Trombosis valvular gigante

63-year-old male with a medical history of coronary artery bypass and mitral valve mechanic prosthesis. He was evaluated in the emergency department due to cerebrovascular stroke. An echocardiogram was performed, there was a mass in the mitral valve prosthesis; thrombus formation. Albeit anticoagulation with unfractionated heparin the patient had rapid thrombus progression, therefore surgical valve replacement was performed. Post-operative echocardiogram showed, good opening of the mitral discs, a mean gradient of 4-5 mmHg and physiologic intraprosthetic regurgitation.Se presenta el caso de un hombre de 63 años con antecedentes de cardiopatía isquémica intervenida, portador de prótesis mecánica mitral, que acude a urgencias por focalidad neurológica. En la ecocardiografía se observa una masa sobre válvula mitral protésica que sugiere la presencia de un trombo protésico. Se inicia anticoagulación con heparina sódica y, ante una evolución desfavorable (el trombo crece), se decide optar por el recambio de la válvula protésica. Tras la intervención se observa en la ecocardiografía de control una prótesis mitral con buena apertura de discos, gradiente medio de 4-5 mmHg y mínima regurgitación intraprotésica

Fibroelastoma en el ventrículo izquierdo: un hallazgo muy poco frecuente

The evaluation of cardiac masses is a relatively frequent clinical problem for cardiac imaging techniques. We present the case of a cardiac mass with an unusual location in which imaging techniques made it possible to guide the diagnosis, which, how could it be otherwise, was confirmed in surgery.La valoración de las masas cardíacas es un problema clínico relativamente frecuente para las técnicas de imagen cardíca. Presentamos el caso de una masa cardíaca con localización inusual en el que las técnicas de imagen permitieron orientar el diagnóstico, que como no puede ser de otro modo, se confirmó en la cirugía

Global impacts of Covid-19 on lifestyles and health and preparation preferences: an international survey of 30 countries

Background: The health area being greatest impacted by coronavirus disease 2019 (COVID-19) and residents' perspective to better prepare for future pandemic remain unknown. We aimed to assess and make cross-country and cross-region comparisons of the global impacts of COVID-19 and preparation preferences of pandemic. Methods: We recruited adults in 30 countries covering all World Health Organization (WHO) regions from July 2020 to August 2021. 5 Likert-point scales were used to measure their perceived change in 32 aspects due to COVID-19 (-2 = substantially reduced to 2 = substantially increased) and perceived importance of 13 preparations (1 = not important to 5 = extremely important). Samples were stratified by age and gender in the corresponding countries. Multidimensional preference analysis displays disparities between 30 countries, WHO regions, economic development levels, and COVID-19 severity levels. Results: 16 512 adults participated, with 10 351 females. Among 32 aspects of impact, the most affected were having a meal at home (mean (m) = 0.84, standard error (SE) = 0.01), cooking at home (m = 0.78, SE = 0.01), social activities (m = -0.68, SE = 0.01), duration of screen time (m = 0.67, SE = 0.01), and duration of sitting (m = 0.59, SE = 0.01). Alcohol (m = -0.36, SE = 0.01) and tobacco (m = -0.38, SE = 0.01) consumption declined moderately. Among 13 preparations, respondents rated medicine delivery (m = 3.50, SE = 0.01), getting prescribed medicine in a hospital visit / follow-up in a community pharmacy (m = 3.37, SE = 0.01), and online shopping (m = 3.33, SE = 0.02) as the most important. The multidimensional preference analysis showed the European Region, Region of the Americas, Western Pacific Region and countries with a high-income level or medium to high COVID-19 severity were more adversely impacted on sitting and screen time duration and social activities, whereas other regions and countries experienced more cooking and eating at home. Countries with a high-income level or medium to high COVID-19 severity reported higher perceived mental burden and emotional distress. Except for low- and lower-middle-income countries, medicine delivery was always prioritised. Conclusions: Global increasing sitting and screen time and limiting social activities deserve as much attention as mental health. Besides, the pandemic has ushered in a notable enhancement in lifestyle of home cooking and eating, while simultaneously reducing the consumption of tobacco and alcohol. A health care system and technological infrastructure that facilitate medicine delivery, medicine prescription, and online shopping are priorities for coping with future pandemics

Key lifestyles and interim health outcomes for effective interventions in general populations: A network analysis of a large international observational study

Background The interconnected nature of lifestyles and interim health outcomes implies the presence of the central lifestyle, central interim health outcome and bridge lifestyle, which are yet to be determined. Modifying these factors holds immense potential for substantial positive changes across all aspects of health and lifestyles. We aimed to identify these factors from a pool of 18 lifestyle factors and 13 interim health outcomes while investigating potential gender and occupation differences. Methods An international cross-sectional study was conducted in 30 countries across six World Health Organization regions from July 2020 to August 2021, with 16 512 adults self-reporting changes in 18 lifestyle factors and 13 interim health outcomes since the pandemic. Results Three networks were computed and tested. The central variables decided by the expected influence centrality were consumption of fruits and vegetables (centrality = 0.98) jointly with less sugary drinks (centrality = 0.93) in the lifestyles network; and quality of life (centrality = 1.00) co-dominant (centrality = 1.00) with less emotional distress in the interim health outcomes network. The overall amount of exercise had the highest bridge expected influence centrality in the bridge network (centrality = 0.51). No significant differences were found in the network global strength or the centrality of the aforementioned key variables within each network between males and females or health workers and non-health workers (all P-values >0.05 after Holm-Bonferroni correction). Conclusions Consumption of fruits and vegetables, sugary drinks, quality of life, emotional distress, and the overall amount of exercise are key intervention components for improving overall lifestyle, overall health and overall health via lifestyle in the general population, respectively. Although modifications are needed for all aspects of lifestyle and interim health outcomes, a larger allocation of resources and more intensive interventions were recommended for these key variables to produce the most cost-effective improvements in lifestyles and health, regardless of gender or occupation