Atypical form of acute myocardial infarction with tamponade

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2019.Background: Nowadays it is well recognized that the absence of obstructive coronary artery disease in a patient presenting with symptoms suggestive of ischemia and ST-segment alterations does not preclude an atherothrombotic etiology. CMR is an essential method for the investigation of Myocardial infarction (MI) with non obstructive coronary artery disease (MINOCA). Clinical Case: A 66 years-old female patient was referred after an episode of acute oppressive chest pain, nausea and hypersudorese, followed by syncope. She had a previous medical history of rheumatoid arthritis, under immunosuppression, occlusion of the cilioretinal artery, hypertension and dyslipidemia. On admission she was hypotensive (80/60mmHg). The ECG showed sinus rhythm and mild ST depression in V2-V3 leads, and the echocardiogram a small circumferential pericardial effusion (10mm) with signs of hemodynamic compromise. The blood tests documented a slight leukocytosis and an elevated troponin (hs-TnT 619ng/L).info:eu-repo/semantics/publishedVersio

AS CIRCUNSTÂNCIAS DA APRENDIZAGEM NO ENSINO REMOTO PANDEMIA COVID 19

Este trabalho baseia-se nas observações feitas na imersão do Programa de Iniciação à Docência, durante a Pandemia da covid-19. A pesquisa é do tipo qualitativa observacional, identifica conteúdos trabalhados em 2020, relativos à memórias espontâneas dos alunos do Ensino Médio, de diferentes instituições, que versa com os descritos na Base Nacional Comum Curricular. Essa previsão facilitaria ao professor a dar continuidade ao previsto pelos documentos normativos da Secretaria da Educação do Estado do Paraná. Por causa do teor das respostas descritas pelos alunos, buscamos refletir sobre a educação, o uso da tecnologia como ferramenta pedagógica, a estrutura escolar e a motivação na busca pelo ensino e aprendizagem. O estudo apontou que precisamos pensar em políticas públicas, em formações de professores e no aperfeiçoamento do uso das tecnologias virtuais como instrumento educacional. A educação significativa não depende apenas do professor, mas também envolve a participação ativa de toda sociedade

An unusual cause of myocardial infarction

Copyright © 2019 European Society of CardiologyBackground: In order to direct the treatment it, is well established that is fundamental to clarify the aetiology of heart failure and the cause of myocardial infarction (MI) with non obstructive coronary artery disease (MINOCA), with CMR being one of the methods of choice in both clinical situations. Case report: A 70 years-old male patient was admitted in our emergency department with complaints of irregular palpitations, progressive dyspnoea and fatigue on exertion, with two weeks of evolution; these symptoms were associated to retrosternal chest pain in the last twelve hours. He had a previous medical history of dyslipidemia, no other cardiovascular risk factors were known. On admission, his heart rate was 130bpm, with an irregularly irregular pulse and the pulmonary auscultation revealed bibasal crackles. The remaining physical examination was unremarkable. The ECG showed an atrial fibrillation rhythm, with a mild ST elevation and T wave inversion in inferior leads. The echocardiogram revealed a diffuse hypokinesia of left ventricle with an ejection fraction of 35-40%. The lab tests documented an elevation of troponin (hs-TnT 210ng/L) and NTproBNP (1945pg/ml). The coronary angiogram showed no lesions.info:eu-repo/semantics/publishedVersio

CHARACTERIZATION AND ANTIFUNGAL ACTIVITY OF THE ESSENTIAL OIL OF TAGETES MINUTA FRONT OF THE CRYPTOCOCCUS SPP. ISOLATES FROM THE ENVIRONMENT

Objective: This study evaluated the chemical composition and antifungal activity of the essential oil of inflorescences of Tagetes minuta (EOTM) belonging to the Asteraceae family against Cryptococcus spp. This microorganism is the encapsulated yeast-like and is recognized as an opportunistic fungal pathogen of great clinical importance.Methods: The inflorescences of T. minuta were collected in Itaara/RS, Brazil, in April 2013, and identification of the components was performed by GC-MS. The species of fungi are environmental isolates of Cryptococcus spp. identified by direct examination with India ink, urease test, culture and agar Niger medium canavanine glycine bromothymol blue, and all fungi isolates were confirmed by the use of automated panel MicroScan® Rapid Yeast ID (SIEMENS®). ATCC strains of C. gattii, C. neoformans and C. grubii belonging to the Microbiology Laboratory of the Centro Universitário Franciscano of Santa Maria/RS, Brazil were also used. The antifungal activity of the EOTM was evaluated by microdilution.Results: Most strains of Cryptococcus spp. were sensitive to EOTM even at low concentrations, except when the microorganism in question was Cryptococcus grubii which the essential oil showed a weak antifungal action.Conclusion: The EOTM appears as promising in prospecting for new drugs for the treatment of cryptococcosis.Keywords: Cryptococcosis, Natural products, Antifungal, Marigol

The value of multiparametric prediction scores in heart failure varies with the type of follow‐up after discharge: a comparative analysis

© 2023 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.Aims: Multiple prediction score models have been validated to predict major adverse events in patients with heart failure. However, these scores do not include variables related to the type of follow-up. This study aimed to evaluate the impact of a protocol-based follow-up programme of patients with heart failure regarding scores accuracy for predicting hospitalizations and mortality occurring during the first year after hospital discharge. Methods and results: Data from two heart failure populations were collected: one composed of patients included in a protocol-based follow-up programme after an index hospitalization for acute heart failure and a second one-the control group-composed of patients not included in a multidisciplinary HF management programme after discharge. For each patient, the risk of hospitalization and/or mortality within a period of 12 months after discharge was calculated using four different scores: BCN Bio-HF Calculator, COACH Risk Engine, MAGGIC Risk Calculator, and Seattle Heart Failure Model. The accuracy of each score was established using the area under the receiver operating characteristic curve (AUC), calibration graphs, and discordance calculation. AUC comparison was established by the DeLong method. The protocol-based follow-up programme group included 56 patients, and the control group, 106 patients, with no significant differences between groups (median age: 67 years vs. 68.4 years; male sex: 58% vs. 55%; median ejection fraction: 28.2% vs. 30.5%; functional class II: 60.7% vs. 56.2%, I: 30.4% vs. 31.9%; P = not significant). Hospitalization and mortality rates were significantly lower in the protocol-based follow-up programme group (21.4% vs. 54.7%; P < 0.001 and 5.4% vs. 17.9%; P < 0.001, respectively). When applied to the control group, COACH Risk Engine and BCN Bio-HF Calculator had, respectively, good (AUC: 0.835) and reasonable (AUC: 0.712) accuracy to predict hospitalization. There was a significant reduction of COACH Risk Engine accuracy (AUC: 0.572; P = 0.011) and a non-significant accuracy reduction of BCN Bio-HF Calculator (AUC: 0.536; P = 0.1) when applied to the protocol-based follow-up programme group. All scores showed good accuracy to predict 1 year mortality (AUC: 0.863, 0.87, 0.818, and 0.82, respectively) when applied to the control group. However, when applied to the protocol-based follow-up programme group, a significant predictive accuracy reduction of COACH Risk Engine, BCN Bio-HF Calculator, and MAGGIC Risk Calculator (AUC: 0.366, 0.642, and 0.277, P < 0.001, 0.002, and <0.001, respectively) was observed. Seattle Heart Failure Model had non-significant reduction in its acuity (AUC: 0.597; P = 0.24). Conclusions: The accuracy of the aforementioned scores to predict major events in patients with heart failure is significantly reduced when they are applied to patients included in a multidisciplinary heart failure management programme.This work was supported by national funds, Fundação para a Ciência e a Tecnologia, reference number UIDB/00306/2020.info:eu-repo/semantics/publishedVersio

Left atrial abnormal mechanics by speckle tracking as an early subclinical manifestation in patients with systemic sclerosis

© The European Society of Cardiology 2018. All rights reserved.Introduction: Heart involvement in systemic sclerosis (SSc) affects the prognosis of the disease when clinically evident. SSc may be associated with myocardial microvascular obstruction and micronecrosis is a presumible determinant of ventricular dysfunction, heart failure and sudden death. The aim of this study was to assess whether there were early changes of left atrial (LA) deformation by speckle tracking in patients with normal ejection fraction.info:eu-repo/semantics/publishedVersio

Programa de seguimento protocolado de doentes com insuficiência cardíaca : impacto no prognóstico e na qualidade de vida

© 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.Introduction: Heart failure is associated with high rates of readmission and mortality, and there is a need for measures to improve outcomes. This study aims to assess the impact of the implementation of a protocol-based follow-up program for heart failure patients on readmission and mortality rates and quality of life. Methods: A quasi-experimental study was performed, with a prospective registry of 50 consecutive patients discharged after hospitalization for acute heart failure. The study group was followed by a cardiologist at days 7-10 and the first, third, sixth and 12th month after discharge, with predefined procedures. The control group consisted of patients hospitalized for heart failure prior to implementation of the program and followed on a routine basis. Results: No significant differences were observed between the two groups regarding mean age (67.1±11.2 vs. 65.8±13.4 years, p=0.5), NYHA functional class (p=0.37), or median left ventricular ejection fraction (27% [19.8-35.3] vs. 29% [23.5-40]; p=0.23) at discharge. Mean follow-up after discharge was similar (11±5.3 vs. 10.9±5.5 months, p=0.81). The protocol-based follow-up program was associated with a significant reduction in allcause readmission (26% vs. 60%, p=0.003), heart failure readmission (16% vs. 36%, p=0.032), and mortality (4% vs. 20%, p=0.044). In the study group there was a significant improvement in all quality of life measures (p<0.001). Conclusion: A protocol-based follow-up program for patients with heart failure led to a signif-icant reduction in readmission and mortality rates, and was associated with better quality of life.info:eu-repo/semantics/publishedVersio

Cálculo das recomendações de ingestão protéica: aplicação a pré-escolar, escolar e adulto utilizando alimentos brasileiros

As recomendações de ingestão protéica variam conforme o teor de proteína, da quantidade de aminoácidos essenciais oferecidas e da digestibilidade da dieta. Em geral as recomendações protéicas tomam por base um alimento considerado padrão como o ovo ou o leite. No entanto, a nível populacional, ingere-se misturas de alimentos em quantidades e qualidades diferentes, que variam de região para região. A título de ilustração foram calculadas as recomendações de ingestão protéica para uma mistura de alimentos habitualmente usados pela população brasileira e consumida por três grupos etários diferentes: o pré escolar, o escolar e o adulto. São apresentadas 10 combinações de alimentos, todas tendo como principal fonte protéica o arroz e/ou o feijão. Observa-se que a recomendação de ingestão protéica do pré escolar, pode variar entre 1,15 a 1,77 g/kg por dia dependendo da mistura utilizada. Discute-se também a importância da quantidade de alimentos ingeridos e a presença de outros nutrientes. Sugere-se que ao se recomendar a ingestão protéica de uma determinada mistura de alimentos sejam considerados os seguintes fatores: teor total de nitrogênio, quantidade de aminoácidos essenciais, digestibilidade, peso total da mistura e a presença de outros nutrientes.The recommendations for protein consumption depend on the essential amino acid and total nitrogen content of a diet, and food digestibility. International recommendations are based on egg or milk proteins. However, populations eat different food mixtures. Brazilians use rice and beans as their main protein food source. This study presents different Brazilian diets, with variable amount of rice and beans. The results show that for each diet there is a different amount of protein recommended. Pre-school children, for example, must receive from 1.15 to 1.77 g/protein/day, depending on the mixture of their dietary protein intake. Besides the diet protein's quality and quantity, the total food intake and presence of other essential nutrients, such as iron, calcium and vitamin C has also to be considered. The correct protein recommendation with respect to a diet or a mixture of food, should take into consideration: digestibility, total nitrogen, essential amino acids, presence of others nutrients and weight os food consumed