RESUMO
This article examines the role of aspirin in the primary prevention of cardiovascular disease. It highlights findings from major studies such as ASPREE (ASPirin in Reducing Events in the Elderly), ARRIVE (Aspirin to Reduce Risk of Initial Vascular Events), and ASPREE-XT (ASPirin in Reducing Events in the Elderly - eXTension) , among others. The review focuses on aspirin's role in primary prevention for specific populations including older adults, diabetics, hypertension patients, rheumatoid arthritis patients, kidney transplant recipients, and those with specific lipoprotein(a) genotypes, among other groups. We review these studies, noting aspirin's role in reducing events such as myocardial infarctions and its potential for increasing bleeding risks. The review also considers the implications for patients with kidney disease, referencing the Chronic Renal Insufficiency Cohort (CRIC) study and the International Polycap Study-3 (TIPS-3) trial. Additionally, it addresses the shifting paradigms in guidelines from the US Preventive Services Task Force and other entities, underscoring the importance of individualized aspirin use by balancing benefits against bleeding risks. The article further explores the concept of platelet reactivity, discusses strategies for improving adherence to aspirin therapy, and identifies existing research gaps, such as the phenomenon of aspirin resistance. It concludes by suggesting potential areas for future investigation to enhance understanding and application of aspirin in cardiovascular disease prevention.
RESUMO
Hashimoto's thyroiditis is an autoimmune thyroid disease characterized by lymphocytic infiltration and thyroid-specific autoantibodies. Hashimoto's encephalopathy, a rare entity associated with these antibodies, presents as a relapsing encephalopathy with neuropsychiatric manifestations and seizures. A 15-year-old girl, initially healthy, experienced a tonic-clonic seizure. Despite unremarkable initial assessments, she returned with generalized convulsive status epilepticus. Hashimoto's thyroiditis was suggested by elevated thyroid-stimulating hormone levels, low thyroxine levels, and high anti-thyroid antibodies, and was confirmed by ultrasound. Steroids were not used initially due to seizure cessation with anesthesia. Post-treatment with levothyroxine and antiepileptics, she was seizure-free at follow-up and eventually maintained solely on levothyroxine. Hashimoto's encephalopathy, characterized by diverse symptoms, often necessitates corticosteroids, immunoglobulins, and plasmapheresis, as traditional anti-seizure medications fail. Further research into its etiology and pathophysiology is essential. Consider Hashimoto's encephalopathy in unexplained seizures, especially with ineffective standard treatments. Pediatric diagnostic criteria need to be revisited.
RESUMO
The presence of chyle in the pleural cavity is referred to as chylothorax. Exudative chylothorax is usually related to damage or obstruction of the lymphatic vasculature with subsequent leakage into the pleural space. In contrast, transudative chylothorax is related to increased hydrostatic pressure caused by elevated intra-abdominal pressure, which leads to the translocation of chylous fluid into the pleural space. Cirrhosis is the most common cause of transudative chylothorax, commonly presenting with ascites and portal hypertension. To the best of our knowledge, isolated transudative chylothorax as a consequence of cirrhosis is exceptionally rare and has been scarcely reported in the literature. We herein report a female patient in her fifties who presented to our hospital with isolated unilateral transudative hepatic chylothorax, with no clinical evidence of cirrhosis or any stigmata of portal hypertension at the time of presentation.
