Taquicardia ventricular idiopatica fascicular : caracteristicas clinicas, eletrocardiograficas, eletrofisiologicas e opções terapeuticas

Orientador: Paulo Franco de OliveiraCo-orientador: Eduardo Argentino SosaDissertação (mestrado) - Universidade Federal do Parana, Setor de Ciencias da SaudeResumo:Foram estudados 8 pacientes, 4 homens, com idade entre 12 e 48 anos (média de 30 anos), portadores de taquicardia ventricular idiopática de ventrículo esquerdo - também chamada de fascicular ou verapamil sensitiva -, com o propósito de analisar as características clínicas, eletrocardiográficas, eletrofisiológicas - bem como outros exames complementares - e as opções terapêuticas com o respectivo seguimento clínico. As crises taquicárdicas foram do tipo paroxística sustentada em 6 pacientes e incessante em 2; bem toleradas em 6 pacientes e mal toleradas em 2. Em 2 pacientes a história clínica das crises taquicárdicas apresentou-se com evolução de 2 0 anos, e não ocorreram óbitos com seguimento ambulatorial de 48 meses, em média. 0 padrão morfológico da taquicardia foi de bloqueio completo de ramo direito, com desvio de eixo para a esquerda,em todos os pacientes,exceto em um,com desvio de eixo para a direita; a duração do complexo QRS foi 0,128, em média. Foram registradas ondas T negativas e simétricas na região ínfero-lateral do ventrículo esquerdo em 4 pacientes, nos quais o eletrocardiograma foi realizado logo após a interrupção de crises prolongadas de taquicardia, com regressão paulatina dessas alterações nos dias subseqüentes. Todos os pacientes apresentaram no estudo eletrofisiológico, ativação retrógrada do feixe de His, durante a taquicardia. No mapeamento através de pace-mapping, o foco arritmógeno foi localizado, em 3 pacientes, na região ínfero-apical do ventrículo esquerdo. Nesse local, durante ritmo sinusal, em 2 pacientes, foi observada a deflexão do fascículo pósteroinferior, sugerindo haver uma relação direta do foco arritmógeno com o tecido especializado de condução. Durante a estimulação programada, a indução e a interrupção da taquicardia - através de estimulação contínua e extra- -estímulos foi observada em 5 dos 6 pacientes portadores de taquicardia do tipo paroxística, sugerindo ser de caráter reentrante o mecanismo da arritmia. As crises taquicárdicas foram interrompidas com verapamil endovenoso em 7 dos 8 pacientes, sugerindo que o substrato arritmógeno apresenta área de condução lenta, mediada por canais de resposta lenta. Todos os pacientes foram tratados, inicialmente, com drogas antiarrítmicas, dos quais 4 permanecem sob tratamento clínico, bem controlados. Dos demais, 2 foram submetidos ã crio-ablação pós-ventriculotomia e os outros 2 submetidos ã fulguração, e permanecem sob acompanhamento ambulatorial, sem drogas e assintomáticos

Diabetic Macular Edema Characterization and Visualization Using Optical Coherence Tomography Images

Diabetic Retinopathy and Diabetic Macular Edema (DME) represent one of the main causes of blindness in developed countries. They are characterized by fluid deposits in the retinal layers, causing a progressive vision loss over the time. The clinical literature defines three DME types according to the texture and disposition of the fluid accumulations: Cystoid Macular Edema (CME), Diffuse Retinal Thickening (DRT) and Serous Retinal Detachment (SRD). Detecting each one is essential as, depending on their presence, the expert will decide on the adequate treatment of the pathology. In this work, we propose a robust detection and visualization methodology based on the analysis of independent image regions. We study a complete and heterogeneous library of 375 texture and intensity features in a dataset of 356 labeled images from two of the most used capture devices in the clinical domain: a CIRRUSTM HD-OCT 500 Carl Zeiss Meditec and 179 OCT images from a modular HRA + OCT SPECTRALIS(R) from Heidelberg Engineering, Inc. We extracted 33,810 samples for each type of DME for the feature analysis and incremental training of four different classifier paradigms. This way, we achieved an 84.04% average accuracy for CME, 78.44% average accuracy for DRT and 95.40% average accuracy for SRD. These models are used to generate an intuitive visualization of the fluid regions. We use an image sampling and voting strategy, resulting in a system capable of detecting and characterizing the three types of DME presenting them in an intuitive and repeatable way

Probing the reciprocal lattice associated with a triangular slit to determine the orbital angular momentum for a photon

The orbital angular momentum conservation of light reveals different diffraction patterns univocally dependent on the topological charge of the incident light beam when passing through a triangular aperture. It is demonstrated that these patterns, which are accessed by observing the far-field measurement of the diffracted light, can also be obtained using few photon sources. In order to explain the observed patterns, we introduce an analogy of this optical phenomenon with the study of diffraction for the characterization of the crystal structure of solids. We demonstrate that the finite pattern can be associated with the reciprocal lattice obtained from the direct lattice generated by the primitive vectors composing any two of the sides of the equilateral triangular slit responsible for the diffraction. Using the relation that exists between the direct and reciprocal lattices, we provide a conclusive explanation as to why the diffraction pattern of the main maxima is finite. This can shed a new light on the investigation of crystallographic systems

Effects of Euterpe oleracea Mart. (AÇAÍ) extract in acute lung inflammation induced by cigarette smoke in the mouse

AbstractShort term inhalation of cigarette smoke (CS) induces significant lung inflammation due to an imbalance of oxidant/antioxidant mechanisms. Açai fruit (Euterpe oleracea) has significant antioxidant and anti-inflammatory actions. The present study aimed to determine whether oral administration of an açai stone extract (ASE) could reduce lung inflammation induced by CS. Thirty C57BL/6 mice were assigned to three groups (n=10 each): the Control+A group was exposed to ambient air and treated orally with ASE 300mg/kg/day; the CS group was exposed to smoke from 6 cigarettes per day for 5 days; and the CS+A group was exposed to smoke from 6 cigarettes per day for 5 days and treated orally with ASE (300mg/kg/day). On day 6, all mice were sacrificed. After bronchoalveolar lavage, the lungs were removed for histological and biochemical analyses. The CS group exhibited increases in alveolar macrophage (AMs) and neutrophil numbers (PMNs), myeloperoxidase (MPO), superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase activities (GPx), TNF-α expression, and nitrites levels in lung tissue when compared with the control ones (p<0.001 for all parameters). The AMs, PMNs, MPO, SOD, CAT, GPx and nitrite were significantly reduced by oral administration of ASE when compared with CS group (p<0.001 for all parameters, with exception of AMs p<0.01). The present results suggested that systemic administration of an ASE extract could reduce the inflammatory and oxidant actions of CS. Thus, the results of this study in mice should stimulate future studies on ASE as a potential agent to protect against CS-induced inflammation in humans

Robust multi-view approaches for retinal layer segmentation in glaucoma patients via transfer learning

Background: Glaucoma is the leading global cause of irreversible blindness. Glaucoma patients experience a progressive deterioration of the retinal nervous tissues that begins with a loss of peripheral vision. An early diagnosis is essential in order to prevent blindness. Ophthalmologists measure the deterioration caused by this disease by assessing the retinal layers in different regions of the eye, using different optical coherence tomography (OCT) scanning patterns to extract images, generating different views from multiple parts of the retina. These images are used to measure the thickness of the retinal layers in different regions. Methods: We present two approaches for the multi-region segmentation of the retinal layers in OCT images of glaucoma patients. These approaches can extract the relevant anatomical structures for glaucoma assessment from three different OCT scan patterns: circumpapillary circle scans, macular cube scans and optic disc (OD) radial scans. By employing transfer learning to take advantage of the visual patterns present in a related domain, these approaches use state-of-the-art segmentation modules to achieve a robust, fully automatic segmentation of the retinal layers. The first approach exploits inter-view similarities by using a single module to segment all of the scan patterns, considering them as a single domain. The second approach uses view-specific modules for the segmentation of each scan pattern, automatically detecting the suitable module to analyse each image. Results: The proposed approaches produced satisfactory results with the first approach achieving a dice coefficient of 0.85±0.06 and the second one 0.87±0.08 for all segmented layers. The first approach produced the best results for the radial scans. Concurrently, the view-specific second approach achieved the best results for the better represented circle and cube scan patterns. Conclusions: To the extent of our knowledge, this is the first proposal in the literature for the multi-view segmentation of the retinal layers of glaucoma patients, demonstrating the applicability of machine learningbased systems for aiding in the diagnosis of this relevant pathology

Energy Estimation of Cosmic Rays with the Engineering Radio Array of the Pierre Auger Observatory

The Auger Engineering Radio Array (AERA) is part of the Pierre Auger Observatory and is used to detect the radio emission of cosmic-ray air showers. These observations are compared to the data of the surface detector stations of the Observatory, which provide well-calibrated information on the cosmic-ray energies and arrival directions. The response of the radio stations in the 30 to 80 MHz regime has been thoroughly calibrated to enable the reconstruction of the incoming electric field. For the latter, the energy deposit per area is determined from the radio pulses at each observer position and is interpolated using a two-dimensional function that takes into account signal asymmetries due to interference between the geomagnetic and charge-excess emission components. The spatial integral over the signal distribution gives a direct measurement of the energy transferred from the primary cosmic ray into radio emission in the AERA frequency range. We measure 15.8 MeV of radiation energy for a 1 EeV air shower arriving perpendicularly to the geomagnetic field. This radiation energy -- corrected for geometrical effects -- is used as a cosmic-ray energy estimator. Performing an absolute energy calibration against the surface-detector information, we observe that this radio-energy estimator scales quadratically with the cosmic-ray energy as expected for coherent emission. We find an energy resolution of the radio reconstruction of 22% for the data set and 17% for a high-quality subset containing only events with at least five radio stations with signal.Comment: Replaced with published version. Added journal reference and DO

Subacute Cognitive Impairment in Individuals With Mild and Moderate COVID-19: A Case Series

Background: Previous reported neurologic sequelae associated with SARS-CoV-2 infection have mainly been confined to hospital-based patients in which viral detection was restricted to nasal/throat swabs or to IgM/IgG peripheral blood serology. Here we describe seven cases from Brazil of outpatients with previous mild or moderate COVID-19 who developed subacute cognitive disturbances. Methods: From June 1 to August 15, 2020, seven individuals 18 to 60 years old, with confirmed mild/moderate COVID-19 and findings consistent with encephalopathy who were observed >7 days after respiratory symptom initiation, were screened for cognitive dysfunction. Paired sera and CSF were tested for SARS-CoV-2 (IgA, IgG ELISA, and RT-PCR). Serum and intrathecal antibody dynamics were evaluated with oligoclonal bands and IgG index. Cognitive dysfunction was assessed by the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and the Clock Drawing Test (CDT). Results: All but one of our patients were female, and the mean age was 42.6 years. Neurologic symptoms were first reported a median of 16 days (IQR 15–33) after initial COVID-19 symptoms. All patients had headache and altered behavior. Cognitive dysfunction was observed mainly in phonemic verbal fluency (MoCA) with a median of six words/min (IQR 5.25–10.75) and altered visuospatial construction with a median of four points (IQR 4–9) (CDT). CSF pleocytosis was not detected, and only one patient was positive for SARS-Co Conclusions: A subacute cognitive syndrome suggestive of SARS-CoV-2-initiated damage to cortico-subcortical associative pathways that could not be attributed solely to inflammation and hypoxia was present in seven individuals with mild/moderate COVID-19