Acute clomipramine exposure elicits dose-dependent surfacing behavior in adult zebrafish (Danio rerio).

Chronic treatment with clomipramine, a tricyclic antidepressant drug, reduces symptoms of obsessive-compulsive disorder (OCD) and can influence the activity of the hypothalamic-pituitary-adrenal axis. However, little is known regarding the effects of acute clomipramine on the immediate expression of stress responses. Serotonergic drugs can elicit surfacing, a behavioral profile potentially related to toxicity in fish, although surfacing has not yet been observed after clomipramine exposure. The present study investigated the impact of acute exposure to clomipramine on basal and stress-induced behaviors in the novel tank test and cortisol levels in mixed-sex, wild-type, adult zebrafish (Danio rerio). The findings show clomipramine-exposed groups (regardless of stress exposure) spent much more time in the top of the novel tank and had significantly less overall motor activity in the behavioral task compared to the fish not exposed to the drug. Then, the dose-dependent effects of acute clomipramine on activity in the surface of the novel tank (top third of the top half) were investigated further. Clomipramine dose-dependently increased surface-dwelling and elicited a dose-dependent hypoactivity in overall motor behavior. There were no statistically significant differences in whole-body cortisol levels in either experiment. Like other serotonin-acting drugs, clomipramine strongly elicited surface-dwelling and depressed motor behavior in adult zebrafish. Additional testing is needed to elucidate whether surfacing represents a toxic state and how serotonin regulates surfacing.

Fístula coronário-cavitária com aneurisma em seu trajeto: relato de caso de tratamento percutâneo / Coronary-cavitary fistula with aneurysm in its path: case report of percutaneous treatment

RESUMO: Discorre-se o caso de uma paciente de 29 anos com palpitações, dor torácica e dispneia aos esforços, com diagnóstico de fístula coronariana direita e submetida à correção percutânea de trajeto fistuloso com prótese Amplatzer.

ABSTRACT: The authors report the case of a 29-year-old, female patient with palpitations, chest pain, and dyspnea on exertion. The patient was diagnosed with right coronary fistula and underwent percutaneous correction of the fistulous tract with an Amplatzer prosthesis.

Causa inusitada de insuficiencia aórtica aguda / Unusual cause of acute aortic insufficiency

CASO: Paciente, pós-implante de marcapasso (MP) definitivo, com piora da classe funcional. O ecocardiograma mostra insuficiência aórtica (IAo) aguda. É incorreto afirmar: a. A imagem é sugestiva de dissecção tipo I com acometimento valvar. b. A IAo não é secundária a alteração da anatomia das válvulas nem do anel valvar aórtico. c. O ECG de 12 derivações e a radiografia de tórax em perfil oferecem importantes informações que podem levar à suspeita diagnóstica. d. A anticoagulação oral (ACO) pode ser necessária para prevenção de eventos embólicos até a resolução definitiva da causa da IAo. RESPOSTA: a. A imagem é sugestiva de eletrodo de MP impactando na valva aórtica, não é característica de linha de disseção e não altera a anatomia das valvas nem do anel aórtico. Até a retirada e reposicionamento do eletrodo, a ACO ajuda diminuir a incidência de eventos tromboembólicos secundários à localização do eletrodo em circulação sistémica. link do youtube: https://youtu.be/BEAwtn7yPjA

Modelación de la evolución de neonatos con bajo peso al nacer, atendidos en el Hospital Universitario del Valle, durante el período 2002 a 2010: Estudio de Cohorte / Modelling the evolution of neonates with low birth weight, treated at the Hospital Universitario del Valle, during the period 2002-2010: Cohort study

Esta investigación tuvo como objetivos observar relaciones y encontrargrupos de neonatos que muestren un comportamiento similar con respecto a las variables de crecimiento físico, morbilidad e intervención y modelar la evolución del peso del neonato con bajo peso al nacer a través del tiempo. Materiales y Métodos:Se analizó una muestra de historias clínicas de 159 neonatos prematuros nacidos en el Hospital Universitario del Valle (HUV), entre febrero de 2002 y noviembre de2010, que pertenecen al programa de seguimiento de alto riesgo y canguro del HUV. Se realizó un análisis de correspondencias y un análisis de conglomerados y en segunda instancia, se ajustó un modelo de coeficientes aleatorios. Resultados:Se encontraron dos grupos bien definidos de neonatos, los que presentan extremo bajo peso y los que presentan bajo peso y muy bajo peso al nacer. Las curvas estimadas a partir del modelo ajustado, muestran pesos un poco más altos para los neonatos con control prenatal. Conclusiones: El tener un modelo que permita estimar la curva de evolución del peso de cada neonato que nace con bajo peso en el HUV, resulta de gran ventaja para los pediatras, ya que permite observar que tan variable es ésta frente a la curva del peso medio esperado...

Terapias, prácticas y acciones en la búsqueda de un mejor estado de salud-enfermedad / Therapies, practices and actions in the search for better health

Alrededor del mundo y a lo largo de la historia, las personas han realizad y seguirán realizando actividades, acciones, prácticas y terapias, en su afán de contar con un mejor estado de salud enfermedad. Materiales y Métodos: Se buscaron artículos científicos principalmente en las bases de datos disponibles en el Sistema de Bibliotecas y Documentación de la Universidad de Costa Rica, además de otras fuentes de información, luego del análisis correspondiente se estructuró una comunicación que contempló tres grandes secciones: aspectos conceptuales, categorías terapéuticas y otros aspectos relacionados. Resultados: Se destaca que no existe un único concepto que englobe la diversidad de opciones existentes utilizadas. A disposición de la población existen más de 160 categorías terapéuticas, las cuales varían según el contexto social, cultural, geográfico, político, económico e ideológico en el que se desarrollan. Conclusión: Se necesita mayor consenso y participación de los entes involucrados en el tema, con miras a desarrollar sistemáticamente mayor evidencia científica que demuestre el potencial de todo el arsenal terapéutico que sea eficaz, efectivo, seguro y de calidad. Es necesaria una mayor regulación, educación formal e información dirigida a los diferentes actores involucrados en el uso de las distintas opciones terapéuticas con la finalidad de resguardar el bien común...

Around the world and throughout history, people have done, and will continue doing activities, actions, practices and therapies, in their eagerness to have a better health condition. Materials and Methods: Scientific articles were sought mainly in the databases available in the University Library System at the University of Costa Rica, and other sources of information, and then the analysis was structured for a communication which includes three main sections: conceptual, categories therapeutic and other related aspects. Results: Of the most important highlights that no single concept that encompasses the diversity of options used by people, available to the population there are more than 160 therapeutic categories, which vary according to the social, cultural, geographic, political, economic and ideological context in which they develop. Conclusion: Greater consensus is needed for and participation of the entities involved in the issue, in order to systematically develop further scientific evidence that demonstrates the potential of all therapeutic arsenal is efficient, effective, safe and quality. We need more regulation, formal education and information to different stakeholders in the use of different therapeutic options in order to safeguard the common good...

Trombo e vegetação em átrio direito em paciente renal crônico e bacteremia frequente / Right atrium thrombosis and vegetation in chronic renal patient with frequent bacteremia

A utilização temporária de catéter central, em pacientes com insuficiência renal crônica, pode estar associada a trombo em átrio direito. Na ocorrência de bacteremia, a hipótese de trombo infectado, apesar de raro, deve ser lembrada, devido à gravidade do quadro clínico e à necessidade de intervenção cirúrgica.

Hipotensão arterial durante a ecocardiografia de estresse com dobutamina: implicação clínica e diagnóstica / Hypotension during dobutamine stress echocardiography: clinical and diagnostic implications

Introdução: A ecocardiografia de estresse com Dobutamina (ECO estresse) é um método acurado para detectar a presença de coronariopatia. Para alguns pacientes o teste é interrompido pela presença de hipotensão sistólica (HS) ou diastólica (HD) cuja etiologia e significado clínico são controversos e é pobre a literatura sobre a hiopotensão diastólica. Objetivo: Avaliar a prevalência, magnetude e implicação clínica da hipotensão sistólica (HS) e diastólica(HD) durante a ecocardiografia de estresse com Dobutamina. Método: Em 3223 pacientes (p) submetidos ao ECO estresse observou-se a presença de HS e/ou HD durante o teste em 977p/3223p (30,3 por cento). Resultados: Ocorreu HS em 312p/977p (31,9 por cento), sendo lenta (queda gradual em dois ou mais estágios >-10mmHg em 88p/312p (28,2 por cento) e brusca(queda acentuada em um estágio >- 20mmHg)...

Standard values for real-time transthoracic three-dimensional echocardiographic dyssynchrony indexes in a normal population.

BACKGROUND: There is a paucity of information describing the real-time 3-dimensional echocardiography (RT3DE) and dyssynchrony indexes (DIs) of a normal population. We evaluate the RT3DE DIs in a population with normal electrocardiograms and 2- and 3-dimensional echocardiographic analyses. This information is relevant for cardiac resynchronization therapy. METHODS: We evaluated 131 healthy volunteers (73 were male, aged 46 +/- 14 years) who were referred for routine echocardiography; who presented normal cardiac structure on electrocardiography, 2-dimensional echocardiography, and RT3DE; and who had no history of cardiac diseases. We analyzed 3-dimensional left ventricular ejection fraction, left ventricle end-diastolic volume, left ventricle end-systolic volume, and left ventricular systolic DI% (6-, 12-, and 16-segment models). RT3DE data were analyzed by quantifying the statistical distribution (mean, median, standard deviation [SD], relative SD, coefficient of skewness, coefficient of kurtosis, Kolmogorov-Smirnov test, D'Agostino-Pearson test, percentiles, and 95% confidence interval). RESULTS: Left ventricular ejection fraction ranged from 50% to 80% (66.1% +/- 7.1%); left ventricle end-diastolic volume ranged from 39.8 to 145 mL (79.1 +/- 24.9 mL); left ventricle end-systolic volume ranged from 12.9 to 66 mL (27 +/- 12.1 mL); 6-segment DI% ranged from 0.20% to 3.80% (1.21% +/- 0.66%), median: 1.06, relative SD: 0.5482, coefficient of skewness: 1.2620 (P < .0001), coefficient of Kurtosis: 1.9956 (P = .0039); percentile 2.5%: 0.2900, percentile 97.5%: 2.8300; 12-segment DI% ranged from 0.22% to 4.01% (1.29% +/- 0.71%), median: 1.14, relative SD: 0.95, coefficient of skewness: 1.1089 (P < .0001), coefficient of Kurtosis: 1.6372 (P = .0100), percentile 2.5%: 0.2850, percentile 97.5%: 3.0700; and 16-segment DI% ranged from 0.29% to 4.88% (1.59 +/- 0.99), median: 1.39, relative SD: 0.56, coefficient of skewness: 1.0792 (P < .0001), coefficient of Kurtosis: 0.9248 (P = .07), percentile 2.5%: 0.3750, percentile 97.5%: 3.750. CONCLUSION: This study allows for the quantification of RT3DE DIs in normal subjects, providing a comparison for patients with heart failure who may be candidates for cardiac resynchronization therapy.

Cardiovascular effects of local anesthesia with vasoconstrictor during dental extraction in coronary patients.

OBJECTIVE: To evaluate the occurrence of variables detecting myocardial ischemia during or after dental treatment under anesthesia with vasoconstrictor (epinephrine). METHODS: A total of 54 coronary patients undergoing dental extraction under local anesthesia with or without vasoconstrictor were included. They were divided into two groups (by drawing envelopes): group I (27 patients) using anesthetics with vasoconstrictor, and group II (27 cases) without vasoconstrictor. 24-hour Holter monitoring, Doppler-echocardiogram before and after dental intervention, and determination of biochemical markers (CK-MB mass, CK-MB activity, and troponin T) before and 24 hours after dental extraction were performed in all patients. Heart rate and blood pressure were also measured in the pre, post-anesthesia and post-dental extraction phases. Doppler echocardiography assessed left ventricular segmental contractility and the occasional occurrence of mitral regurgitation. The usual pharmaceutical treatment prescribed by the cardiologist was maintained in all cases. RESULTS: Three patients in group I presented ST-segment depression (1.0 mm) during administration of anesthesia; two other patients in group I had CK-MB mass elevation, and ischemia was not observed in any other case, as assessed by the other methods. No chest pain, arrhythmias, occurrence or worsening of left ventricular segmental hypocontractility or mitral regurgitation were observed in the study. CONCLUSION: Dental extraction performed under anesthesia with 1:100,000 epinephrine does not imply additional ischemic risks, as long as performed with good anesthetic technique and maintenance of the pharmacological treatment prescribed by the cardiologist.

Efeitos cardiovasculares da anestesia local com vasoconstritor durante exodontia em coronariopatas / Cardiovascular effects of local anesthesia with vasoconstrictor during dental extraction in coronary patients

OBJETIVO: Avaliar a ocorrência de variáveis detectoras de isquemia miocárdica, durante ou após o tratamento odontológico, sob anestesia com vasoconstritor (adrenalina). MÉTODOS: Foram incluídos 54 pacientes coronariopatas submetidos a exodontia sob anestesia local com ou sem vasoconstritor, divididos em dois grupos (sorteio por envelope): grupo I, composto por 27 que receberam anestésico com vasoconstritor; e grupo II, composto por 27 que receberam anestésico sem vasoconstritor. Todos os pacientes foram submetidos a monitoração eletrocardiográfica com Holter por 24 horas, a Doppler-ecocardiografia realizada antes e após intervenção odontológica, e a dosagem dos marcadores bioquímicos antes e 24 horas após a exodontia (creatina cinase fração MB [CK-MB] massa, CK-MB atividade e troponina T). A freqüência cardíaca e a pressão arterial nas fases pré-anestesia, pós-anestesia e pós-exodontia também foram aferidas. A Doppler-ecocardiografia teve como objetivo avaliar a contratilidade segmentar do ventrículo esquerdo e a eventual ocorrência de insuficiência mitral. Em todos os casos foi mantido o protocolo farmacológico habitual prescrito pelo cardiologista. RESULTADOS: Três pacientes do grupo I apresentaram depressão do segmento ST (1,0 mm) durante a aplicação da anestesia, dois outros pacientes do mesmo grupo tiveram elevação da CK-MB massa, e em nenhum caso foi verificada presença de isquemia avaliada pelos demais métodos. Não houve registro, neste estudo, de precordialgia, arritmias e ocorrência ou agravamento de hipocontratilidade segmentar do ventrículo esquerdo ou insuficiência mitral. CONCLUSÃO: A exodontia praticada sob uso de anestesia com adrenalina 1:100.000 não implica riscos isquêmicos adicionais quando realizada com boa técnica anestésica e manutenção do tratamento farmacológico prescrito pelo cardiologista.

OBJECTIVE: To evaluate the occurrence of variables detecting myocardial ischemia during or after dental treatment under anesthesia with vasoconstrictor (epinephrine). METHODS: A total of 54 coronary patients undergoing dental extraction under local anesthesia with or without vasoconstrictor were included. They were divided into two groups (by drawing envelopes): group I (27 patients) using anesthetics with vasoconstrictor, and group II (27 cases) without vasoconstrictor. 24-hour Holter monitoring, Doppler-echocardiogram before and after dental intervention, and determination of biochemical markers (CK-MB mass, CK-MB activity, and troponin T) before and 24 hours after dental extraction were performed in all patients. Heart rate and blood pressure were also measured in the pre, post-anesthesia and post-dental extraction phases. Doppler echocardiography assessed left ventricular segmental contractility and the occasional occurrence of mitral regurgitation. The usual pharmaceutical treatment prescribed by the cardiologist was maintained in all cases. RESULTS: Three patients in group I presented ST-segment depression (1.0 mm) during administration of anesthesia; two other patients in group I had CK-MB mass elevation, and ischemia was not observed in any other case, as assessed by the other methods. No chest pain, arrhythmias, occurrence or worsening of left ventricular segmental hypocontractility or mitral regurgitation were observed in the study. CONCLUSION: Dental extraction performed under anesthesia with 1:100,000 epinephrine does not imply additional ischemic risks, as long as performed with good anesthetic technique and maintenance of the pharmacological treatment prescribed by the cardiologist.