Omalizumab induced Takotsubo syndrome : case report

© The Author(s) 2019.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]: Omalizumab is a humanized monoclonal anti-immunoglobulin E antibody, approved for the treatment of spontaneous chronic urticaria, with high efficacy and an excellent safety profile. Although its adverse effects are rare, allergic reactions and cardiovascular events were previously described. Case summary: The authors describe the case of a 75-year-old woman, followed at the outpatient dermatology clinic due to spontaneous chronic urticaria, treated with omalizumab 300 mg every 4 weeks. After the 11th administration of omalizumab, the patient developed an episode of thoracalgia associated with electro- and echocardiographic abnormalities. Coronary angiogram excluded coronary artery disease, and left ventriculography demonstrated mid-apical akinesia and basal hyperkinesia, consistent with the Takotsubo syndrome (TS). Discussion: Takotsubo syndrome was already reported in association with other monoclonal antibodies. However, to our knowledge, this is the first case of TS following the administration of omalizumab.info:eu-repo/semantics/publishedVersio

Atypical form of acute myocardial infarction with tamponade

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2019.Background: Nowadays it is well recognized that the absence of obstructive coronary artery disease in a patient presenting with symptoms suggestive of ischemia and ST-segment alterations does not preclude an atherothrombotic etiology. CMR is an essential method for the investigation of Myocardial infarction (MI) with non obstructive coronary artery disease (MINOCA). Clinical Case: A 66 years-old female patient was referred after an episode of acute oppressive chest pain, nausea and hypersudorese, followed by syncope. She had a previous medical history of rheumatoid arthritis, under immunosuppression, occlusion of the cilioretinal artery, hypertension and dyslipidemia. On admission she was hypotensive (80/60mmHg). The ECG showed sinus rhythm and mild ST depression in V2-V3 leads, and the echocardiogram a small circumferential pericardial effusion (10mm) with signs of hemodynamic compromise. The blood tests documented a slight leukocytosis and an elevated troponin (hs-TnT 619ng/L).info:eu-repo/semantics/publishedVersio

Rapidly progressive coronary aneurysm: a rare case of isolated coronary vasculitis with recurrent myocardial infarction

© 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This article is available under the Creative Commons CC-BY-NC-ND license and permits non-commercial use of the work as published, without adaptation or alteration provided the work is fully attributed.Isolated coronary arteritis without systemic involvement in adults is exceedingly rare. A 60-year-old patient developed recurrent non–ST-segment elevation myocardial infarctions for 1 year. After an initial coronary angiogram that was normal, serial angiograms showed de novo aneurysm formation. The patient responded favorably to corticosteroids, supporting the diagnosis of isolated coronary arteritis.info:eu-repo/semantics/publishedVersio

An unusual cause of myocardial infarction

Copyright © 2019 European Society of CardiologyBackground: In order to direct the treatment it, is well established that is fundamental to clarify the aetiology of heart failure and the cause of myocardial infarction (MI) with non obstructive coronary artery disease (MINOCA), with CMR being one of the methods of choice in both clinical situations. Case report: A 70 years-old male patient was admitted in our emergency department with complaints of irregular palpitations, progressive dyspnoea and fatigue on exertion, with two weeks of evolution; these symptoms were associated to retrosternal chest pain in the last twelve hours. He had a previous medical history of dyslipidemia, no other cardiovascular risk factors were known. On admission, his heart rate was 130bpm, with an irregularly irregular pulse and the pulmonary auscultation revealed bibasal crackles. The remaining physical examination was unremarkable. The ECG showed an atrial fibrillation rhythm, with a mild ST elevation and T wave inversion in inferior leads. The echocardiogram revealed a diffuse hypokinesia of left ventricle with an ejection fraction of 35-40%. The lab tests documented an elevation of troponin (hs-TnT 210ng/L) and NTproBNP (1945pg/ml). The coronary angiogram showed no lesions.info:eu-repo/semantics/publishedVersio

Left ventricular systolic dysfunction in Marfan syndrome is related to aortic distensibility

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2019.Background: The cardiovascular involvement in Marfan syndrome (MS) is characterized mainly by dilatation and reduced distensibility of the ascending aorta. Left ventricular (LV) dysfunction has been detected in MS and a primary cardiomyopathy has been suggested but the pathophysiology is unclear. The purpose of this study was to evaluate the LV function in patients with MS and to assess the relationship with the aortic distensibility, as possible underlying mechanism. Methods: We studied 53 patients with MS (27.0 ± 11 years, 29 men) without valvular or hypertensive heart disease and a control group of 26 healthy subjects (29 ± 9 years, 17 men). All underwent echocardiography and cardiac magnetic resonance (CMR) and the following indexes were analyzed: a) Echo: mitral flow velocities E/A ratio and deceleration of mitral E; E’ velocity obtained from the medial and lateral mitral ring; E/E’ ratio b) CMR: LV volumes indexed to BSA and ejection fraction (EF); global longitudinal strain (GLS, Circle cvI42); maximal size and distensibility of proximal ascending aorta. Distensibility was calculated from maximal (systolic) and minimum (diastolic) area of maximal proximal ascending aorta (cross-sectional images from SSFP sequence) using the formula=(maximum area-minimum area)/[ minimum area x (systolic BP-diastolic BP)]. Results: 17 from 53 patients with MS had increased LV end-diastolic volume, 14 decreased EF (<50%) and 22 decreased GLS. Compared with the control group, patients with MS showed increased LV end-diastolic volume (85.0 ± 5.2vs 80.1 ± 5.3ml/m2, p = 0.04), lower GLS (17.1 ± 1.9 vs 18.9 ± 2.2, p = 0.01) lower LVEF (53.0 ± 7.1% vs 56.0 ± 5.4%, p = 0.03) and higher E/E’ value (9.2 ± 1.3 vs. 6.2 ± 0.8, p = 0.01) as well as larger dimensions of proximal aorta (39 ± 2.2cm vs 32 ± 0.8,p = 0.010) and lower aortic distensibility (3.4 ± 1.9 vs. 4.4 ± 1.7 dynes cm-1, p = 0.03). In the group of patients, a correlation was found between the aortic distensibility and the LVEF (r = 0.47, p = 0.045) and GLS (r = 0.65, p = 0.02), but not with the other variables. Aortic distensibility was an independent predictor of LV dysfunction using a cutoff of 50% for LVEF and 19% for GLS. Conclusion: In our population of patients with MS, we found changes in the LV function, which were related with aortic distensibility, possibly sharing a common pathway. The prognostic significance of these findings is under evaluation.info:eu-repo/semantics/publishedVersio

Control of Milk Allergenicity

UID/SEM/04077/2013. P0C1-01-0145- FEDER-007728.Food allergies are classified among the largest problems of human health by World Health Organization (WHO), with 2-10% of the world's population (children and adults) being confronted with it. Milk protein allergy is one of the most common types of allergies. But milk and dairy products are widely consumed and represent not only an inexpensive and easily accessible source of protein, calcium and vitamin D, but also an important share in the world food industry economy. Here, it is presented an overview of the different approaches, tested and developed to help the dairy industry in controlling the allergenicity of these products. Special emphasis is given to protein cross linking by transglutaminase, a recent technique that has attracted increasing attention in the scientific and industrial community. In fact, it does not involve the use of chemicals, it is easy to control and it is not necessary to remove the allergenic protein after the treatment, leading to a final non-allergenic product with equivalent protein content to the original product.publishe

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

Right ventricular lead in cardiac resynchronization therapy : what is the most electrically favorable stimulation site?

© The European Society of Cardiology 2018. All rights reserved.Introduction: The most recent studies in cardiac resynchronization therapy (CRT) have been focused on attempts to improve response rate, such as the determination of the optimal placement of the left ventricular (LV) lead. The position of the LV lead guided by the site of latest electrical delay (ED), seems to be a promising strategy. The same strategy may be useful in assessing the ideal positioning of right ventricular (RV) lead in CRT. Purpose: To determine the most favorable position of the RV lead (septal versus apical) in CRT, by measuring the ED of the LV poles during septal or apical RV pacing in patients with triple-site CRT (TRIV). Methods: A single-center prospective study of consecutive patients (Oct. 2014 to Oct. 2017) submited to CRT device implantation (Quadra Allure MPTM, which allows post-implantation ED measurement) in TRIV mode - with a quadripolar lead in the LV, a RV lead positioned at the septum and a RV lead at the apex. In the follow-up, the lead position was confirmed and determined by fluoroscopic evaluation (anterior, lateral and postero-lateral in the short axis and basal, mid and apical on the long axis). The ED was measured at the 4-pole LV lead, during apical and septal RV pacing and the relation between the ED and lead position was evaluated. Results: Twenty two patients were included: 82% male, median age 78 years; 50% implanted CRT with defibrillator; 27% had ischemic heart disease and 73% non-ischemic etiology; all patients had permanent atrial fibrillation and the QRS duration was of 176±29ms. The position of the LE lead poles was classified as lateral in 44% and postero-lateral in 56%, basal in 28%, medial in 39% and apical in 34%. We evaluated 160 ED. The mean ED between the apical RV lead and the LV poles was significantly higher than the delay between septal RV lead and the LV poles [161±33ms vs 75±45ms (p<0.001)]. This difference remained significant in LV poles located in a lateral position (76±62 vs. 166±36ms; p<0.001) or in a postero-lateral position (74±30 vs. 157±31ms; p<0.001); the same ocurred for LV poles in a basal (99±62 vs. 179±24ms, p<0.001), mid (72±38 vs. 167±31ms, p<0.001) and apical location (57±24 vs. 140±32ms, p<0.001). Conclusion: The LV lead position is an important determinant of the success of CRT, but is conditioned by anatomical and technical characteristics. The optimization of CRT may then depend on the positioning of RV lead. This study demonstrated that the apical (vs. septal) RV lead positioning presents higher ED in relation to LV lead, regardless of the latter position.info:eu-repo/semantics/publishedVersio

Chemical characterization and bioactivity of phytochemicals from Iberian endemic Santolina semidentata and strategies for ex situ propagation

Asteraceae family members are well-known for their medicinal potential, comprising several properties that make them unique among plants. Here we focus on Santolina semidentata, an endemic plant from the Iberian Peninsula, not yet described for its medicinal properties. Phytochemical characterization of S. semidentata was performed, concerning total phenol content, flavonoid content, antioxidant capacity, HPLC-DAD profile, acetylcholinesterase inhibitory capacity, cytotoxicity and neuroprotective effect in a human neurodegeneration cell model. Moreover, essential oil composition and antifungal activity were also analised. This oil might be useful for therapeutical purposes, particularly in the treatment of dermatophytosis. S. semidentata potential for neuroprotection was revealed by acetylcholinesterase inhibitory capacity and also by an effective protective effect in human neuronal cells. Furthermore, different seed conservation protocols, as well as successful in vitro propagation were established which may be useful when integrated in a broad strategy for the conservation of these endemic plants and their sustainable use for potential biotechnological applications. The results presented here greatly contribute to value this species regarding its potential as a source of phytochemicals with prospective neuroprotective health benefits, either as alternative neuroprotective drugs or as leads for synthetizing more effective molecules.The authors wish to thank to “Fundo EDP para a Biodiversidade” for financial support. This work was also supported by “Fundação para a Ciência e a Tecnologia” through grant PEst-OE/EQB/LA0004/2011, BGCT/33418/2008, Green-it: UID/Multi/04551/2013, iNOVA4Health: UID/Multi/04462/2013 and financial support to CNS (IF/01097/20132), RP (SFRH/BD/63615/2009), IF (SFRH/BD/86584/2012) and AG (SFRH/BD/103155/2014).info:eu-repo/semantics/publishedVersio