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AbstractBackground:Myocardial perfusion scintigraphy (MPS) in patients not reaching 85% of the maximum predicted heart rate (MPHR) has reduced sensitivity.Objectives:In an attempt to maintain diagnostic sensitivity without losing functional exercise data, a new exercise and dipyridamole combined protocol (EDCP) was developed. Our aim was to evaluate the feasibility and safety of this protocol and to compare its diagnostic sensitivity against standard exercise and dipyridamole protocols.Methods:In patients not reaching a sufficient exercise (SE) test and with no contraindications, 0.56 mg/kg of dipyridamole were IV administered over 1 minute simultaneously with exercise, followed by 99mTc-MIBI injection.Results:Of 155 patients, 41 had MPS with EDCP, 47 had a SE test (≥ 85% MPHR) and 67 underwent the dipyridamole alone test (DIP). They all underwent coronary angiography within 3 months. The three stress methods for diagnosis of coronary lesions had their sensitivity compared. For stenosis ≥ 70%, EDCP yielded 97% sensitivity, SE 90% and DIP 95% (p = 0.43). For lesions ≥ 50%, the sensitivities were 94%, 88% and 95%, respectively (p = 0.35). Side effects of EDCP were present in only 12% of the patients, significantly less than with DIP (p < 0.001).Conclusions:The proposed combined protocol is a valid and safe method that yields adequate diagnostic sensitivity, keeping exercise prognostic information in patients unable to reach target heart rate, with fewer side effects than the DIP.

FUNDAMENTO: Quando um teste de ecocardiografia de estresse com dobutamina é realizado, a piloereção é freqüentemente observada na área do escalpo. OBJETIVO: O objetivo do presente estudo foi estabelecer a incidência desse fenômeno e sua relação com outros achados clínicos. MÉTODOS: 218 pacientes consecutivos que foram submetidos a teste de ecocardiografia de estresse com dobutamina em nosso departamento foram incluídos no estudo. RESULTADOS: A piloereção estava presente em 42,2% dos casos. Nenhuma correlação pôde ser estabelecida entre a piloereção e o sexo, resultados do teste de estresse ou outros efeitos colaterais. Uma correlação estatisticamente significante foi estabelecida com a idade dos pacientes: a piloereção estava presente em 73% dos pacientes com 50 anos ou menos. A reação aparece mais freqüentemente com uma dose de dobutamina de 10 µg/kg/min. CONCLUSÃO: A piloereção é um efeito colateral freqüente da infusão de dobutamina, particularmente em pacientes com 50 anos ou menos. Ela geralmente precede o aumento da freqüência cardíaca causada pela dobutamina; portanto, é uma indicação clara e precoce de que a infusão intravenosa está funcionando adequadamente. Além disso, avisar aos pacientes sobre sua possível ocorrência pode contribuir para o bem estar dos mesmos.FUNDAMENTO: Cuando se realiza un test de ecocardiografía de esfuerzo con dobutamina, la piloerección se observa frecuentemente en el cuero cabelludo. OBJETIVO: El objetivo del presente estudio fue establecer la incidencia de este fenómeno y su relación con otros resultados clínicos. MÉTODOS: Se incluyeron en el estudio 218 pacientes consecutivos que fueron sometidos a tests de ecocardiografía de esfuerzo con dobutamina en nuestro departamento. RESULTADOS: La piloerección estaba presente en el 42,2 % de los casos. No se pudo establecer ninguna correlación entre la piloerección y el sexo, resultados del test de esfuerzo u otros efectos colaterales. Una correlación estadísticamente significante se estableció con la edad de los pacientes: la piloerección estaba presente en un 73% de los pacientes con 50 años o menos. La reacción aparece más frecuentemente con una dosis de dobutamina de 10 µg/kg/min. CONCLUSIONES: La piloerección es un efecto colateral frecuente de la infusión de dobutamina, particularmente en pacientes con 50 años o menos. Esta precede generalmente el aumento de la frecuencia cardíaca provocada por la dobutamina. Por tanto es una indicación clara y precoz de que la infusión intravenosa está funcionando adecuadamente. Además de ello, avisar a los pacientes sobre su posible ocurrencia puede contribuir para el bienestar de los mismos.BACKGROUND: When a dobutamine stress echocardiogram is performed, piloerection is frequently found in the scalp area. OBJECTIVE: The aim of the present study was to establish the incidence of this phenomenon and its association with other clinical findings. METHODS: A total of 218 consecutive patients that underwent dobutamine stress echocardiography in our department were included in the study. RESULTS: Piloerection was present in 42.2% of the sample. No correlations could be established between piloerection and gender, result of the stress test or other side effects. A statistically significant correlation was established with the age of the patients: piloerection was present in 73% of patients aged 50 years or younger. It appears most often with a dobutamine dose of 10 µg/kg/min. CONCLUSION: Piloerection is a frequent side effect of dobutamine infusion, particularly in patients aged 50 or less; it usually precedes the increase in heart rate caused by dobutamine; therefore, it is an early and clear indication that the intravenous set is working properly. Also, the previous warning of its possible appearance may contribute to the patient's well-being.

Sr. Editor: El trabajo "Acción Midriática de la Beta-Iso-Eucaína en humanos" es el resultado de una idea e investigación original de mi padre, el Profesor Kempis Vidal, ya fallecido. Durante sus últimos meses de vida, a su pedido, colaboré con él para ordenar los hallazgos y comenzar a describirlos para su publicación. Dada la importancia científica de los mismos y el esfuerzo de tantos, decidí, sobre la base de lo ya elaborado juntos, completar la redacción del trabajo y posibilitar así su difusión.

Background: Myocardial dysfunction is increasingly recognized as a complication of COVID-19 infection, with implications for patient prognosis and long-term cardiovascular health. Longitudinal strain, measured via echocardiography, is a sensitive marker of myocardial function that may provide valuable insights into cardiac involvement in COVID-19 patients. This study aimed to assess myocardial dysfunction using longitudinal strain analysis in COVID-19 patients, correlating clinical symptoms and laboratory results at admission and four months post-treatment. Methods : This study compared clinical and laboratory parameters in COVID-19 patients post-recovery with and without myocardial dysfunction. Adult COVID-19 survivors were included if they were hospitalized and met certain criteria. Independent variables included clinical factors and laboratory factors at admission, while the dependent variable was myocardial dysfunction assessed through longitudinal strain of the left and right ventricles on speckle tracking echocardiography. The study was conducted at the Harapan Kita Heart and Blood Vessel Center (RSJPDHK - FKUI)/Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Jakarta. Results: This study examined the cardiovascular health of 162 participants three months after getting infected with COVID-19. Those with comorbidities had the lowest LV GLS levels. Admission factors like obesity, SpO2, and PaO2 levels were linked to decreased LV GLS levels. These findings suggest that these admission factors may predict the progression of COVID-19 syndrome and its implications on cardiovascular health. Conclusion: COVID-19 patients with cardiovascular comorbidities have lower LV-GLS values. CAD status during admission affects LV GLS values 3-6 months after COVID-19 infection, indicating myocardial dysfunction. Basal lateral LV-GLS correlates with obesity status, SpO2, and PaO2 during admission. Closely monitor COVID-19 patients with cardiovascular comorbidities and recognize the implications of CAD status on myocardial function post-infection.

Introdução: A metastização óssea associa-se, geralmente, a mau prognóstico, com evidência de doença neoplásica avançada. Pretende-se caracterizar uma amostra de doentes internados no hospital com o diagnóstico de metastização óssea, comparando-se os doentes com diagnóstico já conhecido de neoplasia com os doentes sem neoplasia identificada. Material e métodos: Estudo observacional retrospectivo, incluídos doentes com diagnóstico de “neoplasia óssea secundária” ou “metástases ósseas”, no período de 2009 a 2013. Analisados os dados de doentes com metástases ósseas com neoplasia primária conhecida ou oculta. Resultados: Analisados os processos de 94 doentes, média de idades de 69±12.66anos, 68% do sexo masculino. Os sintomas apresentados eram principalmente dorso-lombalgia (34%) e défice de força muscular dos membros (15%). Em 42% dos doentes, existia previamente o diagnóstico de neoplasia. A coluna vertebral constituiu o principal local de metastização. Em 22% dos doentes não se identificou a neoplasia primária. A taxa de mortalidade durante o internamento foi de 14%, e no follow-up após um ano de 31%. Discussão: No estudo efectuado, verifica-se que a mortalidade à data de alta do internamento em doentes com neoplasia conhecida é superior à dos doentes com neoplasia indeterminada, o que não se verifica no follow-up a 1 ano. Pode considerar-se que os doentes com neoplasia previamente conhecida podem apresentar metastização óssea mais tardia, e assim, com pior prognóstico. Conclusão: A disseminação tumoral com expressão através da metastização relaciona-se com um agravamento do prognóstico no follow-up. Introduction: The bone metastasis have usually a bad prognosis, with evidence of advance malignancy. It’s intended to characterize a sample of patients admitted to hospital with the diagnosis of bone metastasis, comparing patients with previous diagnosis of neoplasia with patients without diagnosed neoplasia. Material and methods: A retrospective observational study, included patients with diagnois of “secondary bone cancer” or “bone metastasis”, from 2009 to 2013. Analysed data from patients with bone metastasis with known primary neoplasia or with unknow origin. Results: Analized the process of 94 patientes, mean age 69±12.66 years, 68% male. The symptoms were mostly back pain (34%) and muscular strength deficits (15%). In 42% there was a previous diagnosis of neoplasia. The spine was the primary site of metastasis. In 22% of patients, wasn’t identify the primary tumor. The mortality rate during hospitalization was 14%, and in the follow-up to one year of 31%. Discussion: In the study carried out, it is found that mortality at the end of hospitalization in patients with known neoplasia was higher than of the patient with unknow neoplasia, wich is not the case in the follow-up to one year. It can be regarded that patients with known neoplasia may present later bone metastasis, and therefore, a worst prognosis. Conclusion: The tumor spread with expression through metastasis relates with a worsening of the prognosis in the follow-up.

Resumo Doente do sexo masculino, de 49 anos, internado no Serviço de Medicina de um Hospital Central para estudo de múltiplas fracturas de costelas de origem não traumática. Apresentava uma densitometria óssea, realizada em ambulatório, com critérios de osteoporose e uma biópsia óssea de um dos locais de fractura que revelava apenas processo cicatricial. O estudo etiológico realizado não permitiu identificar uma causa para a osteoporose, estabelecendo-se o diagnóstico de osteoporose masculina idiopática, e iniciando-se terapêutica anti-reabsortiva. A osteoporose masculina idiopática normalmente ocorre em homens de meia-idade que se apresentam com fractura ou dor lombar de causa não traumática e nos quais não se encontra uma etiologia que o justifique. Abstract Male patient, 49 years old, was admitted to study multiple fractures of ribs, of nontraumatic origin. He had a bone densitometry performed on an outpatient basis with osteoporosis criteria, and a bone biopsy of the fracture site that revealed only healing process. The etiologic study not identified a cause for osteoporosis, establishing the diagnosis of idiopathic male osteoporosis and starting up anti-reabsorptive therapy. Idiopathic male osteoporosis usually occurs in middle-aged men who present with fractures or back pain from non-traumatic causes and which is not an etiology that justifies.