Ecocardiograma transesofágico revela fonte cardíaca de embolia cerebral em pacientes com AVC e mais que 45 anos

Cerebral embolism from cardiac source is an important cause of stroke, specially in patients younger than 45 years old. OBJECTIVE: To describe the transesophageal echocardiography (TEE) findings in young and non-young stroke patients without any prior evidence of cardiac source for cerebral embolism. METHOD: Transversal study: 523 patients (267 men and 256 women) with ischemic stroke, without any evidence of cardiac abnormality, underwent to TEE. RESULTS: Ten percent were aged 45 years; or less. Left ventricle hypertrophy, left atrial enlargement, spontaneous contrast in aorta, interatrial septum aneurysm, mitral and aortic valve calcification, aortic valve regurgitation, and atherosclerotic plaques in aorta were significantly more frequent in patients aged more than 45 years; 2.8% of non-young patients had thrombus in left heart. CONCLUSION: TEE is widely used to diagnose cardiac source of cerebral embolism in young patients, but it seems to be as useful for older ones, in whom cerebral embolism risk is underestimated; atherogenic and cardioembolic causes may actually coexist, and both should be treated.Embolia cerebral de fonte cardíaca é frequentemente relacionada a acidente vascular cerebral (AVC) em jovem. OBJETIVO: Descrever achados ecocardiográficos em jovens e não jovens com AVC isquêmico, sem suspeita de fonte cardíaca. MÉTODO: Estudo transversal; 523 pacientes (267 homens e 256 mulheres) com AVC isquêmico sem evidência de fonte cardíaca submeteram-se ao ecocardiograma transesofágico (ECOTE). RESULTADOS: 10% dos pacientes tinha 45 anos; ou menos. Hipertrofia do ventrículo esquerdo, aumento do átrio esquerdo, contraste espontâneo na aorta, aneurisma do septo interatrial, calcificação da válvula mitral e aórtica, insuficiência aórtica e placas de ateroma na aorta foram significantemente mais frequentes nos pacientes com mais que 45 anos; 2.8% dos não-jovens apresentaram trombo nas câmaras esquerdas. CONCLUSÃO: ECOTE é amplamente sugerido na investigação de embolia em pacientes jovens, porém parece ser tão importante também no grupo de pacientes mais velhos, nos quais o risco de embolia cerebral é subestimado; etiologia cardioembólica e aterosclerótica coexistem, e ambas devem ser identificadas e tratadas para melhor prognóstico.São Paulo Federal University Division of Neurological EmergenciesUNIFESP Division of CardiologyOMNI - Non-invasive Cardiological Diagnosis CenterJohns Hopkins University Division of CardiologySão Paulo Federal University Division of Neurological EmergenciesUNIFESP, Division of CardiologySciEL

ATUALIZAÇÕES DAS MANIFESTAÇÕES CLÍNICAS DA DOENÇA PULMONAR OBSTRUTIVA CRÔNICA: UMA REVISÃO INTEGRATIVA

This work aims to discuss and highlight the main clinical manifestations present in chronic obstructive pulmonary disease (COPD). The work is an integrative review, carried out through the search, in the PubMed database, of the following Descriptors in Health Sciences (DeCS): clinical; manifestations; chronic; obstructive; pulmonary; disease. Of the works found, only those published in 2023, until 08/31/2023, were selected, in which 30 articles were selected, 23 of which were excluded and 7 were analyzed for the production of the work. The clinical manifestations of COPD are multiple, with pulmonary manifestations (cough, throat clearing, shortness of breath) and extrapulmonary manifestations (anxiety and muscle weakness). From this information, it is important to make an overview of the main works on this subject to help in the therapeutic plan. Este trabalho tem o objetivo de debater e evidenciar as principais manifestações clínicas presentes na doença pulmonar obstrutiva crônica (DPOC). O trabalho trata-se de uma revisão integrativa, realizada através da busca, na base de dados PubMed, dos seguintes Descritores em Ciências da Saúde (DeCS): clinical; manifestations; chronic; obstructive; pulmonary; disease. Dos trabalhos encontrados foram selecionados apenas os publicados em 2023, até a data de 31/08/2023, em que foram selecionados 30 artigos, sendo que 23 foram excluídos e 7 foram analisados para a produção do trabalho. As manifestações clínicas da DPOC são múltiplas, possuindo manifestações pulmonares (tosse, pigarro, falta de ar) e extrapulmonares (ansiedade e fraqueza muscular), dessa forma o debate e conhecimento dessas manifestações é de extrema importância para o seguimento clínico e orientação do paciente. A partir destas informações, é importante que se faça um apanhado dos principais trabalhos acerca deste tema para o auxílio no plano terapêutico. &nbsp

The complete genome sequence of Chromobacterium violaceum reveals remarkable and exploitable bacterial adaptability

Chromobacterium violaceum is one of millions of species of free-living microorganisms that populate the soil and water in the extant areas of tropical biodiversity around the world. Its complete genome sequence reveals (i) extensive alternative pathways for energy generation, (ii) ≈500 ORFs for transport-related proteins, (iii) complex and extensive systems for stress adaptation and motility, and (iv) wide-spread utilization of quorum sensing for control of inducible systems, all of which underpin the versatility and adaptability of the organism. The genome also contains extensive but incomplete arrays of ORFs coding for proteins associated with mammalian pathogenicity, possibly involved in the occasional but often fatal cases of human C. violaceum infection. There is, in addition, a series of previously unknown but important enzymes and secondary metabolites including paraquat-inducible proteins, drug and heavy-metal-resistance proteins, multiple chitinases, and proteins for the detoxification of xenobiotics that may have biotechnological applications

Tissue Dopller a new paradigm in ventricular function assessment

Resum

Study of the Myocardial Contraction and Relaxation Velocities through Doppler Tissue Imaging Echocardiography: A New Alternative in the Assessment of the Segmental Ventricular Function

OBJECTIVE: Doppler tissue imaging (DTI) enables the study of the velocity of contraction and relaxation of myocardial segments. We established standards for the peak velocity of the different myocardial segments of the left ventricle in systole and diastole, and correlated them with the electrocardiogram. METHODS: We studied 35 healthy individuals (27 were male) with ages ranging from 12 to 59 years (32.9 ± 10.6). Systolic and diastolic peak velocities were assessed by Doppler tissue imaging in 12 segments of the left ventricle, establishing their mean values and the temporal correlation with the cardiac cycle. RESULTS: The means (and standard deviation) of the peak velocities in the basal, medial, and apical regions (of the septal, anterior, lateral, and posterior left ventricle walls) were respectively, in cm/s, 7.35(1.64), 5.26(1.88), and 3.33(1.58) in systole and 10.56(2.34), 7.92(2.37), and 3.98(1.64) in diastole. The mean time in which systolic peak velocity was recorded was 131.59ms (±19.12ms), and diastolic was 459.18ms (±18.13ms) based on the peak of the R wave of the electrocardiogram. CONCLUSION: In healthy individuals, maximum left ventricle segment velocities decreased from the bases to the ventricular apex, with certain proportionality between contraction and relaxation (P<0.05). The use of Doppler tissue imaging may be very helpful in detecting early alterations in ventricular contraction and relaxation