Search

It takes only 1 profound experience to change someone's life. We invite you to read about how an experience of struggle led to a motivation in medicine. Through a first-person perspective, the author details the sequence of diagnosis and treatment of his own case of cardiac transplantation secondary to viral cardiomyopathy.

Percutaneous mechanical circulatory support (pMCS) devices are increasingly used in patients with cardiogenic shock as a bridge to recovery or bridge to decision to advanced heart failure therapies. Gastrointestinal bleeding (GIB) is a common complication that can be catastrophic. Because of the paucity of data describing the association of GIB with pMCS, we analyzed this population using the United States National Inpatient Sample database. We performed a retrospective study in patients with pMCS devices who had GIB during the index hospitalization using the National Inpatient Sample. Multivariate logistic regression analysis was performed to determine independent predictors of GIB in these patients. A total of 466,627 patients were included. We observed an overall increase in the incidence of adjusted GIB from 2.9% to 3.5% (p = 0.0025) from 2005 to 2014. In comparison to patients without GIB, those with GIB had significantly higher in-hospital mortality, length of stay, and hospitalization cost. In addition to the usual co-morbid conditions, the presence of small bowel and colonic ischemia, colon cancer, diverticulosis, chronic liver disease, and peptic ulcer disease were noted to be significant predictors of GIB for all (p0.001). In conclusion, patients with pMCS and GIB have higher in-hospital mortality, longer length of stay, and higher cost of hospitalization. Awareness of patient risk factors for bleeding and gastrointestinal disorders are important before the use of mechanical circulatory support devices because they are associated with a substantially higher risk for bleeding.

Parachute mitral valve (PMV) is a rare congenital cardiac valvular anomaly often associated with other congenital cardiac defects, particularly Shone's complex, but may infrequently occur in isolation. PMV and its variants are predominantly associated with mitral stenosis (MS) or rarely mitral regurgitation (MR). We present the case of a middle-aged female who was evaluated for a syncopal episode and found to have an atypical variant PMV with disproportionately long anterior mitral leaflet, bileaflet mitral valve prolapse, and mitral annular disjunction, without associated MS or MR. This is the first case report to highlight this particular constellation of findings.

Introdução: A Covid-19 é uma infecção com caráter multissistêmico, onde manifestações tardias como fadiga, dispneia, perda do condicionamento aeróbico e massa muscular são comuns até em pacientes que não desenvolveram a forma grave da doença, e com isso se faz necessário recursos terapêuticos que tratem esses sintomas remanescentes. Objetivo: Investigar as repercussões imediatas de técnicas de fisioterapia respiratória realizadas através de uma sessão em pacientes com histórico de Covid-19 no interior da Amazônia. Metodologia: Tratou-se de um estudo experimental randomizado, de abordagem quantitativa, realizado na Universidade do Estado do Pará. Participaram 76 voluntários com histórico de Covid-19 que foram randomizados em quatro grupos, sendo um grupo controle e três experimentais. Os três grupos experimentais foram submetidos a técnicas de fisioterapia respiratória e as variáveis utilizadas foram a pressão inspiratória (Pimax) e expiratória máxima (Pemax) e o teste de caminhada de 6 minutos (TC6M). Resultados e Discussão: Os resultados demonstraram significância da ventilação não invasiva (VNI) sobre a variável Pimax na melhora da força muscular inspiratória. A VNI associada ao cicloergômetro e aos exercícios respiratórios demonstraram resultados significativos no TC6M, apresentando melhora na tolerância do exercício. Não houve resultado significativo na comparação entre os grupos. Considerações finais: As técnicas em fisioterapia respiratória podem ser benéficas na aquisição de tolerância ao exercício e na melhora da força muscular inspiratória. Introduction: Covid-19 is a multisystemic infection, where late manifestations such as fatigue, dyspnea, loss of aerobic conditioning and muscle mass are common even in patients who have not developed the severe form of the disease, and therefore therapeutic resources are needed to treat these remaining symptoms. Objective: Investigate the immediate repercussions of respiratory physiotherapy techniques performed through a session on patients with a history of Covid-19 in the interior of the Amazon. Methodology: This is a randomized experimental study, with a quantitative-qualitative approach, carried out at the University of the State of Pará. 76 volunteers with a history of Covid-19 participated who were randomized into four groups, one control group and three experimental groups. The three experimental groups were submitted to respiratory physiotherapy techniques and the variables used were the inspiratory pressure (Pimax) and maximum expiratory pressure (Pemax) and the Six-minute walk test (6MWT). Results and Discussion: The results demonstrated the significance of non-invasive ventilation (NIV) on the PiMAX variable in improving inspiratory muscle strength. NIV associated with cycle ergometer and breathing exercises showed significant results in the 6MWT, showing improvement in exercise tolerance. There was no significant result in the comparison between groups. Final considerations: Techniques in respiratory physiotherapy can be beneficial in acquiring exercise tolerance and improving inspiratory muscle strength, but further studies should be encouraged with better methodological designs. Introducción: El Covid-19 es una infección multisistémica, donde las manifestaciones tardías como fatiga, disnea, pérdida de acondicionamiento aeróbico y de masa muscular son comunes incluso en pacientes que no han desarrollado la forma grave de la enfermedad, por lo que se necesitan recursos terapéuticos para tratarla. estos síntomas restantes. Objetivo: Investigar las repercusiones inmediatas de las técnicas de fisioterapia respiratoria realizadas a través de una sesión en pacientes con antecedentes de Covid-19 en el interior de la Amazonía. Metodología: Se trata de un estudio experimental aleatorio, con enfoque cuantitativo-cualitativo, realizado en la Universidad del Estado de Pará. Participaron 76 voluntarios con antecedentes de Covid-19 que fueron aleatorizados en cuatro grupos, un grupo control y tres grupos experimentales. Los tres grupos experimentales fueron sometidos a técnicas de fisioterapia respiratoria y las variables utilizadas fueron la presión inspiratoria (PIMAX), la presión espiratoria máxima (Pemax) y la prueba de caminata de 6 minutos (6MWT). Resultados y discusión: Los resultados demostraron la importancia de la ventilación no invasiva (VNI) en la variable PiMAX para mejorar la fuerza de los músculos inspiratorios. La VNI asociada a cicloergómetro y ejercicios respiratorios mostró resultados significativos en la PM6M, mostrando una mejora en la tolerancia al ejercicio. No hubo resultado significativo en la comparación entre grupos. Consideraciones finales: Las técnicas en fisioterapia respiratoria pueden ser beneficiosas para adquirir tolerancia al ejercicio y mejorar la fuerza de los músculos inspiratorios, pero se deben fomentar más estudios con mejores diseños metodológicos.

Introduction: Although rare, pediatric stroke is more common than one may think. Deficits may not be evident in the short term but emerge months or years later, when psychomotor development, educational, and social requirements increase. Aims: To characterize the pediatric population with stroke followed at the Physical and Rehabilitation Medicine (PRM) consultation in a tertiary center and compare it with data in the literature and review the evidence on pediatric stroke rehabilitation care. Material and Methods: This was a retrospective study focusing on the first observation of stroke patients followed at a pediatric PRM consultation over 12 months. Gender, age, type of stroke, vascular territory, risk factors, functionality, event recurrence, and mortality were assessed. A bibliographic search was conducted on PubMed and Medline using the keywords ‘stroke’, ‘pediatric’, ‘perinatal’, ‘neuroplasticity’, ‘functionality’, and ‘rehabilitation’. Inclusion criteria comprised meta-analysis, systematic review, and review type of studies, written in Portuguese and English languages, and focusing human studies. Results: The study included 42 patients, 25 of whom were male (60%). Perinatal stroke was reported in 33 patients (13 in the prenatal period and 20 up to 28 days of life). Ischemic stroke was reported in 35 cases (83%), with the middle cerebral artery being the most affected vascular territory in 29 cases (69%). Fifty percent of patients had known risk factors, specifically prematurity in 21%. Fifty to 75% of patients had high functionality levels. No stroke recurrence or deaths were reported during the study period. Rehabilitation care should be implemented as soon as possible. Evidence-based guidance is still lacking for this population. Conclusions: Stroke, although uncommon in the pediatric population, is a major cause of morbidity and mortality. Diagnosis is challenging, as symptoms are often subtle and mimic other more frequent diseases in this age group. Timely referral to the physiatrist allows integration of the child into a rehabilitation program, optimizing neuroplasticity and improving participation in several activities., Introdução: Embora raro, o acidente vascular cerebral (AVC) em idade pediátrica é mais comum do que se pensa. Os défices podem não ser evidentes a curto prazo mas surgir à medida que aumentam as exigências do desenvolvimento psicomotor, educacionais e sociais. Objetivos: Caracterizar a população pediátrica com AVC seguida na consulta de Medicina Física e de Reabilitação (MFR) de um hospital terciário, comparando os resultados com os previamente publicados na literatura, e rever a literatura relativamente aos melhores cuidados de reabilitação para uma intervenção mais eficaz. Material e Métodos: Foi realizado um estudo retrospetivo de doentes com AVC seguidos em consulta de MFR Pediátrica, à data da primeira observação, ao longo de um período de 12 meses. Foram analisadas as variáveis género, idade, tipo de AVC, território vascular, fatores de risco, funcionalidade, recorrência do evento e mortalidade. Foi efetuada uma pesquisa bibliográfica no PubMed e Medline utilizando as palavras-chave ‘stroke’, ‘pediatric’, ‘perinatal’, ‘neuroplasticity’, ‘functionality’ e ‘rehabilitation’. Os critérios de inclusão compreenderam meta-análises, revisões sistemáticas e revisões, escritas em português e inglês, focando estudos em humanos. Resultados: O estudo incluiu 42 doentes, 25 dos quais do sexo masculino (60%). Foram registados 33 casos de AVC perinatal (13 no período pré-natal e 20 até aos 28 dias de vida). Foram registados 35 casos (83%) de AVC isquémico, sendo a artéria cerebral média o território vascular mais afetado em 29 (69%) deles. Cinquenta por cento dos doentes tinham fatores de risco conhecidos, 21% dos quais prematuridade. Cinquenta a 75% dos doentes apresentavam altos níveis de funcionalidade. Não foram registadas recorrências de AVC ou mortes. Os cuidados de reabilitação devem ser implementados o mais rapidamente possível. São necessárias orientações baseadas em evidência, ainda em falta para esta população. Conclusões: Embora incomum em idade pediátrica, o AVC é uma das principais causas de morbilidade e mortalidade. O diagnóstico é desafiante, pois os sintomas habitualmente são subtis e mimetizam outras doenças mais frequentes nesta faixa etária. A referenciação atempada para o médico fisiatra possibilita a integração da criança num programa de reabilitação, com otimização da neuroplasticidade e máxima participação em todas as atividades.

The coronavirus disease (COVID-19) manifests symptoms in the most diverse systems of the individual, such as, for example, tachycardia, chest pain, loss of muscle mass, fatigue, cough and decreased functional capacity. Considering the severity of the dysfunctions observed in patients, it is extremely important that they receive adequate treatment. In this way, the physical therapist is active both in the prevention and in the rehabilitation of pulmonary diseases and functional limitations present in the individual's activities of daily living (ADL's). The present study aims to describe the experience of academics regarding the cardiorespiratory rehabilitation of post-COVID-19 patients. Methodologically, this article was an experience report on the performance of academics from the Physiotherapy outpatient internship, in the cardiorespiratory rehabilitation of patients with post-COVID-19 sequelae who were treated at the outpatient clinic of a university in the interior of the Amazon. The study reported on the experiences of academics involved in such care, through their reports regarding the characterization of the rehabilitation environment and the public served, as well as on their performance in the first evaluation of patients, and also the description of the care and results obtained. generally in the rehabilitation process. It is considered that the period of care contributed significantly to the training of academics, as well as to the cardiorespiratory and emotional improvement of the welcomed public. La enfermedad por coronavirus (COVID-19) manifiesta síntomas en los más diversos sistemas del individuo como, por ejemplo, taquicardia, dolor torácico, pérdida de masa muscular, fatiga, tos y disminución de la capacidad funcional. Teniendo en cuenta la gravedad de las disfunciones observadas en los pacientes, es de suma importancia que reciban un tratamiento adecuado. De esta forma, el fisioterapeuta actúa tanto en la prevención como en la rehabilitación de las enfermedades pulmonares y limitaciones funcionales presentes en las actividades de la vida diaria (AVD) del individuo. El presente estudio tiene como objetivo describir la experiencia de académicos con respecto a la rehabilitación cardiorrespiratoria de pacientes post-COVID-19. Metodológicamente, este artículo fue un relato de experiencia sobre la actuación de académicos del internado de Fisioterapia, en la rehabilitación cardiorrespiratoria de pacientes con secuelas post-COVID-19 que fueron atendidos en el ambulatorio de una universidad del interior de la Amazonía. El estudio relató las experiencias de los académicos involucrados en esa atención, a través de sus informes sobre la caracterización del ambiente de rehabilitación y del público atendido, así como sobre su actuación en la primera evaluación de los pacientes, así como la descripción de la atención y los resultados. generalmente en el proceso de rehabilitación. Se considera que el período de atención contribuyó significativamente a la formación de académicos, así como a la mejora cardiorrespiratoria y emocional del público acogido. A doença do coronavírus (COVID-19) manifesta sintomas nos mais diversos sistemas do indivíduo, como, por exemplo, taquicardia, dor torácica, perda de massa muscular, fadiga, tosse e diminuição da capacidade funcional. Considerando a gravidade das disfunções observadas nos pacientes é de extrema importância que estes recebam tratamento adequado. Desse modo, o fisioterapeuta é atuante tanto na prevenção como na reabilitação dos agravos pulmonares e limitações funcionais presentes nas atividades de vida diária (AVD’S) do indivíduo. O presente estudo tem como objetivo descrever a experiência de acadêmicos quanto à atuação na reabilitação cardiorrespiratória de pacientes pós-COVID-19. Metodologicamente este artigo tratou-se de um relato de experiência sobre a atuação de acadêmicos do estágio ambulatorial de Fisioterapia, na reabilitação cardiorrespiratória de pacientes com sequelas pós-COVID-19 e que foram atendidos no ambulatório de uma universidade do interior da Amazônia. O estudo relatou sobre as experiências dos acadêmicos envolvidos em tais atendimentos, através dos seus relatos quanto à caracterização do ambiente de reabilitação e do público atendido, bem como sobre a sua atuação na primeira avaliação dos pacientes, e ainda a descrição dos atendimentos e resultados obtidos de forma geral no processo de reabilitação. Considera-se que o período de atendimentos contribuiu significativamente na formação dos acadêmicos, assim como na melhora tanto cardiorrespiratória quanto emocional do público acolhido.

The extent of diastolic dysfunction is of clinical importance in the risk stratification and management of Takotsubo cardiomyopathy (TC) patients. Standard echocardiographic indices for diastolic dysfunction have robust predictive ability in other diseases, however, these have not been validated in TC. This study compares Doppler metrics of diastolic function against catheterization measured filling pressures in TC.Patients with TC who met our inclusion and exclusion criteria were evaluated with echocardiography and catheterization obtained within 24 hours. Both LVEDP (Left Ventricular End Diastolic Pressure) and LV Pre-A diastolic pressures were obtained from catheterization tracings. The echocardiographic parameters for diastolic function were extracted using the American Society of Echocardiography (ASE) recommendations and a previously validated regression equation for mean left atrial pressure (mLAP).A total of 51 patients with TC were included. Patient were predominantly females (72.5%), with mean age 58 ± 13, and mean ejection fraction 24 ± 10%. The E/e' (septal, average, and lateral), and calculated mean LAP correlated positively with catheterization LV pre-A, with fair to moderate correlation (coefficients range: 0.38 to 0.44). The t-test mean difference between the LV pre-A pressure and calculated mLAP was 0.77 ± 7.34 mmHg (95% CI ± 14.68 mmHg) suggesting inconsistent measures. The mLAP also exhibited poor diagnostic ability to discriminate elevated LV pre-A diastolic pressure with a ROC area under the curve of 0.69 (95% CI 0.50 - 0.88).Commonly used echocardiographic parameters for diastolic function demonstrated less than optimal correlation, with poor sensitivity and specificity, when compared to invasively measured LVEDP or LV-pre-A wave diastolic pressures in TC. Precise characterization of LV filling pressure in TC using contemporary noninvasive echocardiographic parameters appears challenging. Invasive measurements of filling pressure should remain the gold standard for optimal risk stratification and management of TC.

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare cytotoxic cutaneous lymphoma. Differential diagnosis with lupus erythematosus panniculitis (LEP) can be challenging and overlapping cases have been described. In this study, we investigate whether gene expression profiling may or not identify markers that can be used to improve our understanding of the disease and to make a precise differential diagnosis. SPTCL, LEP, and overlapping cases were analyzed using a customized NanoString platform including 208 genes related to T-cell differentiation, stromal signatures, oncogenes, and tumor suppressor genes. Gene expression unsupervised analysis of the samples differentiated SPTCL from LEP samples. Most overlapping cases were clustered with LEP cases. Differentially expressed genes were observed when comparing SPTCL with LEP cases; and overlapping with LEP cases. Gene set enrichment analysis recognized gene sets defining each group. In conclusion, SPTCL and LEP have distinctive molecular profiles and the molecular background of overlapping cases more closely resembles LEP.

Literature on bioresorbable-polymer-stents (BPS) and second-generation durable-polymer-stents (DPS) in percutaneous coronary intervention (PCI) for all comer CAD is conflicting.Randomized controlled studies comparing PCI among BPS and second-generation DPS were identified up until May-2020 from online databases. Primary outcomes included are all-cause myocardial infarction (MI), cardiac-death, target-vessel-revascularization (TVR), target-vessel MI (TVMI), and stent-thrombosis (ST). Random effect method of risk ratio and confidence interval of 95% was used.25 prospective randomized controlled trials with 31,822 patients (BPSPatients undergoing PCI treated with BPS had comparable outcomes in terms of cardiac death, TVR, ST, TVMI, and all-cause MI to patients treated with second-generation DPS; however, BPS had higher rates of TVR for follow-up of ≥5-years.

Coronary ectasia (CE) is defined as dilation of the coronary artery, 1.5 times that of the surrounding vessel. Outcomes of percutaneous intervention (PCI) in patients with CE presenting as ST-elevated myocardial infarction (STEMI) remain a topic of debate.Studies comparing outcomes of PCI in CE versus no-ectasia (NE) STEMI patients were identified. Baseline angiographic characteristics include thrombolysis in myocardial infarction (TIMI) 0-1 flow, right coronary artery (RCA) involvement, and primary outcomes including thrombus aspiration, no-reflow, mortality, and TIMI-3 post-PCI. Odds ratio (OR) and 95% confidence interval (CI) were calculated.Six studies (n = 5746, CE-340 and NE-5406) qualified for the analysis. RCA involvement was more common in CE than NE, OR-1.39 (95%CI1.06-1.82, p-0.02). Pre-procedure TIMI-0-1 was of comparable results between the groups (p-1.13). Higher thrombus aspiration for CE (OR 2.18, 95%CI1.44-3.32;p-0.001). CE had higher incidence of no-reflow (OR 4.07, 95%CI2.42-6.84;p-0.001). TIMI-3 flow post-PCI was achieved less commonly in the CE group (OR-0.64, 95%CI-0.48-0.86;p-0.001). Mortality on follow-up was comparable (0.83, 95%CI0.39-1.78;p-0.63). Metaregression analysis did not show confounding effects from comorbidities.Coronary ectasia patients with STEMI had higher rates of PCI failure and no-reflow than NE; however, mortality during follow-up was comparable.

Graphical abstract, Highlights • Mitral annular disjunction is an underrecognized finding on echocardiography. • Mitral valve prolapse is strongly associated with mitral annular disjunction. • Patients with Marfan syndrome are potentially high risk for mitral annular disjunction. • Paradoxical annular unsaddling occurs in mitral annular disjunction. • Mitral valvular apparatus tension during systole contributes to arrhythmic syndrome.

Takotsubo Syndrome (TS) patients are at high risk of developing atrial fibrillation. We sought to investigate the outcomes and economic impact of atrial fibrillation on TS patients utilizing the National Inpatient Sample.Patients with TS were identified in the National Inpatient Sample (NIS) database between 2010 and 2014 using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), and subsequently were divided into two groups, those with and without atrial fibrillation. The primary outcome was all-cause in-hospital mortality in the two groups. Secondary outcomes were in-hospital complications. We also evaluated the length of hospital stay and the cost of hospitalization. Propensity score-matched analysis was performed to address potential confounding factors.Among the study population, the prevalence of atrial fibrillation was 17.57%. After matching, the atrial fibrillation group had no significant increase of in-hospital mortality (OR: 1.13; 95% CI: 0.94-1.35, p = 0.211). However, atrial fibrillation patients were more likely to develop cardiac arrest and ventricular arrhythmias (OR: 1.51, 95% CI: 1.26-1.80, p 0.0001), have higher rate of major cardiac complications when combined as a single endpoint in-hospital complication (OR: 1.16, 95% CI: 1.04-1.29, p: 0.006), also they were more likely to stay longer in hospital (OR: 1.13, 95% CI: 1.08-1.19, p 0.0001), and have increased cost of hospitalization (OR: 1.13, 95% CI 1.07-1.20, p 0.0001).Atrial fibrillation does not increase in-hospital mortality in patients presenting with TS. However atrial fibrillation is associated with an increased risk of ventricular arrhythmias, length of stay, non-routine discharges and cost of hospitalization.