Outcomes following transcatheter repair in patients with functional mitral regurgitation not receiving guideline directed medical therapy in Israel.

BACKGROUND: Transcatheter edge to edge repair (TEER) improves prognosis in patients with functional mitral regurgitation (FMR) receiving guideline directed medical therapy (GDMT). Many patients with FMR do not receive GDMT and the utility of TEER in this population remains unclear. METHODS: We retrospectively studied patients undergoing TEER. Clinical, echocardiographic and procedural variables were recorded. GDMT was defined as use of RAAS inhibitors and MRAs unless GFR was under 30 as well as beta blockers. The primary endpoint of the study was one year mortality. RESULTS: 168 patients (mean age 71.3 ± 9.3; 66% males) with FMR who underwent TEER were included of whom 116 (69%) received GDMT at the time of TEER and 52 (31%) did not. There were no significant demographic or clinical differences between the groups. There were no significant differences in procedural success and complications between groups. One year mortality was identical in the two groups (15% vs. 15%; RR 1.06, CI 0.43-2.63, P = 0.90). CONCLUSIONS: Our findings suggest that procedural success and one year mortality following TEER was not significantly different in HFREF patients with FMR with or without GDMT. Larger, prospective studies are necessary to define the benefit of TEER in this population.

Out-of-proportion pulmonary hypertension and heart failure with preserved ejection fraction.

BACKGROUND: A subset of patients with heart failure with preserved ejection fraction (HFpEF) will have a marked increase in pulmonary artery pressure (PAP). OBJECTIVE: To evaluate the clinical and hemodynamic characteristics of these patients in comparison to patients with idiopathic pulmonary arterial hypertension (IPAH). METHODS: We reviewed the clinical and hemodynamic data of patients with HFpEF with out-of-proportion pulmonary hypertension (HFpEF-PH) and compared it to the corresponding data of age-matched patients with IPAH. RESULTS: Twenty consecutive patients with HFpEF-PH and 20 patients with IPAH were included in the study. The mean age (±SD) was 71.3 ± 7.8 and 70.2 ± 6.7 years, respectively. The majority of the HFpEF-PH patients were postmenopausal females with at least two features of the metabolic syndrome and atrial fibrillation. Although HFpEF-PH patients fulfilled the criteria for out-of-proportion PH, with transpulmonary gradient (TPG) >12 mm Hg, the difference between the diastolic PAP and the pulmonary capillary wedge pressure (PCWP) was significantly lower compared to IPAH (6.3 ± 6.2 vs. 27.5 ± 4.8, p < 0.00001). CONCLUSIONS: Our results suggest that a diagnosis of HFpEF-PH should be suspected when severe PH occurs in an elderly postmenopausal female with one or more features of the metabolic syndrome and atrial fibrillation. Interestingly, these patients had significantly lower differences between diastolic PAP and PCWP, suggesting that the increase in TPG is mainly caused by an elevated systolic PAP, possibly as a result of increased pulmonary vascular stiffness, and not pulmonary vascular remodeling.

Novel Babesia and Hepatozoon agents infecting non-volant small mammals in the Brazilian Pantanal, with the first record of the tick Ornithodoros guaporensis in Brazil.

Taking into account the diversity of small terrestrial mammals of the Pantanal, the present study aimed to verify the occurrence of infection by Ehrlichia spp., Anaplasma spp., Rickettsia spp., Hepatozoon spp., Babesia spp. and parasitism by ticks in non-volant small mammals collected in the Brazilian Pantanal. Samples of blood, liver and spleen were collected from 64 captured animals, 22 marsupials and 42 rodents. Pathogen detection was performed by the use of genus-specific Polymerase Chain Reaction (PCR) assays. Ticks collected from the animals consisted of Amblyomma sculptum and Amblyomma triste nymphs, and Ornithodoros guaporensis larvae. None of the vertebrate samples (blood, liver, or spleen) yielded detectable DNA of Rickettsia spp. or Ehrlichia spp. The blood of the rodent Hylaeamys megacephalus yielded an Anaplasma sp. genotype (partial 16S rRNA gene) 99% similar to multiple Anaplasma spp. genotypes around the world. The blood of three rodents of the species Calomys callosus were positive for a novel Hepatozoon sp. agent, phylogenetically related (18S rDNA gene) to distinct Hepatozoon genotypes that have been detected in rodents from different parts of the world. One marsupial (Monodelphis domestica) and three rodents (Thrichomys pachyurus) were positive to novel piroplasmid genotypes, phylogenetically (18S rDNA gene) related to Theileria bicornis, Cytauxzoon manul, and Cytauxzoon felis. The present study provides the first molecular detection of Hepatozoon sp. and piroplasmids in small mammals in Brazil. Additionally, we expanded the distribution of O. guaporensis to Brazil, since this tick species was previously known to occur only in Bolivia.

Rickettsial infection in ticks (Acari: Ixodidae) of wild animals in midwestern Brazil.

Ticks collected in the last two decades from free-living and captive wild animals from 28 municipalities of the Brazilian state of Mato Grosso were identified and tested using molecular methods for the presence of rickettsial agents. A total of 4467 ticks (229 larvae, 1676 nymphs, 1565 males, 997 females) representing 27 ixodid species were collected from 235 species of amphibians, reptiles, birds, and mammals from three different ecoregions (Pantanal, Cerrado, and Amazonia). The species Amblyomma parkeri, Amblyomma romitii, Amblyomma varium and Ixodes luciae are reported for the first time in the state of Mato Grosso. Amongst 538 ticks tested by molecular methods for rickettsial infection, we detected 'Candidatus Rickettsia amblyommii' infecting Amblyomma cajennense sensu stricto and Amblyomma coelebs, Rickettsia sp. strain Atlantic rainforest infecting Amblyomma ovale, Rickettsia sp. strain NOD infecting Amblyomma nodosum, and 'Candidatus Rickettsia andeanae' infecting Amblyomma sculptum. Our results represent an impressive expansion of knowledge on tick fauna and rickettsiae and are essential for understanding the ecology of ticks and tick-borne diseases in the Neotropical region, particularly in midwestern Brazil.

Método de avaliaçäo da hipotrofia muscular por desuso empregando eletromiografia de superfície / Evaluation method of the muscular hypotrophy caused by lack of use employing surface electromyography

This article presents an evaluation method of muscular atrophy caused by lack of use, employing surface electromyography.Describes a new instrument to measure muscular activity in a practical an reliabe way.For the performance of 96 tests, four muscles were select: wrist flexors, biceps rectus femoris, and the gastrocnemius.These were implemented in two groups: (1) comtrol group and (2) experimental group.The results obtained in all muscular groups measurered showed that the reason reference/affected in group (2) presented a variation of 27 percentage to 142 percentage comparared to reason dominant / contralateral in group (1), confirming the unbalance among the members in the experimental group.In the control group the variabily was much smaller than the difference obtained in the limbs tested, showing this to be an auxiliary instrument in prescription an evolution of rehabilitation treatments