Ponte miocárdica: revisão de literatura

A ponte miocárdica é uma anomalia congênita das artérias coronárias em que feixes de miocárdio envolvem um segmento de artéria coronária epicárdica, levando a compressão de um segmento na sístole ventricular, se revertendo na diástole. Ela constitui um dos principais diagnósticos diferenciais de doença arterial coronariana, podendo se manifestar como dor torácica, infarto agudo do miocárdio ou morte súbita, mas na maioria das vezes é assintomática. Sua fisiopatologia ainda é controversa. Seu diagnóstico clínico deve ser considerado em pacientes com dor no peito e sem fatores de risco para doenças cardiovasculares. Nos exames complementares, o achado mais comum na cineangiocoronariografia é a compressão de um segmento coronário durante a sístole, revertido na diástole. A conduta de primeira linha no tratamento da ponte miocárdica sintomática é o uso de medicamentos para reduzir sintomas de isquemia e minimizar o risco de futuros eventos cardíacos. Na persistência da sintomatologia ao tratamento clínico, a intervenção percutânea com o uso de stents ou o tratamento cirúrgico estão indicados. O prognóstico a longo prazo em geral é bom. Embora seja um achado anatômico geralmente assintomático, em raros casos pode causar complicações importantes, inclusive morte súbita. Portanto, a ponte miocárdia deve ser considerada em pacientes jovens, com baixo risco para doenças cardiovasculares e sem evidências de isquemia miocárdica, porém com dor torácica ou sintomas não condizentes com a severidade da doença arterial coronariana.The myocardial bridging is a congenital anomaly of the coronary arteries in which bundles of myocardial involve a segment of the epicardial coronary artery, leading to compression of a segment in the ventricular systole, reversing itself during diastole. It’s one of the main differential diagnosis of coronary artery disease and may manifest as chest pain, myocardial infarction or sudden death, but in most cases are asymptomatic. Its pathophysiology is still controversial. His clinical diagnosis should be considered in patients with chest pain and no risk factors for cardiovascular disease. In laboratory exams, the most common finding in coronary angiography is the compression of a coronary segment during systole, reversed during diastole. The first treatment of symptomatic myocardial bridging is medications to reduce symptoms of ischemia and minimize the risk of future cardiac events. In the persistence of clinical symptomatology, percutaneous intervention using stents or surgical treatment are types of threatment. The long-term prognosis is usually good. Although an anatomical finding is usually asymptomatic, in rare cases can cause major complications, including sudden death. Therefore, the myocardial bridge should be considered in young patients at low risk for cardiovascular disease and no evidence of myocardial ischemia, but with no chest pain or symptoms consistent with the severity of coronary artery disease

Cardiomiopatia de Takotsubo: Relato de Caso

Introdução: A cardiomiopatia de Takotsubo é uma doença cardiovascular com quadro clínico semelhante ao infarto agudo do miocárdio, porém com coronárias normais na cineangiocoronariografia.Caso Clínico: Mulher de 73 anos de idade, com manifestações clínicas de infarto agudo do miocárdio e alterações compatíveis com esta doença em exames complementares, porém sem obstrução na cineangiocoronariografia e com balonamento apical do ventrículo esquerdo na ventriculografia esquerda, corroborando com o diagnóstico de Cardiomiopatia de Takostubo. Neste caso, a paciente foi tratada com beta bloqueador, nitrato e antiagregante plaquetário. Sua evolução foi satisfatória, com o desaparecimento da dor torácica, sem sinais de insuficiência cardíaca e com restauração da função ventricular.Conclusão: O tratamento de suporte hemodinâmico instituído foi eficaz neste caso. Ressalta-se, com este trabalho e com a revisão de literatura, a importância desta doença, tanto no diagnóstico quanto no tratamento dessa enfermidade

PREVALÊNCIA DE MANIFESTAÇÕES ORAIS EM PACIENTES INFANTO-JUVENIS SUBMETIDOS À QUIMIOTERAPIA

Atualmente, 70% das crianças acometidas por câncer podem ser curadas, se diagnosticadas precocemente e tratadas em centros especializados. OBJETIVO: Registrar a prevalência das manifestações orais provocadas pela quimioterapia das doenças neoplásicas. METODOLOGIA: Foi realizado através de coleta de dados de prontuários de 162 pacientes que estiveram em tratamento quimioterápico, sendo 86 do sexo masculino e 76 do sexo feminino com idade entre 1 a 19 anos, e média de 8,39 anos (DP ± 4,81), onde foram observadas as principais manifestações orais como: mucosite, xerostomia, candidíase,e relacionadas com o gênero, idade, e tipo de tumor. RESULTADOS: As neoplasias mais encontradas foram as leucemias (35,8%), e as manifestações orais mais prevalentes foram a mucosite, candidíase e xerostomia, com índices de 37%; 6% e 6%, respectivamente. CONCLUSÕES: As leucemias foram as neoplasias que mais acometeram os pacientes

Predominance of Leishmania (Leishmania) amazonensis DNA in Lutzomyia longipalpis sand flies (Diptera: Psychodidae) from an endemic area for leishmaniasis in Northeastern Brazil

Leishmaniasis is a serious public health concern in the Northeastern region of Brazil, where the sand fly fauna is well studied, although few species have been identified as competent vectors. The detection of Leishmania spp. parasites in wild-caught sand flies could help sanitary authorities draw strategies to avoid the transmission of the parasites and, therefore, the incidence of leishmaniases. We detected Leishmania DNA in wild-caught sand flies and correlated that data with aspects of sand fly ecology in the Caxias municipality, Maranhao State, Brazil. The sand flies were sampled in the peridomicile (open areas in the vicinity of human residences) and intradomicile (inside the residences) from July/2019 to March/2020. Leishmania DNA was detected in females, targeting a fragment of the Internal Transcribed Spacer (ITS1) from ribosomal DNA. Among the fourteen species of sand flies identified, five (Lutzomyia longipalpis, Nyssomyia whitmani, Evandromyia evandroi, Micropygomyia trinidadensis, and Micropygomyia quinquefer) harbored DNA of Leishmania (Leishmania) amazonensis. The most abundant species in rural (Ny. whitmani: 35.2% and Ev. evandroi: 32.4%) and urban areas (Lu. longipalpis: 89.8%) are the permissive vectors of L. (L.) amazonensis, especially Ny. whitmani, a known vector of causative agents of cutaneous leishmaniasis. Although Lu. longipalpis is the vector of L. (L.) infantum, which was not detected in this study, its permissiveness for the transmission of L. (L.) amazonensis has been reported. We suspect that visceral leishmaniasis and cutaneous leishmaniasis are caused by L. (L.) amazonensis, and the transmission may be occurring through Lu. longipalpis, at least in the urban area

Periodontal conditions in Human Immunodeficiency Virus-positive patients under highly active antiretroviral therapy from a metropolitan area of Rio de Janeiro

Submitted by Janaína Nascimento ([email protected]) on 2019-02-06T11:52:47Z No. of bitstreams: 1 ve_Barreto_Luis_etal_INI_2016.pdf: 538578 bytes, checksum: 0e7f76f2ddd1ca57c79567f795fcdf7a (MD5)Approved for entry into archive by Janaína Nascimento ([email protected]) on 2019-02-11T11:19:52Z (GMT) No. of bitstreams: 1 ve_Barreto_Luis_etal_INI_2016.pdf: 538578 bytes, checksum: 0e7f76f2ddd1ca57c79567f795fcdf7a (MD5)Made available in DSpace on 2019-02-11T11:19:52Z (GMT). No. of bitstreams: 1 ve_Barreto_Luis_etal_INI_2016.pdf: 538578 bytes, checksum: 0e7f76f2ddd1ca57c79567f795fcdf7a (MD5) Previous issue date: 2016University of Grande Rio. Faculty of Dentistry. Department of Periodontics. Duque de Caxias, Rio de Janeiro, RJ, Brazil.University of Grande Rio. Faculty of Dentistry. Department of Periodontics. Duque de Caxias, Rio de Janeiro, RJ, Brazil.University of Grande Rio. Faculty of Medicine. Department of Infectious Disease. Duque de Caxias, Rio de Janeiro, RJ, Brazil.University of Grande Rio. Faculty of Medicine. Department of Infectious Disease. Duque de Caxias, Rio de Janeiro, RJ, Brazil / Oswaldo Cruz Foundation. National Institute of Infectology Evandro Chagas. Rio de Janeiro, RJ, Brazil.University of Grande Rio. Faculty of Dentistry. Department of Periodontics. Duque de Caxias, Rio de Janeiro, RJ, Brazil.University of Grande Rio. Faculty of Dentistry. Department of Periodontics. Duque de Caxias, Rio de Janeiro, RJ, Brazil.University of Grande Rio. Faculty of Dentistry. Department of Periodontics. Duque de Caxias, Rio de Janeiro, RJ, Brazil.University of Grande Rio. Faculty of Dentistry. Department of Periodontics. Duque de Caxias, Rio de Janeiro, RJ, Brazil.Federal University of Juiz de Fora. Department of Periodontics. Juiz de Fora, MG, Brazil.Background: The aim of this study is to evaluate the periodontal status and the presence of opportunistic oral lesions in human immunodeficiency virus–positive (HIV+) patients under highly active antiretroviral therapy (HAART) and their association with cluster of differentiation (CD)4+ and CD4+ nadir T-cell counts and viral load levels. Methods: Clinical periodontal parameters and the presence of opportunistic oral lesions along with records of CD4+ counts and viral load levels were evaluated in 29 individuals (16 females; mean age: 42.7 years) with previous serologic diagnosis of HIV, from the acquired immunodeficiency syndrome program of the Health Center of Duque de Caxias, Rio de Janeiro, Brazil. Results: All individuals presented gingivitis or periodontitis. A higher non-significant prevalence of periodontitis was found in smokers (93.8%) compared with non-smokers (76.9%). A significant weak positive correlation was observed between CD4+ counts and missing teeth (r = 0.380, P <0.05), CD4+nadir and periodontal diagnosis (r = 0.418, P <0.005), and CD4+ nadir and moderate probing depth (PD) (r = 0.424, P <0.05). When only non-smokers were analyzed, a significant moderate positive association was found between viral load and moderate clinical attachment level (CAL) (r = 0.638, P <0.05), CD4+ nadir and diagnosis (r = 0.586, P <0.05), and CD4+ nadir and moderate CAL (r = 0.680, P <0.05). Analysis considering only smokers found no correlations between serologic parameters and demographic or clinical parameters. Conclusions: The current investigation demonstrates that HIV+ individuals under HAART presents a high prevalence of mild to moderate periodontal disease. Viral load levels, CD4+ nadir, and CD4+ counts may present a weak to moderate correlation to the number of missing teeth, periodontal diagnosis, moderate PD, and moderate CAL, which may also reflect some effect of these systemic conditions on the periodontal status