Percutaneous Strategies in Structural Heart Diseases: Focus on Chronic Heart Failure. / Estratégias Percutâneas em Doenças Estruturais: Foco em Insuficiência Cardíaca Crônica.

BACKGROUND: Central Illustration : Percutaneous Strategies in Structural Heart Diseases: Focus on Chronic Heart Failure Transcatheter devices for monitoring and treating advanced chronic heart failure patients. PA: pulmonary artery; LA: left atrium; AFR: atrial flow regulator; TASS: Transcatheter Atrial Shunt System; VNS: vagus nerve stimulation; BAT: baroreceptor activation therapy; RDN: renal sympathetic denervation; F: approval by the American regulatory agency (FDA); E: approval by the European regulatory agency (CE Mark). BACKGROUND: Innovations in devices during the last decade contributed to enhanced diagnosis and treatment of patients with cardiac insufficiency. These tools progressively adapted to minimally invasive strategies with rapid, widespread use. The present article focuses on actual and future directions of device-related diagnosis and treatment of chronic heart failure.

Non-contrast transcatheter aortic valve implantation for patients with aortic stenosis and chronic kidney disease: a pilot study.

Background: Acute kidney injury (AKI) is frequently observed after transcatheter aortic valve implantation (TAVI). Of note, it is associated with a threefold increase in all-cause and cardiac death. We propose a new non-contrast strategy for evaluating and performing the TAVI procedure that can be especially valuable for patients with aortic stenosis (AS) and chronic kidney disease (CKD) to prevent AKI. Methods: Patients with severe symptomatic AS and CKD stage ≥3a were evaluated for TAVI using four non-contrast imaging modalities for procedural planning: transesophageal echocardiogram (TEE), cardiac magnetic resonance, multidetector computed tomography (MDCT), and aortoiliac CO2 angiography. Patients underwent transfemoral (TF) TAVI using the self-expandable Evolut R/Pro, and the procedures were guided by fluoroscopy and TEE. Contrast MDCT and contrast injection at certain checkpoints during the procedure were used in a blinded fashion to guarantee patient safety. Results: A total of 25 patients underwent TF-TAVI with the zero-contrast technique. The mean age was 79.9 ± 6.1 years, 72% in NYHA class III/IV, with a mean STS-PROM of 3.0% ± 1.5%, and creatinine clearance of 49 ± 7 ml/min. The self-expandable Evolut R and Pro were implanted in 80% and 20% of patients, respectively. In 36% of the cases, the transcatheter heart valve (THV) chosen was one size larger than the one by contrast MDCT, but none of these cases presented adverse events. Device success and the combined safety endpoint (at 30 days) both achieved 92%. Pacemaker implantation was needed in 17%. Conclusion: This pilot study demonstrated that the zero-contrast technique for procedural planning and THV implantation was feasible and safe and might become the preferable strategy for a significant population of CKD patients undergoing TAVR. Future studies with a larger number of patients are still needed to confirm such interesting findings.

Estratégias Percutâneas em Doenças Estruturais: Foco em Insuficiência Cardíaca Crônica / Percutaneous Strategies in Structural Heart Diseases: Focus on Chronic Heart Failure

Resumo As inovações em dispositivos ao longo das últimas décadas proporcionaram uma melhora no diagnóstico e tratamento de pacientes com insuficiência cardíaca. Essas novas ferramentas progressivamente adaptaram-se a estratégias minimamente invasivas e as opções percutâneas multiplicaram-se de forma rápida. No presente artigo revisamos as direções atuais e futuras dos dispositivos utilizados como opções adjuvantes para o diagnóstico e tratamento adjuvante na insuficiência cardíaca crônica, o seu desenvolvimento, mecanismos e estudos mais recentes

Abstract Innovations in devices during the last decade contributed to enhanced diagnosis and treatment of patients with cardiac insufficiency. These tools progressively adapted to minimally invasive strategies with rapid, widespread use. The present article focuses on actual and future directions of device-related diagnosis and treatment of chronic heart failure.

Combined transcatheter aortic valve replacement and left atrial appendage occlusion in patients ineligible for oral anticoagulation: A case series.

Patients presenting with aortic stenosis and atrial fibrillation (AF) undergoing transcatheter aortic valve replacement (TAVR) are commonly at increased risk for stroke and bleeding complications. Concomitant left atrial appendage occlusion (LAAO) after TAVR may be an alternative to oral anticoagulation (OAC).Between 2018 and 2022, 7 consecutive patients who were ineligible for OAC underwent simultaneous TAVR and LAAO. The mean age was 84.9 ±â€¯4.9 years. The mean CHA2DS2-VASc, HAS-BLED, and STS predicted risk of mortality scores were 5.9 ±â€¯0.7, 3.9 ±â€¯1.1, and 8.8 ±â€¯3.4%, respectively. The median follow-up time was 23 (1 to 27) months. All procedures achieved technical success and no adverse events were observed during follow-up. This case series shows that concomitant TAVR and LAAO is feasible and safe among patients with severe aortic stenosis and AF who are deemed ineligible for OAC. Learning objectives: Atrial fibrillation is the most common arrhythmia in the transcatheter aortic valve replacement (TAVR) population. In those who experience major or life-threatening bleeding, mortality is doubled. We report a case series of 7 concomitant left atrial appendage occlusions (LAAO) after TAVR in patients ineligible for oral anticoagulation. All procedures achieved technical success and no adverse events were observed. The simultaneous approach with TAVR and LAAO was feasible and safe in this case series.

Analysis of the energy balance and CO2 flow under the influence of the seasonality of climatic elements in a mangrove ecosystem in Eastern Amazon.

An unprecedented study was carried out in a mangrove ecosystem in the northeastern coast of the Brazilian Amazon to understand the behavior of climatic elements in a year with the occurrence of El Niño (2015), associated with the seasonal function source/sink of CO2 by the ecosystem. Global radiation (Rg), net radiation (Rn), temperature, relative humidity, precipitation, horizontal wind speed and direction, as well as turbulent flows of sensible heat (H), latent heat (LE), and carbon (f_CO2) were recorded using eddy covariance, a system for studying turbulent flows of heat and gases in the atmosphere. We observed a drastic reduction in rainfall volumes, which accounts for 63.7% of the expected total according to the region's climatology. Regarding f_ CO2, the highest values of photosynthesis, autotrophic, and heterotrophic respiration of the ecosystem occurred in the wet season due to precipitation, ideal photosynthetically active radiation, lower soil salinity, and higher NDVI of the ecosystem. In the 2nd semester of the year, we observed that the decrease in cloudiness, causing a higher radiation supply in the forest canopy, accompanied by a reduction in precipitation and an increase in the value of H and soil salinity, favored the increase of foliar abscission by the dominant genus Rhizophora and Avicennia, thus influencing the reduction of magnitudes of carbon source/sink functions in the ecosystem during this season, even on high tide days.

Embolisation of branches of the superior mesenteric artery in the treatment of haemosuccus pancreaticus.

Haemosuccus pancreaticus (HP) is an uncommon cause of upper gastrointestinal (GI) bleeding, most often intermittent, making it difficult to diagnose, becoming fatal. It usually occurs in patients with chronic pancreatitis and is caused by the rupture of a visceral aneurysm within the main pancreatic duct. The association between pseudoaneurysm formation and pancreatitis is well established. Pseudoaneurysm occurs in 3.5%-10% of pancreatitis cases and its rupture is a rare but life-threatening complication of chronic pancreatitis occurring in 6%-8% of patients with pseudocysts and corresponds to less than 1% of cases of GI bleeding.Its diagnosis is challenging, given the intermittent nature of bleeding. Angiographic therapy is considered the first-choice treatment, especially in patients who are stable haemodynamically. We present a case of embolisation of inferior pancreaticoduodenal branches with polyvinyl alcohol microparticles in the treatment of HP.

Anxiety and Depression as Longitudinal Predictors of Mild Cognitive Impairment in Older Adults.

INTRODUCTION: Few studies have dealt with the potential correlation between anxiety, depression, and cognitive impairment in community-dwelling older adults. METHOD: This longitudinal study was conducted in the city of Montreal, Canada, with 352 older adults aged 55 years or more. The participants were interviewed at baseline and again 2 years later. The Montreal Cognitive Assessment (MoCA) score was estimated and compared between the 2 time points, the Composite International Diagnostic Interview (CIDI) was used to assess major depression and anxiety, and the K10 measured high psychological distress. Likewise, major depression, anxiety disorders, and psychological distress were evaluated at the 2 study time points. RESULTS: In older adults with a diagnosis of depression or anxiety at baseline, no significant reduction in the MoCA score indicating deterioration in cognitive function was found 2 years later. Nevertheless, in individuals with a high level of psychological distress at baseline, there was a significant reduction in MoCA scores 2 years later, indicating deterioration in cognition. The findings of the present study suggest that a high level of psychological distress in addition to environmental factors may constitute important predictors for cognitive health.

Gas exchange of Handroanthus impetiginosus (Mart. ex DC) Mattos plants under water stress and rehydration / Trocas gasosas de plantas de Handroanthus impetiginosus (Mart. ex DC) Mattos submetidas ao déficit hídrico e posterior reidratação

O conhecimento de aspectos relacionados à ecofisiologia das espécies vegetais presentes na Caatinga é escasso, sendo necessário estudos que possibilitem o entendimento das adaptações apresentadas pelas plantas para conseguir sobreviver em condições de baixa disponibilidade hídrica. Nesse sentido, desenvolveu-se este estudo com o objetivo de analisar as trocas gasosas de plantas jovens de ipê-roxo submetidas ao déficit hídrico progressivo, através da suspensão da irrigação, e à reidratação. As plantas com com doze meses de idade, crescendo em sacos plásticos pretos contendo 5 kg de substrato, foram submetidas a dois tratamentos: irrigado (tratamento controle) e de déficit hídrico, imposto através da suspensão da irrigação. Diariamente foram avaliadas o conteúdo relativo de água (CRA), condutância estomática (gs), transpiração (E), concentração intercelular de CO2 (Ci) e fotossíntese (A) e calculada a Eficiência instatânea no uso da água (EUA). Após permanecerem dez dias sob a condição de déficit, a irrigação foi restabelecida, e foi avaliada a recuperação das mesmas. O déficit hídrico reduziu de maneira rápida e progressiva todos os parâmetros avaliados, exceto o Ci. Após a retomada do fornecimento de água, as plantas apresentaram recuperação nesses processos fisiológicos. O déficit hídrico não afetou a eficiência instantânea no uso da água das plantas de ipê-roxo.(AU)

Knowledge of aspects related to the ecophysiology of plant species present in Caatinga is scarce, needing studies that allow the understanding of the adaptations made by plants to be able to survive under conditions of low water availability. Accordingly, this study was developed with the purpose of analyzing the gas exchange of ipê-roxo seedlings subjected to progressive water stress, through the suspension of irrigation, and rehydration. 12 month old plants, growing up in black plastic bags containing 5 kg of substrate, were subjected to two treatments: irrigated and water stress imposed by withholding water. The relative water content, stomatal conductance, transpiration rate, intercellular CO2 concentration, and photosynthetic rates were evaluated daily. After ten days remaining under this stress condition, irrigation was restored, and recovery was evaluated. Drought stress decreased rapidly and also progressively the relative water content, stomatal conductance, transpiration, carboxylation efficiency and photosynthesis of plants. An increase in intercellular CO2 concentration with increase of water stress was observed. After the resumption of water supply, the plants showed recovery of these physiological processes. Water stress did not affect the water efficiency use of plants.(AU)

Increased Anxiety, Akathisia, and Suicidal Thoughts in Patients with Mood Disorder on Aripiprazole and Lamotrigine.

Introduction. Akathisia affects around 18% of patients with bipolar disorder treated with aripiprazole and may worsen when aripiprazole is combined with lamotrigine and antidepressants. Case. This paper reports on two clinical cases involving patients with a diagnosis of mood disorder who developed severe akathisia, anxiety, and suicidal ideation while using a combination of aripiprazole, antidepressants, and lamotrigine. Discussion. We recommend that patients with a mood disorder taking multiple drugs should begin aripiprazole therapy with low doses and be monitored for the development of akathisia, increased anxiety, or suicidal thoughts. The appearance of these limiting side effects requires discontinuation of the drug.

Diagnóstico da aspergilose invasiva:Aplicação das Técnicas de Reação em Cadeia da Polimerase (PCR) e Ensaio Imunoenzimático de Detecção da Galactomanana (EIA-GM®) / Diagnosis of invasive aspergillosis: Application of Polymerase Chain Reaction Techniques (PCR) and Enzyme-Linked Immunosorbent Assay for Detectionof Galactomannan (EIA-GM®)

Introdução: a aspergilose invasiva (IA) é uma infecção fúngica grave causada por espécies do gênero Aspergillus e acomete principalmente pacientes leucêmicos,diabéticos e aqueles receptores de transplante de células-tronco, que apresentem neutropenia. Os esporos dos fungos que colonizam o epitélio pulmonar podem invadir as células endoteliais de revestimento e o acesso vascular e, assim, disseminar-se paraoutros órgãos através do sangue. A elevada mortalidade da doença está relacionada à imunossupressão grave, à rápida progressão da infecção e, principalmente, à ausência de um diagnóstico precoce e eficiente. Portanto, o diagnóstico na fase inicial da infecção é adequado, proporcionando uma terapia mais eficaz, o que pode reduzir a taxa de mortalidade da doença. Objetivo: o presente estudo teve em vista avaliar a aplicabilidadeda técnica de reação em cadeia da polimerase (PCR) no auxílio do diagnóstico de AI, em comparação com os resultados gerados pelo ensaio imunoenzimático de galactomanana (EIA-GM®), este já validado comercialmente. Métodos: foram analisadas 245 amostras de pacientes tratados no hospital Santa Casa de Belo Horizonte. Entre essas amostras, 16% (N = 39) foram positivos nos testes EIA-GM®. Em seguida, essas 39amostras positivas foram analisadas pela técnica de PCR. Resultados: de acordo com os resultados, a técnica de PCR apresentou taxa de 97,44% de sensibilidade, 97,96% de acurácia e 100% de especificidade, quando comparada ao método EIA-GM®. Conclusão:a técnica de PCR pode auxiliar no diagnóstico da AI, sempre associando os seus resultados à clinica do paciente e aos testes de imunoensaios.

Introduction: invasive aspergillosis (AI) is a serious fungal infection caused by species of the genus Aspergillus that primarily affects leukemic and diabetic patients and those recipients of stem cell transplants, which have neutropenia. The fungi spores that colonize the lung epithelium may invade the endothelial cell lining and vascular access and thus, spread to other organs through the blood. The high mortality of the disease is related tosevere immunosuppression, rapid infection progression, and especially lack of an early and efficient diagnosis. Therefore, the diagnosis in the initial infection phase is beneficial,providing a more effective therapy that can reduce the disease?s mortality rate. Objective:this study aimed at evaluating the applicability of the polymerase chain reaction (PCR) cheganin assisting the diagnosis of AI compared to the resultsgenerated by galactomannan enzyme immunoassay (EIA-GM®) that is already commercially validated. Methods: 245 samples from patients treated in the Santa Casa de Belo Horizonte hospital were analyzed. Among these samples, 16% (N = 39) were positive in EIA-GM®tests. Subsequently, these 39 positive samples were analyzedby PCR. Results: According to the results, the PCR technique showed 97.44% sensitivity, 97.96% accuracy, and 100% specificity compared to EIA-GM®. Conclusion:the PCR technique may aid in the diagnosis of AI,always associating the results to the patient's clinicaland immunoassay tests.

The relationship between mental disorders and types of crime in inmates in a Brazilian prison.

This cross-sectional study conducted in prisons in the city of Salvador, Bahia, Brazil, investigated the association between the presence of psychiatric disorders in 462 prisoners and the types of crimes committed by them. Psychiatric diagnosis was obtained by means of the Brazilian Portuguese version of the Mini-International Neuropsychiatric Interview. A statistically significant association was found between some psychiatric disorders and specific groups of crime: lifelong substance addiction with sex crimes and homicide; antisocial personality disorder with robbery and with kidnapping and extortion; borderline personality disorder with sex crimes; and lifelong alcohol addiction with fraud and conspiracy and with armed robbery and murder. It was concluded that the mental disorders considered more severe (psychosis and bipolar disorder) were not associated with violent crimes, suggesting that the severity of the psychotic disorder may be the factor that has caused psychosis to be associated with violent crimes in previous studies.

Síndrome de Waardenburg: relato de casos / Waardenburg syndrome: case reports

JUSTIFICATIVA E OBJETIVOS: A síndrome de Waardenburg é uma doença genética que na forma clássica, os pacientes apresentam várias características físicas marcantes e também surdez neurossensorial. Assim, a partir da exposição dos casos espera-se que os profissionais de saúde tomem conhecimento da doença e possam levantar a hipótese diagnóstica diante de um pacientecom fenótipo sugestivo, tendo em vista que possui baixa frequência na população e seu diagnóstico precoce melhora muito a qualidade de vida dos pacientes.RELATO DOS CASOS: Trata-se de três casos dentro de uma mesma família com características diferentes, inclusive, em relação à surdez genética. Características marcantes estão presentes nos casos, como: dystopia canthorum, epicanto, base nasal proeminente e alargada, maxila encurtada, poliose, encanecimento precoce e surdez congênita neurossensorial. CONCLUSÃO: A grande maioria dos casos desta síndrome é acompanhada de surdez congênita. As características físicas que acompanham a doença permitem o seu diagnóstico clínico, e o ideal seria que esses pacientes fossem diagnosticados ainda na infância para que possam ter acesso precocemente à reabilitação auditiva, contribuindo para melhor desenvolvimento neuropsíquico, levando-se em conta que eles também deverão receber aconselhamento genético.

BACKGROUND AND OBJECTIVES: Waardenburg syndrome is a rare genetic disease that shows variable penetrance and expressivity. In its classic form, patients have several outstanding characteristics, such as deafness. Thus, from the exposure of cases, it is important to be aware of this clinical disease, to health professionals, for early diagnosis, avoiding unnecessary examinations, and achieving effective therapeutic approach.CASE REPORTS: These are three cases in one family with different characteristics, including in relation to genetic deafness. Striking features are present in cases like: dystopia canthorum, epicanthus, prominent and broad nasal base, shortened jaw, poliosis, premature graying and congenital sensorineural deafness. CONCLUSION: Most cases of this syndrome is accompanied by congenital deafness. Therefore, early diagnosis will certainly help in hearing rehabilitation, improving the capacity of developing hearing and communication skills of these individuals.

Relationship between learning problems and attention deficit in childhood.

OBJECTIVE: To assess the impact of attention deficit on learning problems in a sample of schoolchildren in the city of Salvador, Bahia, Brazil. METHOD: All students enrolled in selected elementary schools were included in this study, making a total of 774 children. Each child was assessed by his or her teacher using a standardized scale. The Attention Deficit Hyperactivity Disorder Scale-Teacher's Version (Benczic, 2000) was used to evaluate ADHD symptoms and learning problems. RESULTS: A very strong association was found between attention deficit and learning problems (prevalence ratio [PR] = 31.7; 95% confidence interval = [16.1, 62.3]). CONCLUSION: Results suggest either that attention deficit leads to learning problems or that attention deficit and learning problems are comorbid conditions, in which case learning problems may also contribute to secondary symptoms in ADHD.

Dry matter and nutrients accumulation in Gliricidia sepium in response to water stress and phosphorus levels / Acúmulo de massa seca e de nutrientes em gliricídia em resposta ao estresse hídrico e a doses de fósforo

Among the factors that have limited plant growth and crop production in tropical regions are the low availability of phosphorus and water stress. These factures assume even greater proportion in the semiarid region of northeastern Brazil. As a result, we conducted an experiment to evaluate the effects of phosphorus and two water regimes effects in dry matter and nutrients accumulation in Gliricidia sepium plants. The experimental design was a randomized block design, arranged in a 2 x 4 factorial scheme, corresponding to two water regimes (with and without water stress) and four phosphorus levels (0; 50; 100 and 150 mg dm-3 of P). The plants grown in plastic pots containing 9 kg of soil, and the water stress was imposed by the suspension of irrigation, 45 days after emergence and remained in that condition for 15 days. It were analyzed the dry matter and N, P, K, Ca, Mg, S, Fe, Mn, Cu and Zn content in shoots. Water stress was detrimental to the production of dry matter and N and Zn accumulation, while promoted accumulation of P, S and Cu. The fertilization favored N, P, Ca, S, Mn, and Fe shoot accumulation.

Dentre os fatores que mais têm limitado o crescimento vegetal e a produção agrícola nas regiões tropicais estão a baixa disponibilidade de fósforo e o estresse hídrico. Esses fatores assumem proporção ainda maior na região semiárida do Nordeste do Brasil. Em função disso, conduziu-se um experimento com o objetivo de avaliar o efeito de doses de fósforo e dois regimes hídricos nos acúmulos de massa seca da parte aérea (MSPA) e de nutrientes em plantas de gliricídia. O delineamento experimental foi o de blocos casualizados, disposto em esquema fatorial 2 x 4, correspondendo a dois regimes hídricos (com e sem estresse hídrico) e quatro doses de fósforo (0, 50, 100 e 150 mg dm-³ de P). As plantas cresceram em vasos plásticos contendo 9 kg de solo e o estresse hídrico foi imposto através da suspensão da irrigação, aos 45 dias após a emergência, permanecendo durante 15 dias nessa condição. Foram analisadas a matéria seca das plantas e os conteúdos de N, P, K, Ca, Mg, S, Fe, Mn, Cu e Zn na parte aérea. O estresse hídrico reduziu a produção de massa seca e o acúmulo de N e Zn, e aumentou o acúmulo de P, S e Cu na MSPA das plantas. A adubação fosfatada aumentou o acúmulo de N, P, Ca, S, Mn e Fe na MSPA das plantas.