One Aneurysm and Two Pseudoaneurysms, Same Patient

Ventricular pseudoaneurysms are rare pathological entities that mainly arise in the context of myocardial infarction or post-cardiac surgery. The clinical presentation is usually non-specific, and at times patients are asymptomatic. Mortality is high even with timely surgical intervention.The authors present a case of postoperative recurrence of a left ventricular pseudoaneurysm superimposed on an ischaemic true aneurysm.info:eu-repo/semantics/publishedVersio

Transient neonatal hyperthyroidism

Graves’ disease is the main cause of hyperthyroidism in women of childbearing age. It occurs by the presence of serum immunoglobulins which stimulate the thyrotropin receptor (TRAbs) and may cross the placenta. It has serious consequences when uncontrolled, leading to fetal and/or neonatal hyperthyroidism or hypothyroidism. The authors describe the case of a newborn from a mother with poorly controlled Graves’ disease during pregnancy. He had an uneventful early neonatal period but developed hyperthyroidism in the second week of life. He was treated for two days with propranolol to manage tachycardia and metimazol during 4 months, with favourable clinical and laboratory outcome. During pregnancy, it is essential to control thyroid function and TRAbs in women with Graves’ disease. Newborns should be screened for thyroid function at birth and must have a regular follow up as it allows the diagnosis of transient hyperthyroidism or hypothyroidism and its early treatment, avoiding short and long term complications. Based on this case and literature review, the authors present a proposal of protocol in infants born to mothers with Graves’ disease

Score CRUSADE: será ainda um bom score para prever a hemorragia na síndrome coronária aguda?

Introduction: Major bleeding is a serious complication of acute coronary syndrome (ACS) andis associated with a worse prognosis. The CRUSADE bleeding score is used to stratify the risk ofmajor bleeding in ACS.Objective: To assess the predictive ability of the CRUSADE score in a contemporary ACS popu-lation.Methods: In a single-center retrospective study of 2818 patients admitted with ACS, the CRU-SADE score was calculated for each patient and its discrimination and goodness of fit wereassessed by the area under the receiver operating characteristic curve (AUC) and by the Hosmer-Lemeshow test, respectively. Predictors of in-hospital major bleeding (IHMB) were determined.Results: The IHMB rate was 1.8%, significantly lower than predicted by the CRUSADE score (7.1%,p<0.001). The incidence of IHMB was 0.5% in the very low risk category (rate predicted by thescore 3.1%), 1.5% in the low risk category (5.5%), 1.6% in the moderate risk category (8.6%),5.5% in the high risk category (11.9%), and 4.4% in the very high risk category (19.5%). Thepredictive ability of the CRUSADE score for IHMB was only moderate (AUC 0.73).The in-hospital mortality rate was 4.0%. Advanced age (p=0.027), femoral vascular access(p=0.004), higher heart rate (p=0.047) and ticagrelor use (p=0.027) were independent predictorsof IHMB.Conclusions: The CRUSADE score, although presenting some discriminatory power, significantlyoverestimated the IHMB rate, especially in patients at higher risk. These results questionwhether the CRUSADE score should continue to be used in the stratification of ACS.Introdução: A hemorragia major (HM) é uma complicação grave da síndrome coronária aguda (SCA) e está associada a pior prognóstico. O score CRUSADE permite estratificar o risco de HMna SCA.Objetivo: Avaliar a capacidade preditiva do score CRUSADE numa populac ̧ão contemporânea deSCA.Métodos: Estudo unicêntrico e retrospetivo com 2.818 doentes admitidos por SCA. O scoreCRUSADE foi calculado para cada doente, a sua discriminac ̧ão e calibrac ̧ão foram avaliadas pelaárea abaixo da curva (AUC) Receiver Operating Characteristic e pelo teste Hosmer-Lemeshow,respetivamente. Foram determinados os preditores de HM intra-hospitalar (HMIH).Resultados: A taxa de HMIH foi de 1.8%, valor significativamente inferior ao estimado peloscore CRUSADE (7,1%, p<0,001). A incidência de HMIH nas diferentes categorias foi de 0,5% nade muito baixo risco (taxa estimada pelo score de 3,1%); 1,5% na de baixo (estimada de 5,5%);1,6% na de moderado (estimada de 8,6%); 5,5% na de elevado (estimada de 11,9%) e 4,4% na demuito elevado (estimada de 19,5%). A capacidade preditora do score CRUSADE para HMIH foiapenas moderada (AUC 0,73). A taxa de mortalidade intra-hospitalar foi de 4,0%. A idade maisavanc ̧ada (p=0,027), o acesso vascular femoral (p=0,004), a frequência cardíaca mais elevada(p=0,047) e o ticagrelor (p=0,027) foram preditores independentes de HMIH.Conclusão: O score CRUSADE, apesar de apresentar algum poder discriminatório, sobrestimou de forma significativa a taxa de HMIH, principalmente nos doentes de maior risco. Esses resultados questionam se o score CRUSADE deverá continuar a ser usado na estratificação da SC

Modulating Effect of Cardiac Rehabilitation on Autonomic Nervous System Function in Patients with Coronary Artery Disease

info:eu-repo/semantics/publishedVersio

Scaling solutions from interacting fluids

We examine the dynamical implications of an interaction between some of the fluid components of the universe. We consider the combination of three matter components, one of which is a perfect fluid and the other two are interacting. The interaction term generalizes the cases found in scalar field cosmologies with an exponential potential. We find that attracting scaling solutions are obtained in several regions of parameter space, that oscillating behaviour is possible, and that new curvature scaling solutions exist. We also discuss the inflationary behaviour of the solutions and present some of the constraints on the strength of the coupling, namely those arising from nucleosynthesis.Comment: RevTeX, 21 pages, 8 figure

Reabilitação Cardíaca Após Síndrome Coronária Aguda. Deveremos Continuar a Reabilitar os Doentes de Baixo Risco? Experiência de um Centro

Introdução: A Reabilitação cardíaca (Rc) é um elemento fundamental na prevenção secundária após síndrome coronária aguda (ScA). A American Association of Cardiovascular and Pulmonary Rehabilitation (AAcPR)definiu critérios de estratificação de risco para os doentes elegíveis para programas de Rc. Contudo, tem sido questionada a integração de doentes de baixo risco em programas estruturados de treino de exercício. Objectivo: comparar o impacto da Rc nos doentes de baixo risco cardiovascular versus risco moderado/alto, segundo os critérios a AAcPR, de forma a avaliar o real benefício da Rc na capacidade de exercício nos doentes de baixo risco, quantificada por prova de esforço cardiorrespiratória (PecR). Métodos: Análise retrospetiva dos doentes submetidos a Rc após ScA e submetidos a PecR antes e após a integração num programa de treino de exercício supervisionado constituído por 36 sessões. Foram incluídos doentes desde janeiro de 2004 a dezembro de 2013, num centro Hospitalar Terciário. Os doentes foram divididos em dois grupos: grupo de risco cardiovascular baixo (GRB) e grupo de doentes com risco moderado a alto (GRMA) de acordo com os critérios da AAcPR. Os parâmetros avaliados na PecR foram: pico de consumo de oxigénio (pVO2), pVO2 em relação ao valor previsto para idade e género (%pVO2), declive da rampa do equivalente ventilatório de dióxido de carbono (Ve/VcO2slope), (Ve/VcO2slope)/pVO2 e potência circulatória de pico (PcP). Resultados: Foram incluídos em programa de Rc, pós ScA, 129 doentes, 86,0% do género masculino, com idade média de 56,3±9,8 anos. Setenta e nove doentes (61,3%) foram incluídos no grupo de baixo risco e 50 doentes (38,7%) no grupo de risco moderado a alto.Comparando os resultados da PecR basal verifica-se uma melhor capacidade funcional nos indivíduos de baixo risco (pVO2 26,7±7,0 versus 23,9±5,7 ml/kg/min; p=0,019). Esta diferença significativa desapareceu após a conclusão do programa de Rc, apresentando o GRB pVO2 final de 28,5±7,3ml/kg/min e o GRMA 27,0±7,0ml/kg/min (p=0,232). Ao confrontar os parâmetros da prova de esforço cardiorrespiratória prévios e após reabilitação cardíaca, verifica-se, em ambos os grupos, um aumento significativo da capacidade funcional expresso pelo aumento do pVO2, (Ve/VcO2slope)/pVO2, PcP e duração da prova. No entanto, apenas no grupo de baixo risco se evidencia uma diminuição signi-ficativa do Ve/VcO2 slope (26,7±6,2 versus 25,7±5,3; p=0,029). A amplitude da melhoria de pVO2 foi menos marcada no GRB (1,8±6,5 ml/kg/min versus 3,1±5,0 ml/kg/min; p=0.133). Um incremento no pVO2 superior a 10% em relação ao valor inicial foi atingido em 41,8% dos doentes no GRB e 58,0% dos doentes no GRMA (p=0,072). Conclusão: independentemente do grau de risco cardiovascular inicial, existe benefício na capacidade funcional de exercício após programa de Rc com 36 sessões de treino de exercício, objetivamente quantificado pelos parâmetros da PecR. No entanto, esta melhoria é mais acentuada nos indivíduos de risco moderado a alto comparativamente aos indivíduos de baixo risco. Atendendo à limitação de recursos, deverá ser privilegiada a inclusão de indivíduos de moderado e alto risco, não subvalorizando, no entanto, o benefício também alcançado pelos indivíduos de baixo risco cardiovascular

Solution generating in scalar-tensor theories with a massless scalar field and stiff perfect fluid as a source

We present a method for generating solutions in some scalar-tensor theories with a minimally coupled massless scalar field or irrotational stiff perfect fluid as a source. The method is based on the group of symmetries of the dilaton-matter sector in the Einstein frame. In the case of Barker's theory the dilaton-matter sector possesses SU(2) group of symmetries. In the case of Brans-Dicke and the theory with "conformal coupling", the dilaton- matter sector has $SL(2,R)$ as a group of symmetries. We describe an explicit algorithm for generating exact scalar-tensor solutions from solutions of Einstein-minimally-coupled-scalar-field equations by employing the nonlinear action of the symmetry group of the dilaton-matter sector. In the general case, when the Einstein frame dilaton-matter sector may not possess nontrivial symmetries we also present a solution generating technique which allows us to construct exact scalar-tensor solutions starting with the solutions of Einstein-minimally-coupled-scalar-field equations. As an illustration of the general techniques, examples of explicit exact solutions are constructed. In particular, we construct inhomogeneous cosmological scalar-tensor solutions whose curvature invariants are everywhere regular in space-time. A generalization of the method for scalar-tensor-Maxwell gravity is outlined.Comment: 10 pages,Revtex; v2 extended version, new parts added and some parts rewritten, results presented more concisely, some simple examples of homogeneous solutions replaced with new regular inhomogeneous solutions, typos corrected, references and acknowledgements added, accepted for publication in Phys.Rev.

The Portuguese Registry of Hypertrophic Cardiomyopathy: Overall results

INTRODUCTION: We report the results of the Portuguese Registry of Hypertrophic Cardiomyopathy, an initiative that reflects the current spectrum of cardiology centers throughout the territory of Portugal. METHODS: A direct invitation to participate was sent to cardiology departments. Baseline and outcome data were collected. RESULTS: A total of 29 centers participated and 1042 patients were recruited. Four centers recruited 49% of the patients, of whom 59% were male, and mean age at diagnosis was 53±16 years. Hypertrophic cardiomyopathy (HCM) was identified as familial in 33%. The major reason for diagnosis was symptoms (53%). HCM was obstructive in 35% of cases and genetic testing was performed in 51%. Invasive septal reduction therapy was offered to 8% (23% of obstructive patients). Most patients (84%) had an estimated five-year risk of sudden death of <6%. Thirteen percent received an implantable cardioverter-defibrillator. After a median follow-up of 3.3 years (interquartile range [P25-P75] 1.3-6.5 years), 31% were asymptomatic. All-cause mortality was 1.19%/year and cardiovascular mortality 0.65%/year. The incidence of heart failure-related death was 0.25%/year, of sudden cardiac death 0.22%/year and of stroke-related death 0.04%/year. Heart failure-related death plus heart transplantation occurred in 0.27%/year and sudden cardiac death plus equivalents occurred in 0.53%/year. CONCLUSIONS: Contemporary HCM in Portugal is characterized by relatively advanced age at diagnosis, and a high proportion of invasive treatment of obstructive forms. Long-term mortality is low; heart failure is the most common cause of death followed by sudden cardiac death. However, the burden of morbidity remains considerable, emphasizing the need for disease-specific treatments that impact the natural history of the disease

Inhomogeneous cosmologies, the Copernican principle and the cosmic microwave background: More on the EGS theorem

We discuss inhomogeneous cosmological models which satisfy the Copernican principle. We construct some inhomogeneous cosmological models starting from the ansatz that the all the observers in the models view an isotropic cosmic microwave background. We discuss multi-fluid models, and illustrate how more general inhomogeneous models may be derived, both in General Relativity and in scalar-tensor theories of gravity. Thus we illustrate that the cosmological principle, the assumption that the Universe we live in is spatially homogeneous, does not necessarily follow from the Copernican principle and the high isotropy of the cosmic microwave background.Comment: 17 pages; to appear in GR