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Gerbode defect is defined as an abnormal left ventricle–right atrium shunting which may have congenital or acquired origin, first described by Thurman in 1838, representing 0.08% of intracardiac shunts and <1% of the congenital heart diseases. The acquired defect can be classified as iatrogenic or non-iatrogenic, with previous cardiac surgery being the most common cause. Gerbode defect is classified depending on its position with respect to the tricuspid valve in supravalvular, infravalvular, or intermediate. Our purpose was to report a rare case of an iatrogenic and acquired Gerbode defect in a 10-year-old male patient following surgical correction of a partial anomalous pulmonary venous return of the right pulmonary veins to the right atrium. The defect was successfully closed percutaneously with an Amplatzer™ Vascular Plug II device. Percutaneous closure of acquired Gerbode defects could be considered as a good option using soft devices to reduce the possibility of severe complications such as complete heart block due to the location of the defect. < Learning objective: Transesophageal echocardiography has a high sensitivity for detection of left ventricle-right atrium shunts; however, it is often difficult to diagnose the anatomic location, relationships of the shunt, and also to distinguish left ventricle–right atrium shunt from sinus of Valsalva rupture, endocardial cushion defect, ventricular septal defect, and tricuspid regurgitation (high flow velocity shunts may also be misinterpreted as pulmonary hypertension). Percutaneous closure of Gerbode defects using soft devices could be considered a good alternative to surgical repair.> [ABSTRACT FROM AUTHOR]

In previous studies we showed that prevalence of myocardial fibrosis as assessed by late enhancement on cardiac MRI in SSc patients is 45% and is associated to diffuse disease (dcSSc) and lower left ventricle ejection fraction; microvascular damage defined as decreased perfusion on cardiac MRI after adenosine infusion, was also very frequent (79%). Our aim was to identify baseline characteristics associated to the development of cardiovascular outcomes (heart failure, coronary artery disease, arrhythmias, vasculopathy, elevated systolic pulmonary artery pressure and death) in SSc patients with previously documented myocardial fibrosis and microvascular damage. We included 62 SSc patients who participated in the study of prevalence of myocardial fibrosis (2008–2010) and in our local SSc cohort. We performed baseline clinical evaluation, cardiac MRI, coronary CT angiography, transthoracic echocardiogram, and yearly clinical and cardiovascular evaluation that included Medsger's severity scale items, electrocardiogram, echocardiogram, chest X-ray or HRCT and spirometry; we registered presence and severity of internal organ involvement and cardiovascular outcomes. Ordinal variables were analyzed using Chi square test and Fisher test when appropriate, numeric variables were compared using Student's t -test or Mann Whitney U when appropriate, logistic regression and Cox proportional hazard ratio were used to perform multivariable analysis. We obtained follow-up information from 62 patients (29 dcSSc, 33 lcSSc), mean follow-up was 43.5 months. Multivariable analysis showed that elevated basal ultrasensitive CRP was associated to mortality (p = 0.004, OR: 11.9, 95% CI 2.1–65.7) and recurrent digital tip ischemic ulcers (p = 0.001, OR 26.8, 95% CI 3,9–181.3) on follow-up. Myocardial fibrosis, particularly in the middle segments (p = 0.01, OR: 11.49, 95% CI 1.6–83), and older age (p = 0.02, OR: 1.11, 95% CI 1.01–1.22) were associated to heart failure on follow-up. Higher maximum mRSS was associated to coronary artery disease (p = 0.02, OR: 1.2, 95% CI 1.02–1.38), while insertion point fibrosis (p = 0.001, OR: 12.5 95% CI 2.7–56.6) was associated to recurrent digital tip ischemic ulcers. This study shows that myocardial fibrosis, elevated ultrasensitive CRP, and higher maximum mRSS are independent predictors of cardiovascular outcomes in SSc patients. Future studies should focus on early preventive and therapeutic strategies for this group of patients. [ABSTRACT FROM AUTHOR]

Background and objectives: Nixtamalized dry masa flour was supplemented with 5% or 10% dry soybean bagasse (SB) and then processed into table tortillas. Proximate chemical composition, dietary fiber content, affective sensory analyses of corn tortillas prepared from dry masa flour enriched with 5% or 10% dried SB were determined. Also, the in vitro protein digestibility and protein digestibility‐corrected amino acid score (PDCAAS) of the tortillas were evaluated. Findings: Ten per cent SB addition reduced masa hardness by about 32% and chewiness 47% without affecting adhesiveness. In terms of rapid viscosity analysis, the addition of incremental levels of SB decreased peak and final viscosities 42% and 49%, respectively. The tortilla insoluble and soluble dietary fiber contents increased 50% and fourfold, respectively, while the lysine daily requirement for preschool infants improved from 45.6% to 67.0% when 10% SB was used. Enriched tortillas showed a similar overall acceptance and had improved texture over storage time at room temperature (25% less force to rupture compared with the control tortilla stored for the same time). Conclusions: The addition of 5% soybean bagasse to nixtamalized corn flour produced masa with good machinability and tortillas with better overall acceptance and textural shelf life and a product with four times more soluble dietary fiber, 10% less starch and with higher amounts of limiting amino acids lysine and tryptophan. The upgraded amino acid balance significantly improved PDCAAS from 41% to 59% in the tortilla containing 10% SB. Significance and novelty: Soybean bagasse is a viable option to increased fiber and protein quality in nixtamalized corn flour tortillas, with a positive impact on texture during shelf life and consumer acceptance. [ABSTRACT FROM AUTHOR]

Objective To evaluate the anti-inflammatory, analgesic, antioxidant and acute toxicity of extracts obtained from a successive extraction with solvents of ascending polarity [hexane, hex; chloroform, CHCl 3 and ethanol (EtOH)] of Ternstroemia sylvatica Schltdl. & Cham. Methods The antioxidant potential was evaluated by 2,2 diphenyl-1-picrylhydrazyl, the ferric reducing/antioxidant power assays and by determining the total phenolic content. The anti-inflammatory and antinociceptive effects were evaluated using the in vivo croton oil-induced ear edema, phorbol 12-myristate 13-acetate induced ear edema, carrageenan-induced paw edema, acetic acid-induced writhing and formalin murine models. The acute toxicity was tested using the Lorke's method in mice. Results The EtOH extract was the most active for the antioxidant potential tests diphenyl-1-picrylhydrazyl (68.70% inhibition), ferric reducing/antioxidant power [(2 431.30 ± 102.10) mmol Fe 2+ and total polyphenols content (215.80 ± 8.50) meqAG/g]. The anti-inflammatory activity was evaluated by topical application of croton oil (2 mg/ear dose) where the EtOH extract showed the strongest activity compared to the control group (45.13% inhibition), whereas in the phorbol 12-myristate 13-acetate model, at the same dose, the CHCl 3 extract showed the highest inhibition (42.88%). In the carrageenan induced edema model, the EtOH extract showed a stronger inhibition compared to indomethacin (56.34% and 50.70% at doses of 250 and 500 mg/kg of extract, respectively) during the first hour. Similarly, the same extract showed the highest analgesic activity (30.60% inhibition) in the acetic acid contortion assay, and in the formalin test it showed a greater effect with respect to the control group in both phases. Conclusions Our work confirms the value of Ternstroemia sylvatica as an important anti-inflammatory and analgesic plant, whose mechanism seems to be associated to its antioxidant effects, and supports its uses in the Mexican traditional medicine. [ABSTRACT FROM AUTHOR]

La amiloidosis es una enfermedad heterogénea, de origen hereditario o adquirido, que se caracteriza por el depósito anormal de proteínas fibrilares en diversos tejidos. Esta enfermedad puede manifestarse de manera localizada o sistémica, lo que genera una amplia variabilidad en su presentación clínica y, frecuentemente, retrasa el diagnóstico. Por ello, es fundamental la identificación temprana de los signos y síntomas para mejorar el pronóstico. El primer posicionamiento mexicano sobre la amiloidosis cardíaca tiene como objetivo resumir las principales características de la enfermedad y sus subtipos, identificando datos de alarma que incrementen la sospecha de su presencia. Además, busca ofrecer un algoritmo diagnóstico que integre los estudios de imagen y de laboratorio disponibles en nuestro país, con el fin de simplificar la toma de decisiones y llegar a un diagnóstico de manera rápida, práctica y actualizada, basado en recomendaciones sustentadas en evidencia científica. Una vez confirmado el diagnóstico, se abordan los distintos retos terapéuticos, tanto farmacológicos como no farmacológicos, ya que los pacientes no responden al tratamiento convencional de insuficiencia cardíaca. Por ello, el tratamiento debe ser individualizado para cada paciente, teniendo en cuenta la presencia de otras comorbilidades. Finalmente, se presentan los principales factores pronósticos que guiarán un tratamiento adecuado, incluyendo los resultados del asesoramiento genético., (Copyright: © 2024 Permanyer.)

Objective: Cardiac involvement in SSc is characterized by myocardial fibrosis, arrhythmias and pericarditis. Prevalence studies have shown variable results. The objective of this study was to determine the prevalence of cardiac involvement in SSc patients using the non-invasive, highly sensitive diagnostic methods of cardiac MRI and coronary angiotomography., Methods: We included 62 SSc patients and excluded those with heart disease prior to the onset of SSc, renal failure, diabetes mellitus, hyperlipidaemia, arterial hypertension, untreated thyroid disease, cor pulmonale, pregnancy or contraindications to performing cardiac MRI. All underwent clinical and laboratory evaluation, ECG, coronary angiotomography and cardiac MRI., Results: The prevalence of myocardial fibrosis was 45% and was higher in dcSSc (59%) than in lcSSc patients (33%; P = 0.04). The mean left ventricular ejection fraction (LVEF) was lower in patients with myocardial fibrosis (56%) than in those without fibrosis (63%; P = 0.0009); myocardial fibrosis on MRI was more frequent in the basal-septal segments of the LV. Seventy-nine per cent of patients had subendocardial perfusion defects and these were associated with higher ultrasensitive serum CRP values. There was no association of myocardial fibrosis or microvascular damage with atherosclerosis., Conclusion: The prevalence of myocardial fibrosis on MRI attributable to SSc is 45%, is more frequent and severe in dcSSc patients, is associated with lower LVEF and affects mainly basal LV walls. Microvascular damage in SSc is common and is associated with elevated ultrasensitive CRP levels. Cardiac damage due to SSc is not associated with coronary artery disease., (© The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Ischemic hepatitis is an infrequent entity, usually associated with low cardiac out put. We present a case of a 57 year-old man with chronic renal failure and cardiac tamponade who developed elevation of serum alanine transferase level of 5,054 U/L, aspartate transferase level of 8,747 U/L and lactate dehydrogenasa level of 15,220 U/L. The patient developed hepatic encephalopathy and hypoglycemia. Liver Doppler ultrasound was normal. He was seronegative for HBV and HCV, drugs list was scrutinized for the names of known hepatotoxins. Ischemic hepatitis was diagnosed. The hypoglycemia and encephalopathy were solved and the patient was discharged with normal transaminase levels. Ischemic hepatitis is typically preceded by hypotension, hypoxemia, or both. As one would expect, the most common cause of sustained systemic hypotension is cardiovascular disease. Liver biopsy is usually not necessary. The best treatment is support measures and correct the underlying condition.

Background: Myocardial involvement occurs in about 20% of patients with mixed connective tissue disease. The purpose of this study was to determine the prevalence of conduction disturbances, their association with other manifestations of the disease., Objective: Determine the prevalence of cardiac conduction disturbances in patients with mixed connective tissue disease attended in an institute in Mexico City and their relation with other manifestations of the disease., Methods: One hundred thirteen patients admitted to the Institute with a diagnosis of mixed connective tissue disease were divided into those with conduction disturbances (n = 23) and those without (n = 90). Over a mean follow-up of 10.2 +/- 7.8 years, clinical course, treatment, duration of the disease, types of conduction disturbances and systemic alterations were examined., Results: There was an overwhelming predominance of women in both groups. Conduction disturbances occurred in about 20% of the patients with mixed connective tissue disease and that was not possible to find significant differences in the outcome of them. As could be expected a significant difference between the two groups was QRS axis, related to anterior hemiblock, the most common conduction alteration observed. During the follow-up one patient death in-group A, but none in group B., Conclusion: Conduction disturbances were present in 20%; in agree with other authors in the literature. However, did not participate in the outcome of the disease.

We report a 36-year-old woman with hypertrophic cardiomyopathy with asymmetric septal hypertrophy without outflow tract obstruction associated with an ostium secundum-type atrial septal defect with significant hemodynamic repercussion. Diagnosis was established with transesophageal echocardiography. This is the second case of this rare association reported in the literature and the first evaluated by transesophageal echocardiography.