Cardiovascular complications related to cocaine use: case report

BACKGROUND AND OBJECTIVES: Cocaine is the most commonly used illicit drug and its acute and chronic effects are related to a variety of physiological changes, mainly in the cardiovascular system. This study is a case report of a patient with cardiomyopathy related to cocaine use. CASE REPORT: A 19 year old men, who has been using cocaine and crack since 15 years old, was admitted to the emergency department (ED) in February 2006 with progressive dyspnea during minimal efforts and bloody expectoration. During the physical exam it was observed legs edema, jugular stasis and dyspnea at rest. The echocardiogram demonstrated left ventricular hypocinesia, a 17 mm ventricular thrombus and a 12% ejection fraction. A bleeding from the left upper lobe was identified during a pulmonary bronchoscopy which was treated with arterial embolization. After 48h of the procedure, the patient was asymptomatic and an antithrombotic treatment with warfarin and enoxaparin was started. No obstruction was found at the cineangiography and the patient was discharged after clinical improvement. The patient was admitted again to the intensive care unit in July with intense chest pain and dyspnea at rest. A new cineangiography was performed and it was observed occlusion in the anterior descendent coronary artery. CONCLUSIONS: The cocaine acute effects are commonly seen at the ED but the chronic effects, as the cardiovascular manifestations, can take longer to be correlated as a side effect of cocaine use. Its prolonged use is related to left ventricular systolic dysfunction due to hypertrophy or myocardial dilation, atherosclerosis, arrhythmias, myocyte apoptosis and sympathetic damage.JUSTIFICATIVA E OBJETIVOS: A cocaína é uma droga ilícita amplamente utilizada e o seu uso tem sido associado a efeitos decorrentes da toxicidade aguda e crônica em praticamente todos os órgãos, particularmente no sistema cardiovascular. Este artigo visou descrever um caso de cardiomiopatia em paciente jovem usuário crônico de cocaína. RELATO DO CASO: Paciente do sexo masculino, 19 anos, usuário de cocaína por inalação e crack desde os 15 anos de idade. Foi internado em fevereiro de 2006 devido a dispnéia progressiva aos mínimos esforços e expectoração sanguinolenta. Ao exame físico apresentava edema nos membros inferiores, estase jugular e dispnéia em repouso. Foram observados no ecocardiograma: dilatação das quatro câmaras cardíacas, com hipocinesia difusa de ventrículo esquerdo (VE), trombo mural em VE de 17 mm e fração de ejeção de 12%. Realizada broncoscopia pulmonar que identificou sangramento em língula ativo, tratado com embolização. Após 48h do procedimento, o paciente manteve-se assintomático e sem expectoração sanguinolenta. Iniciado tratamento antitrombótico com warfarina e enoxaparina. A cineangiocoronariografia não evidenciou lesões obstrutivas e o paciente recebeu alta após melhora clínica. Re-internado em julho de 2006 com dor precordial de forte intensidade e dispnéia de repouso. Nova cineangiocoronariografia evidenciou oclusão de terço médio da artéria descendente anterior. CONCLUSÕES: Os efeitos agudos da cocaína freqüentemente motivam atendimento de emergência. Já as suas manifestações crônicas, como as doenças cardiovasculares, podem produzir alterações de difícil correlação futura ao seu consumo prévio. O uso prolongado da cocaína está relacionado à alteração da função sistólica ventricular esquerda por hipertrofia ou dilatação miocárdica, aterosclerose, disritmias cardíacas, apoptose de cardiomiócitos e lesão simpática.UNIFESPUniversidade São FranciscoUNIFESPSciEL

Aspergillus Species and Antifungals Susceptibility in Clinical Setting in the North of Portugal: Cryptic Species and Emerging Azoles Resistance in A. fumigatus

Aspergillus spp. are agents of a broad-spectrum of diseases among humans. Their growing resistance to azoles, the cornerstone in the management of human aspergillosis, is a worrisome problem around the world. Considering lack of data from Portugal on this topic, particularly from the northern region, a retrospective surveillance study was planned to assess frequency of cryptic Aspergillus species and azoles resistance. A total of 227 clinical isolates, mainly from the respiratory tract (92.1%), collected from three hospitals serving a population of about three million people, were studied for their epidemiology and antifungal susceptibility patterns determined by the E.DEF.9.3 protocol of EUCAST. Employing molecular methods, seven Aspergillus complexes were identified; Aspergillus fumigatus sensu stricto was the most frequent isolate (86.7%). A 7.5% prevalence of cryptic species was found; A. welwitschiae (A. niger complex-3.1%) and A. lentulus (A. fumigatus complex-2.2%) were the most frequent. Amongst cryptic species, it was found a percentage of resistance to voriconazole, posaconazole and isavuconazole of 47.1, 82.4, and 100%, respectively. Five A. fumigatus sensu stricto showed pan-azole resistance. Sequencing their cyp51A gene revealed the presence of one isolate with TR46/Y121F/T289A mutation and two isolates with TR34/L98H mutation. This study emphasizes the need to identify strains to the species level and to evaluate their antifungal susceptibility in all human originated Aspergillus spp. isolates, particularly those from invasive aspergillosis.This work was supported by Grant IN-PT-131-1755 from Gilead Sciences.info:eu-repo/semantics/publishedVersio

Optimal control for an irrigation planning problem: characterisation of solution and validation of the numerical results

In a previous study, the authors developed the planning of the water used in the irrigation systems of a given farmland in order to ensure that the field cultivation is in a good state of preservation. This planning was modelled and tackled as an optimal control problem: minimize the water flow (control) so that the extent water amount in the soil (trajectory) fulfils the cultivation water requirements. In this paper, we characterize the solution of our problem guaranteeing the existence of the solution and applying the necessary and sufficient conditions of optimality. We validate the numerical results obtained previously, comparing the analytical and numerical solutions.PEst-OE/MAT/UI0013/2014 and PEST-C/FIS/UI607/2013, European Union FP7 (FP7-PEOPLE-2010-ITN, Grant Agreement no. 264735- SADCO), FCT projects PTDC/EEA-CRO/116014/2009 and PTDC/EEI-AUT/1450/201

Additional simulation training:does it affect students' knowledge acquisition and retention?

Introduction Teaching medical skills during clinical rotation is a complex challenge, which often does not allow students to practise their skills. Nowadays, the use of simulation training has increased to teach skills to medical students. However, transferring the learnt skills from one setting to the other is challenging. In this study, we investigated whether adding a simulation training before the clinical rotation would improve students’ acquisition and retention of knowledge.Methods Two subsequent cohorts were compared. Group A followed the traditional curriculum without additional simulation training. Group B attended an additional simulation training, in which history taking, physical examination and procedures for the primary survey in emergency situations were taught. Both groups answered the same knowledge test before entering their clinical rotation and after 6 months. To analyse students’ scores over time, we conducted a repeated measure analysis of variance. To investigate the difference between knowledge, we conducted a t-test.Results Group B scored significantly higher in both tests and all subscores, except in the Trauma topic in the first measurement point. Students in group A showed decay in knowledge whereas group B showed an increase in knowledge.Conclusions Adding a simulation training, before students entered their clinical rotation, improves students’ knowledge acquisition and retention compared with those who did not receive the additional simulation training

The barriers dentists face to communicate cancer diagnosis:self-assessment based on SPIKES protocol

This study aimed to characterize the barriers faced by Brazilian dentists to deliver bad news (DBN) about oral and oropharyngeal cancer diagnoses to patients by using a questionnaire based on the guidelines of the SPIKES protocol. This was an observational cross-sectional study. The questionnaire contained 27 questions based on the SPIKES protocol, which were answered in the SurveyMonkey platform. A total of 186/249 dentists answered the questionnaire. The main specialties reported were 36.02% oral medicine, 21.5% oral pathology, and 9.13% oral and maxillofacial surgery. A total of 44.6% expressed concern about the patient?s emotional reactions, and 46.24% of respondents had never participated in any specific training to communicate bad news. The lack of training and low confidence in dealing with patients? emotional reactions dentists were considered the greatest barriers to DBNs. Moreover, most dentists who participated in the survey believe that a protocol to guide the communication of bad news would be useful for clinical practice. For those protocols to be used by dentists, training is critical for these protocols to be incorporated by professionals

Glucose Restriction Promotes Osteocyte Specification by Activating a PGC-1α-Dependent Transcriptional Program

Molecular mechanism of behavior; Molecular physiology; Specialized functions of cellsMecanismo molecular del comportamiento; Fisiología molecular; Funciones especializadas de las célulasMecanisme molecular del comportament; Fisiologia molecular; Funcions especialitzades de les cèl·lulesOsteocytes, the most abundant of bone cells, differentiate while they remain buried within the bone matrix. This encasement limits their access to nutrients and likely affects their differentiation, a process that remains poorly defined. Here, we show that restriction in glucose supply promotes the osteocyte transcriptional program while also being associated with increased mitochondrial DNA levels. Glucose deprivation triggered the activation of the AMPK/PGC-1 pathway. AMPK and SIRT1 activators or PGC-1α overexpression are sufficient to enhance osteocyte gene expression in IDG-SW3 cells, murine primary osteoblasts, osteocytes, and organotypic/ex vivo bone cultures. Conversely, osteoblasts and osteocytes deficient in Ppargc1a and b were refractory to the effects of glucose restriction. Finally, conditional ablation of both genes in osteoblasts and osteocytes generate osteopenia and reduce osteocytic gene expression in mice. Altogether, we uncovered a role for PGC-1 in the regulation of osteocyte gene expressio

Perinatal hypoxic-ischemic encephalopathy: acute period and outcome

Ninety four neonates with hypoxic ischemic encephalopathy HIE attended at the University of Ribeirão Preto since 1982 were studied in terms of the neurological alterations during the acute phase and outcome over a mean period of 47 months. From 43 newborns with HIE I, 40 recovered within 96 hours and 3 died. Among 40 infants with HIE II, 37.5% recovered within the first week, and the others continued abnormal beyond the 7th day. All 11 infants with HIE III died before the second month of life. The HIE I group had no motor sequelae. Among the HIE II group, 34.5% showed cerebral palsy and 17.7% neuromotor retardation. 80.0% of those with sequelae persisted abnormal beyond 7th day of life, during the acute phase of the HIE. Epilepsy occurred in 17.5% of cases with HIE grade II, only among those with neuromotor sequelae. The 1Q test did not show statistically significant difference between the HIE I, II without motor sequelae and the control groups. The authors reaffirm the value of the findings in the acute phase of HIE on the outcome of these patients.Noventa e quatro recém-nascidos com encefalopatia hipóxico-isquêmica (EHI), atendidos no Hospital das Clínicas de Ribeirão Preto desde 1982, foram avaliados evolutivamente na fase aguda e por período médio de 47 meses. De 43 casos com EHI 1,40 se recuperaram em 96 horas e 3 faleceram. Dos 40 com EHI II, 37,5% se recuperaram até o sétimo dia e demais permaneceram com alterações. Os 11 casos com grau III faleceram até o segundo mês de vida. As crianças com EHI grau I não apresentaram seqüelas motoras. Do grupo com EHI grau II 34,5% apresentaram paralisia cerebral e 17,7% atraso neuromotor. 80% dos casos com sequela apresentaram exame neurológico anormal além do sétimo dia, na fase aguda da EHI. Epilepsia ocorreu em 17,5% dos casos com EHI grau II e somente no grupo com seqüelas motoras. Teste de QI não evidenciou diferença significativa entre os grupos com grau I, II sem seqüelas motoras e o grupo controle. Com esses dados os autores reafirmaram a importância prognostica da evolução da EHI na fase aguda.77177