Search

Introdução. O resveratrol é um estilbeno encontrado em alguns alimentos. Os efeitos desse polifenol estão sendo cada vez mais estudados, devido ao seu potencial antioxidante e preventivo contra doenças neurodegenerativas. Além disso, sugere-se que a suplementação com resveratrol pode causar um efeito benéfico no humor. Objetivo. Esta revisão tem como objetivo avaliar ensaios clínicos randomizados que analisaram os efeitos do resveratrol no humor, por meio de suplementação oral. Método. Foram identificados estudos publicados até 20 de novembro de 2020 nas bases de dados PubMed, Web of Science e Scopus. Os critérios de inclusão foram: o termo resveratrol incluído no título, resumo ou palavra-chave; artigos em adultos saudáveis ​​ou mulheres saudáveis ​​no período pós-menopausa; tratamento apenas com suplementos orais. Esta revisão sistemática foi registrada no PROSPERO (CRD42020205072). A análise das evidências foi realizada pela ferramenta de avaliação do risco de viés (RoB 2.0). Resultados. Um total de 5 estudos envolvendo 339 participantes foram incluídos. Um estudo demonstrou resultados significantes, um na redução da fadiga, um na redução da ansiedade e dois no aumento do bem-estar geral. Nesses casos, o resveratrol demonstrou melhorar certos aspectos dos estados de humor; no entanto, a concordância entre os estudos é limitada. Conclusão. Com base nos resultados desta revisão, a literatura atual não fornece suporte suficiente para correlacionar a suplementação de resveratrol com melhora no humor, pesquisas com um tamanho amostral maior e alta qualidade metodológica são necessárias para medir a eficácia legítima do resveratrol no humor.

Objective: The aim of this study was to evaluate the influence of early exposure to agricultural pesticides and their relationship with autism spectrum disorder. Data source: This systematic review was registered at PROSPERO as CRD42020204842. The subject was systematically analyzed on PubMed, Scopus, and Web of Science databases until April 2021. Only studies with humans with early exposure to agricultural pesticides and diagnosis of autism were included. Exclusion criteria were studies on pesticides for domestic or veterinary use and late exposure. There were no language and time restriction. The quality analysis of the studies used the Newcastle-Ottawa Scale. Data synthesis: Six case-control studies were included; three of them measured the route of exposure by maternal biomarkers and the others by the residence address. The studies had scores between moderate and high in the quality assessment tool. It was found high rates of association between early exposure to agricultural pesticides and autism and detection limit above the quantification for a sample of polychlorinated biphenyls, hexachlorobenzene, and dichlorodiphenyldichloroethylene. Conclusions: There is evidence concerning the exposure to agricultural pesticides in early life and the development of the autism spectrum disorder; however, more studies are required to better understand their possible association. RESUMO Objetivo: Compreender a influência da exposição precoce a agrotóxicos de uso agrícola e sua relação com o transtorno do espectro autista. Fontes de dados: Esta revisão sistemática foi registrada no banco de dados PROSPERO sob número CRD42020204842. Por meio das bases de dados PubMed, Scopus e Web of Science, o assunto foi analisado sistematicamente até abril de 2021. Foram incluídos somente estudos com humanos, sendo critérios de inclusão a exposição precoce a agrotóxicos de uso agrícola e o diagnóstico de autismo e critérios de exclusão agrotóxicos de uso doméstico ou veterinário e exposição tardia. Todos os estudos foram analisados sem restrição de linguagem e tempo. A qualidade dos estudos foi avaliada pela NewCastle Ottawa Scale. Síntese dos dados: No total, seis estudos caso-controle foram incluídos. Três deles mensuraram a exposição pelos biomarcadores maternos e os demais (50%) pelo endereço de moradia. Os trabalhos apresentaram qualidade entre moderada e alta. Encontrou-se alta taxa de associação entre a exposição precoce à agrotóxicos e o autismo e detecção acima do limite de quantificação para amostras de bifenilas policloradas, hexaclorobenzeno e diclorodifenildicloroetileno. Conclusões: Existem evidências sobre a exposição a agrotóxicos de uso agrícola precocemente e o desenvolvimento do transtorno do espectro autista, porém mais pesquisas são necessárias para melhor compreensão da associação.

We describe the internal oral morphology and chondrocranial anatomy for Boana crepitans tadpoles, and compare them with available descriptions for other species in the subfamily Cophomantinae. Among species of the Boana faber group, the chondrocranial anatomy has been reported only for one species internal oral morphology and cranial anatomy are similar to other described species of Boana and Cophomantinae. B. crepitans lacks unique features in the oral cavity and chondrocranium that would distinguish it from other congeneric species. We identify six characters from the internal oral anatomy of tadpoles unique for Cophomantinae. In addition, Boana has infralabial papillae projections, buccal floor arena papillae, and lateral ridge papillae projections shorter than those described for Aplastodiscus and Bokermannohyla.

Although risk behaviors could place transgender people at increased risk of anal cancer, few studies have examined anal cancer knowledge and screening use among this population. This study assessed knowledge of anal cancer and associated screening tools, self-perceived risk for anal cancer, and willingness to undergo anal cytology testing among transgender persons in an HIV/sexually transmitted infection (STI)-dense region. Adult transgender persons were recruited locally and surveyed electronically. Descriptive statistics, student's t tests, ANOVA, and Pearson's chi-squared test were performed. Among 79 transgender persons, identified anal cancer risk factors included smoking, STI history, anoreceptive intercourse, and inconsistent condom use. Nearly half (43%) reported little to no knowledge of anal cancer. The vast majority (82%) had little to no perceived risk of developing anal cancer. Twenty-eight percent had heard of anal cytology, and few (17%) had undergone it. Despite susceptibility, transgender persons lack knowledge and have a low perception of personal risk of anal cancer, highlighting the need to increase awareness of anal cancer, risk factors, and screening methods among this population.

Introduction Liver involvement is common in patients with Turner syndrome. Most patients are asymptomatic and the pathogenesis of these findings remains unclear. Objectives The aim of this study is to correlate the main clinical, anthropometric and laboratory characteristics with the findings of hepatic elastography in patients with Turner syndrome. Methods We performed an observational cross-sectional study of adult patients diagnosed with Turner syndrome, confirmed by karyotype, without signs/symptoms of acute or chronic liver disease. Anthropometric and laboratory tests were done, including liver enzymes, lipid, and glycemic profile. Patients underwent liver health assessment using transient liver elastography at a tertiary hospital. Continuous variables were compared by Student's t-test and Mann-Whitney test as appropriate, while categorical variables were compared by Chi-square and Fisher exact test as appropriate. Results Twenty-three patients were enrolled and completed the study, with valid results from parameters of hepatic elastography. Patients who presented hepatic fibrosis risk on elastography, showed a higher concentration of triglycerides (p=0,046) and ALT/TGP (p=0. 028). The group with fatty liver showed higher concentrations of triglycerides (p=0. 033) and GGT (p=0. 046). Nine patients (34,8%) demonstrated intermediate risk of fibrosis and only one patient (4,8%) had a value suggestive of advanced fibrosis on liver elastography by kPa measurement. On the other hand, the CAP (Controlled Attenuation Parameter) identified steatosis grade I (S1) in 1/23 patients (4.3%), grade II (S2) in 1/23 patients (4.3%), and grade III (S3) in 7/23 patients (30.4%). Hepatic fibrosis and steatosis were not associated with the use of rhGH in childhood (p=0.190), neither with karyotype (p=0.675). Conclusions Our data showed a mild relationship among findings of elastography and comorbidities/kariotype. We demonstrate the importance of elastography as a non-invasive method for assessing liver involvement in Turner's syndrome, identifying degrees of fibrosis and steatosis in this population. Thus, fibroscan, with the measures of LSM (liver stiffness measurement) and CAP, emerges as a promising technique in the routine assessment of liver health in patients with Turner syndrome. Presentation: No date and time listed

The skin is a physical barrier that protects the body from the external environment. Through its immune system, it limits the attack of environmental threats. Unregulated immune reactions, however, can cause chronic inflammatory skin diseases, requiring that effective treatment routes be sought. Turmeric, a root originated from Southeast Asia, has a number of therapeutic benefits, including anti-inflammatory activity. The aim of this review was to evaluate the effects of turmeric oral supplementation in the treatment of chronic inflammatory skin diseases. Through PubMed, Scopus, and Web of Science databases, clinical studies examining the relationship between turmeric, curcumin, and skin health in humans until September 2019 were systematically searched. Evidence analysis were performed using robust tools to evaluate the risk of bias (RoB 2.0), (ROBINS-I) and methodological quality (GRADE) of the included studies. A total of eleven studies were included. The skin conditions examined include psoriasis, pruritus, oral lichen planus, facial redness, as well as types of skin cancers. Overall, therapeutic benefits for skin health have been observed through oral turmeric supplementation. The current published studies, nevertheless, are limited, requiring continuity and improvement in the intervention methodology employed.

BACKGROUND The venous access for the insertion of permanent leads of cardiac implantable electronic devices is often achieved by venous cutdown of the cephalic vein, or by "blind" puncture of the subclavian vein using anatomical landmarks, or by fluoroscopy-assisted methods. METHODS We have retrospectively analyzed our clinical experience to verify the feasibility, the safety, and efficacy of the adoption of ultrasound-guided puncture/cannulation of the axillary vein for this purpose. RESULTS Nine hundred eighty-seven leads were placed during 548 consecutive procedures, accessing the axillary vein in the infraclavicular area using real-time ultrasound guidance. Venipuncture was successful in 99.8% of cases. The access time was 11 seconds (range 4-580). We recorded three cases of pneumothorax (0.5%), but no hemothorax and no hemo-mediastinum. The incidence of local hematoma was 2.1% (12 cases). No injury to the brachial plexus or to the phrenic nerve was recorded. In a follow-up of 33 months (range 16-39), we observed no cases of "subclavian crush syndrome" (damage of the leads at the level of the thoracic inlet), and the rate of pocket infection/infective endocarditis was 0.7%. CONCLUSION In our experience, ultrasound-guided puncture/cannulation of the axillary vein for implantation of permanent leads is feasible, effective, and safe. It might be considered as a first option for this procedure.

Although risk behaviors could place transgender people at increased risk of anal cancer, few studies have examined anal cancer knowledge and screening use among this population. This study assessed knowledge of anal cancer and associated screening tools, self-perceived risk for anal cancer, and willingness to undergo anal cytology testing among transgender persons in an HIV/sexually transmitted infection (STI)-dense region. Adult transgender persons were recruited locally and surveyed electronically. Descriptive statistics, student's t tests, ANOVA, and Pearson's chi-squared test were performed. Among 79 transgender persons, identified anal cancer risk factors included smoking, STI history, anoreceptive intercourse, and inconsistent condom use. Nearly half (43%) reported little to no knowledge of anal cancer. The vast majority (82%) had little to no perceived risk of developing anal cancer. Twenty-eight percent had heard of anal cytology, and few (17%) had undergone it. Despite susceptibility, transgender persons lack knowledge and have a low perception of personal risk of anal cancer, highlighting the need to increase awareness of anal cancer, risk factors, and screening methods among this population.

The genus Phyllodytes comprises 15 species, ten of them having their tadpole external morphology described in the literature. However, there are few descriptive studies on chondrocranium and hyobranchial skeleton. In this work, we describe the chondrocranium and hyobranchial skeleton of Phyllodytes larvae and discuss shared features and interspecific variation. Our findings suggest that the skeletal morphology is mostly conserved in the genus, with common features including a single suprarostral cartilage, short infrarostral cartilages, and overall short trabecular horns. Main intrageneric variations include the arrangement of the ascending process, the presence of larval otic process, and the configuration of the crista parotica. These variations are not correlated with the phylogenetic structure of the genus. Some distinctive aspects of P. praeceptor and P. gyrinaethes are also described in tadpoles of Osteopilus ocellatus, and could be related to oophagous habits in these tadpoles.

To summarize epidemiology, pathophysiology, prognostic relevance, and treatment options of coronary artery disease (CAD) when coupled with severe aortic stenosis (SAS). In regard to treatment options, we focused on the most recently adopted therapeutic approaches and on the future perspectives in light of the latest percutaneous and surgical technical improvements in the field of both CAD and SAS management. Nowadays, SAS is the most common valve disease requiring intervention, either surgical or percutaneous. On the other side, CAD is one of the leading causes of death in the developed countries. CAD and degenerative SAS share several predisposing factors and are often concurrently found in clinical practice. Despite in the last years the transcatheter aortic valve replacement (TAVR) has been deeply changing the therapeutic approach to SAS, the correct management of patients with concomitant CAD remains controversial due to limited and heterogeneous data in the literature. Coronary revascularization is often performed in patients with concomitant CAD and SAS. Complete surgical approach is still the standard of care according to international guidelines. However, in light of the recent results of TAVR trials, the therapeutic approach is expected to change. To date, percutaneous coronary intervention performed before TAVR is safe and feasible even if the optimal timing for revascularization remains debated. Due to the great complexity of the patients affected by SAS and CAD and until unquestionable truths will come from large randomized trials, the role of the Heart Team in the decision-making process is of primary importance to guarantee the best tailored therapeutic strategy for the single patient.

A 3D transoesophageal echocardiography (3D-TOE) reconstruction tool has recently been introduced. The system automatically configures a geometric model of the aortic root and performs quantitative analysis of these structures. We compared the measurements of the aortic annulus (AA) obtained by semi-automated 3D-TOE quantitative software and manual analysis vs. multislice computed tomography (MSCT) ones.One hundred and seventy-five patients (mean age 81.3 ± 6.3 years, 77 men) who underwent both MSCT and 3D-TOE for annulus assessment before transcatheter aortic valve implantation were analysed. Hypothetical prosthetic valve sizing was evaluated using the 3D manual, semi-automated measurements using manufacturer-recommended CT-based sizing algorithm as gold standard. Good correlation between 3D-TOE methods vs. MSCT measurements was found, but the semi-automated analysis demonstrated slightly better correlations for AA major diameter (r = 0.89), perimeter (r = 0.89), and area (r = 0.85) (all P 0.0001) than manual one. Both 3D methods underestimated the MSCT measurements, but semi-automated measurements showed narrower limits of agreement and lesser bias than manual measurements for most of AA parameters. On average, 3D-TOE semi-automated major diameter, area, and perimeter underestimated the respective MSCT measurements by 7.4%, 3.5%, and 4.4%, respectively, whereas minor diameter was overestimated by 0.3%. Moderate agreement for valve sizing for both 3D-TOE techniques was found: Kappa agreement 0.5 for both semi-automated and manual analysis. Interobserver and intraobserver agreements for the AA measurements were excellent for both techniques (intraclass correlation coefficients for all parameters0.80).The 3D-TOE semi-automated analysis of AA is feasible and reliable and can be used in clinical practice as an alternative to MSCT for AA assessment.

BACKGROUND Transcatheter heart valve thrombosis (THV-t) and endocarditis (THV-e) are relevant complications after transcatheter aortic valve implantation (TAVI). Transcatheter heart valve (THV) dysfunction definition is mostly based on Doppler (stenosis/regurgitation) without considering leaflets characteristics. PURPOSE To evaluate the additional diagnostic value of leaflets echocardiographic features over Doppler when prosthetic valve complication is suspected. METHODS Among 621 post-TAVI patients, 128 cases with probable valve complication were identified. THV-t was finally diagnosed in 13 patients (10%) and THV-e in 8 (6%), while the remaining 107 (84%) had no definitive diagnosis of thrombosis/endocarditis (THV-no). We analyzed at 2 time points (baseline and follow-up) both traditional Doppler parameters and leaflets morpho-functional features. RESULTS Both Doppler and leaflets parameters showed high sensitivity (sensitivity 92%) and low specificity (ranging from specificity 32% to 74%) in detecting THV-t. Interestingly, the combination of mean aortic pressure gradient ≥20 mm Hg and leaflet thickening significantly improved the specificity of echocardiography for diagnosis of THV thrombosis (specificity 94%). On the other hand, echocardiographic diagnosis of THV endocarditis remained limited by very low sensitivity despite showing high specificity. CONCLUSIONS The combination of Doppler and leaflets parameters can improve the echocardiographic diagnosis of THV thrombosis in post-TAVI patients with suspicious symptoms, via a significant increase in the overall test specificity. This would potentially allow more rational gatekeeping to more expensive/invasive diagnostic examinations (eg, CT scan) or therapeutic trials (eg, unnecessary anticoagulation).

As a result of a growing wave of more environmental awareness and a rise in environmental concerns, companies have started to incorporate green marketing strategies to meet consumers demands and expectations for sustainable products. Nevertheless, despite this rising interest in environmentally friendly products, many sustainable products struggle to receive commercial success. Consequently, in the past decades, an increasing body of research has started to explore this inconsistency between green attitudes and purchasing behavior. It is still unclear, however, why it occurs, and which factors play a major role in the decision-making process. We explore how perceptions of functional quality can act as a potential barrier to green consumerism. Building on theories of attribute centrality, we study how products with central and peripheral green attributes are evaluated in contrast to a baseline, non-green alternative product in a strong product category. Further, we study the relationship between level of processing and consumers evaluations. By means of a field experiment, we find from the main effects that consumers seem to choose the different alternatives equally, as no significant differences were found on choice neither when contrasting green vs. non-green nor when considering attribute centrality, in the strong product category. For this category, we find that there is a trade-off between sustainability and quality, as the green alternatives are perceived to have lower functional quality. Interestingly, a higher market success is nonetheless anticipated for these alternatives. Further, this trade-off seems to occur, irrespective of the cognitive information processing system. However, the cognitive enhancement manipulation reveals a significant positive effect on choice, with the green central alternative appearing as the preferred product. Under this manipulation, the green central alternative is, as well, ranked at the top when it comes to anticipated market success. Therefore, when system 2 is activated, eco-friendliness can increase product preference, although this might be perceived by consumers to have inferior functional quality. nhhmas

Objective To identify risk factors for and understanding of anal cancer and associated screening tests among transgender persons. Methods An anonymous survey was designed and distributed with SurveyMonkey.com to transgender persons recruited at health fairs, surgical clinics, and self-referral by word of mouth. Descriptive statistical analysis was performed. Results 24 transgender women (TGW), age 23–67 years old (mean=42) and 13 transgender men (TGM), age 18–59 years old (mean=29) participated. The majority were Caucasian [TGW, 15 (63%); TGM, 12 (92%)], and insured [17(71%) TGW; 10 (77%) TGM]. Reported risk factors for anal cancer included smoking history [(14 (58%) TGW; 7(54%) TGM], past STI diagnosis [9(38%) TGW; 1(8%) TGM], HIV positivity (1(4%) TGW), receptive anal intercourse [17(71%) TGW, 7(54%) TGM], and inconsistent condom use [10(42%) TGW; 7(54%) TGM]. Only 4(17%) TGW perceived themselves to be at risk for anal cancer. Most TGW reported little to no knowledge of anal cancer (16, 67%) or anal pap smears (18, 75%). While five (21%) reported past screening, most expressed willingness to undergo future testing (n=19, 79%). Among TGM, only two (15%) perceived themselves to be at risk for anal cancer; five (38%)were familiar with anal pap smears; and only one (8%) person reported past testing. Eight (62%) reported willingness for future screening. Conclusion Transgender persons have multiple risk factors for anal cancer, yet self-perceived risk is low. Most are unfamiliar with anal cancer screening and have not been tested. This suggests transgender persons would benefit from increased awareness of anal cancer risk and screening methods.

Objective The aim of the study was to assess risk factors for anal human papillomavirus (HPV) infection and anal dysplasia among a cohort of transgender women (TGW). Methods A retrospective chart review was conducted based on electronic medical records of TGW patients seen in the University of Miami Health System between 2010 and 2016. Outcome measures included risk factors of anal dysplasia, including HIV infection, receptive anal intercourse, and smoking history. Descriptive statistical analysis and χ testing were used. Results Sixty-nine TGW patients' charts were reviewed. Patients' ages ranged from 18 to 72 (mean = 38 [15]). Twenty-two (30%) were older than 50 years; 10 (15%) were black/African descent; 20 (29%) reported a smoking history; 6 (9%) were HIV positive, and 28 (72%) among those with known partner preference (n = 39) reported male partners. Male partner preference was significantly associated with being black/African descent (p = .009) and being single (p = .048). Older age was significantly associated with HIV-positive status (p = .023). The average number of risk factors per person was 2.10 (0.97). Sixty-one years or older had the highest average number of risk factors (2.90 [0.88]). Conclusions Because rates of HIV, dangerous sexual behaviors, and other risk factors for anal dysplasia continue to persist among TGW, this study reinforces the need to increase the focus on anal health in the care of TGW and the need for further research to guide patient care and anal dysplasia screening strategies among those individuals.

AIM To assess serum levels of the plaque calcification regulators osteoprotegerin (OPG) and Matrix Gla-proteins (MGP) in individuals with stable angina and acute myocardial infarction submitted to coronary angiography and their relation to coronary artery disease burden. METHODS The study included 40 individuals affected by ST-elevation myocardial infarction (STEMI) and 40 individuals with stable angina who all underwent coronary angiography, with evaluation of the extent of coronary artery disease by Syntax Score calculation and measurement of serum OPG and MGP levels. Osteoporosis was excluded by femoral and vertebral computerized bone mineralometry. RESULTS Serum OPG and MGP levels were respectively 3.87 ± 1.07 pmol/l and 6.80 ± 2.43 nmol/l in the stable angina group, 7.57 ± 1.5 pmol/l and 7.18 ± 1.93 nmol/l in the STEMI group (P

Corythomantis greeningi e uma perereca-de-cabeca-ossificada que ocorre em regioes xericas e sub-umidas do nordeste do Brasil. Frequentemente os individuos sao encontrados sobre as rochas as margens de riachos temporarios ou em acumulos de agua nos “lajedos”. Girinos suctoriais muitas vezes sao encontrados aderidos as rochas dos riachos para nao serem carreados pelas correntes e por isso, apresentam morfologia externa e interna muito particulares. Aqui, descrevemos a anatomia oral interna e o condrocrânio do girino de C. greeningi e comparamos com as descricoes disponiveis de representantes da subfamilia Lophyohylinae e outros girinos suctoriais. A morfologia oral interna em C. greeningi assemelha-se aos girinos dos demais sapos de cabeca ossificada que se desenvolvem em poca, apesar deste ter sido encontrado em ambiente temporario lotico. Corythomantis greeningi tem uma morfologia condrocranial particular em relacao aos outros Lophyohylinae descritos, apresentando marcadas diferencas nos cornua trabeculae e palatoquadrate. Aparentemente, a morfologia do condrocrânio esta mais relacionada a aspectos ecomorfologicos, pois e estruturalmente mais semelhante a outros girinos suctoriais que habitam ambientes loticos do que com especies filogeneticamente mais proximas, como Trachycephalus typhonius and Phyllodytes gyrinaethes

Percutaneous tricuspid valve (TV) repair procedures are emerging therapies for patients with symptomatic severe tricuspid regurgitation (TR) who are deemed inoperable. Some of these procedures target the tricuspid annulus (TA), mimicking the Kay procedure, or the leaflets, mimicking Alfieri stitch

A 67-year-old man with a dilated cardiomyopathy and severe aortic regurgitation (AR) secondary to a traumatic cusp lesion was referred to our institution because of progressive worsening of dyspnea. After formal discussion in the heart team, the patient was scheduled for TAVI (transcatheter aortic valve implantation). The pre procedural computed tomography scan revealed a minimum amount of calcium on the aortic valve and low position of coronary ostia. The TAVI procedure was performed with the implantation of a fully retrievable and repositionable aortic valve prosthesis (Direct Flow 29 mm, Direct Flow Medical, Santa Rosa, California) with an excellent result and no paravalvular leak. The TAVI devices designed for the treatment of calcific aortic stenosis have numerous limitations for the treatment of pure AR such as the risk of residual AR, the lack of repositionability and retrievability, and the need for valve- in-valve implantation. We believe that treatment of selected cases of pure AR with the Direct Flow valve is feasible and takes advantage of the retrievability of the prosthesis.

BACKGROUND: Previously referred to as rare in the population of young adults, in Brazil in the last five years a frequency found approaching 30 % of young adults between those who have suffered a stroke. OBJECTIVE: To identify the sociodemographic, clinical and functional characteristics of young adult patients. METHODS: It was a cross-sectional study, conducted with individuals assisted in a stroke unit with ischemic or hemorrhagic stroke diagnosis and age of 18-50 years old between August 2014 to April 2015. It was used the National Institutes of Health Stroke Scale (NIHSS), and the modified Rankin Scale (mRS). RESULTS: The study population consisted of 47 individuals, 28 (59,6%) were female, Average age 39,2 (DP±8,3) years old, brown skin color, 21 (44,7%). They had time in education of 8,9 years. With 28 (59,6%) patients were diagnosed with ischemic stroke, 30 (63,8%) had involvement of the anterior circulation, 23 (48,9%) the left hemisphere. 26 (55,3%) patients having Hypertension and was sedentary, 36 (76,6%).The stroke severity had a median of 7 ( 0-23 ) points and the functional capacity of patients was Rakin Scale 5, 30 (63,7%) . It was found a statistically significant difference for hypertensive etiology of hemorrhagic stroke in men ( p = 0.047) when compared with gender and the stroke of occurrence of the right hemisphere in women (p=0,032). CONCLUSION: The profile of the young adult patients from a stroke unit are females , of brown skin color, in socio economic activity with moderate stroke severity and severe functional disability

Background The incidence of anal cancer is on the rise among HIV-infected men who have sex with men (MSM). Given the increasing availability of screening, this study explored anal cancer screening awareness and behaviors among MSM infected with HIV. Methods In-depth interviews were conducted with 58 MSM infected with HIV. Results Other than 2 participants treated for anal cancer and 3 treated for precancerous anal lesions, the majority of participants had never heard of anal cancer. Men reported lack of awareness and recommendations from their health care professionals as the greatest barriers to screening. Upon learning about their risk for anal cancer and the availability of screening, the men were eager to discuss screening with their physicians. Participants provided numerous recommendations for future interventions, including training health care professionals to promote screening, disseminating information pertaining to anal cancer through social networks, and creating media campaigns to raise awareness about the need to screen for this type of cancer. Conclusions Future intervention work should focus on ensuring that health care professionals, particularly among HIV/primary care specialists, promote screening for anal dysplasia. It is critical that intervention methods use a community-based approach to raise awareness about the need to screen for anal cancer, especially among MSM infected with HIV.

Chronic functional mitral regurgitation (FMR) is a frequent finding of ischemic heart disease and dilated cardiomyopathy (DCM), associated with unfavourable prognosis. Several pathophysiologic mechanisms are involved in FMR, such as annular dilatation and dysfunction, left ventricle (LV) remodeling, dysfunction and dyssynchrony, papillary muscles displacement and dyssynchrony. The best therapeutic choice for FMR is still debated. When optimal medical treatment has already been set, a further option for cardiac resynchronization therapy (CRT) and/or surgical correction should be considered. CRT is able to contrast most of the pathophysiologic determinants of FMR by minimizing LV dyssynchrony through different mechanisms: Increasing closing forces, reducing tethering forces, reshaping annular geometry and function, correcting diastolic MR. Deformation imaging in terms of two-dimensional speckle tracking has been validated for LV dyssynchrony assessment. Radial speckle tracking and three-dimensional strain analysis appear to be the best methods to quantify intraventricular delay and to predict CRT-responders. Speckle-tracking echocardiography in patients with mitral valve regurgitation has been usually proposed for the assessment of LV and left atrial function. However it has also revealed a fundamental role of intraventricular dyssynchrony in determining FMR especially in DCM, rather than in ischemic cardiomyopathy in which MR severity seems to be more related to mitral valve deformation indexes. Furthermore speckle tracking allows the assessment of papillary muscle dyssynchrony. Therefore this technique can help to identify optimal candidates to CRT that will probably demonstrate a reduction in FMR degree and thus will experience a better outcome.

We report a case of a 66-year-old Caucasian male who presented to our department with unstable angina in July 2011. He had a medical history of trivessel coronary artery disease and underwent several percutaneous coronary interventions (2003, 2004, and 2006). The latest coronary angiography, performed in January 2011, showed mild intimal hyperplasia within the proximal left anterior descending segment, treated with a sirolimus-eluting stent in 2003. On admission, electrocardiogram was positive for a recent acute coronary syndrome, so the patient underwent coronary angiography, which showed proximal left anterior descending stent thrombosis, occurred eight years after drug-eluting stent implantation. Intravascular ultrasound revealed a soft plaque rupture within the stented segment, which was the cause of stent thrombosis.So the lack of endothelialization over stent struts is not the only mechanism determining acute coronary syndromes late after stent implantation. In-stent neoatherosclerosis, frequently disregarded, is another possible actor especially of very late thrombotic events. However, the pathogenesis of this phenomenon has not been clearly established. © 2012 Japanese College of Cardiology.

Tetralogy of Fallot is the most common cyanotic congenital heart defect and accounts for about 5% of all congenital cardiopathies. The definitive treatment modality for tetralogy of Fallot is reparative surgery, which is recommended to be performed by the time of diagnosis. Without surgical repair, most patients would die during their childhood. In the past, survival data indicated that 66% of persons with tetralogy of Fallot not surgically treated lived until the age of 1, 49% lived until the age of 3, and 24% lived until the age of 10. We now present a rare case of a man with unrepaired tetralogy of Fallot who survived until the age of 85. He presented to our emergency room for dyspnea and palpitations due to a new-onset high-frequency atrial fibrillation and acute heart failure; transthoracic echocardiography showed the presence of tetralogy of Fallot. By consulting the scientific literature, we can say that this is the second patient who survived more than 80 years without surgical intervention.

A 49-year-old African American woman (S.A.) has been receiving HIV specialty and primary care in an urban hospital-based adult HIVoutpatient clinic since 2001. She has also been followed by colorectal surgery and HIV gynecology clinics. Her social history includes a 45-pack/year tobacco habit and crack cocaine use since 1982, but she has denied alcohol use. S.A. presented to the emergency room in March 1997 with shortness of breath, and the hospital admitted her with presumptive Pneumocystis jiroveci pneumonia. She tested positive for HIVinfection, and her CD41 T cell count was 7 cells/mm 3 . Her surgical history was significant for a Bartholin cyst incision and drainage 15 years prior. Her discharge medications included sulfamethoxazole/trimethoprim and azithromycin with a follow-up appointment in the adult HIV clinic scheduled for 2 weeks later; she was not started or discharged on antiretroviral therapy (ART). She failed to follow up in the adult HIVoutpatient clinic but was subsequently admitted in 1998 for orbital cellulitis and cytomegalovirus retinitis with blindness, and in 1999 for seizures, at which time she was diagnosed with cryptococcol meningitis. The last admission note indicated that the patient had not taken her ART in 5 months; however, the names of the medications that she was previously on were not specified. S.A. was lost to follow-up until July 2001 when she was brought to the emergency room from

The tadpoles of Physalaemus albifrons used in this description were obtained from a pair collected in a permanent pond in Brotas de Macaubas, state of Bahia, Brazil. The external morphological features are similar to those of other members of the P. albifrons species group, differing by the presence of interruptions in the row of the marginal papillae of the lower lip. Labial tooth row formula is 2(2)/3(1, 2). The internal oral morphology of P. albifrons differed from those of P. marmoratus, P. santafecinus and P. biligonigerus by the presence of three lingual papillae.

The increased risk of anal cancer among individuals living with HIV suggests that anal health (e.g., anal symptoms, anal practices, examination of the anus) should be an issue of priority for HIV care providers to discuss with their HIV-infected patients. We investigated the prevalence of HIV-infected individuals discussing anal health with their HIV primary care provider and factors associated with this discussion. We surveyed 518 adult patients from 5 HIV primary care clinics in Miami, Florida, from May 2004 to May 2005. Overall, only 22% of women, 32% of heterosexual men, and 54% of men who have sex with men (MSM) reported discussing anal health with their HIV providers in the prior 12 months. In a multivariable logistic regression, when adjusting for other factors, heterosexual men and MSM were 2.31 and 5.56 times, respectively, more likely to discuss anal health with their HIV providers compared to their women counterparts. Other factors associated with anal health discussion were the patients' better perception of engagement with HIV providers and having had a sexually transmitted disease exam in the past 12 months. Reporting of unprotected sex with HIV-negative or unknown HIV status was inversely related to discussion of anal health with primary care providers (odds ratio [OR] = 0.53). Efforts are greatly needed to increase the focus on anal health in the HIV primary care setting for both men and women.

Essential amino acid supplementation (EAS) may counteract hypercatabolic states, such as chronic heart failure (CHF). This pilot study investigated whether EAS could improve quality of life (QoL), cardiac function and exercise tolerance in patients (pts) with stable CHF on optimal medical treatment (OMT). We enrolled 27 pts (21 males) with ejection fraction (EF)

Severe strongyloidiasis, including hyperinfection and dissemination, is a recognized complication of solid organ transplantation. However, the development of strongyloidiasis in a liver transplant recipient has not been previously described. We present a case of severe strongyloidiasis occurring in a patient 4 months after liver transplantation and 1 month after receiving treatment for acute rejection. We assess the management challenges in this patient who remained symptomatic despite oral treatment with ivermectin and albendazole and eventual successful treatment with parenteral ivermectin. We review the published experience with alternative methods of ivermectin administration. We also investigate the possible source of infection, as the patient was not from an endemic area.