The polypill: from concept and evidence to implementation

© 2022 Elsevier Ltd. All rights reserved.About 18 million deaths occur due to cardiovascular diseases each year, of which 80% are in low-income and middle-income countries, and three times as many individuals have non-fatal cardiovascular diseases. These diseases are widespread and demand global, populationwide action, but the approach to their control has been based on individualised treatment plans, leaving the majority of people at risk neglected.info:eu-repo/semantics/publishedVersio

a contribution to strengthen assessment towards quality improvement in interventional cardiology

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Cardiac involvement in COVID-19: a matter close to the heart, beyond the acute illness

© 2023 International Journal of Cardiovascular Sciences. This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Human infection with the SARS-CoV-2 virus and COVID-19 have been ravaging the entire world since December 2019. As of February 17, 2023, records from the World Health Organization point to more than 756 million confirmed cases and approximately 6,845,000 deaths. In Brazil, until this date, approximately 36,961,000 cases have been reported, with about 698,000 deaths.Among the deaths, the main comorbidities reported are heart disease (40%), diabetes (28%), obesity (10%), neurological diseases (5%), kidney diseases (5%), and pneumopathies (5%). Furthermore, 70% of patients who died were 60 years old or older, and males were prevalent in 60% of the cases.info:eu-repo/semantics/publishedVersio

COVID-19 : a matter close to the heart

© This is an open-access article distributed under the terms of the Creative Commons Attribution License 4.0 International – CC BYThe world is facing a new challenge, the novel coronavirus disease 2019 (COVID-19), caused by a betacoronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), phylogenetically identical to the SARS-CoV (severe acute respiratory syndrome coronavirus) and the MERS-CoV (Middle East respiratory syndrome coronavirus) responsible for innumerable deaths in China in 2003 and in the Middle East in 2012, respectively.info:eu-repo/semantics/publishedVersio

Endocardite infecciosa: ainda mais desafios que certezas

© Sociedade Brasileira de Cardiologia - SBC. This is an open-access article distributed under the terms of the Creative Commons Attribution LicenseAfter fourteen decades of medical and technological evolution, infective endocarditis continues to challenge physicians in its daily diagnosis and management. Its increasing incidence, demographic shifts (affecting older patients), microbiology with higher rates of Staphylococcus infection, still frequent serious complications and substantial mortality make endocarditis a very complex disease. Despite this, innovations in the diagnosis, involving microbiology and imaging, and improvements in intensive care and cardiac surgical techniques, materials and timing can impact the prognosis of this disease. Ongoing challenges persist, including rethinking prophylaxis, improving the diagnosis criteria comprising blood culture-negative endocarditis and prosthetic valve endocarditis, timing of surgical intervention, and whether to perform surgery in the presence of ischemic stroke or in intravenous drug users. A combined strategy on infective endocarditis is crucial, involving advanced clinical decisions and protocols, a multidisciplinary approach, national healthcare organization and health policies to achieve better results for our patients.Após catorze décadas de evolução médica e tecnológica, a endocardite infeciosa continua a desafiar médicos no seu diagnóstico e manejo diário. O aumento da incidência, alterações demográficas (afetando pacientes mais idosos), microbiologia com taxas de infeção por Staphylococcus mais elevadas, com complicações graves ainda frequentes e uma mortalidade substancial tornam a endocardite uma doença muito complexa. Apesar de tudo, a inovação no seu diagnóstico, nomeadamente na área da microbiologia e imagem, e a melhoria nos cuidados intensivos e na cirurgia cardíaca (quanto às técnicas, materiais usados e momento de intervenção) podem ter um impacto no seu prognóstico. Os desafios persistem, incluindo repensar a profilaxia, melhorar os critérios de diagnóstico incluindo a endocardite com culturas negativas e endocardite de prótese valvar, o timing para a intervenção cirúrgica, e sua realização ou não na presença de acidente vascular cerebral isquêmico e em usuários de drogas intravenosas. Uma estratégia combinada na endocardite infeciosa é fundamental, incluindo decisões e protocolos clínicos avançados, um manejo multidisciplinar, organização e políticas de saúde que culminem em melhores resultados para os nossos pacientes.info:eu-repo/semantics/publishedVersio

Decision-making support systems on extended hospital length of stay: validation and recalibration of a model for patients with AMI

Copyright © 2023 Xavier, Seringa, Pinto and Magalhães. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.Background: Cardiovascular diseases are still a significant cause of death and hospitalization. In 2019, circulatory diseases were responsible for 29.9% of deaths in Portugal. These diseases have a significant impact on the hospital length of stay. Length of stay predictive models is an efficient way to aid decision-making in health. This study aimed to validate a predictive model on the extended length of stay in patients with acute myocardial infarction at the time of admission. Methods: An analysis was conducted to test and recalibrate a previously developed model in the prediction of prolonged length of stay, for a new set of population. The study was conducted based on administrative and laboratory data of patients admitted for acute myocardial infarction events from a public hospital in Portugal from 2013 to 2015. Results: Comparable performance measures were observed upon the validation and recalibration of the predictive model of extended length of stay. Comorbidities such as shock, diabetes with complications, dysrhythmia, pulmonary edema, and respiratory infections were the common variables found between the previous model and the validated and recalibrated model for acute myocardial infarction. Conclusion: Predictive models for the extended length of stay can be applied in clinical practice since they are recalibrated and modeled to the relevant population characteristics.This study was funded by Fundação Ciência e Tecnologia, IP national support through CHRC (UIDP/04923/2020).info:eu-repo/semantics/publishedVersio

Role of microRNAs in the regulation of cardiovascular diseases : focus on remodelling

MicroRNAs (miRNAs) are a large class of noncoding RNAs that regulate the expression of protein-coding genes at the post-transcriptional level . They are recognized as regulators of biological processes underlying cardiovascular disorders including hypertrophy, ischemic heart disease, valvular disease and arrhythmias. Particularly, circulating miRNAs are promising biomarkers of cardiovascular pathology (1). MiRNAs are small, noncoding, RNA molecules with approximately 22 nucleotides in length, which act as post-transcriptional regulators of gene expression. Individual miRNAs have been demonstrated to negatively regulate the expression of multiple gene transcripts by the cleavage or suppression of translation of a target mRNA. Conversely, the expression of individual genes can be regulated by multiple miRNAs. Since their experimental description in 1993 (2), a large number of miRNAs known by their gene-regulatory roles in different biological processes, have been catalogued. In fact, miRNAs are known to regulate approximately one third of all coding gene transcripts in mammals, showing their importance as key process modulators (3). Regarding cardiovascular diseases, miRNAs have been identified as key regulators of complex biological processes linked to several conditions as presented above, including left ventricular remodelling, atherosclerosis and myocardial infarction, heart failure, hypertension and arrhythmias (1). miRNAs are expressed in the cardiovascular system, but their role in cardiovascular diseases has not yet been entirely clarified. Moreover, since the discovery that miRNAs are present in the circulation, they have been investigated as novel biomarker as presented bellow. Only 3% of the human genome codes for proteins. Nevertheless, while noncoding RNAs will not act for coding into proteins they modulate all genomic functions. These noncoding RNAs include short miRNAs with approximately 22 nucleotides) and longer, with >200 nucleotides, long noncoding RNAs (lncRNAs) with important biological functions (4) since they are now clearly recognised to play key roles in gene regulation and may simultaneously represent diagnostic and prognostic biomarkers in cardiovascular diseases. (5,6) there are in excess of 2000 human miRNAs (catalogued in mirBase (http://www.mirbase.org) (7). Of note, the key feature of the mechanism of action of miRNAs is that a single miRNA can regulate the expression of several genes, depending on the specificity of the target sequence. On the other side, individual genes can be regulated by different miRNAs particularly if they involve complementary sequences for more than one miRNA. These factors lead to a highly complex regulatory mechanism, often difficult to understand. (8,9). In the healthy adult heart, data from a large sequencing project and other sequential studies, has identified a number of miRNAs that are highly expressed in healthy cardiac tissue and thus expected to play a key role in both normal cardiac function and disease. (10,11) These include miR-1, miR-16, miR-27b, miR-30d, miR-126, miR-133, miR-143, miR-208 and the let-7 family. However, many others have been identified and are now under study. The concept of miRNA-based therapeutics has been emerging and under development, with synthetic antagonists of miRNAs (antagomiRs or antimirs) and very promising in animal models but awaiting new advances in phase II human trials, still in its infancy (12,13). miRNAs clearly intervene in physiological and pathological processes in the cardiovascular diseases. We will review miRNA biology and its role on LV remodeling in myocardial infarction, heart failure, hypertension and aortic stenosis as additionally a note will be provided on the potential of miRNAs for therapeutics.info:eu-repo/semantics/publishedVersio

Hábitos de sono nos estudantes da FML

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2018Introdução: Para muitos estudantes, a faculdade é uma altura de transição crítica que continua a ser associada a uma quantidade de horas dormidas insuficiente bem como a uma fraca qualidade do sono. A privação crónica de sono, para além de ser comum entre os estudantes de medicina, é comparativamente mais prevalente do que nos estudantes de outras áreas, não existindo estudos em Portugal sobre esta temática nos alunos de medicina. Objetivo: Caracterizar e comparar os hábitos de sono dos estudantes de medicina da Faculdade de Medicina de Lisboa (FML) de todos os anos, no ano letivo 2016/2017. Metodologias: Foi enviado a todos alunos dos 6 anos do curso de Medicina na FML, um questionário de autopreenchimento, anónimo, de preenchimento único e não remunerado, utilizando o software de inquéritos disponível na internet, denominado Survs®. Resultados: Em todos os anos do mestrado integrado de medicina da FML, apesar de existir uma noção semelhante e correta acerca do número de horas que se deve dormir, a maioria dos estudantes no período de aulas dorme apenas cerca de 6 a 7 horas e no período de exames, os alunos dos anos pré-clínicos (1º ao 3º ano) dormem menos horas comparativamente com os anos clínicos (4º ao 6º ano), apresentando também mais hipersonolência diurna e mais níveis de depressão, ansiedade e stress comparativamente com os anos clínicos. Conclusões: Os anos pré-clínicos apresentaram piores outcomes comparativamente com os anos clínicos no que se refere ao número de horas dormidas no período de exames, hipersonolência diurna, depressão, ansiedade e stress.Background: For many students, the faculty is a critical transition time that continues to be associated with an insufficient number of sleeping hours as well as poor sleep quality. Chronic sleep deprivation, in addition to being common among medical students, is comparatively more prevalent than in students in other areas and there are no studies in Portugal on this subject in medical students. Purpose: To determine and investigate associations between the sleeping habits of all students of Faculdade de Medicina de Lisboa (FML) during the academic year of 2016/2017. Methods: An anonymous, self-rating, non refundable online survey was created and emailed to all six years students of Faculdade de Medicina de Lisboa using an online platform called Survs®. Results: All six years students of Faculdade de Medicina de Lisboa, beside the right idea about the number of hours that they should sleep, most of them during the class period sleep only 6-7 hours per night and in the examination period the pre-clinical years (1st to 3rd) sleep less hours than the clinical years (4th to 6th), and they also had more daytime sleepiness, depression, anxiety and stress than the clinical years. Conclusions: The pre-clinical years revealed worst outcomes comparing with the clinical years on the number of hours slept during the examination period, daytime sleepiness, depression, anxiety and stress

An experimental approach for assessing the harmonic impact of fast charging electric vehicles on the distribution systems

Fast charging is seen by users as a preferential way for electric vehicles (EV) to extend average daily mobility. Fast chargers rated power, their expected operation mostly during peak hours and clustering in designated stations, raise significant concerns. On one hand it raises concerns about power quality standard requirements, especially harmonic distortion due to the use of power electronics connecting to high loads typically ranging from 18-24 kWh, and on the other hand infrastructure dimensioning and design for those investing on such facilities. We performed four sets of measurements during an EV complete fast charging cycles and analysed individual harmonic’s amplitude and phase angles behaviour and calculated the voltage and current total harmonic distortion (THD) and Total Demand Distortion (TDD) comparing it with IEEE519, IEC 61000/EN50160 standards. Additionally, we simulated, two vehicles being fast charged while connected to the same feeder, and analysed how the harmonic phase angles would relate. We concluded that the use of TDD was a better indicator than THD since the first one uses the maximum current (IL) and the latter uses the fundamental current, sometimes misleading conclusions, hence suggested to be included in IEC/EN standard updates. Voltage THD and TDD for the analysed charger, were within the standards limitations 1.2% and 12% respectively, however individual harmonics (11th and 13th ) failed to comply with the 5.5% limit in IEEE 519 (5% and 3% respectively in IEC61000). Phase angles tended to have preferential range differences from the fundamental. We found that the average difference between the same harmonic order phase angles, are lower than 90°, meaning that when more than one vehicle is connected to the same feeder the amplitudes will tend to add. Since the limits are dependable on the upstream short circuit current (ISC), if the number of vehicles increase (i.e. IL), the standard limits will decrease and eventually are broken. The harmonic limitation is hence a first binding condition, well before the power limitation is. The number of chargers will be limited first not by the power capacity of the upstream power circuit but by the harmonic limits for electric pollution.JRC.F.3-Energy Security, Systems and Marke

Reconstrução tridimensional dinâmica do coração através da ecocardiografia transesofágica

Copyright © 1997-99 Arquivos Brasileiros de CardiologiaObjective – To evaluate echocardiography accuracy in performing and obtaining images for dynamical threedimensional (3D) reconstruction. Methods – Three-dimensional (3D) image reconstruction was obtained in 20 consecutive patients who underwent transesophageal echocardiography. A multiplanar 5 MHz transducer was used for 3D reconstruction. Results – Twenty patients were studied consecutively. The following cardiac diseases were present: valvar prostheses – 6 (2 mitral, 2 aortic and 2 mitral and aortic); mitral valve prolapse – 3; mitral and aortic disease – 2; aortic valve disease – 5; congenital heart disease – 3 (2 atrial septal defect –ASD- and 1 transposition of the great arteries -TGA); arteriovenous fistula – 1. In 7 patients, color Doppler was also obtained and used for 3D flow reconstruction. Twenty five cardiac structures were acquired and 60 reconstructions generated (28 of mitral valves, 14 of aortic valves, 4 of mitral prostheses, 7 of aortic prostheses and 7 of the ASD). Fifty five of 60 (91.6%) reconstructions were considered of good quality by 2 independent observers. The 11 reconstructed mitral valves/prostheses and the 2 reconstructed ASDs provided more anatomical information than two dimensional echocardiography (2DE) alone. Conclusion – 3D echocardiography using a transesophageal transducer is a feasible technique, which improves detection of anatomical details of cardiac structures, particularly of the mitral valve and atrial septum.Objetivo - Avaliar a acuidade da ecocardiografia na realização e obtenção de imagens para reconstrução tridimensional dinâmica (3D). Métodos - Foram obtidas imagens para reconstruções 3D em 20 doentes consecutivos submetidos a ecocardiografia transesofágica. Foi utilizado um transdutor de 5 Mhz multiplanar ligado ao sistema de reconstrução 3D. Resultados – Foram estudados, consecutivamente, 20 doentes, idade média de 56±16 anos, com as seguintes doenças cardíacas: próteses valvulares - 6 (2 mitrais, 2 aórticas e 2 mitro-aórticas); prolapso da válvula mitral - 3; doença mitro-aórtica - 2; doença da válvula aórtica - 5; cardiopatia congênita - 3 (2 comunicação interatrial (CIA) e 1 transposição das grandes artérias (TGA)); fístula arteriovenosa - 1. Em 7 doentes foi também obtido fluxo por Doppler a cores e feita a reconstrução 3D do fluxo. Foram adquiridas 25 estruturas cardíacas e foram realizadas 60 reconstruções (28 de válvulas mitrais, 14 de válvulas aórticas, 4 de próteses mitrais, 7 de próteses aórticas e 7 de CIA). Das 60 (91,6%) reconstruções, 55 foram consideradas de boa qualidade por 2 observadores independentes. As 11 válvulas/próteses mitrais e 2 CIAs reconstruídas forneceram mais informações anatômicas do que apenas o ecocardiograma bidimensional. Conclusão - A ecocardiografia 3D, pela via transesofágica, é uma técnica exeqüível, que melhora o reconhecimento de detalhes anatômicos de estruturas cardíacas, particularmente a válvula mitral e o septo interatrial.info:eu-repo/semantics/publishedVersio