Hematoma de septo interauricular como complicación postquirúrgica inusual: A propósito de un caso

Atrial septal hematoma is a rare entity that can be caused by various etiologies. Mitral valve surgery is the most common iatrogenic cause of atrial septal hematoma or dissection, although it has also been described as a complication of other surgical and percutaneous procedures. We present a case of a woman with an interatrial septal hematoma as a post-surgical complication. Through this clinical case we will briefly review this rare entity.El hematoma del septo interauricular constituye una entidad poco habitual que puede tener diferentes etiologías. La cirugía sobre la válvula mitral es la causa iatrogénica de hematoma o disección de septo interauricular más frecuente, aunque también se ha descrito como complicación de otros procedimientos tanto quirúrgicos como percutáneos. Presentamos un caso de una mujer con un hematoma de septo interauricular como complicación postquirúrgica. A través de este caso clínico haremos una pequeña revisión de esta rara entidad

Fibroelastoma en cuerdas tendinosas de la válvula mitral como causa de ictus embólico

We present 2 cases of cardiac fibroelastoma on the chordae tendineae of the mitral valve that debuted as an embolic stroke. In both cases, the presumptive diagnosis was made by echocardiography, they underwent surgery and the initial suspicion was confirmed in the histological study. Cardiac fibroelastoma is the second most common primary cardiac tumor. It’s a cause of strokes and embolisms. The management of these is controversial due to their low prevalence in general population.Presentamos 2 casos de fibroelastoma cardiaco sobre las cuerdas tendinosas de la válvula mitral que debutaron como ictus embólico. El diagnóstico de presunción fue ecocardiográfico y se realizó una escisión quirúrgica de ambos confirmando la sospecha inicial mediante histopatología. Se trata del segundo tumor cardiaco primario más frecuente, causante conocido de ictus y otras embolias y con un manejo clínico controvertido dada la baja prevalencia de estos en la población general

Masa intraventricular en el contexto de disfunción ventricular: diagnóstico diferencial

We present a clinical case of an intracardiac mass in the context of left ventricular dysfunction in a patient without anticoagulant treatment, with the challenge of making an adequate differential diagnosis without any other tool than the transthoracic echocardiogram.Se presenta un caso clínico sobre una masa intracardíaca en el contexto de disfunción ventricular en un paciente sin tratamiento anticoagulante, con el reto adicional de realizar un adecuado diagnóstico diferencial sin otra herramienta que no sea la ecocardiografía transtorácica (ETT)

Un curioso hallazgo extracardíaco en un paciente con pericarditis aguda

Extracardiac findings are relatively common on transthoracic echocardiography. We present a clinical case in which the “routine” echocardiography for pericarditis allowed to diagnose a liver abscess and solve the patient’s problem. This case demonstrates the importance of paying attention to everything that can be seen in the echocardiogram image.Es relativamente frecuente encontrar hallazgos extracardíacos en la ecocardiografía transtorácica. Se presenta un caso clínico en el que la ecocardiografía “rutinaria” por pericarditis permitió hacer el diagnóstico de un absceso hepático y resolver el problema del paciente. Este caso demuestra la importancia de prestar atención a todo lo que se pueda ver en la imagen de la ecocardiografía

Derrame pericárdico loculado en paciente con cáncer avanzado

More than 50% of pericardial effusions in cancer patients are caused by a non-malignant process. Transthoracic echocardiography is the first line technique for the evaluation of pericardial disease, but sometimes multimodality imaging can help. CT have emerged as an alternative to determine the amount and distribution of the fluid and to characterize pericardial anatomy, masses or the pericardial fluid itself providing useful information to determine the aetiology of the effusion and to guide the management. In this clinical case we will briefly review the usefulness of CT in pericardial diseaseMás del 50% de los derrames pericárdicos en pacientes oncológicos son debidos a otro proceso no maligno. Es fundamental establecer la causa por sus connotaciones pronósticas. La ecocardiografía transtorácica es la técnica de elección para la valoración del pericardio, pero en ocasiones la imagen multimodal puede ayudar. El TAC ha surgido como una alternativa para determinar la cantidad y distribución del líquido y caracterizar los engrosamientos, masas y el propio líquido pericárdico; aportando información útil para determinar su etiología y guiar su drenaje. A través de un caso clínico, repasaremos brevemente la utilidad del TAC en la enfermedad pericárdica

Jardins per a la salut

Facultat de Farmàcia, Universitat de Barcelona. Ensenyament: Grau de Farmàcia. Assignatura: Botànica farmacèutica. Curs: 2014-2015. Coordinadors: Joan Simon, Cèsar Blanché i Maria Bosch.Els materials que aquí es presenten són el recull de les fitxes botàniques de 128 espècies presents en el Jardí Ferran Soldevila de l’Edifici Històric de la UB. Els treballs han estat realitzats manera individual per part dels estudiants dels grups M-3 i T-1 de l’assignatura Botànica Farmacèutica durant els mesos de febrer a maig del curs 2014-15 com a resultat final del Projecte d’Innovació Docent «Jardins per a la salut: aprenentatge servei a Botànica farmacèutica» (codi 2014PID-UB/054). Tots els treballs s’han dut a terme a través de la plataforma de GoogleDocs i han estat tutoritzats pels professors de l’assignatura. L’objectiu principal de l’activitat ha estat fomentar l’aprenentatge autònom i col·laboratiu en Botànica farmacèutica. També s’ha pretès motivar els estudiants a través del retorn de part del seu esforç a la societat a través d’una experiència d’Aprenentatge-Servei, deixant disponible finalment el treball dels estudiants per a poder ser consultable a través d’una Web pública amb la possibilitat de poder-ho fer in-situ en el propi jardí mitjançant codis QR amb un smartphone

Prospective individual patient data meta-analysis of two randomized trials on convalescent plasma for COVID-19 outpatients

Data on convalescent plasma (CP) treatment in COVID-19 outpatients are scarce. We aimed to assess whether CP administered during the first week of symptoms reduced the disease progression or risk of hospitalization of outpatients. Two multicenter, double-blind randomized trials (NCT04621123, NCT04589949) were merged with data pooling starting when = 50 years and symptomatic for <= 7days were included. The intervention consisted of 200-300mL of CP with a predefined minimum level of antibodies. Primary endpoints were a 5-point disease severity scale and a composite of hospitalization or death by 28 days. Amongst the 797 patients included, 390 received CP and 392 placebo; they had a median age of 58 years, 1 comorbidity, 5 days symptoms and 93% had negative IgG antibody-test. Seventy-four patients were hospitalized, 6 required mechanical ventilation and 3 died. The odds ratio (OR) of CP for improved disease severity scale was 0.936 (credible interval (CI) 0.667-1.311); OR for hospitalization or death was 0.919 (CI 0.592-1.416). CP effect on hospital admission or death was largest in patients with <= 5 days of symptoms (OR 0.658, 95%CI 0.394-1.085). CP did not decrease the time to full symptom resolution

High-titre methylene blue-treated convalescent plasma as an early treatment for outpatients with COVID-19: a randomised, placebo-controlled trial.

BACKGROUND: Convalescent plasma has been proposed as an early treatment to interrupt the progression of early COVID-19 to severe disease, but there is little definitive evidence. We aimed to assess whether early treatment with convalescent plasma reduces the risk of hospitalisation and reduces SARS-CoV-2 viral load among outpatients with COVID-19. METHODS: We did a multicentre, double-blind, randomised, placebo-controlled trial in four health-care centres in Catalonia, Spain. Adult outpatients aged 50 years or older with the onset of mild COVID-19 symptoms 7 days or less before randomisation were eligible for enrolment. Participants were randomly assigned (1:1) to receive one intravenous infusion of either 250-300 mL of ABO-compatible high anti-SARS-CoV-2 IgG titres (EUROIMMUN ratio ≥6) methylene blue-treated convalescent plasma (experimental group) or 250 mL of sterile 0·9% saline solution (control). Randomisation was done with the use of a central web-based system with concealment of the trial group assignment and no stratification. To preserve masking, we used opaque tubular bags that covered the investigational product and the infusion catheter. The coprimary endpoints were the incidence of hospitalisation within 28 days from baseline and the mean change in viral load (in log10 copies per mL) in nasopharyngeal swabs from baseline to day 7. The trial was stopped early following a data safety monitoring board recommendation because more than 85% of the target population had received a COVID-19 vaccine. Primary efficacy analyses were done in the intention-to-treat population, safety was assessed in all patients who received the investigational product. This study is registered with ClinicalTrials.gov, NCT04621123. FINDINGS: Between Nov 10, 2020, and July 28, 2021, we assessed 909 patients with confirmed COVID-19 for inclusion in the trial, 376 of whom were eligible and were randomly assigned to treatment (convalescent plasma n=188 [serum antibody-negative n=160]; placebo n=188 [serum antibody-negative n=166]). Median age was 56 years (IQR 52-62) and the mean symptom duration was 4·4 days (SD 1·4) before random assignment. In the intention-to-treat population, hospitalisation within 28 days from baseline occurred in 22 (12%) participants who received convalescent plasma versus 21 (11%) who received placebo (relative risk 1·05 [95% CI 0·78 to 1·41]). The mean change in viral load from baseline to day 7 was -2·41 log10 copies per mL (SD 1·32) with convalescent plasma and -2·32 log10 copies per mL (1·43) with placebo (crude difference -0·10 log10 copies per mL [95% CI -0·35 to 0·15]). One participant with mild COVID-19 developed a thromboembolic event 7 days after convalescent plasma infusion, which was reported as a serious adverse event possibly related to COVID-19 or to the experimental intervention. INTERPRETATION: Methylene blue-treated convalescent plasma did not prevent progression from mild to severe illness and did not reduce viral load in outpatients with COVID-19. Therefore, formal recommendations to support the use of convalescent plasma in outpatients with COVID-19 cannot be concluded. FUNDING: Grifols, Crowdfunding campaign YoMeCorono

Presentación atípica de tromboembolismo pulmonar detectado mediante ecocardiografía de estrés

We present the case of a young woman who was admitted to our hospital due to exertional chest pain. A stress echocardiogram was performed without visualizing segmental contractility alterations of the left ventricle, but right ventricle dilatation and overload signs were seen, both suggestive of an acute pulmonary embolism. The diagnosis was later confirmed with a CT angiography of the pulmonary arteries. Very few cases of pulmonary embolisms initially detected by stress echocardiography have been described in the literature. The patient had a good evolution and was discharged with oral anticoagulation.Presentamos el caso de una mujer joven, que ingresa en nuestro hospital por dolor torácico de esfuerzo. Se realizó un ecocardiograma de estrés sin objetivar alteraciones de la contractilidad segmentaria en el ventrículo izquierdo, pero si dilatación y datos de sobrecarga de ventrículo derecho, sugestivos de un tromboembolismo pulmonar agudo. El diagnóstico se confirmó posteriormente con un angioTAC de arterias pulmonares. Son muy pocos los casos descritos en la literatura de tromboembolismos pulmonares detectados inicialmente por ecocardiografía de estrés. La paciente tuvo una buena evolución y fue dada de alta con antiocoagulación oral