Hemangioma of the mitral valve: Following the murmur.

Cardiac hemangiomas are an exceedingly rare condition, with about 100 cases described in the literature, of which only 13 were valvular. We report the case of a 66-year-old woman, with no prior cardiovascular disease, who presented with an abdominal infection caused by Enterococcus faecalis, complicated by recrudescent fever and new-onset systolic mitral murmur. The transesophageal echocardiogram revealed a large vegetation on the posterior leaflet of the mitral valve, with a high embolic risk, leading to a diagnosis of acute endocarditis. The patient began antibiotics, with no clinical improvement, developing severe heart failure and coronary and cerebrovascular embolic phenomena, and underwent excision of the mass and placement of a biological mitral prosthesis. The histopathologic analysis revealed a cavernous hemangioma. Eight months later, the patient presented with recurrence of acute bacterial endocarditis and septic shock, and underwent replacement of the prosthetic valve. The histologic exam showed no signs of hemangioma. The rarity of this case and its complications make its presentation relevant.

Molecular identification and characterization of Rickettsia spp. and other tick-borne pathogens in cattle and their ticks from Huambo, Angola.

Ticks are one of the most common vectors of a broad variety of pathogenic agents that significantly affects cattle production causing reduced productivity and important economic losses, while simultaneously having an impact on human health due to the zoonotic risk. In much of the territory of Angola urban population has grown rapidly in recent decades, sharing today close contact with large farms that are generally owned by city residents, providing the ideal conditions for vector-borne pathogens (VBP) transmission between animals and humans. Here we studied the occurrence of Rickettsia, Anaplasma, Ehrlichia, Babesia and Theileria in domestic cattle (n = 98) from Huambo, Angola, and their ticks (n = 116) to obtain a more detailed knowledge into the spectrum of tick-borne agents circulating in this population. We morphologically identified Amblyomma variegatum, Rhipicephalus decoloratus and R. evertsi mimeticus ticks, further confirmed by molecular analysis of the 12S rDNA and 16S rDNA genes. Although none of the bovine blood showed to be positive for R. africae by the ompB, ompA and gltA assays, five ticks showed to be positive for R. africae by the ompB, ompA and the gltA PCRs. Two 18S rRNA sequences were retrieved from bovine blood and one sequence from A. variegatum tick, showing 100% identity with Theileria mutans. By using a PCR targeting the 16S rRNA gene of Anaplama spp. we have also obtained six bovine blood samples showing 99-100 % nucleotide sequence identity with A. capra, two showing 98 % nucleotide sequence identity with A. phagocytophilum and three showing 98-100 % nucleotide sequence identity with A. platys. None of the ticks were positive. The present study shows the presence of a wide range of vector-borne diseases in domestic cattle and their ticks in Huambo province, Angola. Given the lack of both animal and human health infrastructures in this rural region, swift diagnosis and treatment is hampered which could produce a more severe impact on health.

Pacemaker lead as an iatrogenic cause of right heart failure: Case report. / Electrocatéter como causa iatrogénica de insuficiência cardíaca direita ­ relato de um caso.

Technical advances in health care have improved patient survival and quality of life, but are not devoid of complications. We present the case of a 74-year-old woman with a history of hypertensive heart disease with preserved systolic function, atrial fibrillation and dyslipidemia. She had a DDDR pacemaker implanted in 2005 due to symptomatic complete atrioventricular block. The patient reported progressive fatigue, weakness, ascites with abdominal discomfort, and lower limb edema, accompanied by non-specific hepatic cholestasis on biochemical testing. Abdominal ultrasound revealed homogeneous hepatomegaly and dilatation of the inferior vena cava and upper hepatic veins, suggestive of congestive hepatopathy. Echocardiography revealed tricuspid regurgitation progressively worsening over the previous four years and dilatation and progressive dysfunction of the right ventricle, with preserved left ventricular function. The transesophageal echocardiogram revealed severe tricuspid regurgitation with flail septal leaflet and marked dilatation of the tricuspid annulus due to mechanical interference of the pacemaker lead, which was adhering to the septal leaflet. Minimally invasive surgical treatment was performed with partial resection of the leaflet, placement of a tricuspid annuloplasty ring and replacement of the pacemaker lead. Regression of the congestive symptoms was observed, and the postoperative echocardiogram showed the tricuspid annuloplasty ring with no evidence of stenosis and only slightly dilated right chambers with moderate pulmonary hypertension. Six months after the procedure, the patient suffered an acute neurological event and died.

A perceção da transição para a aposentadoria na perspetiva dos participantes do Reativa / The perception of the retirement transitions on the Reativa participants perspective

A aposentadoria constitui uma transição do ciclo de vida que expõe os seus protagonistas a estados de diferente vulnerabilidade biológica, psicológica, social e ecológica. O projeto REATIVA visa a promover um envelhecimento ativo e, numa primeira fase do seu desenvolvimento que teve por objetivo geral conhecer as perceções que os indivíduos apresentam relativamente à aposentadoria, descobriu que estes a percecionam como uma continuidade, readaptação, ganho, perda ou ambivalência.(AU)

Retirement is a life cycle transition that exposes its protagonists to different states of biological, psychological, social and ecological vulnerability. The project REATIV aims to promote an active ageing and in a first phase of its development had as the overall objective to know the perceptions that individuals have regarding retirement, and found that they perceive it as a continuum, readaptation, gain, loss or ambivalence.(AU)

A perceção da transição para a aposentadoria na perspetiva dos participantes do Reativa / The perception of the retirement transitions on the Reativa participants perspective

A aposentadoria constitui uma transição do ciclo de vida que expõe os seus protagonistas a estados de diferente vulnerabilidade biológica, psicológica, social e ecológica. O projeto REATIVA visa a promover um envelhecimento ativo e, numa primeira fase do seu desenvolvimento que teve por objetivo geral conhecer as perceções que os indivíduos apresentam relativamente à aposentadoria, descobriu que estes a percecionam como uma continuidade, readaptação, ganho, perda ou ambivalência.

Retirement is a life cycle transition that exposes its protagonists to different states of biological, psychological, social and ecological vulnerability. The project REATIV aims to promote an active ageing and in a first phase of its development had as the overall objective to know the perceptions that individuals have regarding retirement, and found that they perceive it as a continuum, readaptation, gain, loss or ambivalence.