Exequibilidade, segurança e utilidade da biópsia endomiocárdica ventricular esquerda por acesso transradial : experiência inicial de um centro universitário terciário

© 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 (http://creativecommons.org/licenses/bync-nd/4.0/).Introduction and objectives: Over the last decade, several studies have suggested that left ventricular endomyocardial biopsy is safer and has a higher diagnostic yield than transvenous right ventricular biopsy. In addition, recent publications indicate that the transradial approach is a feasible and safe alternative to the transfemoral approach for sampling the left ventricle. We report our initial experience with transradial endomyocardial biopsy with regards to feasibility, safety and usefulness. Methods: Single-center registry of consecutive patients undergoing intended transradial left endomyocardial biopsy. Clinical and technical data were collected prospectively, with a particular focus on success rate and complications. Results: Twenty-seven patients were screened for left ventricle biopsy. Twenty (25) were selected for an intended transradial approach (mean age 51±18 years old, 22 male). Success rate was 100% with no crossover to femoral approach. There were no major complications. Two patients experienced mild radial spasm. One of them also had a run of non-sustained ventricular tachycardia. Indication for biopsy was either myocarditis or cardiomyopathy of unknown etiology. The final diagnosis was acute lymphocytic myocarditis in five patients, chronic myocarditis in one patient, amyloid light-chain amyloidosis in four patients and transthyretin amyloidosis in six patients. Myocarditis was ruled out in eight patients and amyloidosis in one patient. Conclusions: Transradial left ventricle endomyocardial biopsy is a very safe and feasible method of sampling the myocardium for histopathological analysis, with a good diagnostic yield and clinically meaningful results in properly selected patients.info:eu-repo/semantics/publishedVersio

Enfermidades neurológicas de origem viral em bovinos no estado de Pernambuco, Brasil: estudo clínico e anatomopatológico

Os estudos relacionados as doenças neurológicas assumem grande importância na Medicina Veterinária, particularmente os que envolvem animais de produção como os bovinos, em virtude da grande importância sanitária e de saúde pública. Nesse contexto, este trabalho teve como objetivo descrever a frequência de ocorrência dos principais achados clínicos, laboratoriais e anatomopatológicos dos bovinos diagnosticados com doenças neurológicas de origem viral. Realizou-se a triagem no livro de registro geral dos pacientes com enfermidades que cursaram com sintomatologia neurológica e que foram diagnosticados através de exame anatomopatológico e/ou complementares com enfermidades de origem viral, os quais deram entrada (vivos ou mortos) na Clínica de Bovinos de Garanhuns-UFRPE no período de janeiro de 2009 a dezembro de 2019. As informações obtidas foram inseridas em um banco de dados elaborado no programa de computador Microsoft Excel 2010® distribuídas em dados clínicos, laboratoriais e anatomopatológicos. Os achados clínicos das enfermidades neurológicas de etiologia viral foram muito variados e inespecíficos, sendo os achados anatomopatológicos, aliados aos métodos laboratoriais, de importância fundamental para o estabelecimento do diagnóstico. A elevada frequência dos casos de raiva neste estudo demonstra a importância sanitária desta enfermidade para a pecuária bovina, como também para a saúde pública. Ressalta-se a importância da inclusão da febre catarral maligna e da meningoencefalite herpética no diagnóstico diferencial das doenças neurológicas na região, assim como a adoção de medidas sanitárias. Palavras-chave: achados clínicos; raiva; meningoencefalite herpética; febre catarral maligna; achados anatomopatológicos

Aspectos clínicos da ruptura do músculo gastrocnêmio em ruminantes: descrição de três casos

Esse trabalho tem por finalidade descrever a ocorrência e os aspectos clínicos da ruptura do músculo Gastrocnêmio em três animais (um bovino, um caprino e uma lhama) de idades diferentes, fêmeas, criados de forma semi-intensiva em propriedades distintas, que foram atendidos na Clínica de Bovinos de Garanhuns, Universidade Federal Rural de Pernambuco, cujos proprietários queixavam-se de problema locomotor. Essa enfermidade é rara ou incomum na clínica de ruminantes e, portanto, ainda pouco relatada. As principais causas relacionadas são os traumas e neuropatias pós-parturiente, sendo o diagnóstico geralmente clínico, baseando-se na identificação e no reconhecimento das alterações musculoesqueléticas e da postura, que são características. Os achados clínicos encontrados nos animais atendidos foram incapacidade e\ou dificuldade de levantar e ficar em estação, alteração na marcha, postura característica e inflamação local. Em dois animais a ruptura do músculo foi total e no outro a lesão foi parcial. Diante do prognóstico desfavorável indicou-se o abate do caprino e, em detrimento da idade da lhama, foi instituído tratamento com utilização de anti-inflamatórios não esteroides, porém sem sucesso. No caso do bovino, sugeriu-se a permanência temporária do animal, em espaço restrito, a fim de aproveitar a sua produção láctea. Dada à importância funcional desse músculo, sua ruptura compromete a viabilidade produtiva do animal afetado

Progressão da desnervação simpática cardíaca avaliada por cintigrafia com MIBG-I123 na polineuropatia amiloidótica familiar e o impacto da transplantação hepática

© 2017 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L.U. All rights reserved.Introduction: Familial amyloid polyneuropathy (FAP) is a rare disease caused by systemic deposition of amyloidogenic variants of the transthyretin (TTR) protein. The TTR-V30M mutation is caused by the substitution of valine by methionine at position 30 and mainly affects the peripheral and autonomic nervous systems. Cardiovascular manifestations are common and are due to autonomic denervation and to amyloid deposition in the heart. Cardiac sympathetic denervation detected by iodine-123 labeled metaiodobenzylguanidine (MIBG) is an important prognostic marker in TTR-V30 M FAP. Liver transplantation, widely used to halt neurological involvement, appears to have a varying effect on the progression of amyloid cardiomyopathy. Its effect on the progression of cardiac denervation remains unknown. Methods: In this observational study, patients with the TTR-V30 M mutation underwent annual cardiac assessment and serial MIBG imaging with quantification ofthe late heart-to-mediastinum (H/M) ratio. Results: We studied 232 patients (median age 40 years, 54.7% female, 37.9% asymptomatic at the time of inclusion) who were followed for a median of 4.5 years and underwent a total of 558 MIBG scans. During follow-up, 47 patients (20.3%) died. MIBG scintigraphy at inclusion was a strong predictor of prognosis, with the risk of death increasing by 27.8% for each one-tenth reduction in the late H/M ratio. The late H/M ratio decreased with age (0.082/year, p<0.001), but progression of cardiac denervation was so slow that annual repetition of MIBG imaging did not increase its prognostic accuracy. During follow-up, 70 symptomatic patients underwent liver transplantation. The late H/M ratio decreased by 0.19/year until transplantation but no statistically significant differences were detected after the procedure. Conclusions: Cardiac denervation is common during the progression of TTR-V30 M FAP and quantification of the late H/M ratio on MIBG scintigraphy is valuable for prognostic stratification of these patients. Liver transplantation stabilizes cardiac denervation, without recovery or further deterioration in cardiac MIBG uptake after the procedure.Fundamentação: A polineuropatia amiloidótica familiar (PAF) é uma doença rara devida à deposição sistémica de variantes amiloidogénicas da proteína transtirretina (TTR-V30 M), atingindo especialmente o sistema nervoso periférico. As manifestações cardiovasculares são muito comuns e devem-se à desnervação autonómica e à deposição de amiloide no coração. A desnervação simpática cardíaca, detetada por cintigrafia com metaiodobenzilguanidina (MIBG) marcada com I123, é um importante estratificador prognóstico na PAF TTR-V30 M. O transplante hepático, amplamente utilizado para interromper a progressão do envolvimento neurológico, parece ter impacto heterogéneo na evolução da miocardiopatia amiloidótica. O seu impacto na progressão da desnervação cardíaca permanece desconhecido. Métodos: Estudo observacional de portadores da mutação TTR-V30 M submetidos a avaliação cardiológica anual e a cintigrafias com MIBG seriadas, com quantificação do índice de captação coração/mediastino (C/M) tardio. Resultados: Foram estudados 232 doentes (idade mediana de 40 anos, 54,7% do sexo feminino, 37,9% assintomáticos aquando da inclusão), seguidos durante uma mediana de 4,5 anos e submetidos a um total de 558 cintigrafias MIBG. Durante o seguimento, 47 doentes (20,3%) morreram. A cintigrafia com MIBG inicial foi um forte preditor prognóstico, detetando-se aumento do risco de morte em 27,8% por cada redução decimal do índice C/M tardio. O índice C/M tardio diminuiu com a idade (0,082 por ano; p < 0,001), mas a progressão da desnervação cardíaca foi tão lenta que a repetição anual do exame não aumentou a sua precisão prognóstica. Durante o seguimento, 70 doentes sintomáticos foram submetidos a transplante hepático. O índice C/M tardio diminuiu 0,19/ano até ao transplante, deixando de ser detetadas variações estatisticamente significativas a partir do procedimento. Conclusão: A desnervação cardíaca é frequente durante a progressão da PAF TTR-V30 M e a quantificação do índice C/M tardio por cintigrafia MIBG é valiosa para a estratificação prognóstica destes doentes. O transplante hepático permite a estabilização da desnervação cardíaca, não havendo recuperação ou deterioração adicional da captação cardíaca de MIBG após o procedimento.info:eu-repo/semantics/publishedVersio

The sensitivity of DPD scintigraphy to detect transthyretin cardiac amyloidosis in V30M mutation depends on the phenotypic expression of the disease

© 2020 Informa UK Limited, trading as Taylor & Francis Group.Background: There is a growing need for a non-invasive test to detect cardiac involvement in patients with transthyretin-related hereditary amyloidosis (ATTR) caused by V30M mutation. 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) scintigraphy is a promising method, but its accuracy in this particular mutation remains unknown. Methods: A cohort of 179 patients: 92 with early-onset disease (EoD, symptoms <50-years-old), 33 with late-onset disease (LoD) and 54 asymptomatic carriers were prospectively evaluated and underwent DPD scintigraphy, which was compared with the results of echocardiogram, ambulatory blood pressure monitoring, 24 h-Holter, myocardial 123I-metaiodobenzylguanidine imaging and NT-proBNP. Results: Amyloid cardiomyopathy, defined as septal thickness 13 mm, was present in 32 patients (17.9%) and was more frequent in those with LoD (OR: 3.68, p ¼ .003). Cardiac DPD uptake was present in 22 individuals (12.3%) and correlated with parameters indicative of cardiac amyloidosis. DPD imaging was strongly influenced by the age of disease onset: among patients with myocardial thickening, cardiac DPD retention was present in 11/15 (73.3%) with LoD, in contrast to only 4/17 (26.7%) with EoD (p ¼ .005). Two patients with myocardial thickening and normal DPD scintigraphy underwent endomyocardial biopsy that confirmed ATTR amyloidosis. Conclusion: DPD scintigraphy presents suboptimal sensitivity to detect cardiac involvement in ATTRV30M, particularly in symptomatic patients with EoD.info:eu-repo/semantics/publishedVersio

Reduced myocardial 123-Iodine metaiodobenzylguanidine uptake : a prognostic marker in familial amyloid polyneuropathy

© American Heart Association, Inc. All rights reserved. Unauthorized use prohibited.Background: Transthyretin familial amyloid polyneuropathy is a hereditary form of amyloidosis characterized by sensorimotor and autonomic neuropathy, cardiac conduction defects, and infiltrative cardiomyopathy. Previous studies have suggested that myocardial sympathetic denervation assessed by 123-iodine metaiodobenzylguanidine (MIBG) imaging occurs early in disease progression. However, its prognostic significance was never evaluated. We aimed to study the long-term prognostic value of myocardial sympathetic denervation detected by MIBG imaging in transthyretin familial amyloid polyneuropathy. Methods and results: A total of 143 individuals with V30M transthyretin mutation underwent Holter, ambulatory blood pressure monitoring, echocardiography, and MIBG imaging. Time to all-cause death was compared with late heart-to-mediastinum MIBG uptake ratio (H/M; either in relation to the estimated lower limit of normal [1.60] or as a continuous variable) using Cox proportional hazards regression. Multivariable analyses were performed to test the prognostic accuracy of clinical, neurological, and cardiovascular parameters. During a median follow-up of 5.5 years, 32 (22%) patients died. Five-year mortality rate was 42% for late H/M <1.60 and 7% for late H/M ≥1.60 (hazard ratio, 7.19; P<0.001). Late H/M was identified as an independent prognostic predictor. Fifty-three patients were submitted to liver transplantation. In comparison with neurophysiological score-matched controls, transplanted patients had lower long-term mortality (hazard ratio, 0.32; P=0.012). Patients with late H/M<1.60 were at higher risk of unfavorable outcome but seemed to have benefited from liver transplantation. Conclusions: Cardiac sympathetic denervation as assessed by MIBG imaging is a useful prognostic marker in transthyretin familial amyloid polyneuropathy.This study was supported by Santa Maria University Hospital, and all exams were done according to the local protocol for evaluation of Familial Amyloidal Polyneuropathy patientsinfo:eu-repo/semantics/publishedVersio

Las cooperativas de solidaridad social portuguesas entre la recuperación y la resiliencia en el contexto de covid-19: resultados preliminares del Proyecto COOPVID

Covid-19 posed several challenges to all organisations in general and to social solidarity cooperatives in particular. However, the challenges faced by these cooperatives have unique features arising from their special characteristics compared to other types of cooperatives. Therefore it is vital to study these challenges and the impacts of covid-19. This study has as main goal to understand those challenges and their impact. An exploratory study was undertaken by applying 11 interviews to 11 social solidarity cooperatives. The cooperatives were chosen to be heterogeneous among the existent cooperatives in Portugal. This study corresponds to the first phase of a project that is still underway. This article presents the main results of the content analysis of the data collected from the interviews. Data show cooperatives could promptly adapt and continue their mission under pressure from the pandemic despite the first difficulties encountered in a new and unknown situation, showing a capacity to adapt and serve their members. However, these members were also submitted to several increasing and new challenges. The adaptations were possible due to legal changes in the work organisation law, from layoff to telework, government support involving financial programs, VAT, and other tax relaxation, as well as due to human resources reorganisation and the cooperatives’ staff positive attitude towards the difficulties (both leaders and general workers). Differences between the social solidarity cooperatives under study concerning digital technologies showed that those already having some infrastructure had minor adapting difficulties.La covid-19 planteó varios retos a todas las organizaciones en general y, especialmente, a las cooperativas de solidaridad social. Sin embargo, los desafíos que enfrentan estas cooperativas tienen características únicas que provienen de las características especiales en comparación con el otro tipo de cooperativas. Por lo tanto, es vital estudiar estos desafíos y los impactos de covid-19. Este estudio tiene como objetivo principal entender esos retos e impactos. Se realizó un estudio exploratorio realizando 11 entrevistas a 11 cooperativas de solidaridad social. Las cooperativas fueron elegidas por ser heterogéneas entre las cooperativas existentes en Portugal. Este estudio corresponde a la primera fase de un proyecto que aún está en marcha. Este artículo presenta los principales resultados del análisis de contenido de los datos recogidos con las entrevistas. Los datos muestran que las cooperativas pudieron adaptarse rápidamente y continuar con su misión bajo la presión de la pandemia, a pesar de las primeras dificultades presentadas en una situación nueva y desconocida, mostrando una capacidad de adaptación y de servicio a sus socios. Sin embargo, estos socios también se vieron sometidos a varios retos nuevos y crecientes. Las adaptaciones fueron posibles gracias a los cambios legales en la ley de organización del trabajo, desde el despido hasta el teletrabajo, al apoyo gubernamental que implica programas financieros, al IVA y a la flexibilización de otros impuestos, así como a la reorganización de los recursos humanos y a la actitud positiva del personal de las cooperativas ante las dificultades (tanto de los dirigentes como de los trabajadores en general). Las diferencias entre las cooperativas de solidaridad social estudiadas en relación con las tecnologías digitales mostraron que las que ya contaban con alguna infraestructura tuvieron pequeñas dificultades para adaptarse.info:eu-repo/semantics/publishedVersio

Development and validation of the MMCD score to predict kidney replacement therapy in COVID-19 patients

Abstract Background Acute kidney injury (AKI) is frequently associated with COVID-19, and the need for kidney replacement therapy (KRT) is considered an indicator of disease severity. This study aimed to develop a prognostic score for predicting the need for KRT in hospitalised COVID-19 patients, and to assess the incidence of AKI and KRT requirement. Methods This study is part of a multicentre cohort, the Brazilian COVID-19 Registry. A total of 5212 adult COVID-19 patients were included between March/2020 and September/2020. Variable selection was performed using generalised additive models (GAM), and least absolute shrinkage and selection operator (LASSO) regression was used for score derivation. Accuracy was assessed using the area under the receiver operating characteristic curve (AUC-ROC). Results The median age of the model-derivation cohort was 59 (IQR 47–70) years, 54.5% were men, 34.3% required ICU admission, 20.9% evolved with AKI, 9.3% required KRT, and 15.1% died during hospitalisation. The temporal validation cohort had similar age, sex, ICU admission, AKI, required KRT distribution and in-hospital mortality. The geographic validation cohort had similar age and sex; however, this cohort had higher rates of ICU admission, AKI, need for KRT and in-hospital mortality. Four predictors of the need for KRT were identified using GAM: need for mechanical ventilation, male sex, higher creatinine at hospital presentation and diabetes. The MMCD score had excellent discrimination in derivation (AUROC 0.929, 95% CI 0.918–0.939) and validation (temporal AUROC 0.927, 95% CI 0.911–0.941; geographic AUROC 0.819, 95% CI 0.792–0.845) cohorts and good overall performance (Brier score: 0.057, 0.056 and 0.122, respectively). The score is implemented in a freely available online risk calculator ( https://www.mmcdscore.com/ ). Conclusions The use of the MMCD score to predict the need for KRT may assist healthcare workers in identifying hospitalised COVID-19 patients who may require more intensive monitoring, and can be useful for resource allocation

Brazilian Flora 2020: Leveraging the power of a collaborative scientific network

International audienceThe shortage of reliable primary taxonomic data limits the description of biological taxa and the understanding of biodiversity patterns and processes, complicating biogeographical, ecological, and evolutionary studies. This deficit creates a significant taxonomic impediment to biodiversity research and conservation planning. The taxonomic impediment and the biodiversity crisis are widely recognized, highlighting the urgent need for reliable taxonomic data. Over the past decade, numerous countries worldwide have devoted considerable effort to Target 1 of the Global Strategy for Plant Conservation (GSPC), which called for the preparation of a working list of all known plant species by 2010 and an online world Flora by 2020. Brazil is a megadiverse country, home to more of the world's known plant species than any other country. Despite that, Flora Brasiliensis, concluded in 1906, was the last comprehensive treatment of the Brazilian flora. The lack of accurate estimates of the number of species of algae, fungi, and plants occurring in Brazil contributes to the prevailing taxonomic impediment and delays progress towards the GSPC targets. Over the past 12 years, a legion of taxonomists motivated to meet Target 1 of the GSPC, worked together to gather and integrate knowledge on the algal, plant, and fungal diversity of Brazil. Overall, a team of about 980 taxonomists joined efforts in a highly collaborative project that used cybertaxonomy to prepare an updated Flora of Brazil, showing the power of scientific collaboration to reach ambitious goals. This paper presents an overview of the Brazilian Flora 2020 and provides taxonomic and spatial updates on the algae, fungi, and plants found in one of the world's most biodiverse countries. We further identify collection gaps and summarize future goals that extend beyond 2020. Our results show that Brazil is home to 46,975 native species of algae, fungi, and plants, of which 19,669 are endemic to the country. The data compiled to date suggests that the Atlantic Rainforest might be the most diverse Brazilian domain for all plant groups except gymnosperms, which are most diverse in the Amazon. However, scientific knowledge of Brazilian diversity is still unequally distributed, with the Atlantic Rainforest and the Cerrado being the most intensively sampled and studied biomes in the country. In times of “scientific reductionism”, with botanical and mycological sciences suffering pervasive depreciation in recent decades, the first online Flora of Brazil 2020 significantly enhanced the quality and quantity of taxonomic data available for algae, fungi, and plants from Brazil. This project also made all the information freely available online, providing a firm foundation for future research and for the management, conservation, and sustainable use of the Brazilian funga and flora