Panorama de la ectasia coronaria en el Instituto Nacional de Cardiología Ignacio Chávez: un estudio transversal / Outlook of coronary ectasia at the National Institute of Cardiology Ignacio Chávez: a cross-sectional study

Resumen Introducción: La ectasia coronaria (EC) es una remodelación patológica con una prevalencia mundial baja. Se define como una dilatación difusa mayor a 1.5 veces el diámetro de los segmentos adyacentes de esta o diferentes arterias coronarias. Objetivo: Documentar las características clínicas y angiográficas, y el tratamiento médico que reciben los pacientes con diagnóstico de EC en el Instituto Nacional de Cardiología (INC). Métodos: Estudio de tipo transversal con diseño no experimental descriptivo, con un muestreo por conveniencia no probabilístico. Resultados: De 69 pacientes que asistieron al INC con diagnóstico de EC la mayor parte eran hombres, con una media de edad de 56 ± 11 años, el factor de riesgo coronario más común en los pacientes con EC fue el tabaquismo, en 40 (58%); se asoció un infarto agudo de miocardio con elevación del segmento ST (IAMCEST) en 45 (65.2%), de localización frecuente en la cara inferior 18 (40%), relacionado con la arteria más afectada, la coronaria derecha 48 (69.6%), seguida de la circunfleja 39 (56.5%). Destaca el uso preferente de la terapia antiplaquetaria dual con anticoagulante (APD+ACO) en 40 (58%) al egreso de cada paciente del INC. Conclusión: La EC es una remodelación patológica no infrecuente en el INC. En este estudio se evidenció que el SCA-IAMCEST es la manifestación más típica de la EC, la coronariografía diagnóstica identificó un Markis tipo 3, por lo que se esperaría una tasa baja de mortalidad y recurrencia de eventos cardiovasculares y a pesar de no existir un consenso sobre la terapia ideal, en el INC se prefiere el tratamiento individualizado, recomendando modificación en el estilo de vida y empleando como tratamiento médico el uso de la triple terapia (APD+ACO) solo al momento de egreso del paciente.

Abstract Introduction: Coronary Ectasia (CE) is a pathological remodeling with a low worldwide prevalence. It is defined as a diffuse dilatation greater than 1.5 times the diameter of the adjacent segments of the same or different coronary arteries. Objective: To document the clinical and angiographic characteristics, and medical treatment at the discharge of patients diagnosed with coronary ectasia who attended the National Institute of Cardiology (INC). Methods: Cross-sectional study with a non-experimental descriptive design, with a non-probabilistic convenience sampling. Results: Of 69 patients who attended the INC with a diagnosis of CD, most were men, with a mean age of 56 + 11 years, the most common coronary risk factor in patients with CE was smoking 58% (40); it was associated mostly with an acute myocardial infarction ST-segment elevation (STEMI) 65.2% (45), of frequent location in the lower face 40% (18), correlated with the most affected artery is the Right Coronary Artery (CD) 69.6% (48), followed by the circumflex (Cx) 56.5% (39). A mean LVEF of 47 + 9.72 was evident within the ventricular function. As well as the preferential use of dual antiplatelet therapy with anticoagulant (DAP + OAC) in 58% (40) at the discharge of each patient from the INC. Conclusion: CE is a not uncommon pathological remodeling in INC. This study showed that STEMI is the most typical manifestation of CE, diagnostic coronary angiography identified a type 3 Markis, so a low rate of mortality and recurrence of cardiovascular events would be expected, and despite the lack of consensus on the ideal therapy, at the INC individualized treatment is preferred, recommending lifestyle changes, and using triple therapy (DAP + OAC) as a medical treatment only at the time of patient discharge.

Crosslinking for post-laser-assisted in situ keratomileusis corneal ectasia: Transepithelial flap-on 30 minute and flap-lift 4 minute protocol

Purpose: To evaluate the outcomes of transepithelial corneal collagen crosslinking (CXL) for management of corneal ectasia after laser?assisted in situ keratomileusis (LASIK). Methods: CXL was performed on 18 eyes of 16 patients either with LASIK flap lift (n = 9; 365 nm, 30 mW/cm2, 4 minutes, pulse) or with transepithelial flap?on (n = 9 eyes; 365 nm, 3 mW/cm2, 30 minutes) technique. Postoperative change in maximum keratometry (Kmax), anterior elevation, posterior elevation, spherical equivalent (SE), logMAR uncorrected distance visual acuity (UDVA), aberrations, and central corneal thickness (CCT) were evaluated at 12 months postoperatively. Results: A total of 18 eyes of 16 patients (11 males, 5 females) were included. Overall, Kmax flattened more after flap?on CXL (P = 0.014) compared to flap?lift CXL. The endothelial cell density and posterior elevation were stable throughout the follow?up period. Index of vertical asymmetry (IVA), keratoconus index (KI), and central keratoconus index (CKI) decreased after flap?on CXL at 12 months, postoperatively (P < 0.05), whereas there were no statistically significant changes in these parameters after flap?off CXL group. The spherical aberrations and total root mean square decreased after flap?lift CXL at 12 months, postoperatively (P < 0.05). Conclusion: In our study, transepithelial collagen crosslinking was successfully used to halt disease progression in post?LASIK keratectasia. We recommend flap?on surgical technique for these cases

Prevalence and Predictors of Coronary Artery Ectasia among Delta Population

Background: Localized or widespread non-obstructive lesions of the epicardial coronary arteries, with a luminal dilatation 1.5 times that of the neighbouring normal segments or vessel diameter, have been identified as CAE. This research was performed to determine prevalence and predictors of CAE among Delta population in Egypt. Methods: This cross-sectional research was conducted on 2850 cases over the age of 18 who came for coronary angiography with positive non-invasive diagnostic tests, acute coronary syndrome and stable CAD. Cases were divided into two groups Group I: CAE cases (n =108) and Group II Non-ectasia cases (n =2742). All cases were subjected to history taking, clinical examination, laboratory investigations, standard 12-leads ECG, resting transthoracic echocardiography (TTE) and coronary angiography. Results: CAE occurred in 108 (3.79%) of the studied cases. Total cholesterol level, serum creatinine, were insignificantly different between both groups. CRP, NLR, MPV, and PLR, were significantly higher in CAE cases versus non-Ectasia cases CRP, NLR, PLR, and MPV is a good predicator for CAE, LVESD and LVEDD, were significantly higher in CAE group. Conclusions: The RCA was the most often affected coronary artery. The existence of CAE can be predicted using easily accessible clinical laboratory values such as CRP, Neutrophil to lymphocyte ratio, mean platelet volume, and platelet to lymphocyte ratio.

Coronary Artery Ectasia as a Predictor of Major Adverse Cardiac Events in Patients with Acute ST Elevation Myocardial Infarction

Background: Coronary artery ectasia (CAE) is characterised as localised or widespread non-obstructive lesions of the epicardial coronary arteries with a luminal dilation more than 1.5 times the neighbouring normal segments or vessel diameter. Isolated CAE is CAE in the absence of severe coronary artery stenosis. This aberrant dilatation of coronary arteries can produce angina pectoris and even myocardial infarction in people without coronary artery disease owing to vasospasm, dissection, or thrombus. The purpose of this study was to evaluate the connection between CAE and major adverse cardiac events (MACE) following acute myocardial infarction with ST elevation. Methods: This was a prospective cohort study which was carried out on 300 cases. Cases were divided into two groups: Group I: including about 22 STEMI cases with CAE and Group II: including about 278 STEMI cases without CAE. All cases in this study were subjected to full history taking, clinical examination, laboratory tests, standard 12-leads ECG, resting transthoracic echocardiography (TTE), and coronary angiography. Results: Regarding MACE in the studied groups, Incidence of reinfarction and cardiac death were significant higher in cases with STEMI and CAE than cases with STEMI alone. In univariate regression analysis, CAE (OR: 3.59, p value =0.022) was a significant predictor of cardiac death but age, male sex, and EF were not. Also, in multivariate regression analysis CAE (OR: 3.49, p value =0.029) was a significant predictor of cardiac death but age, male sex, and EF were not smoking with high warfarin consumption. Further, Markis classification 1 and 3 were the most frequent phenotype among cases. In STEMI cases, the incidence of reinfarction and cardiac death were significantly higher in cases with STEMI and CAE than cases with STEMI alone. So, CAE is a significant predictor of cardiac death.

Clinical efficacy evaluation of accelerated epithelium-off corneal collagen cross-linking on corneal ectasia after keratorefractive surgery / 中华实验眼科杂志

Objective:To investigate the efficacy and safety of accelerated epithelium-off corneal collagen cross-linking (CXL) in the treatment of corneal ectasia after keratorefractive surgery.Methods:An observational case series study was performed.Twelve patients (22 eyes) diagnosed with corneal ectasia after keratorefractive surgery in the First Affiliated Hospital of Army Medical University were enrolled from January 2016 to December 2018.All the patients received accelerated epithelium-off CXL and were followed up for 12 months.Before and 1 week, 1, 3, 6, and 12 months after the operation, the uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) converted to the logarithm of the minimum angle of resolution (LogMAR) unit were measured.The sphericity, cylindricity, and spherical equivalent were examined by Topcon auto refractor.The maximum keratometry (Kmax) of the front surface, mean keratometry (Km) of the front surface, Km of the back surface, symmetry index of front surface (SIf), symmetry index of back surface (SIb), thinnest corneal thickness (TCT), total aberrations, total high-order aberrations, coma aberration, trefoil aberration and spherical aberration were detected by the Sirius analyzer.The depth of corneal demarcation lines was determined by optical coherence tomography.The intraocular pressure was measured by the non-contact tonometry.The corneal endothelial cell density was assayed by the endothelial cell densitometry.The inflammatory reaction and haze were observed with a slit lamp at different time points after surgery.This study adhered to the Declaration of Helsinki.The study protocol was approved by the First Affiliated Hospital of Army Medical University (No.KY2020063). Written informed consent was obtained from each patient before entering the cohort.Results:Among the 22 eyes of 12 cases, 3 eyes of 2 cases (13.64%) underwent small incision lenticule extraction, and 19 eyes of 10 cases (86.36%) underwent excimer laser in situ keratomileusis.The UCVA (LogMAR), BCVA (LogMAR), cylindricity and spherical equivalent before the operation were 0.61±0.42, 0.24±0.23, (-2.83±2.39)D, (-3.60±2.66)D, which were significantly worse than 0.45±0.31, 0.12±0.15, (-2.11±1.67)D, (-3.12±2.31)D at 12 months after the operation ( t=4.054, 4.956, -3.728, -2.742; all at P<0.05). The front surface Kmax, front surface Km and SIf at 12 months after the operation were (48.37±5.80), (41.49±3.04), (5.36±4.07)D, which were significantly lower than (49.61±5.97), (41.66±2.97), (5.85±4.18)D before the operation ( t=5.949, 2.278, 2.719; all at P<0.05). There was no significant difference in sphericity, Km of the back surface, SIb, TCT, total aberrations, total high-order aberrations, coma aberration, trefoil aberration, spherical aberration, intraocular pressure and endothelial cell density between before and 12 months after the operation (all at P>0.05). Grade 0.5-2 haze occurred in 8 eyes of 4 patients one month postoperatively.After administration of prednisolone acetate eye drops, haze decreased or disappeared 3 months postoperatively, with UCVA and BCVA unchanged.A corneal demarcation line with a depth of (285.40±51.61)μm was found in 11 eyes of 6 cases at 1 month after operation. Conclusions:Accelerated epithelium-off CXL can significantly improve visual acuity, reduce corneal astigmatism and corneal curvature, as well as effectively prevent the progress of corneal ectasia.

Recent research on platelet-leukocyte aggregates and their role in the pathogenesis of Kawasaki disease / 中国当代儿科杂志

Activated platelets may interact with various types of leukocytes such as monocytes, neutrophils, dendritic cells, and lymphocytes, trigger intercellular signal transduction, and thus lead to thrombosis and synthesis of massive inflammatory mediators. Elevated levels of circulating platelet-leukocyte aggregates have been found in patients with thrombotic or inflammatory diseases. This article reviews the latest research on the formation, function, and detection methods of platelet-leukocyte aggregates and their role in the onset of Kawasaki disease, so as to provide new ideas for studying the pathogenesis of Kawasaki disease.

An Early Onset of Myocardial Infarction Patient with Syphilis and Familial Hypercholesterolemia / 罕见病研究

Syphilis may affect the cardiovascular system, in which coronary arteries are less commonly involved. Familial hypercholesterolemia (FH) is an autosomal dominant inherited disease with elevated low-density lipoprotein-cholesterol (LDL-C) levels due to impaired LDL-C clearance. We report a young male patient with syphilis and FH. The clinical manifestations were acute myocardial infarction and high LDL-C levels. Coronary angiography and intracoronary imaging showed multiple aneurysmal ectasia and stenosis. A drug-eluting stent was implemented when recurrent restenosis occurred after two percutaneous coronary drug-eluting balloon angioplasties.

Ectasia vascular antral gastrica (GAVE) / Gastric antral vascular ectasia (GAVE)

La ectasia vascular antral gástrica (GAVE) ha sido reconocida como una de las causas importantes de hemorragia gastrointestinal oculta y oscura. El diagnóstico generalmente se realiza en función de los rasgos endoscópicos característicos, incluida la fila longitudinal de rayas planas y rojizas que irradian desde el píloro hacia el antro que se asemejan a las rayas de una sandía (Watermelon). Estas apariencias, pueden ser fácilmente malinterpretadas como una gastritis de moderada a severa. El diagnóstico del síndrome GAVE en pacientes con enfermedad renal o hepática suele ser problemático porque hay causas más frecuentes de hemorragia gastrointestinal en estas enfermedades como, por ejemplo, malformaciones vasculares, enfermedad ulcerosa péptica, várices esofágicas o gástricas y úlceras colónicas y rectales que eclipsan al síndrome GAVE. Creemos que el tratamiento quirúrgico es una modalidad cuando los diferentes métodos, no pudieron tratar de solucionar esta patología del GAVE. Probablemente en nuestro medio necesitamos más sospecha clínica de esta patología, como así mismo mayor experiencia en los tratamientos endoscópicos de tipo terapéuticos. Ante la falla de estos métodos, la cirugía , ya sea laparoscópica o convencional siguen teniendo lugar en la resolución de estos pacientes con patología poco común.

Gastric antral vascular ectasia (Gave) has been recognized as one of the important causes of hidden and dark gastrointestinal hemorrhage. The diagnosis is generally performed based on the characteristic endoscopic features, including the longitudinal row of flat and reddish stripes that radiate from the pylorus to the antrum that resemble the stripes of a watermelon (watermelon). These appearances can be easily misunderstood as moderate to severe gastritis. The diagnosis of the Gave syndrome in patients with renal or hepatic disease is usually problematic because there are more frequent causes of gastrointestinal bleeding in these diseases such as vascular malformations, peptic ulcerative disease, esophageal or gastric veins and colonic and rectal ulcers that eclipsan al Gave syndrome. We believe that surgical treatment is a modality when the different methods could not try to solve this pathology of the Gave. Probably in our environment we need more clinical suspicion of this pathology, as well as more experience in therapeutic endoscopic treatments. Given the failure of these methods, surgery, whether laparoscopic or conventional continue to take place in the resolution of these patients with unusual pathology.

A Case Report of Successful Fibrinolysis in a Multiple Coronary Ectasia ST-segment Elevation Myocardial Infarction Validated by Coronary Angiography

Coronary artery ectasia (CAE) often presents in the form of an acute coronary syndrome (ACS) caused by slow blood flow leading to thrombus formation in ectatic coronary arteries. The usual approach is thrombectomy with intracoronary thrombolysis but often does not guarantee immediate blood flow. A 45-year-old male presented with anginal chest pain and was diagnosed with ST-segment elevation myocardial infarction (STEMI), managed Immediately with tissue plasminogen activator(t-PA) followed later with coronary angiography revealing diffused Multiple coronary ectasia MCEA with no identified culprit lesions afterward. The patient was followed up periodically, with favorable outcomes on daily aspirin, direct oral anticoagulant (DOAC), and guideline-directed medical therapy (GDMT) for coronary artery disease (CAD) and reduced ejection fraction heart failure (HF-rEF). This case management strategy was dictated by available resources at the time of presentation; however, it signifies the importance and favorable outcome of thrombolysis in CEA/STEMI patients. Future large-scale studies are required toward defining the duration as well as the choice of long-term anticoagulation.

Ectasia coronaria y miocardiopatía hipertrófica: una entidad infrecuente / Coronary artery ectasia and hypertrophic cardiomyopathy: case report

Resumen Se presenta el caso de un paciente de 54 años que consulta por angina de esfuerzo de 2 años de evolución en quien se identifica una dilatación ectásica del árbol coronario con lesiones ateroscleróticas críticas y miocardiopatía hipertrófica septal obstructiva. Una revisión bibliográfica revela que es una asociación infrecuente de la cual solo existen reportes de casos aislados.

Abstract We present the case of a 54-year-old patient who presented with a history of 2 years with angina. Invasive studies revealed critical coronary artery stenosis coexisting with obstructive hypertrophic miopathy. This is a rare association with only isolated case reports.

Translation and validation of the Portuguese version of the Keratoconus Outcomes Research Questionnaire (KORQ) / Tradução e validação do Keratoconus Outcomes Research Questionnaire (KORQ)

ABSTRACT Purpose: The purpose of this study is to translate and validate a Portuguese version of the Keratoconus Outcomes Research Questionnaire. The Keratoconus Outcomes Research Questionnaire is a psychometrically robust and valid instrument used to assess the impact of keratoconus on activity limitations and symptoms. Methods: We performed a translation, cross-cultural adaptation, and validation of the Portuguese version of the Keratoconus Outcomes Research Questionnaire. The initial translation of the English version to the Portuguese language was performed by two independent native speaker translators, followed by an interdisciplinary panel evaluation of the translated version. The Portuguese version was then back-translated into English by two independent native speakers, followed by evaluation and comparison with the original English version by the same interdisciplinary panel. For subsequent validation, the translated questionnaire was administered at two different times to a population of 30 subjects, and the results were compared in a concordance analysis. Results: The translation into Portuguese and back-translation were determined to be correct. Thirty participants were enrolled in the study (mean age, 29.23 ± 7.56 years). Nine questions (31%) had almost perfect agreement (questions 3, 4, 5, 8, 18, 22, 27, 28, and 29), 15 questions (51.7%) had substantial agreement (questions 1, 2, 6, 7, 9, 12, 14, 15, 16, 17, 20, 21, 23, 25, and 26), 4 questions (13.8%) had moderate agreement (questions 10, 11, 19, and 24) and 1 question (3.5%) had reasonable agreement (question 13). High-correlation coefficients were obtained when comparing results of the initial application and second application of this questionnaire to a sample of 30 individuals, which indicated excellent concordance with regard to results, repeatability, and reliability. Conclusions: This translated and validated questionnaire can be applied to a larger population with the intent to assess quality of life in keratoconus patients in the overall Brazilian population as well as in distinct regions of the country.

RESUMO Objetivo: Desenvolver a versão em Português do Keratoconus Outcomes Research Questionnaire (KORQ). O Keratoconus Outcomes Research Questionnaire é um instrumento psicometricamente válido e robusto para avaliação do impacto do ceratocone na limitação de atividades e sintomas. Métodos: Foi realizado no estudo a tradução, adaptação transcultural e validação em Português do Keratoconus Outcomes Research Questionnaire. A tradução inicial da versão em inglês para o idioma português foi realizada por dois tradutores de língua nativa inglesa independentes, seguida de uma avaliação interdisciplinar da versão traduzida. Após isso, a versão em Português foi traduzida novamente para o inglês por dois tradutores nativos de língua portuguesa independentes, seguida de avaliação e comparação com a versão original em inglês pelo mesmo painel interdisciplinar. Para a subsequente validação, o questionário traduzido foi aplicado em dois tempos diferentes em uma população de 30 indivíduos, e os resultados foram comparados em uma análise de concordância. Resultados: O processo de tradução para a língua portuguesa e tradução reversa do questionario Keratoconus Outcomes Research Questionnaire foi conduzido de maneira satisfatória. Trinta participantes foram incluídos no estudo (média idade, 29.23 ± 7.56 anos). Nove questões (31%) com concordância quase perfeita (questões 3, 4, 5, 8, 18, 22, 27, 28 e 29), cinco questões (51.7%) com concordância substancial (questões 1, 2, 6, 7, 9, 12, 14, 15, 16, 17, 20, 21, 23, 25 e 26), quatro questões (13.8%) com concordância moderada (questões 10, 11, 19 e 24) e uma questão (3.5%) com concordância razoável (questão 13). Os altos coeficientes de correlação obtidos ao comparar os resultados da aplicação inicial com a re-aplicação do questionário em uma amostra de 30 indivíduos indicam a excelente concordância em relação aos resultados, repetibilidade e confiabilidade. Conclusão: Esse questionário traduzido e validado pode ser aplicado em populações maiores com o objetivo de avaliar a qualidade de vida em pacientes com ceratocone na população brasileira em geral, assim como em regiões distintas do país.

Disección coronaria espontánea asociada a lupus eritematoso sistémico / Spontaneous coronary dissection associated with systemic lupus erythematosus

Resumen A 29 year old female with a past medical history of systemic lupus erythematosus, diagnosed 15 years earlier, presents with lupus nephritis, currently on peritoneal dialysis. She had myopericarditis in 2012 and is currently on immunosuppressants. The patient began with exertional dyspnea and angina 2 weeks before admission. An echocardiogram was performed, reporting severe mitral and tricuspid insufficiency. Afterwards, the patient presented with resting angina associated with an adrenergic and vagal response. Initially, rheumatology ruled out autoimmune activity caused by lupus. We performed a coronary angiogram based on clinical presentation, EKG changes and biomarkers, finding a trivascular coronary artery disease classified as a Markis I coronary artery ectasia and a coronary dissection of the ramus intermedius and the circumflex, posterior to the first obtuse marginal artery. Cardiothoracic surgery considered intervention with a coronary bridge posterior to the dissection of the intermedius ramus artery, marginal obtuse and posterolateral artery, as well as a mitral valve replacement and a tricuspid valve repair. Coronary dissection is more common in women (70%), clinical presentation varies from unstable angina to sudden death. In lupus nephritis, it is an uncommon form of extra renal vasculitis. Treatment depends on the number of arteries affected, as well as the haemodynamic state of the patient. It is imperative to individualize treatment options.

Abstract Se presenta el caso de una paciente de 29 años con antecedente de lupus eritematoso sistémico diagnosticado 15 años antes, que desarrolló nefropatía lúpica actualmente en diálisis peritoneal, cuadro de miopericarditis en 2012 y bajo tratamiento inmunosupresor. Inició con deterioro de su clase funcional por disnea y angina 2 semanas previas al ingreso. Se le realizó ecocardiograma, el cual reportó insuficiencias mitral y tricuspídea graves. Posteriormente presentó angina en reposo asociada a descarga adrenérgica y vagal. A su ingreso se descarta actividad lúpica por reumatología. Por presentación clínica, cambios en electrocardiograma y biomarcadores, se realizó cateterismo cardiaco, que reportó enfermedad coronaria trivascular con ectasia coronaria Markis I y disección coronaria de ramo intermedio y circunfleja posterior a la primera marginal obtusa. Se consideró por el servicio de cirugía cardiotorácica realizar intervención con puente coronario posterior a disección del ramo intermedio, marginal obtusa y posterolateral, así como cambio valvular mitral y plastia tricuspídea. La disección coronaria espontánea es más frecuente en las mujeres (70%); puede presentarse como angina inestable y hasta como muerte súbita. La asociación con lupus eritematoso sistémico es poco frecuente, con una incidencia del 0.42%. En la nefropatía lúpica es una manifestación poco frecuente de vasculitis extrarrenal. El tratamiento de elección depende del número de vasos afectados y del estado hemodinámico, por lo que es necesario individualizarlo para cada paciente.

Caracterização de ectasia subclínica com análise integrada da tomografia e biomecânica da córnea / Characterization of subclinical ectasia with integrated corneal tomography and biomechanics assessments

RESUMO O artigo tem como objetivo descrever de forma prospectiva diferentes casos de ectasias altamente assimétricas (very asymmetric ectasia, VAE) para diferenciar formas subclínicas ou "frustas" do ceratocone (forme fruste keratoconus - FFKC) de casos de doença ectásica unilateral. O Caso 1 é um paciente de 39 anos, que admitiu ter coçado intensamente apenas o olho direito (OD) na juventude, se apresentando com ectasia unilateral tratada com sucesso por meio de implante de anel intraestromal em OD. O olho esquerdo (OE) apresentou-se normal ao exame completo por meio de propedêutica multimodal e acuidade visual não corrigida (AVsc) de 20/20, estável por mais de 5 anos, com TBI (tomography and biomechanical index) de 0.02. No Caso 2 é um paciente de 15 anos com ectasia clínica em OD, e OE com topografia normal, mas alterações tomográficas e biomecânicas, incluindo o TBI 0,56, caracterizarando a doença subclínica (FFKC). O Caso 3 é a mãe do paciente do Caso 2, de 46 anos, que se apresentou com presbiopia, sem qualquer histórico oftalmológico relevante. A AVsc foi de 20/20 em cada olho, topografia de Placido com leve encurvamento inferior, mas sem sinais definitivos de ectasia. A avaliação biomecânica e tomográfica revelou sinais de ceratocone em ambos os olhos, com TBI de 1,0 e 0,99. Esses três casos estão de acordo com a definição do consenso global e a hipótese de dois acertos (two-hit hypothesis), que ceratocone é uma doença bilateral, mas ectasia pode ocorrer por causa estritamente mecânica unilateralmente (ou em qualquer olho). A relevância da propedêutica multimodal é destacada, destacando-se a integração do estudo biomecânico e tomográfico com imagens de Scheimpflug.

ABSTRACT The article aims to prospectively describe different cases of highly asymmetric ectasia (very asymmetric ectasia, VAE) to differentiate subclinical or "frustrated" forms of keratoconus (forme fruste keratoconus - FFKC) from cases of unilateral ectatic disease. Case 1 is a 39-year-old patient with unilateral ectasia treated with an intrastromal ring implant. The contralateral eye was normal due to multimodal propaedeutics, stable for more than 3 years, with a TBI of 0.02. The patient admitted to having intensely scratched only his right eye in his youth. In Case 2, a 15-year-old patient with clinical ectasia in the right eye, had a left eye with normal topography and tomographic and biomechanical changes characterizing FFKC. Case 3 is the mother of the case 2 patient, aged 46, who presented with presbyopia, without any relevant ophthalmological history. Uncorrected visual acuity of 20/20 in each eye, Placido topography with slight lower curving, but without definitive signs of ectasia. The biomechanical and tomographic evaluation revealed signs of keratoconus in both eyes. These three cases are in accordance with the definition of the global consensus: keratoconus is a bilateral disease, but ectasia can occur because of strictly mechanical unilateral (in any eye). The relevance of multimodal refractive imaging is highlighted, with a focus on integrating biomechanical and tomographic assessments with Scheimpflug images.

Laser topoguiado como tratamento de ectasia pós lasik / Topoguided laser as treatment of ectasia after lasik

RESUMO O laser in situ keratomileusis (LASIK) é o método cirúrgico refrativo mais realizado no mundo com excelentes resultados, porém tal método não é isento de riscos. A ectasia pós LASIK é uma complicação grave e se caracteriza por um aumento progressivo da curvatura e afinamento da córnea, resultando em astigmatismo irregular e diminuição da acuidade visual. Sua incidência na literatura atual é de aproximadamente 0,033%. O principal tratamento dessa complicação é o implante de anel intra-estromal com cross-linking. Neste artigo descrevemos um caso de uma mulher de 45 anos submetida a sucessivas tentativas de tratamento de ectasia pós LASIK, com implante de anel intra-estromal bilateral, sem sucesso em um dos olhos. Foi feito o uso do excimer laser topoguiado através do photorefractive keratectomy (PRK) sem o cross-linking, que optamos por não realizar pela estabilidade há anos, pelo risco alto de haze e pela ablação apenas na lamela (que era espessa).A paciente obteve melhorasignificativa da visão e da qualidade de vida. Mantemos o acompanhamento a cada seis meses desde então com a tomografia da córnea.

ABSTRACT The laser in situ keratomileusis (LASIK) is the most widely used refractory surgical method in the world with excellent results, but this method is not without risks. Post-LASIK ectasia is a serious complication and is characterized by a progressive increase in curvature and thinning of the cornea, resulting in irregular astigmatism and decreasing visual acuity. Its incidence in the current literature is approximately 0.033%. The main treatment for this complication is the implantation of an intra-stromal ring with crosslinking. In this article, we describe a case of a 45-year-old woman who underwent successive attempts to treat post-LASIK ectasia, with bilateral intra-stromal ring implantation, with no success in the eyes. Excimer laser was used, made through photorefractive keratectomy (PRK) without cross-linking and the patient obtained significant improvement in vision and in quality of life.

A Associação da Relação Proteína C-Reativa/Albumina em Pacientes com Ectasia da Artéria Coronária Isolada / Association of C-Reactive Protein to Albumin Ratio in Patients with Isolated Coronary Artery Ectasia

Resumo Fundamento A ectasia da artéria coronária (EAC) é definida como a dilatação difusa ou localizada do lúmen da artéria coronária com diâmetro de 1,5 a 2,0 vezes o diâmetro da artéria coronária normal adjacente. A relação proteína C-reativa/albumina (CAR, sigla em inglês) é um marcador inflamatório útil que tem sido documentado em doença arterial coronariana. Objetivo Analisar a associação entre a EAC e a CAR. Métodos Um protocolo caso-controle foi utilizado neste estudo. Foram incluídos 102 pacientesconsecutivos com EAC isolada sem estenose (56 homens e 46 mulheres; idade média de 60,4 ± 8,8 anos). O grupo controle era constituido pelo mesmo número de pacientes pareados por sexo e idade com artérias coronárias normais (55 homens e 47 mulheres; idade média de 61,2 ± 9,1 anos). Características clínicas, achados laboratoriais e histórico de uso de medicamentos foram registrados. Foram realizados teste t de Student, teste U de Mann-Whitney, teste do qui-quadrado, análise de regressão linear e logística. Foi considerado estatisticamente significativo p bilateral < 0,05. Resultados A CAR estava aumentada nos pacientes com EAC em comparação com os controles (32 e 16; p < 0,001). Além disso, foi verificado que a CAR era um preditor independente da EAC (razão de chances = 2,202; intervalo de confiança 95%, 1,184 - 5,365; p < 0,001). Conclusão No presente estudo, determinamos que os níveis da CAR estavam significativamente mais altos no grupo EAC que no grupo controle e a CAR estava significativamente correlacionada com a EAC. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Abstract Background Coronary artery ectasia (CAE) is defined as diffuse or localized dilatation of coronary artery lumen with a diameter of 1.5 to 2.0 times the adjacent normal coronary artery. The C-reactive protein to albumin ratio (CAR) is a useful inflammatory marker, which has been documented in coronary artery disease. Objective To analyze the association of CAE and CAR. Methods A case-control protocol was used in this study. We included 102 consecutive patients with isolated CAE without stenosis (56 men and 46 women; mean age 60.4 ± 8.8 years). The control subjects consisted of an equal number of sex and age matched patients with normal coronary arteries (55 men and 47 women; mean age 61.2 ± 9.1 years). Clinical features, laboratory findings, and medication use history were recorded. Student's t test, Mann-Whitney U test, chi-square test, and linear and logistic regression analysis were performed. A 2-sided p < 0.05 was statistically considered significant. Results The CAR was increased in patients with CAE compared to the controls (32 and 16; p < 0.001). In addition, the CAR was found to be an independent predictor of CAE (OR = 2.202; 95% CI 1.184 - 5.365; p < 0.001). Conclusion In the present study, we determined that CAR levels were significantly higher in the CAE group than in the control group, and the CAR was significantly correlated with CAE. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Infarto agudo de miocardio secundario a enfermedad coronaria ectásica y agenesia de la arteria coronaria derecha / Acute myocardial infarction secondary to coronary artery ectasia and right coronary artery agenes

Se presenta el caso de un paciente de sexo masculino de 42 años de edad que cursa con episodio de infarto agudo del miocardio sin elevación del segmento ST, en quien se documenta enfermedad coronaria ectásica moderada a grave y como hallazgo incidental agenesia de la arteria coronaria derecha, entidad poco frecuente. Se realiza una revisión de los aspectos más relevantes de la literatura en ectasia coronaria y una breve descripción del hallazgo incidental.

Herein, we report a 42-year-old male patient with acute myocardial infarction presenting without ST-segment elevation. Moderate to severe coronary ectasia was documented, and a rare case of right coronary artery agenesis was incidentally detected. A literature review on the most relevant aspects of coronary ectasia and a brief description of the incidental finding were conducte.

Curative effects of bipolar electrocoagulation for gastric antral vascular ectasia (with video) / 中华消化内镜杂志

To evaluate the efficacy and feasibility of bipolar electrocoagulation in the treatment of gastric antral vascular ectasia(GAVE). Six patients with GAVE who underwent gastroscopy and bipolar electrocoagulation between January 2018 and December 2019 in the Affiliated Hospital of Medical School of Ningbo University were included in the study.The operation and clinical response were observed. All the 6 patients underwent bipolar electrocoagulation successfully. The mean operation time was 32 min (range 25-45 min). Mean number of sessions required for eradication of GAVE was 1.17. No severe complications related to endoscopic treatment occurred. There was no recurrence of GAVE at a mean time of 10.8 months (range 2-25 months) of follow-up. Stabilization of hemoglobin levels and decrease in blood transfusion requirements along with endoscopically complete or near-complete eradication of GAVE were observed in all patients during the follow-up.Bipolar electrocoagulation in the treatment of GAVE is effective, safe, and simple.

Diagnóstico do ceratocone: um artigo de revisão / A review of keratoconus diagnosis

Resumo Objetivo: Realizar uma revisão sobre o diagnóstico do ceratocone, com enfoque nos métodos propedêuticos disponíveis. Métodos: Foi realizada uma pesquisa no banco de dados PubMed com as palavras chave: Keratoconus, diagnosis, topography e tomography. Por se tratar de uma revisão, não houve restrição de período para a publicação dos artigos selecionados. Foram também utilizados o manual Prefered Practice Pattern(PPP) da academia americana de oftalmologia, assim como o site "eyewiki.aao.org". Resultados: Dos 641 artigos encontrados no PubMed, assim como os usados como referência para o PPP, 36 foram selecionados por serem considerados mais relevantes para o tema proposto. O site "eyewiki.aao.org" foi utilizado como referência para as figuras. Conclusão: O diagnóstico do ceratocone evoluiu consideravelmente desde quando foi primeiramente descrito. É desejável que seja feito em suas fases precoces devido ao alto potencial de morbidade desta doença. Uma possível integração entre os múltiplos índices diagnósticos, investigação genética, biologia molecular e inteligência artificial é almejado para uma maior acurácia diagnóstica.

Abstract Objective: To Perform a review on the diagnosis of keratoconus, focusing on the available propaedeutic methods. Methods: A search was performed in the PubMed database using the key words: Keratoconus, diagnosis, topography and tomography. As it is a review, there was no restriction regarding the publication period of the selected articles. Furthermore, both the preferred practice pattern(PPP) manual of the American Academy of Ophthalmology, as well as the website "eyewiki.aao.org" were used as reference. The project was submitted to the research ethics committee of the Federal University of São Paulo / UNIFESP / SP 2018 (# 2,568,770). Results: Out of the 641 papers found in PubMed, in adition to those used as a reference for PPP, 36 were selected while considered more relevant to the adopted theme. The website "eyewiki.aao.org" was used as a reference for the images. Conclusion: The diagnosis of keratoconus has evolved considerably since it was first described. It is desirable to diagnose it on the early stages due to its high potential of morbility. A possibility of an integration between the various diagnostic indices, genetic research, molecular biology and artificial intelligence is recommended for greater diagnostic accuracy.

Corneal suture for acute corneal hydrops secondary to post-LASIK ectasia: a case report / Sutura corneana em hidrópsia aguda secundária à ectasia pós LASIK: relato de caso

ABSTRACT Corneal ectasia is one of the main complications of keratorefractive procedures. In this report, we describe a case of corneal ectasia after laser-assisted in situ keratomileusis), which progressed with acute hydrops and aqueous leakage and required a suture for correction.

RESUMO A ectasia corneana é uma das principais complicações das cirurgias refrativas. Neste caso, descrevemos um caso de ectasia corneana induzida por laser-assisted in situ keratomileusis, que evoluiu com hidrópsia aguda e extravasamento de humor aquoso, necessitando de sutura corneana.

Enfermedad aneurismática coronaria / Coronary aneurysm disease

Resumen La enfermedad aneurismática coronaria se define como la dilatación de un segmento arterial coronario más 1,5 veces el diámetro de las arterias adyacentes de tamaño normal. Puede ser difusa, y afectar todo el trayecto de la arteria, o localizada y afectar sólo un segmento arterial específico. Puede encontrarse entre un 3 a un 8% de los estudios angiográficos y entre un 0,22% a un 1,4% de las necropsias clínicas. Se presenta 3 reportes de casos, donde la presentación clínica, los hallazgos angiográficos y el manejo farmacológico es diverso como corresponde a esta entidad.

Abstract Coronary aneurysm disease is defined as the dilation of a coronary artery segment more than 1.5 times the diameter of the adjacent arteries of normal size. It may be diffuse, and affect the whole trajectory of the artery, or localised and only affect a specific arterial segment. It can be found in between 3% and 8% of angiograph studies, with between 0.22% and 1.4% in clinical post-mortems. Three case reports are presented in which the clinical presentation, the angiographic findings, and the pharmacological management are shown to be as diverse as this condition itself.