vez mais temos uma conduta conservadora nas diretrizes internacionais, contrastando com as orientações encontradas na última diretriz nacional de valvopatias.8Nesse contexto, um diagnóstico rápido e preciso é o primeiro passo para oferecer ao paciente a chance de uma intervenção mais assertiva e no momento certo. Um diagnóstico tardio e a procrastinação de uma terapia antimicrobiana adequada levam a complicações e piores resultados clínicos.2 O autor3 inclusive aponta para a insuficiência cardíaca congestiva como principal comorbidade associada aos pacientes que foram acompanhados, o que pode trazer uma confusão clínica e um desafio diagnóstico ainda mais complexo, visto que a presença dessa manifestação pode atrasar um diagnóstico preciso que necessitará, mais do que antes, de outros critérios de Duke, como visto nos métodos de imagem.11A apresentação clínica é diversa, partindo desde quadros sépticos graves até síndromes de febre de origem indeterminada ou mesmo manifestações puramente cardiovasculares como insuficiência cardíaca.12 Uma vez diante da possibilidade, o rápido diagnóstico e uma terapia individualizada parecem ser a melhor estratégia para reduzir as complicações, sendo o tratamento cirúrgico, um procedimento que tem papel crescente e decisivo em grupos de pacientes mais graves. A busca por informações desses pacientes proporcionará à cardiologia a chance de transformar os desafios em caminhos pavimentados para as melhores respostas terapêuticas na endocardite infecciosa.Os desafios contemporâneos da Endocardite Infecciosa são diversos e a prevenção é sem sombra de dúvidas a melhor estratégia a ser empregada. 1 A cold assessment of data published internationally2 shows us that despite all the technological advances and an early trend towards surgical intervention, there was no great reduction in clinical outcomes, especially mortality, but a more detailed search for information may bring us other points of view.Infective endocarditis is a rare disease with a high rate of serious complications and can often be seen as a syndrome.3 corroborates the idea of early diagnoses and interventions in this broad spectrum of patients, and observing the epidemiological change of patients over the years is a fundamental key to a broad reading of the management of contemporary infective endocarditis.4The article by Jorge MS et al.2Although the pathology of endocarditis is the same, the disease appears as an old problem in a completely different guise. In the era of the first antimicrobials available, patients were young and had relatively few comorbidities, such as rheumatic or congenital heart disease. Recently, in a time of broad-spectrum antimicrobials and more robust bactericidal potential, the patient who presents has a different profile, is older, has multiple comorbidities, and is clinically more unstable.3 also highlight the change in the epidemiological, clinical profile, and microbiological strains involved. This situation is closely related to the profile of the patient, who is often institutionalized. What used to have Streptococcus as a major protagonist, the contemporary data point to a higher prevalence of Staphylococcus as the causative agent of infective endocarditis.5By observing the evolutionary behavior of the analyzed patients, Jorge MS et al.7Although it has so far been little discussed in a broad or unrestricted way, the changes in the management of antibiotic prophylaxis for the prevention of infective endocarditis may also have impacted this evolution over the last 30 years, in which we have an increasingly conservative approach in international guidelines, contrasting with the guidelines found in the last national guideline on valve diseases.8In this context, a quick and accurate diagnosis is the first step to offer the patient the chance of a more assertive and timely intervention. A late diagnosis and the procrastination of adequate antimicrobial therapy lead to complications and worse clinical outcomes.2 The author3 even points to congestive heart failure as the main comorbidity associated with patients who were followed up, which can lead to clinical confusion and an even more complex diagnostic challenge since the presence of this manifestation can delay an accurate diagnosis that will require more than before, of other Duke criteria, as seen on imaging methods.11The clinical presentation is diverse, ranging from severe sepsis to fever syndromes of an undetermined origin or even purely cardiovascular manifestations such as heart failure.12 Once faced with the possibility, rapid diagnosis, and individualized therapy seem to be the best strategy to reduce complications, with treatment surgery, a procedure that plays a growing and decisive role in groups of more severe patients. The search for information from these patients will allow cardiology to transform challenges into paved paths for the best therapeutic responses in infective endocarditis.The contemporary challenges of Infective Endocarditis are diverse, and prevention is undoubtedly the best strategy to be employed.


Aedes (Stegomyia) aegypti  and Aedes albopictus  are present. The lack of comprehensive sampling of these two vectors limits our understanding of their propagation dynamics in areas at risk of arboviruses. Here, we collected 6,943 observations  of Ae. aegypti and Ae. albopictus between 2020 and 2022. The study was carried out in the Vallee de la Funa, a post-epidemic zone in the city of Kinshasa, Democratic Republic of Congo. Our results provide important information for future basic and advanced studies on the ecology and phenology of these vectors, as well as on vector dynamics after a post-epidemic period. The data from this study are published in the public domain as the Darwin Core Archive in the Global Biodiversity Information Facility.Arbovirus epidemics  are a growing threat in African areas where  Aedes (Stegomyia) aegypti  et Aedes albopictus  sont présents. L’absence d’échantillonnage complet de ces deux vecteurs limite notre compréhension sur la dynamique de propagation de ces derniers dans les zones à risque d’émergence d’arbovirus. Ici, nous avons collecté 6 943 observations (collecte larvaire et capture sur appât humain) de Ae. aegypti et de Ae. albopictus entre 2020 et 2022. L’étude a été réalisée dans la Vallée de la Funa, une zone post-épidémique de la ville de Kinshasa, en République démocratique du Congo. Nos résultats fournissent des informations importantes pour de futures études fondamentales et avancées sur l’écologie et la phénologie de ces vecteurs, ainsi que sur la dynamique de ces vecteurs après une période post-épidémique. Les données de cette étude sont publiées dans le domaine public en tant que Darwin Core Archive dans le Global Biodiversity Information Facility.Les épidémies d’arbovirus  constituent une menace croissante dans les régions africaines où  Aedes aegypti and Aedes albopictus are present –4. The incomplete sampling of these two vectors limits our understanding of their propagation dynamics in areas at risk from arboviruses. Thus, studies such as ours have contributed to understanding the dynamics of these vectors.Arbovirus epidemics, particularly chikungunya, are a growing threat in African areas where Ae. aegypti and Ae. albopictus) in a chikungunya post-epidemic zone in the provincial city of Kinshasa, Democratic Republic of Congo, between 2020 and 2022.Here we describe, for the first time, the geographical distribution of two arbovirus vectors  , based on geographical coordinates (east longitude and south latitude) recorded at each entomological collection point using a Garmin Etrex GPmap 64s GPS. The vector layers used on the map were derived from the Référentiel Géographique Commun database of the Democratic Republic of Congo.The mapping of the sampling points for this study was generated using ArcGIS version 10.8 software  and Ae. albopictus .The general taxonomic coverage description for this work is the Culicidae Family, specifically Aedes spp. between January 5, 2020–December 30, 2022. Whatever the collection method, morphological identification of adult mosquitoes was carried out using the taxonomic keys .Two sampling techniques were used to collect immature and adult stages of Aedes spp. were collected from various breeding sites  using the dipping technique. In this technique, water is taken from the breeding sites using a ladle or a small container, and it is used to search for Culicidae larvae, specifically those of Aedes spp. These larvae were collected and stored in jars containing water from their respective breeding sites, then transported to the insectarium of the Laboratory of Bioecology and Vector Control (or BIOLAV), where they were reared until adulthood under insectarium conditions . In the insectarium, larvae were placed in rearing tanks according to the type of larval habitat they were found in the field; pupae pipetting and adult emergence followed the same classification procedures. Five days after emergence, adult mosquitoes were sucked into cages, placed in jars and cooled to −23 °C to prevent their escape during identification. The identification data was encoded into an Excel sheet, and the mosquito samples were stored at −23 °C for potential future analysis.During the 2020–2022 study period, larvae were collected once a year in October, which heralds the return of heavy rains after the dry season stretching from mid-May to mid-August. Immature stages of Aedes collections were carried out over four samplings each year, for three years, and distributed as follows: January “short rainy season accompanied by a short dry season”; June “dry season”; August “early rainy season”; October “rainy season”. During each sampling campaign, collectors were supervised inside and outside each house to ensure the smooth running of capture activities. Supervisors responded to collectors’ concerns and made unannounced visits to each capture station to ensure the work’s quality was in accordance with the instructions.Following ethical approval and consent, the host-seeking Aedes spp. adults during the day . At the study site, mosquito collections were carried out both indoors and outdoors, with a first group of collectors working from 7:00 a.m. to 12:00 p.m. and replaced by a second group from 12:00 p.m. to 7:00 p.m. At each collection point, a bare-legged, barefoot volunteer served as bait, collecting mosquitoes using hemolysis tubes. Mosquito samples were then transported to the morphological identification room of the Bioecology and Vector Control Laboratory for morphological identification.Human landing catches (HLC) were used to collect  by an entomologist experienced in the identification of Central African Aedes. Once digitized, the data was validated using the Integrated Publishing Toolkit (IPT) validator tool available from the Global Biodiversity Information Facility (GBIF) .Mosquitoes were identified using keys made available in the literature Ae. albopictus was the most abundant species in the studied region, with 6,358 individuals, whereas we recorded 578 Ae. aegypti individuals. Only seven individuals could not be identified to the species level.A total of 6,943 observations  dans une zone post-épidémique de chikungunya de la ville province de Kinshasa, en République démocratique du Congo.Les épidémies d’arbovirus, en particulier ceux conduisant à des maladies telles que le chikungunya, la dingue, constituent une menace croissante dans les zones africaines où Millettia laurentii et Pentaclethra eetveldeana.Cette étude a été réalisée dans la Vallée de la Funa Figure , une gal′06.17′′S et la longitude 15°18′05.77′′E, et couvre environ 45 hectares, et la pluviométrie moyenne annuelle de la zone est d’environ 1 095 mm. De façon générale à Kinshasa, les précipitations sont abondantes et inégalement réparties tout au long de l’année. Le volume de précipitations le plus élevé se produit en novembre, avec une moyenne de 268,1 mm, et le plus faible en juillet, avec une moyenne de 0,7 mm. L’humidité relative annuelle moyenne est de 79%. La galerie forestière est située entre la latitude 4°25SCR_011081) , à partir des coordonnées géographiques (longitude est et latitude sud) enregistrées à chaque point de collecte entomologique à l’aide d’un GPS Garmin Etrex GPmap 64s. Les couches vectorielles utilisées sur la carte ont été dérivées de la base de données du Référentiel Géographique Commun de la République Démocratique du Congo.La cartographie des points d’échantillonnage de cette étude a été réalisée à l’aide du logiciel ArcGIS version 10.8  et Ae. albopictus .La description taxonomique générale pour ce travail est de la famille des Culicidae, spécifiquement .Deux techniques d’échantillonnage ont été utilisées pour collecter les stades immatures et adultes d’Aedes spp. entre le 5 janvier 2020 et le 30 décembre 2022. Quelle que soit les techniques d’échantillonnage utilisées, l’identification morphologique des moustiques adultes a été réalisée à l’aide des clés taxonomiques Au cours de la période d’étude 2020–2022, les larves ont été collectées une fois par an en octobre, mois qui annonce le retour des fortes pluies après une saison sèche qui se tend de mi-mai à mi-août. Les stades immatures des Aedes spp. ont été collectés dans divers sites de reproduction  à l’aide de la technique de dipping. Cette technique consiste à prélever de l’eau dans les gîtes larvaires à l’aide d’une louche ou d’un petit récipient et à rechercher les larves de Culicidae de façon générale, en particulier celles des Aedes spp (cas de cette étude). Ces larves ont été collectées et stockées dans des bocaux contenant l’eau de leurs sites de reproduction respectifs, puis transportées à l’insectarium du Laboratoire de Bioécologie et de Lutte Antivectorielle (ou BIOLAV), où elles ont été élevées jusqu’à l’âge adulte dans des conditions d’insectarium . Dans l’insectarium, les larves ont été placées dans des bacs d’élevage en fonction du type d’habitat larvaire qu’elles ont été trouvées sur le terrain ; le pipetage des pupes et l’émergence des adultes ont suivi les mêmes procédures de classification. Cinq jours après l’émergence, les moustiques adultes ont été aspirés dans des cages, placés dans des bocaux et refroidis à −23 °C pour éviter qu’ils ne s’échappent pendant l’identification. Les données d’identification ont été encodées dans une feuille Excel et les échantillons de moustiques ont été conservés à −23 °C en vue d’une éventuelle analyse ultérieure.Après approbation éthique et consentement, les collectes des Aedes à la recherche d’hôtes ont été effectuées au cours de quatre échantillonnages par an, pendant trois ans, et réparties comme suit : janvier «courte saison des pluies accompagnée d’une courte saison sèche» ; juin « saison sèche» ; août «début de la saison des pluies» ; octobre « saison des pluies». Au cours de chaque campagne d’échantillonnage, les collecteurs ont été supervisés à l’intérieur et à l’extérieur de chaque maison afin d’assurer le bon déroulement des activités de capture. Les superviseurs ont répondu aux préoccupations des collecteurs et ont effectué des visites inopinées à chaque station de capture pour s’assurer que la qualité du travail était conforme aux instructions.. Sur le site de l’étude, les collectes de moustiques ont été effectuées à l’intérieur et à l’extérieur des ménages, un premier groupe de collecteurs travaillant de 7h00 à 12h00 et remplacé par un second groupe de 12h00 à 19h00. À chaque point de collecte, un volontaire pieds nus a servi d’appât et a collecté des moustiques à l’aide de tubes à hémolyse. Les échantillons de moustiques ont ensuite été transportés dans la salle d’identification morphologique du laboratoire de Bioécologie et de Lutte antivectorielle pour l’identification morphologique.La capture sur appât humain (CAH) a été utilisée pour collecter les adultes des Aedes spp. pendant la journée  par un entomologiste expérimenté dans l’identification des Aedes d’Afrique centrale. Une fois numérisées, les données ont été validées à l’aide de l’outil de validation IPT (Integrated Publishing Toolkit) disponible auprès du GBIF  .Les moustiques ont été identifiés à l’aide de clés disponibles dans la littérature Ae. albopictus été l’espèce la plus abondante dans la région étudiée, avec 6 358 individus, alors que nous avons enregistré 578 individus de Ae. aegypti. Seuls sept individus n’ont pu être identifiés au niveau de l’espèce.Au total, 6 943 observations YesIs the language of sufficient quality?YesPlease add additional comments on language quality to clarify if needed
n/aAre all data available and do they match the descriptions in the paper? YesAdditional CommentsnoneAre the data and metadata consistent with relevant minimum information or reporting standards? See GigaDB checklists for examples http://gigadb.org/site/guideYesAdditional CommentsIs the data acquisition clear, complete and methodologically sound?YesAdditional CommentsIs there sufficient detail in the methods and data-processing steps to allow reproduction?YesAdditional CommentsIs there sufficient data validation and statistical analyses of data quality? YesAdditional CommentsIs the validation suitable for this type of data?YesAdditional CommentsIs there sufficient information for others to reuse this dataset or integrate it with other data?YesAdditional CommentsAny Additional Overall Comments to the AuthorRecommendationAccept Reviewer name and names of any other individual's who aided in reviewer Paul TaconetDo you understand and agree to our policy of having open and named reviews, and having your review included with the published papers. YesIs the language of sufficient quality?YesPlease add additional comments on language quality to clarify if needed
Some minor changes that I recommend : "And the relative annual average humidity is 79%." may be changed to "The relative annual average humidity is 79%.". "Aedes albopictus is the most abundant species in the studied region" may be changed to "Aedes albopictus was the most abundant species in the studied region"Are all data available and do they match the descriptions in the paper? NoAdditional Comments1/The data available are of type 'occurrence' ( only in 1 file - the "occurrence" file).
 For a better presentation of the data, I would suggest to transform them into "sampling event" data, which is more suited to this kind of data acquired from sampling events , while keeping the occurrence dataset. This would enable the user to quickly understand the dates and locations of the sampling events.

 2/ In the data, the only available date (column eventDate) is the first of January (eg. 2021-01-01T00:00:00). This does not enable to separte the data into seasons (Rainy et Dry) as presented in table 1 of the manuscript. I strongly suggest the authors to provide the specific date for each collected mosquito in the data.
Are the data and metadata consistent with relevant minimum information or reporting standards? See GigaDB checklists for examples http://gigadb.org/site/guideYesAdditional CommentsIs the data acquisition clear, complete and methodologically sound?NoAdditional Comments1/Larval collections : sampling strategy used ?
 2/How many collection rounds in total ? please provide the dates of collection.
Is there sufficient detail in the methods and data-processing steps to allow reproduction?YesAdditional CommentsIs there sufficient data validation and statistical analyses of data quality? NoAdditional Comments1/Human landing catch : was any quality control done during the collection of data  ? Is the validation suitable for this type of data?YesAdditional CommentsIs there sufficient information for others to reuse this dataset or integrate it with other data?YesAdditional Comments1/comments for figure 1 (map) :
 - "legend" should be written in english (and not in french)
 - "harvesting sites" -> entomological collection points
 - the background layer is not very appropriate. Maybe better to put an Open Street Map background layer

 2/What about ethical approval for the Human Landing Catches ? please provide the name of the institution who has approved the HLC and the approval number, if relevant

 3/ in the dataset, for the species scientific name, I suggest to use the names as presented in : Harbach, R.E. 2013. Mosquito Taxonomic Inventory, https://mosquito-taxonomic-inventory.myspecies.info/ . Or at least, to provide the "nameAccordingTo" column.

 4/ In the dataset, many columns seem totally empty. Please remove them if so.

Any Additional Overall Comments to the AuthorThanks for this nice work and the effort put to publish your entomological data. I strongly suggest you to add the real dates of collection of the data in the GBIF dataset (see comments above).RecommendationMajor Revision Reviewer name and names of any other individual's who aided in reviewer Angeliki F MartinouDo you understand and agree to our policy of having open and named reviews, and having your review included with the published papers. YesIs the language of sufficient quality?YesPlease add additional comments on language quality to clarify if needed
Are all data available and do they match the descriptions in the paper? YesAdditional CommentsIt will be good for the authors the first time that they cite the two species to use the full names
 Aedes (Stegomyia) albopictus (Skuse)
 Aedes (Stegomyia) aegypti

 In the methods section the title should be
 Human Landing Catches and not Human capture on landingAre the data and metadata consistent with relevant minimum information or reporting standards? See GigaDB checklists for examples http://gigadb.org/site/guideYesAdditional CommentsIs the data acquisition clear, complete and methodologically sound?YesAdditional CommentsIs there sufficient detail in the methods and data-processing steps to allow reproduction?YesAdditional CommentsIs there sufficient data validation and statistical analyses of data quality? YesAdditional CommentsIs the validation suitable for this type of data?YesAdditional CommentsIs there sufficient information for others to reuse this dataset or integrate it with other data?YesAdditional CommentsAny Additional Overall Comments to the AuthorRecommendationAccept Reviewer name and names of any other individual's who aided in reviewer Luis Acuna-CantilloDo you understand and agree to our policy of having open and named reviews, and having your review included with the published papers. YesIs the language of sufficient quality?YesPlease add additional comments on language quality to clarify if needed
No applied Are all data available and do they match the descriptions in the paper? YesAdditional CommentsNo appliedAre the data and metadata consistent with relevant minimum information or reporting standards? See GigaDB checklists for examples http://gigadb.org/site/guideYesAdditional CommentsThey must be review the standard Darwin core format for sampling events. https://www.gbif.org/darwin-core.Is the data acquisition clear, complete and methodologically sound?YesAdditional CommentsNo appliedIs there sufficient detail in the methods and data-processing steps to allow reproduction?NoAdditional Comments
 They don't describe how the map of the study area was created, whether they used a GIS or not. Sampling points must be included on the map.

 They don't mention how the identification of the larval stages was carried out and how they were differentiated from other genera of species of the Culicinae subfamily, such as Culex, Haemagogus, Mansonia, Sabethes or other species of the genus Aedes, since the two main species of this genus, were its objective.

 In 5 reference, they mention is only for adult identification. They should include or cite the collection protocols and describe them as much as possible so that the study can be replicated in other African countries.Is there sufficient data validation and statistical analyses of data quality? Not my area of expertiseAdditional CommentsThe data could be validated with biological collection of specimensIs the validation suitable for this type of data?NoAdditional CommentsI don't know, but i believed that data could be validated with biological collection of specimensIs there sufficient information for others to reuse this dataset or integrate it with other data?YesAdditional CommentsThe scientific names must follow the same nomenclature, the first time the full name Aedes aegypti is mentioned and the second time Ae.aegypti, if there are two species within the same genus only one is mentioned the first time and the second time both abbreviated Ae.aegypti and Ae.albopictus.

 Bibliographic references should be cited accordingly, for example: (1-4).

 The names of the diseases must follow the same writing with a capital letter at the beginning or all in lower case Chikungunya or chikungunya.

 From the description of the study and the collection times, I would believe that it fits more with Sampling Events, the data is well organized, however, it is suggested to review the Darwin Core template for this type of data and adjust to the corresponding model. , event_core review: https://www.gbif.org/darwin-core.Any Additional Overall Comments to the AuthorThe data paper can be published with suggestions for improvement. Congratulations, very good job!RecommendationMajor Revision Editor’s AssessmentAedes mosquito spread Arbovirus epidemics , are a growing threat in Africa but a lack of vector data limits our ability to understand their propagation dynamics. This work describes the geographical distribution of Ae. aegypti and Ae. albopictus in Kinshasa, Democratic Republic of Congo between 2020 and 2022. Sharing 6,943 observations under a CC0 waiver as a Darwin Core archive in the University of Kinshasa GBIF database. Review improved the metadata by adding more accurate date information, and this data can provide important information for further basic and advanced studies on the ecology and phenology of these vectors in West Africa.


The oral text reading rate and accuracy values were analyzed. ROC curves were constructed, and sensitivity and specificity calculated for each reading fluency parameter, and each school grade.Sensitivity and specificity for measures of rate and accuracy in text reading were calculated for the 3rd, 4th, and 5th grades. Rate and precision under the ROC curve did not differ statistically. The values for the 2nd grade were mathematically estimated.The cutoff values expected for students from 2nd to 3rd grade were identified, with recommendations for using the oral text reading rate for reading comprehension screening procedures Undoubtedly, the auditory language comprehension characteristics and some of its components, such as vocabulary, world knowledge, inference making ability and comprehension monitoring can be predictors of reading comprehension difficulties.During the learning of reading, the decoding conditions tend to change constantly, until the individual is able to read with the same speed and intonation traits that typifies their prosodic features of speech production during spontaneous oral speech, thus demonstrating that they achieved the automatic recognition of written words. Studies have indicated the relevance of measuring accuracy and considering the minimum proficiency levels as a condition to ensure literal comprehension and, therefore, to be able to appropriately evaluate reading skills.Low fluency rates (correct number of words per minute) may interfere with reading comprehension. Furthermore, there is a decoding threshold established by investigative research, below which students could fail to understand written text.Fluent and accurate reading along with literal comprehension can be evaluated clinically as well as in the learning environment. In this study, the author sought to identify the minimum values for speed and accuracy of oral reading rates required to allow the comprehension of the text, in the presence or absence of a reading disorder. The study showed an increase in reading rate values related to educational level, indicating improvement in literal comprehension only in the ranges from 35 correct number of words per minute (wpm) for students with reading disorders, to 75 wpm for neurotypical 2nd graders. For the 4th graders, the scores ranged from 40 wpm to 90 wpm, for the presence and absence of the disorder, respectively. In other words, reading with accuracy rates higher than these did not prove to be of any advantage for literal comprehension.Similarly, researchers have also investigated to what extent increasing reading fluency rates can improve literal comprehension,7 and procedures of the evaluation process. However, none of these studies considered the minimum fluency rate needed for comprehension to occur, based on the above-mentioned rates.Brazilian researchers have published reference values for the average reading speed and accuracy of local schoolchildren, using different types of assessment - reading isolated words or text.In a learning environment, it can be an effective strategy for continuous monitoring of the student’s reading progress, allowing the identification of the condition based on two approaches: fail, if the student does not reach the cut-off value for average fluency standards expectations; and pass, if they perform equal to or higher than the cut-off for reading speed proficiency.In the context of school learning, comprehension monitoring strategies should be quickly implemented. They can be used to determine which students are at risk of presenting academic performance deficits. Such insufficiencies may appear either in the earliest stages of literacy development or in later phases where the literal comprehension demands tend to build up with each school year due to the increasing complexity of the texts,10.The present study was designed and executed to meet the needs of screening elementary school students for reading fluency to assess reading comprehension. To ensure that the decoding and fluency conditions are sufficient for the comprehension of the text, we conducted a retrospective research to investigate the reading rates and accuracy values of students with and without complaints of low reading proficiency, who participated in two other studiesThis retrospective research aimed to establish a cut-off for reading rate and accuracy of students, from the 2nd to 5th grade of elementary school, aiming to classify readers according to the minimum reading fluency values required for comprehension, as well as to verify which of the two fluency parameters, whether rate or accuracy, is best suited to determine said reading condition. Hence, we proposed to establish cut-off values using screening tests for clinicians and researchers interested in studying the relationship between fluency and literal comprehension.Retrospective exploratory study, developed from the data analysis of protocols standardized in previous research .n=96); G2-school children with difficulties in reading fluency and/or text interpretation, classified as poor readers (n=51). This classification was used herein to conduct a dichotomous distribution of the children into two categories for further analysis with the ROC curve.We analyzed 147 reading assessment protocols of students enrolled in the 3rd up to 5th grades of public and private elementary schools in the city of São Paulo (SP). Notwithstanding the research objectives, the children were selected by their teachers. According to them, the students of the sample group had no complaints or indicators of motor or sensory deficits related to auditory or visual processing disorders (uncorrected); neurological, behavioral, or cognitive deficits or disorders; oral communication impairment; or indication of grade retention in school records. Then, the teachers classified the students based on their reading performance, thus creating two distinct groups: G1-school children with good reading performance ; 59 in the 4th grade ; and 58 in the 5th grade . Of the 147 children, 66.7% were girls. The parents or guardians signed the Informed Consent Form for the participation of their children in the research, providing the data required for the present study.The available data referred only to these three school years. Consequently, the cut-off value to differentiate good and poor readers for the 2nd grade was statistically predicted. Although the evaluations were conducted over the course of 05 years, the procedures and protocols were standardized and applied on the second semester to all students.The oral reading of the text allowed the collection of data on reading rate and accuracy. A text was selected for each school year from the books used in Portuguese lessons . The students were instructed to read the text aloud from the title. The individual readings were recorded for further analysis and calculation of two continuous measurements, namely, the rate  and the accuracy (number of correctly read words per minute).,10. The total score possibilities varied by text read: 27, 25 and 41 ideas for the texts provided for the 3rd, 4th, and 5th grades, respectively. The points scored in the retelling task were added to the scores of the answers to the questions correlated to the text.The correctness criterion was the automatic recognition of words, which implies that any reading repair or fix-up strategy was considered an error, regardless of whether to adjust the decoding or understanding of the text. For each assessment, comprehension was evaluated by reading 06 multiple-choice questions  and by analyzing the oral retelling of the story, according to the number of ideas summarized by them,12.To discriminate between good and poor understanders, the teachers were asked a simple question, which sought to infer whether the child in question had reading and/or literal comprehension difficulties or not: “Based on student X's performance in reading fluency and literal comprehension, would you classify them as a good or poor reader?”. From the categorization made by the teachers, ranking the student in one of these two possibilities, that is, good or poor readers/comprehenders, ROC (Receiver Operating Characteristics curve) curves were drafted and the areas below them were calculated. Using the teacher as a gold standard is a common procedure and it is usually done in research in various areas of child development studiesDataFit 9 software (https://datafit.software.informer.com/9.0/). This way, the three cut-off values obtained, one for each school year, were plotted and, from them, different possibilities of growth trajectories were assessed against the addition of a new school year . Knowing that the distance between the four grades regarding the x-axis is equidistant, it was possible to estimate, for each predictive model evaluated, possibilities for the value referring to the y-axis (rate) for the 2nd grade. Non-linear trajectories were preferred, given the conformity of the three initial points.This method was used for the two outcome measures of the study: rate and accuracy. The continuous measurements that showed the best results would then be used to estimate the probable cut-off value for children in the 2nd year of schooling. If the measures did not differ, the most easily collected  would be used. The estimated cut-off for the 2nd graders was calculated with the progression of the cut-off for the children of the other school years via the . Since the results obtained with the ROC curve for each of the three years , did not fit perfectly for all the non-linear functions tested, approximations were used. Originally, the values obtained for the 3rd, 4th and 5th graders are described in Statistically, the values of the area under the ROC curve did not differ from rate or accuracy . Due to the efficiency of the rate data collection, this measure was used as estimation. Therefore, the cut-off estimation for the 2nd graders was calculated by four nonlinear functions: exponential, first order polynomial, modified logarithm, and modified exponential,5,8. The monitoring of reading skills can be performed not only to know the reading level of the student, but also for the early identification of reading difficulties to provide information for the necessary intervention and educational or clinical support. This approach is usually accompanied by a Response to Intervention program along with support services for monitoring the student.Screening procedures are efficient, quick to apply and are used for the necessary monitoring of reading development during school years,4.The present study calculated and presented cut-off values for tracking by minimum rate or accuracy related to literal comprehension for the initial years of elementary school,6. Considering that there were no apparent differences in the area under the ROC curve between reading rate and accuracy, it was decided to use a measure that can be applied easily and without further calculation, namely, the rate. Ergo, the wpm values of 65, 70 and 91 were considered minimum values for reading fluency as a condition to ensure literal comprehension in the 3rd, 4th, and 5th grades of elementary school, respectively. The texts used  were a useful, quick, and easy tool to track speed associated with comprehension.Knowing threshold values for reading fluency parameters can be useful to compose sample groups of students with the purpose of researching reading comprehension, since both competencies show association between different school years found seven cases of poor reading of real words and 12 cases of decoding among 10-year-old children who were considered competent by the teachers. It is also possible that in this same group, on account of having a more developed reading fluency, other factors, such as vocabulary and monitoring capacity, may have interfered more with the literal comprehension.The values obtained for the rate and accuracy showed a decrease in specificity  from the 3rd to 5th grades . It is p,10. The teacher’s reports and indications are seen as an important primary source of information for the other members of the educational team,16 and, consequently, they play a fundamental role in monitoring the different stages of learning. However, other studies should be conducted with clinical groups with a specific learning disorder diagnosis, as to improve the information provided by the area under the ROC curve, especially for the final years in which the sensitivity and specificity values were less adequate, although still satisfactory , frequency of words, background knowledge necessary for understanding, and other aspects that tend to interfere with text complexity. Therefore, it is strongly recommended to use the same narrative texts applied in this study to identify the minimum fluency rate of correctly read words per minute to ensure literal comprehension. This recommendation also intends to reduce the potential margin of error..Another important limitation is the fact that the cut-off values for younger children have been estimated . NeverthStill, it is emphasized that this estimated value is most suitable to scientific research, rather than to clinical or educational screening procedures. This limitation was overcome, to some extent, by estimating the cut-off values with the statistics used in the present study. Thus, clinicians and researchers can use an appropriate text for 2nd graders with the performance expectations for the adopted cut-off.Researchers and clinicians will be free to benefit from the data for a more efficient assessment and future research, with a large enough sample of children in the studied age group providing cross-validation of the measures presented herein. Another possibility is to investigate whether the provided cut-off values are valid to classify school children as good or poor understanders, with independent samples as well, through cross-validation.Cut-off values were established for oral reading rate and accuracy for students from the 2nd to 5th grade, with the use of reading rate values for each school year being recommended for literacy screening procedures related to literal comprehension. ,2, um dos componentes da fluência de leitura envolvidos na compreensão do texto lido. Indubitavelmente, características da compreensão linguística auditiva e de alguns de seus componentes como o vocabulário, o conhecimento de mundo, a capacidade de elaborar inferências e a de monitorar o próprio entendimento, podem predizer dificuldades de compreensão de leitura.Durante o aprendizado da leitura, as condições de decodificação modificam-se constantemente, até que o leitor demonstre ao ler, a mesma velocidade e entonação que imprime em sua produção de fala durante o discurso oral espontâneo, mostrando, assim, que alcançou o reconhecimento automático das palavras escritas. Algumas pesquisas têm demonstrado a pertinência de buscar e considerar valores mínimos de acurácia como condição para garantir que a compreensão leitora possa acontecer e, portanto, ser avaliada de forma apropriada.Baixas taxas de acurácia de leitura  podem interferir na compreensão do texto. Pesquisadores investigaram um valor limite de decodificação abaixo do qual estariam estudantes que podem falhar em compreender textos.A leitura fluente e acurada e a compreensão do texto lido podem ser avaliadas clinicamente e no ambiente escolar. Nesse estudo, a autora procurou identificar quais taxas de leitura oral poderiam ser o valor mínimo de velocidade e precisão para permitir compreensão do texto, na presença ou ausência de transtorno de leitura. A pesquisa mostrou aumento dos valores de taxa de leitura em função da escolaridade, com melhora da compreensão leitora apenas nas faixas entre 35 palavras lidas corretamente por minuto (p.c.p.m.) para o transtorno de leitura e 75 p.c.p.m. para escolares típicos no 2º ano. Para os de 4º ano, entre 40 p.c.p.m. e 90 p.c.p.m., respectivamente à presença, ou não, do transtorno. Ou seja, ler com taxas superiores a essas não se revelou nenhuma vantagem para a compreensão de leitura.Com propósito semelhante, investigou-se até que ponto aumentar a taxa de leitura pode melhorar a compreensão do texto lido,7 e procedimentos seguidos nessas avaliações. Entretanto, nenhum desses estudos considerou o desempenho mínimo em fluência para o alcance da compreensão, a partir das taxas mencionadas.Estudos nacionais publicaram valores de referência para médias de velocidade e acurácia de leitura de escolares brasileiros, nas suas diferentes formas de avaliação - com leitura de palavras isoladas ou de texto. Em ambiente educacional, pode ser um procedimento eficaz de monitoramento continuado do progresso da leitura, possibilitando a identificação da condição através de duas categorias: falha, se não atingir o ponto de corte; e passa, caso evidencie desempenho igual ou superior ao ponto de corte.No âmbito da aprendizagem escolar, procedimentos de rastreamento das condições de leitura devem ser de rápida aplicação. São utilizados para a identificação de escolares em risco de apresentarem déficits de desempenho acadêmico. Tais déficits podem aparecer desde etapas mais remotas do desenvolvimento relacionadas à época da alfabetização até fases ulteriores de demandas de compreensão leitora de textos cujas complexidades aumentam a cada ano escolar,10.Este estudo foi elaborado e executado para atender às necessidades de triar estudantes do Ensino Fundamental I pela fluência de leitura com vistas à avaliação da compreensão leitora. Para garantir condições de decodificação e fluência, suficientes para a compreensão do texto investigaram-se, retrospectivamente, os valores de taxa e acurácia de leitura textual de escolares com e sem queixa de problemas de leitura, que participaram de outros dois estudosº ao 5º ano do Ensino Fundamental, a fim de separar leitores por valores mínimos de fluência de leitura para a compreensão e verificar qual dos dois parâmetros de fluência, se taxa ou acurácia, melhor determina essa condição de leitura. Desse modo, propôs-se estabelecer pontos de corte por meio de uso de tarefas de rastreamento para o clínico e o pesquisador interessados em estudar a relação entre fluência e compreensão de leitura.O objetivo desta pesquisa retrospectiva foi estabelecer pontos de corte de taxa e acurácia na leitura de escolares, do 2Estudo retrospectivo, de caráter exploratório, realizado a partir da análise de dados de protocolos constituídos em pesquisas anteriores .Analisaram-se 147 protocolos de avaliação da leitura de escolares matriculados do 3º ao 5º ano do Ensino Fundamental de escolas públicas e particulares do município de São Paulo (SP). Independentemente dos objetivos das pesquisas, as crianças foram selecionadas por seus professores. Segundo eles, estavam ausentes queixas ou indicadores de: déficits motores ou sensoriais auditivos ou visuais (não corrigidos); déficits ou distúrbios neurológicos, comportamentais ou cognitivos; alterações da comunicação oral; indicação de retenção no histórico escolar. A seguir, os professores separaram os escolares segundo julgaram seus desempenhos em leitura e, assim, definiram-se dois grupos distintos: G1-escolares com bom desempenho em leitura (n=96); G2-escolares com dificuldades de fluência leitora e/ou de interpretação de texto, classificados como maus leitores (n=51). Essa classificação foi utilizada, no presente estudo, para distribuir as crianças dicotomicamente em duas categorias para posterior análise nas curvas ROC.As crianças também foram distribuídas por ano escolar: 30 eram do 3º ano ; 59 do 4º ano ; e 58 do 5º ano . Das 147 crianças, 66,7% eram meninas. Os pais ou responsáveis assinaram o Termo de Consentimento Livre e Esclarecido para participação de seus filhos e filhas nas pesquisas, cujos dados permitiram este estudo.Os únicos dados disponíveis eram dos três anos escolares. Assim, o ponto de corte para diferenciar bons e maus leitores para o 2º ano foi predito estatisticamente. Embora as avaliações tenham sido realizadas ao longo de 05 anos, os procedimentos e protocolos foram idênticos e aplicados com todos os escolares no segundo semestre letivo.A leitura oral de texto permitiu coletar informações sobre taxa e acurácia leitora. Um texto para cada ano escolar foi selecionado dos livros de Língua Portuguesa utilizados nas escolas . Os escolares foram instruídos a ler o texto em voz alta a partir do título. As leituras, individuais, foram gravadas para posterior análise e cálculo de duas medidas contínuas, a saber, a taxa  e a acurácia .,10. A possibilidade do total de pontos variou por texto lido: 27, 25 e 41 ideias para os textos do 3o, 4o e 5o ano, respectivamente. Procedeu-se à soma da pontuação obtida na tarefa de reconto e nas respostas às questões referentes ao texto lido.O critério de acerto foi o de reconhecimento automático das palavras, o que implica dizer que qualquer atividade de reparo da leitura foi considerada erro, não importando se para ajuste da decodificação ou compreensão. Para cada texto, após a leitura, a compreensão foi avaliada por 06 questões de múltipla escolha  e pela análise do reconto oral da história lida, segundo o número de ideias apresentadasReceiver Operating Characteristics curve) e calculadas as áreas abaixo delas. Usar o professor como gold-standard é um procedimento comum e usualmente feito em pesquisas em diversas áreas do desenvolvimento infantil,12.Para discriminar os bons e maus compreendedores foi feita uma pergunta simples às professoras, que buscava inferir se a criança em questão tinha ou não problemas de leitura e/ou compreensão de texto: “Com base no desempenho do aluno X em fluência de leitura e compreensão leitora, você o classificaria como bom ou mau leitor?”. A partir da categorização feita pelas professoras, em uma dessas duas possibilidades, isto é, bons ou maus leitores/compreendedores, foram construídas curvas ROC (DataFit 9 (https://datafit.software.informer.com/9.0/). Assim, os três valores de ponto de corte obtidos, um para cada ano escolar, foram plotados e, a partir deles, diferentes possibilidades de trajetórias de crescimento foram testadas frente a um acréscimo de um novo ano escolar . Sabendo-se que a distância entre os quatro anos no que tange o eixo x é equidistante, foi possível estimar, para cada modelo preditivo avaliado, possibilidades para o valor referente ao eixo y (taxa) para 2º ano. Deu-se preferência por trajetórias não lineares, dada a própria conformidade dos três pontos iniciais.Esse procedimento foi utilizado com as duas medidas de desfecho do estudo: taxa e acurácia. A medida contínua que demonstrasse os melhores resultados seria utilizada para estimar os prováveis pontos de corte para as crianças do 2º ano de escolarização. Caso as medidas não diferissem, a mais facilmente coletada  seria utilizada. A estimativa dos valores de ponto de corte para o 2º ano foi feita a partir da progressão dos pontos de cortes das crianças dos demais anos escolares por meio do programa A . Uma vez que os resultados obtidos na curva ROC, para cada um dos três anos (dados reais), não se encaixaram perfeitamente para cada uma das funções não-lineares testadas, conduziram-se aproximações. Originalmente, os valores obtidos para 3º, 4º e 5º ano estão descritos na Estatisticamente, os valores da área sob a curva ROC não diferiram para taxa ou para acurácia . Pela facilidade de coleta da taxa, utilizou-se esta medida para a estimação. Assim, a estimação do ponto de corte do 2º ano baseou-se em quatro funções não lineares: exponencial, polinomial de primeira ordem, logaritmo modificado e exponencial modificado,5,8. O acompanhamento das capacidades leitoras pode ter como objetivo não somente o conhecimento do nível de leitura do escolar, como também a identificação precoce de dificuldades de leitura de forma a prover informações para a intervenção e o suporte educacional ou clínico. Geralmente acompanham programas de RTI e fornecem o suporte para o acompanhamento do escolar.Procedimentos de rastreamento são de rápida aplicação e são utilizados para o necessário monitoramento do desenvolvimento da leitura durante a escolarização,4. Este estudo calculou e apresentou pontos de cortes para rastreamento por taxa ou acurácia mínimas para a realização de leitura com compreensão para os anos iniciais do ensino fundamental,6. Por não haver diferenças aparentes na área sob a curva ROC entre a taxa e a acurácia de leitura, optou-se por usar uma medida que pode ser usada facilmente e sem cálculo, a saber, a taxa. Assim, os números 65, 70 e 91 de p.p.m. foram considerados valores mínimos de fluência leitora como condição para garantir a compreensão de leitura no 3º, 4º e 5º ano do ensino fundamental, respectivamente. Os textos utilizados  constituíram-se em ferramenta útil, breve e fácil para rastrear a velocidade com vistas à compreensão.Conhecer valores liminares de parâmetros de fluência leitora pode ser útil para compor amostras de estudantes em pesquisas sobre a compreensão de leitura, uma vez que ambas as competências mostram associação em diferentes anos escolares foram encontrados sete casos de leitura deficiente de palavras reais e 12 de decodificação entre crianças de 10 anos julgadas competentes pelas professoras. É possível também que nesse grupo de crianças, por terem a fluência leitora mais desenvolvida, outros fatores, como vocabulário e capacidade de monitoramento, tenham interferido mais na compreensão leitora.Os valores obtidos para a taxa e acurácia mostraram uma queda na especificidade  do 3º para o 5º ano . É possí,10. Relatos e indicações dos professores são vistos como importante fonte primária de informação para os demais componentes da equipe educacional,16 e, por isso, têm papel fundamental no acompanhamento das diferentes etapas do aprendizado. Entretanto, outros estudos devem ser conduzidos com grupos clínicos, com diagnóstico de problemas específicos de aprendizagem, para melhorar as informações trazidas pela área sob a curva ROC, principalmente nos anos finais em que os valores de sensibilidade e especificidade foram menos adequados, embora ainda satisfatórios , frequência de palavras, nível de conhecimento necessário para o entendimento, e outros aspectos que interferem em sua complexidade. Por isso, recomenda-se fortemente, que os mesmos textos narrativos usados neste estudo sejam utilizados para a identificação do valor mínimo de palavras lidas por minuto para garantir a compreensão do texto lido. Essa recomendação visa, inclusive, à redução de possível margem de erro..Outra limitação importante é o fato de os pontos de corte das crianças mais jovens terem sido estimados . Apesar Ainda assim, ressalta-se que o valor aqui estimado é mais apropriado e mais bem destinado a pesquisas científicas, que a procedimentos de rastreamento clínico ou educacional. Essa limitação foi superada, em certa medida, pela estimação dos pontos de corte por meio da estatística aqui utilizada. Dessa forma, os clínicos e pesquisadores podem utilizar um texto apropriado para crianças de 2º ano com a expectativa de desempenho para os pontos de corte adotados.Pesquisadores e clínicos poderão se beneficiar desses dados para avaliação rápida e em futuras pesquisas com amostra ampliada de crianças na faixa etária estudada e que forneçam validação cruzada dos valores aqui apresentados. Outra possibilidade é investigar se os pontos de corte aqui fornecidos são válidos para separar crianças escolares em bons e maus compreendedores, também, em amostras independentes, por meio de validação cruzada.Estabeleceram-se pontos de corte para taxa e acurácia de leitura oral de texto para escolares do 2º ao 5º ano, com recomendações de utilização dos valores da taxa de leitura de cada ano escolar para procedimentos de rastreamento da compreensão leitora.


Caro editor quando tentaram avaliar a mortalidade hospitalar por todas as causas em pacientes internados por STEMI e NSTEMI em hospitais na América Latina e no Caribe a partir de 2000, concluindo que a mortalidade hospitalar em países de baixa e média renda era alta em comparação com as taxas relatadas em países de alta renda. Para melhorar essas estimativas, se deve buscar maior uso da terapia de reperfusão.Aprecio os esforços de Alves et al.Efetivamente, a qualidade do atendimento ao infarto agudo do miocárdio (IAM) na América Latina está abaixo dos padrões dos países desenvolvidos. Isso se deve a vários motivos: falta de recursos, treinamento inadequado dos profissionais de saúde e infraestrutura precária. Ainda assim, alguns esforços estão sendo feitos para melhorar a qualidade da assistência ao IAM.Alguns países implementaram programas para treinar profissionais de saúde e fornecer-lhes os equipamentos e medicamentos necessários para diagnosticar e tratar o IAM. Além disso, alguns governos estão trabalhando para melhorar o acesso à saúde aumentando o financiamento e expandindo a cobertura de seguro. Finalmente, alguns têm implementado registros de pacientes com Infarto Agudo do Miocárdio. Esses registros de infarto do miocárdio desempenham um papel vital na compreensão da carga dessa doença em cenários de renda média, pois essa é uma das principais causas de morte em todo o mundo. Dados precisos sobre a incidência, fatores de risco e resultados da doença são essenciais para o desenvolvimento de estratégias eficazes de prevenção e tratamento.Os registros coletam dados de pacientes com diagnóstico de infarto do miocárdio, incluindo informações demográficas, histórico médico e detalhes do evento de infarto do miocárdio. Esses dados podem ser usados para entender a epidemiologia da doença, incluindo a incidência e prevalência de infarto do miocárdio, fatores de risco e resultados. Em países de renda média, essas informações podem ajudar a orientar a alocação de recursos e o desenvolvimento de estratégias direcionadas de prevenção e tratamento. Além disso, se uma determinada opção de tratamento parece mais eficaz do que outras em uma determinada população de pacientes, os profissionais de saúde podem usar essas informações para tomar decisões de tratamento mais informadas para futuros pacientes. Isso pode levar a melhores resultados para os pacientes e melhorar a qualidade do atendimento.Um aspecto importante dos registros de IM em cenários de renda média é a capacidade de identificar disparidades na carga de doença. Se os dados do registro mostrarem que certas populações de pacientes não estão recebendo o mesmo nível de atendimento que outras, os profissionais de saúde podem trabalhar para abordar essas disparidades e melhorar o atendimento a esses pacientes.Essas informações podem ajudar políticas e programas que abordam essas disparidades. Os registros podem ser usados para avaliar o impacto de intervenções como programas de cessação do tabagismo, programas de controle da hipertensão e terapia com estatinas.Além disso, os registros de IM também podem ser usados para identificar e rastrear pacientes com alto risco de um IM subsequente. Ao identificar esses pacientes, os profissionais de saúde podem tomar medidas para reduzir o risco e prevenir outro ataque cardíaco. Os registros de infarto do miocárdio também desempenham um papel crítico na pesquisa e no desenvolvimento de novos tratamentos. Ao fornecer um grande conjunto de dados de pacientes e seus resultados, os pesquisadores podem entender melhor as causas subjacentes dos ataques cardíacos e desenvolver novos tratamentos para melhorar os resultados dos pacientes.Em geral, os registros de infarto do miocárdio são uma ferramenta vital para melhorar a qualidade do atendimento a pacientes que sofreram um ataque cardíaco. Ao coletar dados demográficos do paciente, fatores de risco, resultados de testes diagnósticos, opções de tratamento e resultados, os profissionais de saúde podem identificar padrões e tendências que podem ajudá-los a melhorar o atendimento prestado a pacientes com infarto do miocárdio.Global Heart Attack Treatment Initiative(GHATI) para melhorar o tratamento e os resultados de pacientes com infarto agudo do miocárdio em todo o mundo. A iniciativa se concentra em promover o uso de diretrizes baseadas em evidências e melhores práticas para o tratamento de pacientes com ataque cardíaco, bem como aumentar a conscientização e a educação sobre a importância do tratamento oportuno e eficaz. O GHATI também trabalha para facilitar a colaboração internacional e a troca de informações e recursos para melhorar o tratamento de ataques cardíacos globalmente.Assim, o American College of Cardiology lançou aApesar de ter sido lançado há vários anos, nenhum relatório atual sobre os dados do paciente está incluído neste registro. Aparentemente, o surgimento do COVID-19 pode ter influenciado o atraso nas publicações deste projeto.Para concluir, os registros de IM são essenciais para entender a carga de doença em cenários de renda média. Eles fornecem informações valiosas sobre a incidência, fatores de risco e resultados do infarto do miocárdio e podem ser usados para identificar disparidades na carga da doença e monitorar a eficácia das estratégias de prevenção e tratamento. Esta informação é essencial para o desenvolvimento de abordagens eficazes para reduzir a carga de IM em países de renda média. Dear Editorwhen they tried to evaluate all-cause in-hospital mortality in patients admitted for STEMI and NSTEMI in hospitals in Latin America and the Caribbean from 2000 onward, concluding that in-hospital mortality in low- and middle-income countries was high in comparison with rates reported in high-income countries and to improve these estimates, higher use of reperfusion therapy must be pursued.I appreciate the efforts of Alves et al.Effectively, the quality of care for AMI in Latin America is below the standards of developed countries. This is due to several reasons: lack of resources, inadequate training of healthcare professionals, and poor infrastructure. Still, some efforts are being made to improve the quality of care for AMI.Some countries have implemented programs to train healthcare professionals and provide them with the necessary equipment and medications to diagnose and treat AMI. Additionally, some governments are working to improve access to healthcare by increasing funding and expanding insurance coverage. Finally, some have implemented registries of patients with Acute Myocardial Infarction. These registries of myocardial infarction play a vital role in understanding the burden of this disease in middle-income scenarios, as this is a leading cause of death worldwide. Accurate data on the incidence, risk factors, and disease outcomes are essential for developing effective prevention and treatment strategies.Registries collect data on patients diagnosed with MI, including demographic information, medical history, and details of the MI event. This data can be used to understand the epidemiology of the disease, including the incidence and prevalence of MI, risk factors, and outcomes. In middle-income countries, this information can help to guide the allocation of resources and the development of targeted prevention and treatment strategies. Moreover, if a particular treatment option appears more effective than others in a particular patient population, healthcare providers can use this information to make more informed treatment decisions for future patients. This can lead to better patient outcomes and improved quality of care.One important aspect of MI registries in middle-income scenarios is the ability to identify disparities in disease burden. If data from the registry shows that certain patient populations are not receiving the same level of care as others, healthcare providers can work to address these disparities and improve care for these patients.This information can help to inform policies and programs that address these disparities. Registries can be used to evaluate the impact of interventions such as smoking cessation programs, hypertension management programs, and statin therapy.In addition, MI registries can also be used to identify and track patients who are at high risk for a subsequent MI. By identifying these patients, healthcare providers can take steps to reduce their risk and prevent another heart attack. Registries of myocardial infarction also play a critical role in research and developing new treatments. By providing a large dataset of patients and their outcomes, researchers can better understand the underlying causes of heart attacks and develop new treatments to improve patient outcomes.Overall, registries of myocardial infarction are a vital tool for improving the quality of care for patients who have experienced a heart attack. By collecting data on patient demographics, risk factors, diagnostic test results, treatment options, and outcomes, healthcare providers can identify patterns and trends that can help them improve the care they provide to patients with MI.to improve the treatment and outcomes of patients with acute myocardial infarction worldwide. The initiative focuses on promoting the use of evidence-based guidelines and best practices for managing heart attack patients, as well as increasing awareness and education about the importance of timely and effective treatment. GHATI also works to facilitate international collaboration and exchange of information and resources to improve heart attack care globally.Accordingly, The American College of Cardiology launched the Global Heart Attack Treatment Initiative (GHATI)Despite being launched several years ago, no current report on patient data is included in this registry. Apparently, the COVID-19 emergence may have influenced the delay in the publications of this project.To conclude, MI registries are critical in understanding the disease burden in middle-income scenarios. They provide valuable information on the incidence, risk factors, and outcomes of MI and can be used to identify disparities in the burden of disease and to monitor the effectiveness of prevention and treatment strategies. This information is essential for developing effective approaches to reducing the burden of MI in middle-income countries.


I hope everyone is enjoying the summer weather. I am excited to share that JCHLA/JABSC is now indexed in Web of Science Core Collection as part of the Emerging Sources Citation Index (ESCI). ESCI was added to Web of Science Core Collection in 2022. Not only does this aid in discoverability of the works published in JCHLA/JABSC, but beginning in 2024, JCHLA/JABSC will also be assigned a Journal Impact Factor.the full policy on our website. Secondly, JCHLA/JABSC will no longer be using the title “Editor-in-Chief” due to the significance of the term “chief” to Indigenous culture and its use as a pejorative term towards indigenous men. Moving forward JCHLA/JABSC will use the title “Editor” in its place. If you have interest in learning more about eliminating the term “chief” from professional titles you can read an excellent discussion of the issue here.I am also very proud to share the outcomes of our work this year with Equity, Diversity, and Inclusion. Firstly, the JCHLA/JABSC Editorial Team has developed a name change policy. This policy allows authors to request a name change for any reason. You can read This issue marks the end of my three-year term on the JCHLA/JABSC Editorial Board. The experience has been extremely rewarding and I am grateful to all the other JCHLA/JABSC and CHLA/ABSC members who I have been so lucky to work with over the years. Starting in September, Megan Kennedy (University of Alberta) will assume the position of Editor and Jessica McEwan (University of Ottawa) the position of Senior Editor. We are happy also to welcome Ashley Farrell  as Junior Editor and Tyler Ostapyk (University of Manitoba) as Production Editor.The August 2023 issue includes one research article, “Scaffolded, embedded required: information literacy education in undergraduate health sciences.” Also included are three book reviews related to systematic reviews and a product review of ResearchRabbit, a literature discovery tool supported by artificial intelligence. As always, we thank our authors, readers and reviewers for their contributions and support!Colleen PawliukJCHLA/JABSC Editor-in-Chiefeditor@chla-absc.caEmail: Bienvenue au numéro d'août 2023 du JABSC / JCHLA. J'espère que tout le monde profite de l’été. Je suis ravie de partager que le JABSC / JCHLA est maintenant indexé dans Web of Science Core Collection via le Emerging Sources Citation Index (ESCI). L'ESCI a été ajouté à la collection de base de Web of Science en 2022. Non seulement cela aide à la découvrabilité des œuvres publiées dans le JABSC / JCHLA, mais à partir de 2024, le JABSC / JCHLA se verra également attribuer un facteur d'impact de journal.la politique complète sur notre site Web. Deuxièmement, le JABSC / JCHLA n'utilisera plus le titre de « rédacteur en chef » en raison de l'importance du terme « chef » pour la culture autochtone et de son utilisation comme terme péjoratif envers les hommes autochtones. À l'avenir, le JABSC / JCHLA utilisera le titre « Éditeur » à sa place. Si vous souhaitez en savoir plus sur l'élimination du terme « chef » des titres professionnels, vous pouvez lire une excellente discussion sur la question ici.Je suis également très fiere de partager les résultats de notre travail cette année avec l'équité, la diversité et l'inclusion. Premièrement, l'équipe éditoriale du JABSC / JCHLA a élaboré une politique de changement de nom. Cette politique permet aux auteurs de demander un changement de nom pour n'importe quelle raison. Vous pouvez lire Ce numéro marque la fin de mon mandat de trois ans au comité de rédaction du JABSC / JCHLA. L'expérience a été extrêmement enrichissante et je suis reconnaissante à tous les autres membres du JABSC / JCHLA et de l’ABSC / CHLA avec lesquels j'ai eu la chance de travailler au fil des ans. À compter de septembre, Megan Kennedy (Université de l'Alberta) occupera le poste de rédactrice et Jessica McEwan (Université d'Ottawa) le poste de rédactrice senior. Nous sommes également heureux d'accueillir Ashley Farrell (Réseau universitaire de santé) à titre de rédactrice junior et Tyler Ostapyk (Université du Manitoba) à titre de rédacteur de production.Le numéro d'août 2023 comprend un article de recherche, « Scaffolded, embedded required: information literacy education in undergraduate health sciences ». Sont également inclus trois critiques de livres liées à des revues systématiques et une revue de produit de ResearchRabbit, un outil de découverte de littérature soutenu par l'intelligence artificielle. Comme toujours, nous remercions nos auteur.trice.s, lecteur.trice.s et réviseur.e.s pour leurs contributions et leur soutien!Colleen PawliukRédactrice en chef, JABSC / JCHLAeditor@chla-absc.caCourriel:


Scientific Reports 10.1038/s41598-021-81464-5, published online 21 January 2021Correction to: The original version of this Article contained an error in the Acknowledgements section, where the grant number of the DORIS project was incorrect.“This work was partially funded under the project DORIS, PTDC/EEI-AUT/32335-POCI-01-0145-FEDER-032335—funded by FEDER funds through COMPETE2020—Programa Operacional Competitividade e Internacionalização (POCI) and by national funds (PIDDAC) through FCT/MCTES and under the project ”ENDURANCE—Sistema baseado em veículos autónomos para observação oceanográfica de longa duração”, supported by Norte Portugal Regional Operational Programme (NORTE2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF).”now reads:“This work was partially funded under the project DORIS, PTDC/EAM-OCE/32325/2017-POCI-01-0145-FEDER-032325—funded by FEDER funds through COMPETE2020—Programa Operacional Competitividade e Internacionalização (POCI) and by national funds (PIDDAC) through FCT/MCTES and under the project ”ENDURANCE—Sistema baseado em veículos autónomos para observação oceanográfica de longa duração”, supported by Norte Portugal Regional Operational Programme (NORTE2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF).”The original Article has been corrected.


The ulnar artery is the larger terminal branch of the brachial artery. It originates in the cubital fossa and is covered by the flexor muscles of the forearm. We report an anatomic variant in which the ulnar artery was in a superficial position in the forearm. Since this variant was unknown, an attempted venous puncture injured the artery, causing formation of a pseudoaneurysm. Below the retinaculum of the flexors, it surfaces to form the superficial palmar arch, together with the superficial palmar branch of the radial artery.Normally, the ulnar artery originates in the cubital fossa and is the larger of the two terminal branches that arise from division of the brachial artery. It courses distally and medially below the superficial flexor muscles of the forearm and is located over the deep flexor muscle of the fingers (flexor digitorum profundus). Within the distal two-thirds of the forearm, the ulnar artery is lateral to the ulnar nerve, in Guyon’s canal. and it is more common unilaterally in the right arm. The prevalence of bilateral occurrence is 0.01-0.62%.In cases in which the ulnar artery follows a superficial path, it takes an unusual course, superficial to the flexor muscles of the forearm, and may originate either from the brachial artery or from the axillary artery. The prevalence of superficial ulnar artery is in the range of 0.7-9.4%,Pseudoaneurysms of the peripheral arteries are rare, with much lower frequency in upper limbs than in lower limbs.The study protocol was approved by the Ethics Committee at our institution (decision number 5.702.203). A free and informed consent form for studies involving human beings was signed.The patient was a 53-year-old male mechanic with a history of hospital admission for coronary surgery. He presented at the cardiology clinic seeking medical care for a palpable and painless mass of approximately 4 cm in size that had formed on the anterior aspect of his forearm after an attempted venous puncture during the surgical procedure. After physical examination, color Doppler ultrasonography (CDU) of the arteries of the upper limbs was requested with the objective of identifying the nature of the palpable mass . ExaminaAfter the examination, a consultation was scheduled at the Vascular Surgery Clinic, where open surgery was chosen to treat the injury. The time elapsed between the examination and surgery was 50 days. The operation was initiated with a 4-5 cm incision over the pseudoaneurysm, with proximal and distal control of the superficial ulnar artery, in addition to separation of the two basilic veins . Next, d Another study, with 95 cadavers, reported a 4.2% prevalence of superficial ulnar artery, 75% of which were in the right upper limb. Other authors have identified incidence of 0.7-7% of this variant.The superficial ulnar artery anatomic variant is well described in the literature. In a study of 408 upper limbs, a superficial ulnar artery was found in 2.5% of cases.According to Bhat, in some cases in which the ulnar artery has a high origin, emerging from the axillary artery, it can even cross the median nerve and supply the brachial biceps muscle. The greatest relevance of knowing about this rare anatomic variant is that the patient can inform the medical and nursing teams, avoiding an increased possibility of unintentional penetration of the superficial ulnar artery during attempts at peripheral venous puncture of the basilic vein in the forearm or of the intermediate cephalic vein during laboratory tests or venous access for infusion of saline and medications. Pseudoaneurysms in the upper limbs primarily occur in accidents involving penetrating traumas. Diagnostic investigation methods primarily involve CDU. Magnetic resonance or computed tomography angiography can also be used. Treatment may be surgical or non-surgical. Surgical approaches should be chosen in cases with significant masses, distal ischemia of the limb, or neuropathy. Surgical treatments include arterial ligature, construction of venous bypasses, and partial or total removal of the structure containing the pseudoaneurysm and end-to-end ligature for small pseudoaneurysms. Non-surgical treatment can be achieved by ultrasound-guided administration of thrombin injections. In the present case, a pseudoaneurysm caused by accidental venous puncture of the superficial ulnar artery clearly demonstrates the importance of acquiring knowledge of variations of arterial anatomy before undertaking any procedure. In such a situation, CDU, which is a widely-available, low-cost, noninvasive method, can serve as the first-choice preoperative examination, or, in cases of suspicion of a superficial ulnar artery, can be used to rule out any possible anatomic variants and avoid complications.A superficial ulnar artery has considerable clinical importance. The superficial position, over the flexor muscles, makes it more susceptible to traumas and consequent hemorrhages, which can be serious.  . Abaixo do retináculo dos flexores torna-se superficial para formar o arco palmar superficial, junto ao ramo palmar superficial da artéria radial.Normalmente a artéria ulnar apresenta origem na fossa cubital, sendo o maior ramo terminal das duas divisões da artéria braquial. Dirige-se distalmente e medialmente abaixo dos músculos flexores superficiais do antebraço, situando-se sobre o músculo flexor profundo dos dedos. Nos dois terços distais do antebraço, a artéria ulnar situa-se lateralmente ao nervo ulnar no canal de Guyon , é maior unilateralmente no braço direito. A ocorrência bilateral tem prevalência 0,01-0,62% .No caso da artéria ulnar em trajeto superficial, ela apresenta um percurso não usual, superficial aos músculos flexores do antebraço, podendo originar-se tanto da artéria braquial quanto da artéria axilar. A prevalência da artéria ulnar superficial varia entre 0,7-9,4% .Os pseudoaneurismas de artérias periféricas são raros, sendo a frequência muito menor em membros superiores do que em membros inferioresO protocolo foi aprovado pelo Comitê de Ética de nossa instituição (parecer número 5.702.203). O termo de consentimento livre e esclarecido foi assinado para os estudos que envolvem seres humanos.Paciente do sexo masculino, com 53 anos de idade, mecânico, com histórico de internação prévia para cirurgia coronariana. Procurou avaliação médica no ambulatório de cardiologia devido à formação de uma massa palpável e indolor de aproximadamente 4 cm na face anterior de seu antebraço, depois de uma tentativa de punção venosa durante o procedimento cirúrgico. Após exame físico, foi solicitado eco-Doppler colorido (EDC) arterial dos membros superiores com o objetivo de caracterizar a massa palpável . O exameApós o exame, foi agendada uma consulta no ambulatório de cirurgia vascular, onde foi escolhida cirurgia aberta para tratamento da lesão. O intervalo entre o exame e a cirurgia foi de 50 dias. A cirurgia consistiu numa incisão de 4-5 cm sobre o pseudoaneurisma, controle proximal e distal da artéria ulnar superficial, além da separação das duas veias basílicas . Em segu . Outro estudo com 95 cadáveres concluiu a prevalência da artéria ulnar superficial em 4,2% dos membros, sendo desses 75% no membro superior direito . Outros autores identificaram que essa variação tem incidência entre 0,7-7% .A variação anatômica da artéria ulnar superficial está bem descrita na literatura. Em um estudo de 408 membros superiores, a artéria ulnar superficial foi encontrada em 2,5% dos casos .De acordo com Bhat, em alguns casos de uma origem alta, a partir da artéria axilar, a artéria ulnar pode inclusive cruzar o nervo mediano e suprir o músculo bíceps braquial . A maior relevância do conhecimento dessa rara variação anatômica é o paciente poder informar a equipe médica e de enfermagem sobre essa ocorrência, para evitar a grande possibilidade de penetração, de forma não intencional, da artéria ulnar superficial em tentativas de punção venosa periférica da veia basílica no antebraço, ou da veia intermédia do cotovelo em exames laboratoriais, ou acessos venosos para infusão de soro e medicamentos . Pseudoaneurismas nos membros superiores podem ocorrer principalmente em traumas com acidentes penetrantes . Métodos de investigação diagnóstica incluem principalmente o EDC. Angiografia por ressonância magnética ou por tomografia computorizada também podem ser utilizadas. O tratamento pode ser cirúrgico e não cirúrgico. Abordagens cirúrgicas devem ser escolhidas em casos de massas significativas, isquemia distal do membro ou neuropatia. O tratamento cirúrgico inclui ligadura arterial, confeção de ponte venosa ou, ainda, a remoção parcial ou total da estrutura contendo o pseudoaneurisma e ligadura término-terminal em pseudoaneurismas pequenos. O tratamento não cirúrgico pode ser feito através injeções de trombina guiadas por ultrassom . Nesse caso, um pseudoaneurisma, após punção venosa acidental da artéria ulnar superficial, deixa evidente a importância dos conhecimentos das variações anatômicas do percurso arterial antes de qualquer procedimento. Em um cenário como esse, o EDC, por ser um método não invasivo, amplamente disponível e de baixo custo, pode servir como um exame de escolha pré-operatório, ou em casos de suspeita de artéria ulnar superficial, para descartar qualquer possível variação anatômica e evitar complicações.A artéria ulnar superficial apresenta grande importância clínica. A posição superficial, acima dos músculos flexores, a deixa mais sujeita a traumas e consequentes hemorragias, que podem ser graves