Surgical treatment for thrombus straddling a patent foramen ovale

We present a case of a 41-year-old female with deep vein thrombosis after abdominal surgery. The patient quickly developed severe pulmonary embolism and stroke representative of paradoxical embolism. Echocardiography showed a thrombus straddling a patent foramen ovale, which was confirmed intraoperatively. An accurate diagnosis and rapid treatment decisions are crucial for preventing patient deterioration in the form of new pulmonary embolisms or stroke31540640

Efeito da Terapia de Ressincronizaçao Cardíaca na Miocardiopatia Dilatada de Origem Isquêmica: uma Alternativa Incomum para Implante do Eletrodo no Seio Coronariano

O uso de marcapasso biventricular na ressincronizaçao cardíaca tornou-se conduta de rotina no tratamento de pacientes com cardiomiopatia dilatada, embora nao seja indicaçao tradicional como indicaçao em todos pacientes portadores de bradiarritmias. Costumeiramente, utiliza-se um eletrodo na ponta de ventrículo direito e outro na parede lateral do ventrículo esquerdo, o que melhora significativamente a funçao ventricular, a capacidade para o exercício, a classe funcional e a qualidade de vida. Na literatura, verifica-se que nao há consenso acerca das melhores posiçoes para os eletrodos, já que em algumas situaçoes a anatomia da circulaçao venosa coronária torna seu implante problemático. Apresenta-se neste caso uma alternativa de implante na veia coronária anterior esquerda, com resultados equivalentes aos padroes normais

Efeito da Terapia de Ressincronizaçao Cardíaca na Miocardiopatia Dilatada de Origem Isquêmica: uma Alternativa Incomum para Implante do Eletrodo no Seio Coronariano

O uso de marcapasso biventricular na ressincronizaçao cardíaca tornou-se conduta de rotina no tratamento de pacientes com cardiomiopatia dilatada, embora nao seja indicaçao tradicional como indicaçao em todos pacientes portadores de bradiarritmias. Costumeiramente, utiliza-se um eletrodo na ponta de ventrículo direito e outro na parede lateral do ventrículo esquerdo, o que melhora significativamente a funçao ventricular, a capacidade para o exercício, a classe funcional e a qualidade de vida. Na literatura, verifica-se que nao há consenso acerca das melhores posiçoes para os eletrodos, já que em algumas situaçoes a anatomia da circulaçao venosa coronária torna seu implante problemático. Apresenta-se neste caso uma alternativa de implante na veia coronária anterior esquerda, com resultados equivalentes aos padroes normais

Implante de Cardioversor-Desfibrilador de Dupla-Câmara Utilizando Cabo-Eletrodo Unico

O modo VDD com eletrodo único para a estimulaçao cardíaca artificial em pacientes com BAVT e resposta cronotrópica do nó sinusal tem sido utilizado em casos selecionados. Este relato de caso apresenta o uso de um eletrodo similar que inova ao incorporar uma mola de choque para a desfibrilaçao ventricular no mesmo cabo-eletrodo. Um cardioversor-desfibrilador-implantável (CDI) especialmente projetado, com canal de sensibilidade otimizado, permite a captaçao da onda P com segurança na obtençao do sincronismo atrioventricular. Adicionalmente, o sistema permite aumentar a especificidade dos algoritmos de discriminaçao de taquicardias supraventriculares de modo similar aos obtidos nos CDIs de dupla-câmara com dois eletrodos

Implante de Cardioversor-Desfibrilador de Dupla-Câmara Utilizando Cabo-Eletrodo Unico

O modo VDD com eletrodo único para a estimulaçao cardíaca artificial em pacientes com BAVT e resposta cronotrópica do nó sinusal tem sido utilizado em casos selecionados. Este relato de caso apresenta o uso de um eletrodo similar que inova ao incorporar uma mola de choque para a desfibrilaçao ventricular no mesmo cabo-eletrodo. Um cardioversor-desfibrilador-implantável (CDI) especialmente projetado, com canal de sensibilidade otimizado, permite a captaçao da onda P com segurança na obtençao do sincronismo atrioventricular. Adicionalmente, o sistema permite aumentar a especificidade dos algoritmos de discriminaçao de taquicardias supraventriculares de modo similar aos obtidos nos CDIs de dupla-câmara com dois eletrodos

Trained immunity induction by the inactivated mucosal vaccine MV130 protects against experimental viral respiratory infections.

MV130 is an inactivated polybacterial mucosal vaccine that confers protection to patients against recurrent respiratory infections, including those of viral etiology. However, its mechanism of action remains poorly understood. Here, we find that intranasal prophylaxis with MV130 modulates the lung immune landscape and provides long-term heterologous protection against viral respiratory infections in mice. Intranasal administration of MV130 provides protection against systemic candidiasis in wild-type and Rag1-deficient mice lacking functional lymphocytes, indicative of innate immune-mediated protection. Moreover, pharmacological inhibition of trained immunity with metformin abrogates the protection conferred by MV130 against influenza A virus respiratory infection. MV130 induces reprogramming of both mouse bone marrow progenitor cells and in vitro human monocytes, promoting an enhanced cytokine production that relies on a metabolic shift. Our results unveil that the mucosal administration of a fully inactivated bacterial vaccine provides protection against viral infections by a mechanism associated with the induction of trained immunity.We are grateful to members of the D.S. laboratory for discussions and critical reading of the manuscript. We thank the CNIC facilities and personnel for assistance. P.B. is funded by grant BES-2014-069933 (‘‘Ayudas para Contratos Predoctorales para la Formacio´ n de Doctores 2014’’) from the Spanish Ministry of Economy, Industry and Competitiveness (MINECO). L.C. was a recipient of a European Respiratory Society Fellowship (RESPIRE2-2013- 3708). G.D. is supported by a European Molecular Biology Organization Long-term Fellowship (ALTF 379-2019). This project has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Sk1odowska-Curie grant agreement No. 892965. Work in the D.S. laboratory is funded by the CNIC; by the European Research Council (ERC-2016-consolidator grant 725091); by the European Commission (635122-PROCROP H2020); by Ministerio de Ciencia e Innovacio´ n (MICINN), Agencia Estatal de Investigacio´ n (AEI), and Fondo Europeo de Desarrollo Regional (FEDER) (SAF2016-79040-R); by AEI (PID2019-108157RB); by Comunidad de Madrid (B2017/BMD-3733 Immunothercan-CM); by FIS-Instituto de Salud Carlos III, MICINN and FEDER (RD16/0015/0018-REEM); by a collaboration agreement with Inmunotek; by Atresmedia (Constantes y Vitales prize); by Fundacio´ La Marato´ de TV3 (201723); and by Fondo Solidario Juntos (Banco Santander). The CNIC is supported by the Instituto de Salud Carlos III, the MICINN, and the Pro CNIC Foundation.S

Comportamento de Paciente Chagásico após Implante de Cadioversor-Desfibrilador

Esta apresentaçao de caso é de um paciente chagásico com taquicardia/fibrilaçao ventricular encaminhado para implante de cardioversor-desfibrilador cardíaco. Sua evoluçao mostra episódios desta mesma arritmia que foi revertida com sucesso após terapia co

Comportamento de Paciente Chagásico após Implante de Cadioversor-Desfibrilador

Esta apresentaçao de caso é de um paciente chagásico com taquicardia/fibrilaçao ventricular encaminhado para implante de cardioversor-desfibrilador cardíaco. Sua evoluçao mostra episódios desta mesma arritmia que foi revertida com sucesso após terapia co

Long-Term Treatment and Effect of Discontinuation of Calcifediol in Postmenopausal Women with Vitamin D Deficiency: A Randomized Trial

Vitamin D plays a major role in bone health and probably also in multiple extraskeletal acute and chronic diseases. Although supplementation with calcifediol, a vitamin D metabolite, has demonstrated efficacy and safety in short-term clinical trials, its effects after long-term monthly administration have been studied less extensively. This report describes the results of a 1-year, phase III-IV, double-blind, randomized, controlled, parallel, multicenter superiority clinical trial to assess the efficacy and safety of monthly calcifediol 0.266 mg versus cholecalciferol 25,000 IU (0.625 mg) in postmenopausal women with vitamin D deficiency (25(OH)D < 20 ng/mL). A total of 303 women were randomized and 298 evaluated. Patients were randomized 1:1:1 to calcifediol 0.266 mg/month for 12 months (Group A1), calcifediol 0.266 mg/month for 4 months followed by placebo for 8 months (Group A2), and cholecalciferol 25,000 IU/month (0.625 mg/month) for 12 months (Group B). By month 4, stable 25(OH)D levels were documented with both calcifediol and cholecalciferol (intention-to-treat population): 26.8 ± 8.5 ng/mL (Group A1) and 23.1 ± 5.4 ng/mL (Group B). By month 12, 25(OH)D levels were 23.9 ± 8.0 ng/mL (Group A1) and 22.4 ± 5.5 ng/mL (Group B). When calcifediol treatment was withdrawn in Group A2, 25(OH)D levels decreased to baseline levels (28.5 ± 8.7 ng/mL at month 4 versus 14.4 ± 6.0 ng/mL at month 12). No relevant treatment-related safety issues were reported in any of the groups. The results confirm that long-term treatment with monthly calcifediol in vitamin D-deficient patients is effective and safe. The withdrawal of treatment leads to a pronounced decrease of 25(OH)D levels. Calcifediol presented a faster onset of action compared to monthly cholecalciferol. Long-term treatment produces stable and sustained 25(OH)D concentrations with no associated safety concerns.This study was funded by Faes Farma, S.A. and Bruno Farmaceutici S.p.A. The authors wish to thank the study participants, research staff, the secondary investigators of the Osteoferol study group, the home nursing staff (Emibet), and Faes Farma clinical research team: Paula Arranz Gutiérrez, Lorena Elgezabal González, Mariana Frau Usoz, and Iñigo Saez Riesco. Medical writing support was provided by Francisco López de Saro (Trialance SCCL), funded by Faes Farma, S.A

Calcifediol is superior to cholecalciferol in improving vitamin D status in postmenopausal women: a randomized trial

Vitamin D has shown to play a role in multiple diseases due to its skeletal and extraskeletal actions. Furthermore, vitamin D deficiency has become a worldwide health issue. Few supplementation guidelines mention calcifediol treatment, despite being the direct precursor of calcitriol and the biomarker of vitamin D status. This 1-year, phase III-IV, double-blind, randomized, controlled, multicenter clinical trial assessed the efficacy and safety of calcifediol 0.266 mg soft capsules in vitamin D-deficient postmenopausal women, compared to cholecalciferol. Results reported here are from a prespecified interim analysis, for the evaluation of the study's primary endpoint: the percentage of patients with serum 25-hydroxyvitamin D (25(OH)D) levels above 30 ng/ml after 4 months. A total of 303 patients were enrolled, of whom 298 were included in the intention-to-treat (ITT) population. Patients with baseline levels of serum 25(OH)D <20 ng/ml were randomized 1:1:1 to calcifediol 0.266 mg/month for 12 months, calcifediol 0.266 mg/month for 4 months followed by placebo for 8 months, and cholecalciferol 25,000 IU/month for 12 months. At month 4, 35.0% of postmenopausal women treated with calcifediol and 8.2% of those treated with cholecalciferol reached serum 25(OH)D levels above 30 ng/ml (p < 0.0001). The most remarkable difference between both drugs in terms of mean change in serum 25(OH)D levels was observed after the first month of treatment (mean ± standard deviation change = 9.7 ± 6.7 and 5.1 ± 3.5 ng/ml in patients treated with calcifediol and cholecalciferol, respectively). No relevant treatment-related safety issues were reported in any of the groups studied. These results thus confirm that calcifediol is effective, faster, and more potent than cholecalciferol in raising serum 25(OH)D levels and is a valuable option for the treatment of vitamin D deficiency