Miocardiopatia de Takotsubo: importante diagnóstico diferencial de dor torácica na emergência

A miocardiopatia de Takotsubo é uma forma de insuficiência cardíaca aguda, geralmente reversível e desencadeada por um estresse físico ou gatilho emocional, cuja apresentação clínica é bastante similar às síndromes coronarianas agudas, porém sem a obstrução vascular característica da doença coronariana. Relatamos o caso de uma mulher de 53 anos que chegou à emergência cardiológica com dor retroesternal tipicamente coronariana, alterações dinâmicas no eletrocardiograma e aumento dos marcadores de necrose miocárdica. Cateterismo cardíaco mostrou coronárias isentas de ateromatose significativa, embora houvesse pequeno grau de aterosclerose, e achados sugestivos de miocardiopatia de Takotsubo do tipo apical. Foi realizado tratamento de suporte com drogas anti-hipertensivas, visando diminuir trabalho e remodelamento cardíacos. Os marcadores de necrose miocárdica acompanhados durante o internamento mostraram curva descendente. Paciente evoluiu com melhora clínica, recebendo alta hospitalar no 7º dia após internamento, em uso de inibidor da enzima conversora de angiotensina, beta bloqueador de 3ª geração, estatina e antiagregante plaquetário.Takotsubo cardiomyopathy is a form of acute, usually reversible, heart failure triggered by physical or emotional stress. The clinical presentation is very similar to that of acute coronary syndromes, but without the characteristic vascular obstruction of coronary disease. Here we report a case of a 53-year-old woman who presented at the cardiac emergency room with typical coronary chest pain, dynamic electrocardiogram changes, and increased markers of myocardial necrosis. Cardiac catheterization showed coronary arteries without significant atheromatosis, despite a slight degree of atherosclerosis, and findings suggestive of Takotsubo cardiomyopathy of the apical type. Supportive treatment with antihypertensive drugs was performed, aiming to reduce cardiac workload and remodeling. Markers of myocardial necrosis monitored during hospitalization showed a downward curve. The patient had clinical improvement, being discharged on the 7th day after hospitalization, using angiotensin-converting enzyme inhibitor, third-generation beta-blocker, statin and platelet antiaggregants

DESEMPENHO DAS HABILIDADES LOCOMOTORAS DE CRIANÇAS DE 8 A 10 ANOS DE UMA CIDADE DO INTERIOR DO CEARÁ

Desempenho motor refere-se à execução e/ou desenvolvimento das habilidades motoras fundamentais (HMFs), sendo elemento de variados estudos na busca de sua compreensão, por estarem intimamente ligadas ao desenvolvimento integral da criança, pois essas habilidades manifestam-se através da motricidade dos indivíduos

Impactos negativos da administração de hidroxicloroquina e anticoagulante em pacientes com infecção por SARS-COV-2: um ensaio clínico randomizado

Objetivo: Avaliar antimalárico com ou sem tratamento anticoagulante, em pacientes com infecção recente por SARS-COV-2. Métodos: Estudo clínico realizado no Hospital das Clínicas Samuel Libânio da Universidade do Vale do Sapucaí, Pouso Alegre-MG. Aprovado pelo Comitê de Ética (4.034.077) e registrado nos Ensaios Clínicos (NCT04788355). Pacientes suspeitos de COVID-19 foram incluídos na sala de emergência. Os grupos foram: C (controle) com 6 pacientes, A (anticoagulante apixabana) com 9 pacientes, H (hidroxicloroquina) com 5 pacientes e HA (hidroxicloroquina e anticoagulante apixabana) com 8 pacientes. Resultados: não houve diferenças significativas entre os grupos. O grupo HA, no qual houve intervenção com dois medicamentos, apresentou maior número de dias com sintomas (p = 0,037) e piores resultados, quando comparado ao controle: os sintomas mais relevantes foram: tosse (p = 0,001), e anosmia/ageusia (p = 0,011) cefaléia (p = 0,001). Conclusão: O presente estudo teve início quando havia dúvidas sobre o uso de medicamentos como hidroxicloroquina (HCQ) e apixabana (APX). O “n” reduzido foi definido por meio de questões burocráticas e polêmicas independentes das ações dos autores. Nenhum benefício clínico foi associado com HCQ e APX. Houve um aumento no número de dias sintomáticos quando HCQ e APX foram administrados. Apesar das limitações, não houve indicação terapêutica dos medicamentos avaliados.Purpose: To evaluate antimalarial with or without anticoagulant treatment, in patients with recent SARS-COV-2 infection. Methods: Clinical study carried out at Samuel Libânio Clinic Hospital, University of Vale do Sapucaí, Pouso Alegre-MG. Approved by the Ethics Committee (4.034.077) and registered in the Clinical Trials (NCT04788355). Suspected patients for COVID-19 were included in the emergency room. The groups were: C (control) with 6 patients, A (anticoagulant apixaban) with 9 patients, H (hydroxychloroquine) with 5 patients and HA (hydroxychloroquine and anticoagulant apixaban) with 8 patients. Results: there were no significant differences between groups. The HA group, in which there was an intervention with two drugs, presented a greater number of days with symptoms (p = 0.037) and worse results, when compared to the control: most relevant symptoms, were: cough (p = 0.001), and anosmia / ageusia (p = 0.011) headache (p = 0.001). Conclusion: The present study began when there were doubts about the use of drugs such as Hydroxychloroquine (HCQ) and apixaban (APX). The reduced “n” was defined through bureaucratic and polemic issues independent of the authors’ actions. No clinical benefit was associated with HCQ and APX. There was an increase in the number of symptomatic days when HCQ and APX were administered. Despite the limitations, there was no therapeutic indication of the evaluated drugs

OBESIDADE INFANTIL E ADOLESCENTE E SAÚDE MENTAL: IMPACTOS E FATORES PSICOSSOCIAIS

This article reviews the impacts of childhood and adolescent obesity on mental health and the associated psychosocial factors. Obesity in young individuals is strongly linked to mental health issues such as depression, anxiety, and low self-esteem. Stigmatization and weight-related bullying are critical factors that exacerbate these problems. The family environment, including parents’ mental health and parenting practices, plays a crucial role in shaping children’s and adolescents’ eating and physical activity habits, directly influencing the risk of obesity and psychological issues. Schools can be either supportive or stressful environments, depending on the presence of inclusion programs and health promotion versus bullying and discrimination. Additionally, social and economic factors, such as access to healthy food and opportunities for physical activity, are also important determinants. The review highlights the need for multidisciplinary approaches that integrate physical and mental health promotion, emphasizing collaboration among healthcare professionals, educators, and families to develop effective and sustainable long-term interventions.Este artigo revisa os impactos da obesidade infantil e adolescente na saúde mental e os fatores psicossociais associados. A obesidade em jovens está fortemente ligada a problemas de saúde mental, como depressão, ansiedade e baixa autoestima. A estigmatização e o bullying relacionados ao peso são fatores críticos que agravam esses problemas. O ambiente familiar, incluindo a saúde mental dos pais e as práticas parentais, desempenha um papel crucial na formação dos hábitos alimentares e de atividade física das crianças e adolescentes, influenciando diretamente o risco de obesidade e problemas psicológicos. As escolas, por sua vez, podem ser locais de apoio ou de estresse, dependendo da presença de programas de inclusão e promoção da saúde versus bullying e discriminação. Além disso, fatores sociais e econômicos, como acesso a alimentos saudáveis e oportunidades de atividade física, também são determinantes importantes. A revisão destaca a necessidade de abordagens multidisciplinares que integrem a promoção da saúde física e mental, enfatizando a colaboração entre profissionais de saúde, educadores e famílias para desenvolver intervenções eficazes e sustentáveis a longo prazo

DESAFIOS DA PARADA CARDIORRESPIRATÓRIA EM AMBIENTES PRÉ-HOSPITALARES: UMA REVISÃO BIBLIOGRÁFICA

Cardiopulmonary arrest (CPA) is a medical emergency characterized by the sudden cessation of cardiac and respiratory functions, requiring immediate interventions to increase survival chances. In pre-hospital settings, the challenges are heightened by the need for a rapid response, resource limitations, and variations in responders’ skills. This study reviews the literature on the challenges of CPA in pre-hospital environments and strategies to improve clinical outcomes. The efficiency of pre-hospital interventions in CPA depends on the speed and accuracy of the response. Early performance of cardiopulmonary resuscitation (CPR) and the use of automated external defibrillators (AED) are crucial. However, factors such as delays in arrival at the scene and lack of adequate training of responders impact patient prognosis. Airway management and ventilation during CPA also represent challenges, requiring advanced skills and appropriate equipment. Pre-hospital intubation, although common, is complex and should be performed by trained professionals to avoid complications. This literature review identifies the main barriers and facilitators in performing CPA in pre-hospital settings, providing a comprehensive view of current practices and areas for improvement.A parada cardiorrespiratória (PCR) é uma emergência médica caracterizada pela interrupção súbita das funções cardíacas e respiratórias, exigindo intervenções imediatas para aumentar as chances de sobrevivência. Em ambientes pré-hospitalares, os desafios são intensificados pela necessidade de uma resposta rápida, limitações de recursos e variações nas habilidades dos socorristas. Este estudo revisa a literatura sobre os desafios da PCR em ambientes pré-hospitalares e as estratégias para melhorar os resultados clínicos. A eficiência das intervenções pré-hospitalares na PCR depende da rapidez e precisão do atendimento. A realização precoce de ressuscitação cardiopulmonar (RCP) e o uso de desfibriladores automáticos externos (DEA) são cruciais. No entanto, fatores como atrasos na chegada ao local e falta de treinamento adequado dos socorristas impactam o prognóstico dos pacientes. A gestão das vias aéreas e ventilação durante a PCR também representa desafios, exigindo habilidades avançadas e equipamentos adequados. A intubação pré-hospitalar, embora comum, é complexa e deve ser realizada por profissionais capacitados para evitar complicações. Esta revisão literária identifica as principais barreiras e facilitadores na realização da PCR em ambientes pré-hospitalares, oferecendo uma visão abrangente das práticas atuais e áreas de melhoria

MANEJO DO AVC HEMORRÁGICO: OPÇÕES DE TRATAMENTO E CUIDADOS

This article reviews the literature on the management of hemorrhagic stroke, addressing treatment options and care. It emphasizes the importance of patient stabilization and blood pressure control to prevent hematoma expansion. Surgical interventions, such as hematoma evacuation, are discussed with a focus on minimally invasive techniques. The use of anticoagulant reversal agents is crucial in certain cases. Early rehabilitation, including physical and occupational therapies, is essential for recovery. The high mortality and morbidity of hemorrhagic stroke highlight the need for ongoing research to improve therapeutic approaches.Este artigo revisa a literatura sobre o manejo do AVC hemorrágico, abordando opções de tratamento e cuidados. Inicialmente, destaca a importância da estabilização do paciente e controle da pressão arterial para evitar a expansão do hematoma. As intervenções cirúrgicas, como a evacuação do hematoma, são discutidas, com ênfase em técnicas minimamente invasivas. O uso de agentes reversores de anticoagulantes é essencial em certos casos. A reabilitação precoce, incluindo terapias física e ocupacional, é fundamental para a recuperação. A mortalidade e morbidade elevadas do AVC hemorrágico indicam a necessidade de pesquisas contínuas para melhorar as abordagens terapêuticas

Ventricular Septal Rupture after Acute Coronary Syndrome

Objective: Ventricular septal rupture (VSR) is a rare but serious complication of acute myocardial infarction, which occurs in about 0.2 to 0.3% of patients with myocardial ischemia. If early therapy is not initiated, 90% of patients with VSR will die within the first month. This study aimed to evaluate the epidemiological and clinical characteristics of patients with VSR as a mechanical complication of acute myocardial infarction. Methods: A prospective study was conducted among nine patients who presented to the Cardiovascular Emergency Room of Pernambuco with acute coronary syndrome with ST segment elevation and VSR complications. Results: There were five women and 4 men, and the mean age of the patients was 72.5 years. The median time from the onset of the symptoms of acute coronary syndrome with ST segment elevation to the diagnosis of VSR was 3.5 days. Among the nine patients included in the study, three were treated surgically. Of all the patients, including those who underwent corrective surgery, eight patients died, 44.4% (N = 4), in the first four days after AMI. Conclusion: VSR occurs more frequently among elderly patients with multi-arterial involvement, lower wall infarction, and involvement of the right coronary artery. The prognosis is extremely limited, especially in patients who are already admitted to the cardiac emergency room with Killip IV, with > 24 hours of clinical evolution, and do not require surgical correction.Facultad de Ciencias Médica

Giants of the Amazon: how does environmental variation drive the diversity patterns of large trees?

For more than three decades, major efforts in sampling and analyzing tree diversity in South America have focused almost exclusively on trees with stems of at least 10 and 2.5 cm diameter, showing highest species diversity in the wetter western and northern Amazon forests. By contrast, little attention has been paid to patterns and drivers of diversity in the largest canopy and emergent trees, which is surprising given these have dominant ecological functions. Here, we use a machine learning approach to quantify the importance of environmental factors and apply it to generate spatial predictions of the species diversity of all trees (dbh ≥ 10 cm) and for very large trees (dbh ≥ 70 cm) using data from 243 forest plots (108,450 trees and 2832 species) distributed across different forest types and biogeographic regions of the Brazilian Amazon. The diversity of large trees and of all trees was significantly associated with three environmental factors, but in contrasting ways across regions and forest types. Environmental variables associated with disturbances, for example, the lightning flash rate and wind speed, as well as the fraction of photosynthetically active radiation, tend to govern the diversity of large trees. Upland rainforests in the Guiana Shield and Roraima regions had a high diversity of large trees. By contrast, variables associated with resources tend to govern tree diversity in general. Places such as the province of Imeri and the northern portion of the province of Madeira stand out for their high diversity of species in general. Climatic and topographic stability and functional adaptation mechanisms promote ideal conditions for species diversity. Finally, we mapped general patterns of tree species diversity in the Brazilian Amazon, which differ substantially depending on size class