Aortic valve endocarditis by a rare infectious agent in a patient with a rare congenital mitral valve abnormality

© The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact [email protected] description: A 66-year-old woman with a past medical history of high blood pressure, Type 2 diabetes mellitus and no clinical evidence of immunocompromise, presented to the emergency room with fever and acute pulmonary oedema. The patient had presented low-grade fever and anorexia in the previous 3 weeks.info:eu-repo/semantics/publishedVersio

Validação da versão portuguesa do Asthma Quality of Life Questionnaire de Marks (AQLQ-M)

AbstractQuality of Life is one of the leading evaluations in the diagnosis, therapy and investigation of patients with asthma. The aim of this study was to evaluate the psychometric properties of the Portuguese version of the Asthma Quality of Life Questionnaire (AQLQ-M) designed by Marks in Australia. This questionnaire consists of 20 items describing the impact of asthma on patient’s lifestyle and covers 4 dimensions (breathlessness, mood, social limitation and worrying). After a process of translation, backtranslation, and a pretest, the Portuguese version of the AQLQ-M was administered to 82 adult asthmatics living in 3 different urban areas. The following data were also recorded: age, sex, main symptoms, duration of disease, hospital visits, severity of disease, and medication. All patients performed spirometry. The reliability study (internal consistency with Cronbach s alpha coefficient and inter-item correlation analysis) gave satisfactory results (range of r=0.58 to 0.94; a=0.91 to 0.97). Results for construct validity shown that the breathlessness dimension presented the largest number of significant correlations with the most important clinical variables of asthma. In conclusion, this study has shown that the Portuguese version of the AQLQ-M has good psychometric properties, and is suitable for use on individual patients with asthma in our country.Rev Port Pneumol 2005; XI (4): 351-36

Positive Selection Linked with Generation of Novel Mammalian Dentition Patterns

A diverse group of genes are involved in the tooth development of mammals. Several studies, focused mainly on mice and rats, have provided a detailed depiction of the processes coordinating tooth formation and shape. Here we surveyed 236 tooth-associated genes in 39 mammalian genomes and tested for signatures of selection to assess patterns of molecular adaptation in genes regulating mammalian dentition. Of the 236 genes, 31 (∼13.1%) showed strong signatures of positive selection that may be responsible for the phenotypic diversity observed in mammalian dentition. Mammalian-specific tooth-associated genes had accelerated mutation rates compared with older genes found across all vertebrates. More recently evolved genes had fewer interactions (either genetic or physical), were associated with fewer Gene Ontology terms and had faster evolutionary rates compared with older genes. The introns of these positively selected genes also exhibited accelerated evolutionary rates, which may reflect additional adaptive pressure in the intronic regions that are associated with regulatory processes that influence tooth-gene networks. The positively selected genes were mainly involved in processes like mineralization and structural organization of tooth specific tissues such as enamel and dentin. Of the 236 analyzed genes, 12 mammalian-specific genes (younger genes) provided insights on diversification of mammalian teeth as they have higher evolutionary rates and exhibit different expression profiles compared with older genes. Our results suggest that the evolution and development of mammalian dentition occurred in part through positive selection acting on genes that previously had other functions

The adaptive evolution of the mammalian mitochondrial genome

<p>Abstract</p> <p>Background</p> <p>The mitochondria produce up to 95% of a eukaryotic cell's energy through oxidative phosphorylation. The proteins involved in this vital process are under high functional constraints. However, metabolic requirements vary across species, potentially modifying selective pressures. We evaluate the adaptive evolution of 12 protein-coding mitochondrial genes in 41 placental mammalian species by assessing amino acid sequence variation and exploring the functional implications of observed variation in secondary and tertiary protein structures.</p> <p>Results</p> <p>Wide variation in the properties of amino acids were observed at functionally important regions of cytochrome <it>b </it>in species with more-specialized metabolic requirements (such as adaptation to low energy diet <it>or </it>large body size, such as in elephant, dugong, sloth, and pangolin, and adaptation to unusual oxygen requirements, for example diving in cetaceans, flying in bats, and living at high altitudes in alpacas). Signatures of adaptive variation in the NADH dehydrogenase complex were restricted to the loop regions of the transmembrane units which likely function as protons pumps. Evidence of adaptive variation in the cytochrome <it>c </it>oxidase complex was observed mostly at the interface between the mitochondrial and nuclear-encoded subunits, perhaps evidence of co-evolution. The ATP8 subunit, which has an important role in the assembly of F₀, exhibited the highest signal of adaptive variation. ATP6, which has an essential role in rotor performance, showed a high adaptive variation in predicted loop areas.</p> <p>Conclusion</p> <p>Our study provides insight into the adaptive evolution of the mtDNA genome in mammals and its implications for the molecular mechanism of oxidative phosphorylation. We present a framework for future experimental characterization of the impact of specific mutations in the function, physiology, and interactions of the mtDNA encoded proteins involved in oxidative phosphorylation.</p

Suberose e doença dos criadores de aves: estudo comparativo do perfil radiológico, funcional e do lavado broncoalveolar

n/

The value of multiparametric prediction scores in heart failure varies with the type of follow‐up after discharge: a comparative analysis

© 2023 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.Aims: Multiple prediction score models have been validated to predict major adverse events in patients with heart failure. However, these scores do not include variables related to the type of follow-up. This study aimed to evaluate the impact of a protocol-based follow-up programme of patients with heart failure regarding scores accuracy for predicting hospitalizations and mortality occurring during the first year after hospital discharge. Methods and results: Data from two heart failure populations were collected: one composed of patients included in a protocol-based follow-up programme after an index hospitalization for acute heart failure and a second one-the control group-composed of patients not included in a multidisciplinary HF management programme after discharge. For each patient, the risk of hospitalization and/or mortality within a period of 12 months after discharge was calculated using four different scores: BCN Bio-HF Calculator, COACH Risk Engine, MAGGIC Risk Calculator, and Seattle Heart Failure Model. The accuracy of each score was established using the area under the receiver operating characteristic curve (AUC), calibration graphs, and discordance calculation. AUC comparison was established by the DeLong method. The protocol-based follow-up programme group included 56 patients, and the control group, 106 patients, with no significant differences between groups (median age: 67 years vs. 68.4 years; male sex: 58% vs. 55%; median ejection fraction: 28.2% vs. 30.5%; functional class II: 60.7% vs. 56.2%, I: 30.4% vs. 31.9%; P = not significant). Hospitalization and mortality rates were significantly lower in the protocol-based follow-up programme group (21.4% vs. 54.7%; P < 0.001 and 5.4% vs. 17.9%; P < 0.001, respectively). When applied to the control group, COACH Risk Engine and BCN Bio-HF Calculator had, respectively, good (AUC: 0.835) and reasonable (AUC: 0.712) accuracy to predict hospitalization. There was a significant reduction of COACH Risk Engine accuracy (AUC: 0.572; P = 0.011) and a non-significant accuracy reduction of BCN Bio-HF Calculator (AUC: 0.536; P = 0.1) when applied to the protocol-based follow-up programme group. All scores showed good accuracy to predict 1 year mortality (AUC: 0.863, 0.87, 0.818, and 0.82, respectively) when applied to the control group. However, when applied to the protocol-based follow-up programme group, a significant predictive accuracy reduction of COACH Risk Engine, BCN Bio-HF Calculator, and MAGGIC Risk Calculator (AUC: 0.366, 0.642, and 0.277, P < 0.001, 0.002, and <0.001, respectively) was observed. Seattle Heart Failure Model had non-significant reduction in its acuity (AUC: 0.597; P = 0.24). Conclusions: The accuracy of the aforementioned scores to predict major events in patients with heart failure is significantly reduced when they are applied to patients included in a multidisciplinary heart failure management programme.This work was supported by national funds, Fundação para a Ciência e a Tecnologia, reference number UIDB/00306/2020.info:eu-repo/semantics/publishedVersio

Left atrial abnormal mechanics by speckle tracking as an early subclinical manifestation in patients with systemic sclerosis

© The European Society of Cardiology 2018. All rights reserved.Introduction: Heart involvement in systemic sclerosis (SSc) affects the prognosis of the disease when clinically evident. SSc may be associated with myocardial microvascular obstruction and micronecrosis is a presumible determinant of ventricular dysfunction, heart failure and sudden death. The aim of this study was to assess whether there were early changes of left atrial (LA) deformation by speckle tracking in patients with normal ejection fraction.info:eu-repo/semantics/publishedVersio

Programa de seguimento protocolado de doentes com insuficiência cardíaca : impacto no prognóstico e na qualidade de vida

© 2020 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L.U. This is an open access article under the CC BY-NC-ND license.Introduction: Heart failure is associated with high rates of readmission and mortality, and there is a need for measures to improve outcomes. This study aims to assess the impact of the implementation of a protocol-based follow-up program for heart failure patients on readmission and mortality rates and quality of life. Methods: A quasi-experimental study was performed, with a prospective registry of 50 consecutive patients discharged after hospitalization for acute heart failure. The study group was followed by a cardiologist at days 7-10 and the first, third, sixth and 12th month after discharge, with predefined procedures. The control group consisted of patients hospitalized for heart failure prior to implementation of the program and followed on a routine basis. Results: No significant differences were observed between the two groups regarding mean age (67.1±11.2 vs. 65.8±13.4 years, p=0.5), NYHA functional class (p=0.37), or median left ventricular ejection fraction (27% [19.8-35.3] vs. 29% [23.5-40]; p=0.23) at discharge. Mean follow-up after discharge was similar (11±5.3 vs. 10.9±5.5 months, p=0.81). The protocol-based follow-up program was associated with a significant reduction in allcause readmission (26% vs. 60%, p=0.003), heart failure readmission (16% vs. 36%, p=0.032), and mortality (4% vs. 20%, p=0.044). In the study group there was a significant improvement in all quality of life measures (p<0.001). Conclusion: A protocol-based follow-up program for patients with heart failure led to a signif-icant reduction in readmission and mortality rates, and was associated with better quality of life.info:eu-repo/semantics/publishedVersio

Atrial fibrillation ablation : the added value of adenosine test in confirming pulmonary vein isolation

© The European Society of Cardiology 2018. All rights reserved.Introduction: Adenosine test has been increasingly used to confirm pulmonary vein isolation (PVI) in patients undergoing ablation of atrial fibrillation (AF). However, its impact on the success of ablation remains unknown. Purposes: To evaluate the results of the adenosine triphosphate (ATP) test in patients undergoing PVI and assess the success of ablation related to the use of this test (adenosine-guided PVI versus conventional PVI). Methods: Single-center prospective study of consecutive patients undergoing first AF ablation procedure, started at January 2013. After ablation, the persistence of PVI was tested with adenosine triphosphate administration (15–30mg by intravenous route). When adenosine triphosphate-induced pulmonary vein conduction (termed as reconduction) was observed, additional energy applications of radiofrequency were applied to obtain persistent isolation on retesting. Cardiac event recorder was performed at 7 days, 3, 6 and 12 months after ablation and annually from the 2nd year. The adenosine triphosphate-induced reconduction rate was evaluated depending on the pulmonary vein involved. The impact of adenosine test implementation in the success of the ablation at 365 days (recurrence of AF or supraventricular tachycardia) was determined by analysis of overall survival using Kaplan-Meier method. Results: Adenosine test was performed on 151 patients, with reconduction detected on at least one of the pulmonary veins in 11 patients (33.8%) and in 17.6% of the 641 pulmonary veins evaluated, with no statistically significant difference between the different veins. The overall success rate of AF ablation at 365 days was 72% and did not differ significantly between adenosine-guided PVI versus conventional PVI (74.3% versus 70.8%, P = NS), although the duration of follow-up had been shorter in the first group (median of 13.0 vs. 38.3 months; p<0.001). Conclusion: The adenosine-induced reconduction occurs in about one third of the patients. However, the additional adenosine-guided energy applications do not seem to increase the overall success of ablation. We found no significant reduction in the 1 year incidence of recurrent atrial tachyarrhythmias by ATP-guided PVI compared with conventional PVI.info:eu-repo/semantics/publishedVersio