Cardiac Sarcoidosis Presenting as Sustained Ventricular Tachycardia.

Introduction: Sarcoidosis has many possible clinical presentations since it can affect any organ, most commonly the lungs. The hallmark of the disease consists of the formation of non-necrotising granulomas. Pathogenesis is thought to rely on the interplay of genetic, environmental and epigenetic factors. This case highlights the importance of a thorough clinical history and physical examination, and the correlation with imaging findings in the diagnostic work-up of the non-ischaemic cardiomyopathy. Case description: A 57-year-old woman was admitted due to the sudden onset of malaise, dizziness, and chest discomfort. Sustained monomorphic ventricular tachycardia was evidenced and the patient rapidly evolved with haemodynamic instability; she underwent successful electrical cardioversion. The electrocardiogram afterwards showed a high-risk electrocardiographic pattern. Invasive coronary angiography excluded obstructive epicardial coronary lesions. Physical examination revealed skin lesions on the lower limbs which raised suspicion for erythema nodosum and therefore a biopsy was performed. Transthoracic echocardiography and cardiac magnetic resonance imaging revealed features consistent with an inflammatory cardiomyopathy, and an implantable cardioverter-defibrillator was placed. The histologic examination of the cutaneous lesions showed a non-necrotising granulomatous inflammatory process. Radionuclide imaging was inconclusive. The patient underwent an endomyocardial biopsy, which confirmed the diagnosis of systemic sarcoidosis with cardiac involvement. Conclusions: Systemic sarcoidosis with cardiac involvement is a challenging diagnosis. The role of imaging techniques such as transthoracic echocardiography, cardiac magnetic resonance imaging and radionuclide imaging is essential in raising suspicion and diagnosing this pathology. Endomyocardial biopsy is the 'gold standard' for its diagnosis; however, it has a low diagnostic yield. LEARNING POINTS: Systemic sarcoidosis with cardiac involvement is a challenging diagnosis as it may present in many different ways.The case presented highlights the importance of a thorough clinical history and physical examination, and the correlation with imaging findings.Imaging techniques such as transthoracic echocardiogram, cardiac magnetic resonance and radionuclide imaging are essential in raising suspicion and diagnosing cardiac sarcoidosis.

Biomarkers of oxidative stress, inflammation, and genotoxicity to assess exposure to micro- and nanoplastics. A literature review.

The increased awareness about possible health effects arising from micro- and nanoplastics (MNPs) pollution is driving a huge amount of studies. Many international efforts are in place to better understand and characterize the hazard of MNPs present in the environment. The literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology in two different databases (PubMed and Embase). The selection of articles was carried out blind, screening titles and abstracts according to inclusion and exclusion criteria. In general, these studies rely on the methodology already in use for assessing hazard from nanomaterials and particles of concern. However, only a limited number of studies have so far directly measured human exposure to MNPs and examined the relationship between such exposure and its impact on human health. This review aims to provide an overview of the current state of research on biomarkers of oxidative stress, inflammation, and genotoxicity that have been explored in relation to MNPs exposure, using human, cellular, animal, and plant models. Both in-vitro and in-vivo models suggest an increased level of oxidative stress and inflammation as the main mechanism of action (MOA) leading to adverse effects such as chronic inflammation, immunotoxicity and genotoxicity. With the identification of such biological endpoints, representing critical key initiating events (KIEs) towards adaptive or adverse outcomes, it is possible to identify a panel of surrogate biomarkers to be applied and validated especially in occupational settings, where higher levels of exposure may occur.

Brewer's Spent Yeast Cell Wall Polysaccharides as Vegan and Clean Label Additives for Mayonnaise Formulation.

Brewer's spent yeast (BSY) mannoproteins have been reported to possess thickening and emulsifying properties. The commercial interest in yeast mannoproteins might be boosted considering the consolidation of their properties supported by structure/function relationships. This work aimed to attest the use of extracted BSY mannoproteins as a clean label and vegan source of ingredients for the replacement of food additives and protein from animal sources. To achieve this, structure/function relationships were performed by isolating polysaccharides with distinct structural features from BSY, either by using alkaline extraction (mild treatment) or subcritical water extraction (SWE) using microwave technology (hard treatment), and assessment of their emulsifying properties. Alkaline extractions solubilized mostly highly branched mannoproteins (N-linked type; 75%) and glycogen (25%), while SWE solubilized mannoproteins with short mannan chains (O-linked type; 55%) and (1→4)- and (ß1→3)-linked glucans, 33 and 12%, respectively. Extracts with high protein content yielded the most stable emulsions obtained by hand shaking, while the extracts composed of short chain mannans and ß-glucans yielded the best emulsions by using ultraturrax stirring. ß-Glucans and O-linked mannoproteins were found to contribute to emulsion stability by preventing Ostwald ripening. When applied in mayonnaise model emulsions, BSY extracts presented higher stability and yet similar texture properties as the reference emulsifiers. When used in a mayonnaise formulation, the BSY extracts were also able to replace egg yolk and modified starch (E1422) at 1/3 of their concentration. This shows that BSY alkali soluble mannoproteins and subcritical water extracted ß-glucans can be used as replacers of animal protein and additives in sauces.

Thiazide diuretics alone or combined with potassium-sparing diuretics to treat hypertension: a systematic review and network meta-analysis of randomized controlled trials.

BACKGROUND: The magnitude of blood pressure (BP)-lowering effects and decrease of the adverse effects of thiazide diuretics provided by potassium-sparing diuretics remain uncertain. The aim of this study was to compare the BP-lowering efficacy and the incidence of adverse effects of high (T+) and low-dose (T-) thiazide diuretics, alone or combined with high (PS+) or low-dose (PS-) potassium-sparing diuretics in patients with primary hypertension. METHODS: A systematic literature search was performed in PubMed/MEDLINE, the Cochrane Central Register of Controlled Trials, Embase, Web of Science, Scopus and LILACS. Randomized double-blind placebo or active-controlled trials (RCT) with 3 weeks to 1 year of follow-up were included. Sample size, mean and standard deviation from baseline, follow-up and change from baseline values were extracted by two independent reviewers. Pairwise random effect models and Bayesian network meta-analysis models were used to compare the effects of treatments. The risk of bias in individual studies was assessed using the Rob 1.0 tool. The primary outcome was the mean difference in office SBP. Secondary outcomes were the mean difference in biochemical parameters and the incidence of nonmelanoma skin cancer. RESULTS: Two hundred and seventy-six double-blind RCTs involving 58 807 participants (mean age: 55 years; 45% women) were included. All treatment groups were more effective than placebo in lowering BP, with mean differences (MDs) of change from baseline ranging from -7.66 mmHg [95% credible interval (95% CrI), -8.53 to -6.79] for T- to -12.77 mmHg (95% CrI, -15.22 to -10.31) for T+PS-. T+ alone or combined with potassium-sparing was more effective in reducing BP than T-. The surface under the cumulative ranking curve (SUCRA) estimated ranking showed that the best effectiveness in lowering SBP was found for T+PS- (0.69), T+PS+ (0.65) and T+ (0.54). Compared with placebo, all treatments (except T-PS-) were associated with more potassium reduction and T+ compared with all other treatments and T- when compared with T-PS-. Compared with placebo, all active treatments (except T+PS+) showed higher elevations of uric acid. The increase of plasma glucose promoted by thiazides alone was reduced by potassium-sparing agents. CONCLUSION: Thiazides with potassium-sparing diuretics are associated with increased BP-lowering efficacy compared with thiazides alone while minimizing hypokalaemia and hyperglycaemia. These findings demonstrate that thiazide and potassium-sparing diuretic combination is preferable to thiazide alone in treating hypertension.

Ionic liquids as potential electrolytes for sodium-ion batteries: an overview.

In this study, we present an overview on the use of ionic liquids (ILs) as electrolytes in sodium-ion batteries (SIBs). The development of SIBs has gained traction over the last few years because Na is cheaper and more abundant than Li. In this case, although great efforts have been devoted to finding high-capacity and high cell potential materials for SIBs, electrolyte safety is an important factor in producing more competitive and reliable devices. Specifically, the intrinsic volatility of the organic solvent-based electrolytes commonly used in commercial systems is a safety risk during the operation of batteries, and thus replacing them with ILs is an alternative that should be considered. This family of electrolytes is more thermally stable than organic solvents, but they suffer from poor transport properties. Herein, we discuss these properties, considering neat ILs, effects of cations and anions, and effect of salt concentration. Moreover, the strategies to overcome the transport limitations are highlighted. Then, the recent applications of mixtures containing sodium salts and ILs as electrolytes for the negative and positive electrodes in SIBs are presented. Finally, the use of Na-IL mixtures in solid-state electrolytes is discussed.

Feasibility of Brewer's Spent Yeast Microcapsules as Targeted Oral Carriers.

Brewer's spent yeast (BSY) microcapsules have a complex network of cell-wall polysaccharides that are induced by brewing when compared to the baker's yeast (Saccharomyces cerevisiae) microcapsules. These are rich in (ß1→3)-glucans and covalently linked to (α1→4)- and (ß1→4)-glucans in addition to residual mannoproteins. S. cerevisiae is often used as a drug delivery system due to its immunostimulatory potential conferred by the presence of (ß1→3)-glucans. Similarly, BSY microcapsules could also be used in the encapsulation of compounds or drug delivery systems with the advantage of resisting digestion conferred by (ß1→4)-glucans and promoting a broader immunomodulatory response. This work aims to study the feasibility of BSY microcapsules that are the result of alkali and subcritical water extraction processes, as oral carriers for food and biomedical applications by (1) evaluating the resistance of BSY microcapsules to in vitro digestion (IVD), (2) their recognition by the human Dectin-1 immune receptor after IVD, and (3) the recognition of IVD-solubilized material by different mammalian immune receptors. IVD digested 44-63% of the material, depending on the extraction process. The non-digested material, despite some visible agglutination and deformation of the microcapsules, preserved their spherical shape and was enriched in (ß1→3)-glucans. These microcapsules were all recognized by the human Dectin-1 immune receptor. The digested material was differentially recognized by a variety of lectins of the immune system related to (ß1→3)-glucans, glycogen, and mannans. These results show the potential of BSY microcapsules to be used as oral carriers for food and biomedical applications.

Structural differences on cell wall polysaccharides of brewer's spent Saccharomyces and microarray binding profiles with immune receptors.

Brewing practice uses the same yeast to inoculate the following fermentation (repitching). Saccharomyces pastorianus, used to produce Lager beer, is widely reused, not changing its fermentation performance. However, S. cerevisiae, used to produce Ale beer, is partial or not even reused, due to its poor performance. It is hypothesized that cells modulate their wall polysaccharides to increase the cell-wall strength. In this work industrial S. cerevisiae and S. pastorianus brewer's spent yeasts with different repitching numbers were studied. Glucans were the main component of S. cerevisiae whereas mannoproteins were abundant in S. pastorianus. The major changes were noticed on glucans of both species, ß1,3-glucans decrease more pronounced in S. cerevisiae. The increase of α1,4-Glc, related with osmotolerance, was higher in S. cerevisiae while ß1,4-Glc, related with cell-wall strength, had a small increase. In addition, these structural details showed different binding profiles to immune receptors, important to develop tailored bioactive applications.

Empirical and semi-empirical chlorophyll-a modeling for water quality assessment through river-lake transition in extreme Southern Brazil.

Mirim lagoon is the second largest lacustrine water body in Southern Brazil, providing water for local communities. However, algae growth and water quality in the lagoon and in tributaries rivers is influenced by nutrient's increase. In this context, this study performs the empirical and semi-empirical chlorophyll-a (Chl-a) modeling using remote sensing and in situ data for water quality assessment. Water quality data were collected at 15 sample locations in the lagoon on the date of Sentinel-2 satellite overpass. Surface reflectance data were derived from the Sen2Cor atmospheric correction method and correlated with Chl-a concentration. The best model presented a Pearson's correlation coefficient = 0.81 and Mean Absolute Error = 0.13µg.L-1. Low Chl-a concentration is observed at the Northern lagoon, possibly due to suspended solids presence. The same occurs in the left margin, being associated with the influence of land use for agriculture. High Chl-a concentrations are associated with shallower and lentic areas. The mean Chl-a concentration predicted by the model was 17.34µg.L-1, similar to the observed value in situ (16.32µg.L-1). Overall, the empirical model developed can be applied as a tool to reduce costs and efforts in fieldwork measures and to understand eutrophication in this river-lake transition ecosystem.

An Electrifying Case of a Broken Heart Syndrome.

Takotsubo syndrome (TTS) describes an acute and transient left ventricular (LV) dysfunction that, although not obligatory, is many times associated with an underlying emotional, physical, or combined trigger. We describe a rare case of an 80-year-old female who developed TTS after pacemaker implantation in the context of a complete atrioventricular block (CAVB). During the patient's workup, right ventricular (RV) lead dislodgment was found. She developed acute heart failure symptoms 12 hours after device implantation with transthoracic echocardiogram showing de novo severe systolic biventricular dysfunction with dyskinesia of the apical segments and hyperdynamic contractility of the basal segments of both ventricles. Coronarography was normal, and left ventriculography demonstrated apical ballooning. TTS was then considered the most probable diagnosis. The patient received supportive care with diuretics, beta-blocker, and angiotensin-converting enzyme inhibitor (ACEI); an RV lead repositioning was also done. After four weeks, left ventricular function had fully recovered, confirming the diagnosis. This is a rare case of a post-pacemaker implantation TTS with concomitant lead dislodgment that can be assumed as a likely contributing factor. This report emphasizes that, although rare, TTS should be considered in the differential diagnosis of patients with acute heart failure development after pacemaker implantation.

Left Circumflex Coronary Artery-to-Coronary Sinus Fistula with Coronary Sinus Ostial Atresia and a Persistent Left Superior Vena Cava in an Adult Patient.

Understanding of coronary sinus (CS) anatomy and abnormalities is of critical importance due to their use in interventional procedures. Herein, the authors report a rare case of an asymptomatic 72-year-old man with a left circumflex coronary artery-to-CS fistula, together with CS ostial atresia and persistent left superior vena cava. These findings are described using both cardiac CT angiography and MRI with four-dimensional flow for anatomic and functional assessment. Keywords: Cardiac, Coronary Sinus, Aneurysms, Fistula, CT Angiography, MR Imaging Supplemental material is available for this article. © RSNA, 2022.

Understanding Myoblast Differentiation Pathways When Cultured on Electroactive Scaffolds through Proteomic Analysis.

Electroactive materials allow the modulation of cell-materials interactions and cell fate, leading to advanced tissue regeneration strategies. Nevertheless, their effect at the cellular level is still poorly understood. In this context, the proteome analysis of C2C12 cell differentiation cultured on piezoelectric polymer films with null average surface charge (non-poled), net positive surface charge (poled +), and net negative surface charge (poled -) has been addressed. Protein/pathway alterations for skeletal muscle development were identified comparing proteomic profiles of C2C12 cells differentiated on poly(vinylidene fluoride), with similar cells differentiated on a polystyrene plate (control), using label-free liquid chromatography-tandem mass spectrometry (LC-MS/MS). Only significantly expressed proteins (P < 0.01, analysis of variance) were used for bioinformatic analyses. A total of 37 significantly expressed proteins were detected on the C2C12 proteome with PVDF "poled -" at 24 h, whereas on the PVDF "poled +", a total of 105 significantly expressed proteins were considered. At 5 days of differentiation, the number of significantly expressed proteins decreased to 23 and 31 in cells grown on negative and positive surface charge, respectively, the influence of surface charge being more explicit in some proteins. In both cases, proteins such as Fbn1, Hspg2, Rcn3, Tgm2, Mylpf, Anxa2, and Anxa6, involved in calcium-related signaling, were highly expressed during myoblast differentiation. Furthermore, some proteins involved in muscle contraction (Acta2, Anxa2, and Anxa6) were detected in the PVDF "poled +" sample. Upregulation of several proteins that enhance skeletal muscle development was detected in the PVDF "poled -" sample, including Ckm (422%), Tmem14c (384%), Serpinb6a (460%), adh7 (199%), and Car3 (171%), while for the "poled +" samples, these proteins were also upregulated at a smaller magnitude (254, 317, 253, 123, and 72%, respectively). Other differentially expressed proteins such as Mylpf (189%), Mybph (168%), and Mbnl1 (168%) were upregulated only in PVDF "poled -" samples, while Hba-a1 levels (581%) were increased in the PVDF "poled +" sample. On the other hand, cells cultured on non-poled samples have no differences with respect to the ones cultured on the control, in contrary to the poled films, with overall surface charge, demonstrating the relevance of scaffold surface charge on cell behavior. This study demonstrates that both positive and negative overall surface charges promote the differentiation of C2C12 cells through involvement of proteins related with the contraction of the skeletal muscle cells, with a more pronounced effect with the negative charged surfaces.

Thiazide diuretics alone or in combination with a potassium-sparing diuretic on blood pressure-lowering in patients with primary hypertension: protocol for a systematic review and network meta-analysis.

BACKGROUND: The use of thiazide (T) diuretics for the treatment of hypertension may be associated with adverse metabolic effects, which can be minimized by combining thiazides with potassium-sparing (PS) diuretics. The additional blood pressure (BP)-lowering effect provided by the addition of a PS diuretic is unclear. Due to a large number of drugs in the T diuretics class, and the possible difference between them, there is a need to identify the best available evidence for health decision-making. This systematic review with network meta-analysis aims to compare the antihypertensive efficacy of T diuretics alone or in combination with a PS diuretic in patients with primary hypertension, as well as the safety of such drugs through the measurement of drug-related adverse events. METHODS: A comprehensive electronic search will be conducted in six electronic bibliographic databases (PubMed/MEDLINE, Cochrane Library, Embase, Web of Science, Scopus, Lilacs), a registration database ( ClinicalTrials.gov ), and Educational Resources Information Center (ERIC [ProQuest]), published from inception to the date of the search. The search will be updated towards the end of the review. A hand search of the reference sections of the included studies and cited studies will also be performed. In case of missing data, authors will be contacted by e-mail or academic social networking sites whenever possible. To be included in the review, studies must be double-blind randomized controlled trials evaluating T diuretics alone or in combination with PS diuretics in patients with primary hypertension. The primary outcome measure will be office BP. Ambulatory BP monitoring (ABPM), non-melanoma skin cancer, major adverse cardiovascular events, laboratory parameters, and the number of withdrawals will be included as secondary outcomes. The results will be quantitatively summarized using differences between the mean change from baseline or differences between means for quantitative outcomes and relative risk for dichotomous outcomes. Results will be presented as mean or relative risk with credible intervals through a league table. The treatments will also be ranked using the surface under the cumulative ranking curve method. The risk of bias will be assessed through the RoB 1.0 tool. DISCUSSION: To the best of our knowledge, this review will be the first to synthesize currently available evidence on the antihypertensive efficacy of different T diuretics alone or in combination with PS diuretics in adults with hypertension. The goals of hypertension treatment are to control high BP and to reduce associated cardiovascular morbidity and mortality, using the most appropriate therapy. Thiazides are widely used for pharmacological treatment due to their demonstrated effectiveness in reducing BP, favorable safety profile, and low cost. The results of this study will provide evidence regarding the best therapeutic strategies with T and PS diuretics, evidencing interventions with better antihypertensive efficacy and safety profile. TRIAL REGISTRATION: This systematic review and network meta-analysis was prospectively registered at the PROSPERO database ( CRD42018118492 ).

Never Too Old for Congenital Heart Disease: A Case of Cor Triatriatum Sinistrum and Mitral Valve Prolapse.

Cor triatriatum is a congenital atrial abnormality, which comprises a membrane that divides the atrium into two chambers. Symptoms can arise either due to the obstructive nature of this membrane or related to other associated anomalies, such as atrial septal defects or abnormal pulmonary venous return. The authors report the case of an adult male, in whom an incidental finding of cor triatriatum sinistrum was documented in association with mitral valve prolapse. However, both the late diagnosis and the association with mitral valve disease are uncommon. Multimodality imaging evaluation can prove very helpful in these cases to better define the anatomy of the left atrium and appropriately plan for intervention when indicated.

Glucagon-Like Peptide-1 Receptor Agonists in Type 2 Diabetes Mellitus and Cardiovascular Disease: The Past, Present, and Future.

Type 2 diabetes mellitus (T2DM) is associated with high cardiovascular morbidity and mortality, and cardiovascular diseases are the leading causes of death and disability in people with T2DM. Unfortunately, therapies strictly aimed at glycemic control have poorly contributed to a significant reduction in the risk of cardiovascular events. On the other hand, randomized controlled trials have shown that five glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and one exendin-based GLP-1 RA reduced atherosclerotic cardiovascular events in patients with diabetes at high cardiovascular risk. Furthermore, a meta-analysis including these six agents showed a reduction in major adverse cardiovascular events as well as all-cause mortality compared with placebo, regardless of structural homology. Evidence has also shown that some drugs in this class have beneficial effects on renal outcomes, such as preventing the onset of macroalbuminuria. In addition to lowering blood pressure, these drugs also favorably impacted on body weight in large randomized controlled trials as in real-world studies, a result considered a priority in T2DM management; these and other factors may justify the benefits of GLP-1 RAs upon the cardiovascular system, regardless of glycemic control. Finally, studies showed safety with a low risk of hypoglycemia and no increase in pancreatitis events. Given these benefits, GLP-1 RAs were preferentially endorsed in the guidelines of the European and American societies for patients with these conditions. This narrative review provides a current and comprehensive overview of GLP-1 RAs as cardiovascular and renal protective agents, far beyond their use as glucose-lowering drugs, supporting their effectiveness in treating patients with T2DM at high cardiovascular risk.

Impacts of meander migration on the Amazon riverine communities using Landsat time series and cloud computing.

River meander migration is a process that maintains biodiverse riparian ecosystems by producing highly sinuous rivers, and oxbow lakes. However, although the floodplains support communities with fish and other practices in the region, meandering rivers can directly affect the life of local communities. For example, erosion of river banks promotes the loss of land on community shores, while sedimentation increases the distance from house to the river. Therefore, communities living along the Juruá River, one of the most sinuous rivers on Earth, are vulnerable to long-term meander migration. In this study, the river meander migration was detected by using Landsat 5-8 data from 1984 to 2020. A per-pixel Water Surface Change Detection Algorithm (WSCDA) was developed to classify regions subject to erosion and sedimentation processes by applying temporal regressions on the water index, called Modified Normalized Difference Water Index (mNDWI). The WSCDA classified the meander migration with omission and commission errors lower than 13.44% and 7.08%, respectively. Then, the number of riparian communities was mapped using high spatial resolution SPOT images. A total of 369 communities with no road access were identified, the majority of which living in stable regions (58.8%), followed by sedimentation (26.02%) and erosion (15.18%) areas. Furthermore, we identified that larger communities (>20 houses) tend to live in more stable locations (70%) compared to smaller communities (1-10 houses) with 55.6%. A theoretical model was proposed to illustrate the main impacts of meander migration on the communities, related to Inundation, Mobility Change, and Food Security. This is the first study exploring the relationship between meander migration and riverine communities at watershed-level, and the results support the identification of vulnerable communities to improve local planning and floodplain conservation.

p300 or CBP is required for insulin-stimulated glucose uptake in skeletal muscle and adipocytes.

While current thinking posits that insulin signaling to glucose transporter 4 (GLUT4) exocytic translocation and glucose uptake in skeletal muscle and adipocytes is controlled by phosphorylation-based signaling, many proteins in this pathway are acetylated on lysine residues. However, the importance of acetylation and lysine acetyltransferases to insulin-stimulated glucose uptake is incompletely defined. Here, we demonstrate that combined loss of the acetyltransferases E1A binding protein p300 (p300) and cAMP response element binding protein binding protein (CBP) in mouse skeletal muscle caused a complete loss of insulin-stimulated glucose uptake. Similarly, brief (i.e., 1 hour) pharmacological inhibition of p300/CBP acetyltransferase activity recapitulated this phenotype in human and rodent myotubes, 3T3-L1 adipocytes, and mouse muscle. Mechanistically, these effects were due to p300/CBP-mediated regulation of GLUT4 exocytic translocation and occurred downstream of Akt signaling. Taken together, we highlight a fundamental role for acetylation and p300/CBP in the direct regulation of insulin-stimulated glucose transport in skeletal muscle and adipocytes.

Prognostic Value of the Malnutrition-inflammation Score in Hospitalization and Mortality on Long-term Hemodialysis.

OBJECTIVE: Since its development, cumulative evidence has accumulated regarding the prognostic value of the Malnutrition-Inflammation Score (MIS/Kalantar score) prognostic value; however, there is a shortage of recent and large studies with comprehensive statistical methodologies that contribute to support a higher level of evidence and a consensual cutoff. The aim of this study was to assess the strength of MIS association with hospitalization and mortality in a nationwide cohort. METHODS: This was a historical cohort study of hemodialysis patients from 25 outpatient centers followed up for 48 months. Univariable and multivariable Cox additive regression models were used to analyze the data. The C-index was estimated to assess the performance of the final model. RESULTS: Two thousand four hundred forty-four patients were analyzed, 59.0% males, 32.0% diabetic, and median age of 71 years (P25 = 60, P75 = 79). During a median period of 45-month follow-up, with a maximum of 48 months (P25 = 31; P75 = 48), 875 patients presented an MIS <5 (35.8%) and 860 patients (35.2%) died. The proportion of deaths was 23.1% for patients with the MIS <5 and 41.9% if the MIS ≥5 (P < .001). A total of 1,528 patients (62.5%) were hospitalized with a median time to the first hospitalization of 26 months (P25 = 9; P75 = 45). A new cutoff point regarding the risk of death, MIS ≥6, was identified for this study data set. In multivariable analysis for hospitalization risk, a higher MIS, higher comorbidity index, and arteriovenous graft or catheter increased the risk, whereas higher Kt/V and higher albumin had a protective effect. In multivariable analysis for mortality risk, adjusting for age, albumin, normalized protein catabolic rate, Charlson comorbidity index, interdialytic weight gain, Kt/V, diabetes, hematocrit, and vascular access, patients with the MIS ≥6 showed a hazard ratio of 1.469 (95% confidence interval: 1.262-1.711; P < .001). Higher age, higher interdialytic weight gain, higher comorbidity index, and catheter increased significantly the risk, whereas higher Kt/V, higher albumin, and higher normalized protein catabolic rate (≥1.05 g/kg/d) reduced the risk. CONCLUSION: The MIS maintains its relevant and significant association with hospitalization and mortality.

O ensino dos estudos da deficiência: contribuições para a formação em psicologia / La enseñanza de los estudios de la discapacidad: contribuciones a la formación en psicología / Teaching disability studies: contributions to training in psychology

Resumo Esta pesquisa objetivou identificar as contribuições do ensino dos estudos da deficiência (disability studies) para a formação em psicologia na perspectiva das/os participantes de uma disciplina intitulada "Psicologia e Pessoas com Deficiência". O lócus da pesquisa foi um curso de Psicologia de uma universidade pública do sul do Brasil. As informações foram obtidas por meio de questionário sociodemográfico e entrevista semiestruturada com quatorze pessoas que cursaram a disciplina e analisadas a partir da técnica de análise temática. Os resultados indicaram que a disciplina contribuiu para: a apropriação do modelo social da deficiência e das contribuições dos estudos feministas da deficiência; a identificação das pessoas com deficiência como sujeitos políticos; a ampliação da percepção das barreiras sociais; a apropriação de alguns elementos da legislação brasileira sobre a deficiência. Destaca-se a relevância de os estudos da deficiência serem incluídos no currículo para a formação em psicologia na perspectiva dos direitos humanos.

Resumen Esta investigación tuvo como objetivo identificar las contribuciones de la enseñanza de los estudios de la discapacidad a la formación en psicología desde la perspectiva de los estudiantes en una disciplina titulada "Psicología y Personas con Discapacidad". El lugar de la investigación fue un curso de Psicología en una universidad pública del sur de Brasil. La información se obtuvo mediante la aplicación de un cuestionario sociodemográfico y una entrevista semiestructurada a catorce personas que asistieron al curso y se analizaron mediante la técnica de análisis temático. Los resultados indicaron que la disciplina contribuyó a: la apropiación del modelo social de la discapacidad y los aportes de los estudios feministas; la identificación de personas con discapacidad como sujetos políticos; la ampliación de la percepción de barreras sociales; la apropiación de algunos elementos de la legislación brasileña sobre discapacidad. Se destaca la relevancia de la inclusión de los estudios sobre discapacidad en el currículo de formación en Psicología desde la perspectiva de los derechos humanos.

Abstract This research aimed to identify the contributions of teaching disability studies to training in psychology from the perspective of participants in a discipline entitled Psychology and People with Disabilities. The locus of the research was a psychology course at a public university in southern Brazil. Information was obtained through the application of a sociodemographic questionnaire and semi-structured interviews with fourteen people who attended the course and analyzed using the thematic analysis technique. The results showed that the knowledge obtained in the discipline contributed to: the appropriation of the social model of disability and the contributions of feminist disability studies; the identification of disabled people as political people; the expansion of the perception of social barriers and; the appropriation of some elements of the Brazilian legislation on disability. Finally, it emphasizes the relevance of disability studies being included in the curriculum for training in psychology from the perspective of human rights.

Orthodromic Atrioventricular Tachycardia in Wolff-Parkinson-White Syndrome with Two Accessory Pathways Participation during the Same AVT

Case report of a 49-year-old patient with Wolff-Parkinson-White syndrome, very symptomatic, with apparent parahisian pathway who, during an electrophysiological study, presented orthodromic atrioventricular tachycardia, featuring two accessory pathways, retrogradely, the parahisian pathway and a hidden left posterolateral pathway, during the same tachycardia, alternating the retrograde pathway of tachycardia without interruption.

Cardiac arrhythmias in patients presenting with COVID-19 treated in Portuguese hospitals: A national registry from the Portuguese Association of Arrhythmology, Pacing and Electrophysiology.

INTRODUCTION AND OBJECTIVES: In December 2019, SARS-CoV-2, was discovered as the agent of COVID-19 disease. Cardiac arrhythmias have been reported as frequent but their incidence is unknown. The aim of this research was to assess the real incidence of cardiac arrhythmias among COVID-19 patients admitted to Portuguese hospitals and to understand the underlying prognostic implications. METHODS: The Portuguese Association of Arrhythmology, Pacing and Electrophysiology (APAPE) conducted a survey in Portuguese hospitals to assess the occurrence of arrhythmias in COVID-19 patients, their clinical characteristics, the use of experimental therapies and the impact on QT interval. RESULTS: Twenty hospitals participated, reporting 692 hospitalized patients. An arrhythmic episode occurred in 81 (11.7%) and 64 (79%) had detailed information on these episodes. New onset arrhythmias occurred in 41 (64%) patients, 45 (70.3%) male, median age 73.5 (61-80.3) years. There were 51 (79.7%) with associated comorbidities, mainly arterial hypertension (41, 64.1%). Of 53 patients (82.3%) on experimental therapy, 7 (10.9%) had an increased QTc interval. Regarding arrhythmias, two patients (3.1%) had ventricular tachycardia, 5 (7.8%) sinus bradycardia, 17 (26.6%) paroxysmal supraventricular tachycardia and 40 (62.5%) atrial fibrillation or flutter. At the time of reporting, there had been no deaths due to arrhythmic syndrome or related complications. CONCLUSIONS: In a population of COVID-19 patients. The incidence of cardiac arrhythmias is high but not associated with increased cardiac mortality although it does though occur frequently in extremely ill patients and with multiple organ failure. Regardless of the use of experimental drugs, the incidence of ventricular arrhythmias is low and atrial fibrillation and other supraventricular arrhythmias are the most prevalent arrythmias.

INTRODUÇÃO E OBJETIVOS: Em dezembro de 2019, o SARS-CoV-2 foi descoberto como agente da doença Covid-19. As arritmias cardíacas são reportadas como frequentes, mas a sua incidência é desconhecida. O objetivo deste trabalho foi entender a incidência de arritmias em doentes Covid-19 tratados em hospitais portugueses e entender as suas implicações prognósticas. MÉTODOS: A Associação Portuguesa de Arritmologia, Pacing e Electrofisiologia (APAPE) conduziu um inquérito em hospitais portugueses, documentando a ocorrência de arritmias em doentes com Covid-19, as suas caraterísticas clínicas, o uso de terapêutica experimental e o seu impacto no intervalo QT. RESULTADOS: Participaram 20 hospitais, reportando 692 doentes hospitalizados. Ocorreram episódios arrítmicos em 81 (11,7%), 64 (79%) com informação adicional. Documentaram-se arritmias de novo em 41 (64%) doentes, 45 (79%) do sexo masculino, idade mediana 73,5 (61-80,3) anos. Destes, 51 (79,7%) tinham comorbilidades associadas, maioritariamente hipertensão arterial (41, 64,1%). Dos 53 (82,3%) doentes sob terapêutica experimental, 7 (10,9%) tiveram aumento do intervalo QTc. Tiveram taquicardia ventricular 2 (3,1%) doentes, 5 (7,8%) bradicardia sinusal, 17 (26,6%) taquicardia paroxística supraventricular e 40 (7,8%) fibrilhação ou flutter auricular. Nenhum doente teve morte por causa arrítmica ou complicações associadas, à data do registo. CONCLUSÕES: Numa população de doentes com Covid-19, a incidência de arritmias é elevada, mas não associada a aumento de mortalidade cardíaca, apesar da ocorrência mais frequente em doentes graves e com falência multiorgânica. Independentemente do uso de terapêuticas experimentais, a incidência de arritmias ventriculares é baixa e a fibrilhação auricular e outras arritmias supraventriculares são as arritmias mais prevalentes.