Diagnosis and treatment of acute myocarditis in Portugal. Data from the national multicenter registry on myocarditis

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017.Introduction: The diagnosis of acute myocarditis (aMyo) needs a high level of suspicion. Cardiac magnetic resonance (CMR) may contribute to the diagnosis; but endomyocardial biopsy (EMB) is considered the gold standard, although used infrequently worldwide. Short-term course, albeit unpredictable is usually benign and treatment is mainly supportive. Objectives: To assess the usual care attitudes regarding hospitalized patients (pts) with a diagnosis of aMyo in Portugal, report patient's clinical profiles and current therapeutic approaches, and assess the relevance of CMR to eventual changes in management and/or therapeutic decisions. Methods: Prospective nationwide survey of admitted aMyo pts during a 2-year period (25.04.13–15). Electronic CRFs were completed with admission/discharge data, diagnostic tests, treatments and open-ended questions to evaluate physician's opinions and conclusions. Results: 248 pts from 18 centers were included, 98% caucasian, 35±14 (18–84) years old, 83% male. A recent infectious disease was detected in 57.5% (upper respiratory tract in 71.2%) and 23% had been previously treated with antibiotics. On admission, presentation included angina-like thoracic pain (96%), non-CV symptoms- 58.4% (fever-71%, respiratory- 52.8%, GI- 28.1%), heart failure (HF)- 5.4% and cardiogenic shock- 0.8%; abnormal ECG - 82% (mostly ST elevation-78.5%); increased troponin levels in 95%; echo (in 94%pts) showed left ventricular dilatation (LVD) - 5.7%, segmental LV wall abnormalities (segmAbn) - 34%, reduced LV ejection fraction (RLVEF) - 21% and pericardial effusion (PE) - 11.7%. CMR (in 57%pts), didn't change the management in 70% of cases. Coronary angiography (in 40%) revealed significant CAD in 7.4%. EMB was diagnostic in the 2 pts in which was performed (due to severe progressive HF). Multiple viral serologies (in 32.4% pts) were conclusive in only 0.5%. Most pts were treated with NSAIDs, 39% received ACEi or ARB, 36% a beta-blocker (BB) and 8.4% diuretics; 3.4% needed inotropes. Only 1 death occurred (shock). At discharge, an abnormal ECG persisted in 64.4% of pts; echo (in 50.4%) showed LVD in 6%, segmAbn in 24.6%, RLVEF in 14.6% and PE in 10.2%. Most pts (88.2%) were discharged on NSAIDs, 37.6% on ACEi or ARB, 30.36% on BB, and 6.47% on diuretics. Final diagnosis was aMyo in 54.4% (probable/possible in 96.9% and definitive in only 3.1%) and myopericarditis in 45.6%. Diagnostic criteria were “clinical” in 96.4%, supported by lab results in 87.7% and ECG in 68.8%. Echo or CMR contribution in supporting “clinical diagnosis”, was 38.3% and 48.6% respectively. Disease course was in most cases “mild” (87%). Conclusions: Echo and CMR were performed in most pts with aMyo but diagnosis remained mostly “clinical” according to treating physicians. EMB was very rarely performed. Treatment was largely empirical but an “overuse” of CV drugs and NSAIDs was observed.info:eu-repo/semantics/publishedVersio

Social and dental status along the life course and oral health impacts in adolescents: a population-based birth cohort

<p>Abstract</p> <p>Background</p> <p>Harmful social conditions in early life might predispose individuals to dental status which in turn may impact on adolescents' quality of life.</p> <p>Aims</p> <p>To estimate the prevalence of oral health impacts among 12 yr-old Brazilian adolescents (<it>n </it>= 359) and its association with life course socioeconomic variables, dental status and dental services utilization in a population-based birth cohort in Southern Brazil.</p> <p>Methods</p> <p>Exploratory variables were collected at birth, at 6 and 12 yr of age. The Oral Impacts on Daily Performances index (OIDP) was collected in adolescence and it was analyzed as a ranked outcome (OIDP from 0 to 9). Unadjusted and adjusted multivariable Poisson regression with robust variance was performed guided by a theoretical determination model.</p> <p>Results</p> <p>The response rate was of 94.4% (<it>n </it>= 339). The prevalence of OIDP = 1 was 30.1% (CI95%25.2;35.0) and OIDP ≥ 2 was 28.0% (CI95%23.2;32.8). The most common daily activity affected was eating (44.8%), follow by cleaning the mouth and smiling (15.6%, and 15.0%, respectively). In the final model mother schooling and mother employment status in early cohort participant's life were associated with OIDP in adolescence. As higher untreated dental caries at age 6 and 12 years, and the presence of dental pain, gingival bleeding and incisal crowing in adolescence as higher the OIDP score. On the other hand, dental fluorosis was associated with low OIDP score.</p> <p>Conclusion</p> <p>Our findings highlight the importance of adolescent's early life social environmental as mother schooling and mother employment status and the early and later dental status on the adolescent's quality of life regardless family income and use of dental services.</p

Magnetic Catalysis: A Review

We give an overview of the magnetic catalysis phenomenon. In the framework of quantum field theory, magnetic catalysis is broadly defined as an enhancement of dynamical symmetry breaking by an external magnetic field. We start from a brief discussion of spontaneous symmetry breaking and the role of a magnetic field in its a dynamics. This is followed by a detailed presentation of the essential features of the phenomenon. In particular, we emphasize that the dimensional reduction plays a profound role in the pairing dynamics in a magnetic field. Using the general nature of underlying physics and its robustness with respect to interaction types and model content, we argue that magnetic catalysis is a universal and model-independent phenomenon. In support of this claim, we show how magnetic catalysis is realized in various models with short-range and long-range interactions. We argue that the general nature of the phenomenon implies a wide range of potential applications: from certain types of solid state systems to models in cosmology, particle and nuclear physics. We finish the review with general remarks about magnetic catalysis and an outlook for future research.Comment: 37 pages, to appear in Lect. Notes Phys. "Strongly interacting matter in magnetic fields" (Springer), edited by D. Kharzeev, K. Landsteiner, A. Schmitt, H.-U. Yee. Version 2: references adde

Brazilian adolescents' knowledge and beliefs about abortion methods: A school-based internet inquiry

Background: Internet surveys that draw from traditionally generated samples provide the unique conditions to engage adolescents in exploration of sensitive health topics.Methods: We examined awareness of unwanted pregnancy, abortion behaviour, methods, and attitudes toward specific legal indications for abortion via a school-based internet survey among 378 adolescents aged 12-21 years in three Rio de Janeiro public schools.Results: Forty-five percent knew peers who had undergone an abortion. Most students (66.0%) did not disclose abortion method knowledge. However, girls (aOR 4.2, 95% CI 2.4-7.2), those who had experienced their sexual debut (aOR1.76, 95% CI 1.1-3.0), and those attending a prestigious magnet school (aOR 2.7 95% CI 1.4-6.3) were more likely to report methods. Most abortion methods (79.3%) reported were ineffective, obsolete, and/or unsafe. Herbs (e.g. marijuana tea), over-the-counter medications, surgical procedures, foreign objects and blunt trauma were reported. Most techniques (85.2%) were perceived to be dangerous, including methods recommended by the World Health Organization. A majority (61.4%) supported Brazil's existing law permitting abortion in the case of rape. There was no association between gender, age, sexual debut, parental education or socioeconomic status and attitudes toward legal abortion. However, students at the magnet school supported twice as many legal indications (2.7, SE.27) suggesting a likely role of peers and/or educators in shaping abortion views.Conclusions: Abortion knowledge and attitudes are not driven simply by age, religion or class, but rather a complex interplay that includes both social spaces and gender. Prevention of abortion morbidity and mortality among adolescents requires comprehensive sexuality and reproductive health education that includes factual distinctions between safe and unsafe abortion methods