Previous gestational diabetes is independently associated with increased carotid intima-media thickness, similarly to metabolic syndrome - a case control study.

BACKGROUND: Women with previous gestational diabetes mellitus (pGDM) face a higher risk of developing type 2 diabetes and, consequently, a higher cardiovascular risk. This study aimed to compare the carotid intima-media thickness (cIMT) from young women with pGDM to those with metabolic syndrome (MS) and to healthy controls (CG) to verify whether a past history of pGDM could be independently associated with increased cIMT. METHODS: This is a cross-sectional study performed in two academic referral centers. Seventy-nine women with pGDM, 30 women with MS, and 60 CG aged between 18 and 47 years were enrolled. They all underwent physical examination and had blood glucose, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol (LDLc), and triglycerides determined. The cIMT was measured by ultrasound in several carotid segments. The primary endpoint was cIMT and clinically relevant parameters included as predictors were: age, systolic blood pressure, waist, BMI, total cholesterol, LDLc, triglycerides, fasting glucose, previous history of GDM as a whole group, previous history of GDM without MS, presence of DM, presence of MS, and parity. RESULTS: cIMT was significantly higher in pGDM when compared to CG in all sites of measurements (P < 0.05) except for the right common carotid. The pGDM women showed similar cIMT measurements to MS in all sites of measurements, except for the left carotid bifurcation, where it was significantly higher than MS (P < 0.001). In a multivariate analysis which included classical cardiovascular risk factors and was adjusted for confounders, pGDM was shown to be independently associated with increased composite cIMT (P < 0.01). The pGDM without risk factors further showed similar cIMT to MS (P > 0.05) and an increased cIMT when compared to controls (P < 0.05). CONCLUSIONS: Previous GDM was independently associated with increased composite cIMT in this young population, similarly to those with MS and regardless the presence of established cardiovascular risk factors.

[Patient with chronic Chagas heart disease, hepatosplenic schistosomiasis and acquired immunodeficency syndrome: possible spontaneous resolution of thrombus in the right ventricle]. / Paciente com cardiopatia chagásica crônica, esquistossomose hepatoesplênica e síndrome da imunodeficiência adquirida: possível resolução espontânea de trombo no ventrículo direito.

The presence of right-sided cardiac thrombi seems to increase the risk of death due to thromboembolic events. There is a discrepancy, however, between the prevalence of cardiac thrombus and clinical thromboembolic events. Besides, the individual characteristics associated with a high risk of mortality have not been established. We present here a case report of a patient with mansonic schistosomiasis and acquired immunodeficiency syndrome and chronic Chagas disease, who presents with a large thrombus in the right ventricle. The patient had uneventful evolution without any thromboembolic complications with resolution of right-ventricle thrombus.

Paciente com cardiopatia chagásica crônica, esquistossomose hepatoesplênica e síndrome da imunodeficiência adquirida: possível resolução espontânea de trombo no ventrículo direito / Patient with chronic Chagas heart disease, hepatosplenic schistosomiasis and acquired immunodeficency syndrome: possible spontaneous resolution of thrombus in the right ventricle

A presença de trombos nas câmaras cardíacas direitas parece aumentar o risco de morte no tromboembolismo. Entretanto, existe discrepância entre a prevalência de trombos intracavitários cardíacos e evidências clínicas de tromboembolismo. Além disso, as características individuais associadas ao elevado risco de mortalidade não estão bem estabelecidas. Este relato descreve o caso de um paciente portador de esquistossomose mansônica, síndrome da imunodeficiência adquirida (SIDA) e doença de Chagas crônica, apresentando grande trombo no ventrículo direito. A evolução foi favorável, sem complicações tromboembólicas e com provável resolução espontânea do trombo.

The presence of right-sided cardiac thrombi seems to increase the risk of death due to thromboembolic events. There is a discrepancy, however, between the prevalence of cardiac thrombus and clinical thromboembolic events. Besides, the individual characteristics associated with a high risk of mortality have not been established. We present here a case report of a patient with mansonic schistosomiasis and acquired immunodeficiency syndrome and chronic Chagas disease, who presents with a large thrombus in the right ventricle. The patient had uneventful evolution without any thromboembolic complications with resolution of right-ventricle thrombus.

Inverted left atrial appendage presenting as a large left atrial mass.

Inverted left atrial appendage (ILAA) is a rare phenomenon. We describe a patient with mitral stenosis who presented with a homogenous mass in the left atrium, mimicking a large thrombus. The patient was sent to surgery and no thrombus was found; intraoperative examination by the surgeon revealed an ILAA. We briefly discuss the main features of this entity and also some aspects of the differential diagnosis.

Successful medical management of prosthetic-valve endocarditis complicated by perivalvular abscess.

We present a case of a 44-year-old man with prosthetic aortic endocarditis complicated by a perivalvular abscess. He evolved with improvement of the infectious process only under clinical treatment. The patient presented a prior history of rheumatic fever and had previously been undergone three valve replacements due to prosthesis dysfunction and previous endocarditis. In this case report we discuss the main features of perivalvular abscess complicating infective endocarditis.

Comparison between automated and manual measurements of carotid intima-media thickness in clinical practice.

BACKGROUND AND AIM: The measurement of carotid intima-media thickness (cIMT) has been used as a marker of arterial wall disease. Manual measurements have been performed in most epidemiological studies, but, due to the introduction of new technologies, automated software has been increasingly used. This study aimed to compare manual versus automated cIMT measurements in common carotid (CC), bifurcation (BIF), and internal carotid (IC). METHODS: Automated and manual cIMT measurements were performed online in 43 middle-aged females. Carotid segment measurements were compared by Bland-Altman plot and the variation and repeatability coefficients between observers were also determined for comparison. RESULTS: The average timespan for manual measurements (57.30 s) were significantly higher than for automated measurements (2.52 s). There were no systematic errors between methods in any carotid segments. The variation coefficient was 5.54% to 6.34% for CC and BIF, 9.76% for IC, and absolute differences were 85% below 0.1 mm and 70% below 0.05 mm. Interobserver agreement showed no systematic error. The variation and the repeatability coefficients were better for the automated than manual measures. CONCLUSION: Although both methods are reliable for cIMT measurements, the automated technique allows faster evaluation with lesser variability for all carotid segments currently used in atherosclerosis research.

Tratamento clínico de endocardite em prótese valvar complicada por abscesso para-protético / Successful medical management of prosthetic-valve endocarditis complicated by perivalvular abscess

O presente artigo relata o caso de um paciente do sexo masculino, 44 anos, com endocardite em prótese aórtica complicada por abscesso para-protético. Evoluiu com melhora do processo infeccioso apenas com o tratamento clínico. História prévia de doença reumática, submetido a três cirurgias cardíacas para troca valvar por disfunção de prótese e endocardite prévia. Neste relato de caso, discutiremos as características principais do abscesso para-protético como complicação de endocardite

We present a case of a 44-year-old man with prosthetic aortic endocarditis complicated by a perivalvular abscess. He evolved with improvement of the infectious process only under clinical treatment. The patient presented a prior history of rheumatic fever and had previously been undergone three valve replacements due to prosthesis dysfunction and previous endocarditis. In this case report we discuss the main features of perivalvular abscess complicating infective endocarditis

Resolução completa de grande trombo atrial móvel após anticoagulação / Complete resolution of large, mobile, atrial thrombus following anticoagulation therapy

Cardioversão de flutter atrial, em pacientes sem anticoagulação, constitui risco de tromboembolismo. Anticoagulação prolongada com warfarina, antes da cardioversão, produz evidente redução do risco de tromboembolismo relacionado à cardioversão. Acredita-se que o benefício da terapia anticoagulante seja a organização do trombo atrial. Entretanto, a evolução natural dos trombos não está bem definida. O caso a seguir descreve a presença de grande trombo em apêndice atrial esquerdo (AAE), em paciente com flutter atrial, que desapareceu completamente, após quatro semanas de anticoagulação, sem ocorrência de evento tromboembólico.

Piercing-related endocarditis presenting with multiple large masses in the right-side chamber of the heart.

We present a case report of a 15-year-old girl with right-side endocarditis, which presented with multiple large masses located on both right chambers mimicking the appearance of a tumor. There were no predisposing factors other than an infected navel piercing. Piercing-associated infective endocarditis has occasionally been reported, and usually occurs in patients with an underlying cardiac condition. We briefly discuss the main features of piercing-related endocarditis and also some aspects of cardiac tumors as differential diagnosis of large cardiac masses.