Right bundle brunch block in patients with acute myocardial infarction is associated with a higher in-hospital arrhythmic risk and mortality, and a worse prognosis after discharge.

INTRODUCTION: Recently, the presence of right bundle brunch block (RBBB) in patients with persistent ischaemic symptoms has been suggested as an indication for emergent coronary angiography. OBJECTIVE: The aim of this study was to assess the prognostic impact of RBBB in patients with acute myocardial infarction (AMI) before the implementation of the recent recommendations. METHODS: We retrospectively studied consecutive patients admitted with AMI between 2011 and 2013. Patients with left bundle brunch block, pacemaker, or nonspecific intraventricular conduction delay were excluded. Patients with RBBB were compared with those without RBBB. Clinical characteristics, in-hospital evolution, and major adverse cardiovascular events (MACE) during follow-up, defined as cardiovascular death, sustained ventricular arrhythmias, acute heart failure syndromes, recurrent myocardial infarction, or acute stroke, were analysed. RESULTS: The analysis included 481 patients. Thirty two patients (6.7%) had RBBB. Patients with RBBB were older. During hospital admission, RBBB patients had a higher rate of sustained ventricular tachycardia and death. Survival curve analysis showed that patients with RBBB had a lower in-hospital survival rate (Log-rank, p = 0.004). After discharge, during a mean follow-up time of 24.3 ± 11.6 months, 53 patients (12%) died. Survival curve analysis showed a lower survival rate free of MACE for those patients with RBBB (Log-rank, p = 0.011). RBBB was independently associated with MACE occurrence (HR 2.17, 95% CI 1.07-4.43; p = 0.033), after adjusting for demographic data, coronary angiography findings, treatment performed, echocardiographic evaluation, and medical therapy. CONCLUSION: Patients with RBBB had a higher rate of in-hospital mortality and arrhythmic events, and an increased risk of MACE during follow-up.

Sp1-Induced FNBP1 Drives Rigorous 3D Cell Motility in EMT-Type Gastric Cancer Cells.

Cancer is heterogeneous among patients, requiring a thorough understanding of molecular subtypes and the establishment of therapeutic strategies based on its behavior. Gastric cancer (GC) is adenocarcinoma with marked heterogeneity leading to different prognoses. As an effort, we previously identified a stem-like subtype, which is prone to metastasis, with the worst prognosis. Here, we propose FNBP1 as a key to high-level cell motility, present only in aggressive GC cells. FNBP1 is also up-regulated in both the GS subtype from the TCGA project and the EMT subtype from the ACRG study, which include high portions of diffuse histologic type. Ablation of FNBP1 in the EMT-type GC cell line brought changes in the cell periphery in transcriptomic analysis. Indeed, loss of FNBP1 resulted in the loss of invasive ability, especially in a three-dimensional culture system. Live imaging indicated active movement of actin in FNBP1-overexpressed cells cultured in an extracellular matrix dome. To find the transcription factor which drives FNBP1 expression in an EMT-type GC cell line, the FNBP1 promoter region and DNA binding motifs were analyzed. Interestingly, the Sp1 motif was abundant in the promoter, and pharmacological inhibition and knockdown of Sp1 down-regulated FNBP1 promoter activity and the transcription level, respectively. Taken together, our results propose Sp1-driven FNBP1 as a key molecule explaining aggressiveness in EMT-type GC cells.

Clinical Impact of Oral Anticoagulation in Patients with Atrial High-rate Episodes.

BACKGROUND: Atrial high-rate episodes (AHREs) are common in pacemaker patients. Our aims were to compare patients with AHREs to those without them and to assess if, in those with AHREs, the initiation of oral anticoagulation (OAC) has any clinical impact on the occurrence of ischemic and hemorrhagic events. METHODS: From 2014-2017 we selected patients with pacemaker in whom AHREs were detected. AHREs were defined as episodes lasting more than 6 minutes if the electrogram was available or more than 6 hours if not. We used an age- and gender-matched population with pacemaker but no AHRE as a control group (observational study). Those with AHRE were referred to their assistant physician to decide OAC initiation, based on individual circumstances (interventional study). In interventional study, the primary outcome was a composite of systemic thromboembolism or major bleeding. Secondary outcomes were clinical relevant nonmajor bleeding, major and nonmajor bleeding, CV death, and death from all causes. RESULTS: AHREs were detected in 86 patients: 69 patients initiated OAC and the remaining 17 patients did not. When comparing patients with and without AHRE, baseline characteristics were not different between the groups, except for indexed left atrium volume-40 mL (IQR: 34-50) in AHRE group versus 35 mL (IQR: 34-40) in control group (P = .014). AHREs were associated with future development of atrial fibrillation (AF) and the risk was higher if AHRE duration was superior to 6 hours. Death and cardiovascular (CV) death were not significantly different between the groups with and without AHRE. Primary outcome occurred in 4.9 per 100 person-year in OAC group versus 3.4 per 100 person-year in non-OAC group (HR 1.4, 95% CI .2-11.3, P = .78). Secondary outcomes were not significantly different in the groups. CONCLUSIONS: In this group of patients with pacemakers, the presence of AHREs was useful for predicting the future development of AF and the risk of AF was higher in those with a longer duration of AHRE. In the AHRE group, OAC therapy was not associated with a significant difference in the risk of thromboembolism or major bleeding.

Meniscal allograft transplantation in rabbit.

This study evaluated the technique for meniscal allograft transplantation using allografts preserved in glycerin 98% in rabbits. Euthanasia was performed at 70 days to compare the transplanted (TM1 to TM16) versus the contralateral meniscus (OM1 to OM16). Sixteen menisci, 8 transplanted and 8 contralateral, were submitted to gross examination, histomorphometric analysis for identification and quantification of cellular type, and for quantification and distribution of collagen fibers. A revascularization study was conducted in all of the other samples. Lengths of the OM varied from 0.9 to 1.0 cm and two TM were smaller. All TM were completely attached to the synovial membrane, except for one case that presented partial fixation. Both, TM and OM had similar amounts of chondrocytes, fibroblasts and fibrocytes, and at the horns, chondrocytes were predominant. The collagen fibers in TM were well organized throughout the body, and disorganized at the horns. These fibers in OM were organized. The amounts of collagen type I and III, and the vascularization of the perimeniscal tissue and of the edge were similar in OM and TM. These results demonstrated graft integration and thus this transplantation technique and preservation method may be recommended.

The three stages of eosinophilic cardiac damage: A series of case reports.

Hypereosinophilic syndrome is a rare systemic condition characterized by eosinophil-mediated organ damage. Cardiac involvement is common and typically occurs in sequential stages. We present two cases that demonstrate these different stages and presentations of eosinophilia-mediated myocardial disease, where multimodality imaging was essential for the diagnosis. More importantly, they demonstrate, for the first time, the dissociation between the eosinophil count and patients' clinical evolution, suggesting the need for close follow up even after the eosinophilia has been controlled. Learning objective: Cardiac involvement in hypereosinophilic syndrome typically occurs in three stages - necrotic, thrombotic, and fibrotic. Although cardiac damage is mediated by eosinophils, the blood eosinophil count and patients' clinical evolution are dissociated. Therefore, eosinophil count on its own is not an adequate marker of clinical evolution, and cardiac follow up should be continued even after the eosinophilia has been controlled.

A case of lymphocytic myocarditis in a patient treated with an immune checkpoint inhibitor, a recent class of chemotherapy agents.

Chemotherapy-associated cardiotoxicity is a common adverse event. Immune checkpoint inhibitors (ICI) - a new class of monoclonal antibodies - have revolutionized the management of various diseases. Their use is expected to increase in the near future and their cardiac side effects have been increasingly recognized. CLINICAL CASE: We describe a case of a 67-year-old female patient with urothelial carcinoma undergoing treatment with pembrolizumab who presented to the emergency department with progressive fatigue, retrosternal pain and palpitations for three days. On admission she was diagnosed with acute heart failure (HF). The electrocardiogram revealed a right bundle branch block and ventricular bigeminy. Blood tests showed elevated troponin I, while transthoracic echocardiography revealed severe left ventricular dysfunction. Coronary angiography excluded coronary artery disease. Cardiac magnetic resonance revealed moderate left ventricular dysfunction and late gadolinium enhancement typical of myocarditis. Endomyocardial biopsy confirmed the diagnosis of lymphocytic myocarditis. In the first 48h of hospitalization, she developed transient complete AV block. Corticoid and HF therapy were initiated, leading to symptom improvement and disappearance of the rhythm disturbances. She was discharged on the 12th day, maintaining moderate LV dysfunction, which improved only mildly at a subsequent outpatient assessment. She died suddenly 35 days after discharge. CONCLUSION: Lymphocytic myocarditis is a serious cardiac side effect of ICI therapy. Pembrolizumab is increasingly used, so it is important to be aware of its effects, in order to perform an early diagnosis and provide adequate treatment. Corticosteroid therapy seems to be crucial in preventing disease progression and enabling ventricular remodeling.

Permanent cardiac pacing for patients with iatrogenic or potentially reversible bradyarrhythmia. / Bradidisrritmia puramente iatrogénica existe?

INTRODUCTION: In iatrogenic or potentially reversible bradyarrhythmia, drug discontinuation or metabolic correction is recommended before permanent cardiac pacemaker (PM) implantation. These patients often have conduction system disease and there are few data on recurrence or the need for a permanent PM. OBJECTIVE: To analyze the need for PM implantation in patients with iatrogenic bradyarrhythmia or bradyarrhythmia associated with other potentially reversible causes. METHODS: We assessed consecutive symptomatic patients admitted to the emergency department with a primary diagnosis of bradyarrhythmia (atrioventricular [AV] node disease - complete or second-degree AV block (AVB) [CAVB: 2nd-degree AVB - 2:1], sinus bradycardia [SB] and atrial fibrillation [AF] with slow ventricular response [SVR]) in the context of iatrogenic causes or metabolic abnormalities. We determined the percentage of patients who required PM implantation. RESULTS: We studied 153 patients (47% male) admitted for iatrogenic or potentially reversible bradyarrhythmia. Diagnoses were SB 16%, CAVB 63%, second-degree AVB 12%, and AF with SVR 10%. Eighty-five percent of patients were under negative chronotropic therapy, 3% had hyperkalemia and 12% had a combined etiology. After correction of the cause, 55% of patients (n=84) needed a PM. In these patients the most common type of bradyarrhythmia was CAVB, in 77% (n=65) patients. CONCLUSION: In a high percentage of patients with bradyarrhythmia associated with a potentially reversible cause, the arrhythmia recurs or does not resolve during follow-up. Patients with AV node disease constitute a subgroup with a higher risk of recurrence who require greater vigilance during follow-up and should be considered for PM implantation after the first episode.

Ventricular Arrhythmias in Patients with Obstructive Sleep Apnea.

Obstructive Sleep Apnea (OSA) is a prevalent condition thought to increase in the future. Being mostly undiagnosed, the most serious complications are cardiovascular diseases, among which are arrhythmias. Controversy remains as to whether OSA is a primary etiologic factor for ventricular arrhythmias, because of the high incidence of cardiovascular comorbidities in OSA patients. However, there is mostly a strong evidence of a relation between OSA and ventricular arrhythmias. A few mechanisms have been proposed to be responsible for this association and some electrocardiographic changes have also been demonstrated to be more frequent in OSA patients. Treatment of OSA with Continuous Positive Airway Pressure (CPAP) has the potential to reduce arrhythmias and confer a mortality benefit.

Prognostic Impact of Iron Metabolism Changes in Patients with Acute Coronary Syndrome.

BACKGROUND: Iron metabolism disorders have been associated with an increased risk of cardiovascular events. However, the prognostic impact on patients (pts) with acute coronary syndrome (ACS) has yet to be clarified. OBJECTIVE: To determine the prognostic value of serum iron and ferritin levels in pts with ACS in the short and long-term. METHODS: Consecutive pts admitted to a coronary care unit with a diagnosis of ACS, for a period of 2 years, were evaluated. The population was divided into tertiles of serum iron and ferritin distribution. The primary adverse events were the occurrence of in-hospital death or heart failure (HF) and death or HF at 1 year of follow-up. RESULTS: We studied 280 pts (73% males; mean age 68 ± 13 years). The mean levels of serum iron and ferritin were 59 ± 34 mcg/dL and 205 ± 185 ng/mL, respectively. Patients included in the 1st tertile of serum iron (≤ 40 mcg/dL) had a higher rate of adverse events, in-hospital and after 1 year. Lower and higher levels of ferritin (1st and 3rd tertiles, ≤ 110; >219 ng/ml, respectively) were associated with a higher incidence of HF during hospitalization and death at 1 year. A ferritin value >316 ng /mL was an independent risk factor for death at 1 year (adjusted OR: 14; 95%CI: 2.6 to 75.9). CONCLUSION: In this population, iron metabolism alterations were associated with a higher rate of adverse events and higher ferritin levels constituted an independent mortality predictor in the long-term.

Are defibrillators less useful in patients with non-ischemic heart disease? / Será a implantação de desfibrilhador menos útil nos doentes com cardiopatia não isquémica?

INTRODUCTION AND OBJECTIVE: The benefits of implanted defibrillators in patients with ischemic heart disease (IHD) are well known. However, the evidence is less robust in patients with non-ischemic heart disease (non-IHD). We aimed to determine whether patients with non-IHD have a similar incidence of appropriate shocks and all-cause mortality compared to those with IHD. METHODS: In a retrospective single-center study we analyzed all patients with implantable cardioverter-defibrillators or cardiac resynchronization therapy-defibrillators implanted for primary prevention between 2004 and 2014. The population was divided into two groups: patients with IHD and patients with non-IHD. The composite endpoint was appropriate shock and all-cause mortality. RESULTS: Two hundred and eighty-one patients were studied, of whom 187 (66%) had IHD. Patients with IHD were older, more frequently male and with more cardiovascular risk factors. Mean follow-up was 55±42 months. Thirty-four patients (18%) with IHD and 20 patients (21%) with non-IHD had an appropriate shock (p=0.64). Eighty-nine patients (47%) with IHD and 36 (38%) with non-IHD died during follow-up (p=0.19). The rate of shocks or death over time was similar in patients with IHD and non-IHD according to Kaplan-Meier survival curve analysis (log-rank p=0.10). CONCLUSION: In this population, there were no differences in appropriate shocks or all-cause mortality in the two groups.

Relationship between nocturnal blood pressure profiles and the presence and severity of hypertensive retinopathy. / Relação entre o perfil tensional noturno e a prevalência e gravidade da retinopatia hipertensiva.

INTRODUCTION: Non-dipper and extreme dipper blood pressure (BP) profiles are associated with a worse cardiovascular prognosis. The relationship between nocturnal BP profile and hypertensive retinopathy (HR) is not fully established. AIM: To assess the association between the prevalence and severity of HR and nocturnal BP. METHODS: We prospectively studied hypertensive patients who underwent 24-hour ambulatory BP monitoring. The population was divided into two groups according to the presence or absence of lesions and compared according to baseline characteristics, nocturnal BP profile (dippers, non-dippers, inverted dippers/risers and extreme dippers) and mean nocturnal systolic (SBP) and diastolic (DBP) BP values. The presence and severity of HR were assessed using the Scheie classification. The relationship between nocturnal SBP and DBP values (and nocturnal BP profile) and the prevalence and severity of HR was determined. RESULTS: Forty-six patients (46% male, aged 63±12 years) were analyzed, of whom 91% (n=42) were under antihypertensive treatment. Seventy percent (n=33) had uncontrolled BP. HR was diagnosed in 83% (n=38). Patients with HR had higher mean systolic nocturnal BP (151±23 vs. 130±13 mmHg), p=0.008). Patients with greater HR severity (Scheie stage ≥2) had higher nocturnal BP (153±25 vs. 140±16 mmHg, p=0.04). There was no statistically significant association between DBP and nocturnal BP patterns and HR. CONCLUSIONS: The prevalence and severity of HR were associated with higher nocturnal SBP. No relationship was observed between nocturnal BP profile and the presence of HR.

Excessive atrial ectopic activity as an independent risk factor for ischemic stroke.

BACKGROUND: Excessive atrial ectopic activity (EAEA) has been related with an increased risk of atrial fibrillation (AF) and stroke but different cutoff values have been used. We aimed to determine the association between EAEA and stroke, AF and overall death. METHODS: Consecutive 24-hour Holter monitoring performed between 2005 and 2010 in a single center was evaluated. Patients with a previous diagnosis of stroke or AF were excluded. The number of premature atrial contractions (PACs) during 24h was analyzed in 2480 subjects and according to that 3 sub-groups were defined: >97PACs/h (above the top 5th percentile of the population) (EAEA+); intermediate value of PACs/h (below the top 5th percentile but above 30PACs/h) (EAEA+/-) and <30PACs/h (EAEA-). RESULTS: After adjusting for risk factors, laboratory findings and medication, EAEA+ was associated with ischemic stroke (hazard ratio [HR] 2.83; 95% confidence interval [CI], 1.65-4.84, p<0.001). Both EAEA+ and EAEA+/- were independently associated with AF (HR 2.05; 95% CI 1.31-3.23, p=0.010 for EAEA+ and HR 1.90; 95% CI 1.10-2.78, p=0.020 for EAEA+/-) and overall death (HR 2.17; 95% CI 1.48-3.28, p=0.031 for EAEA+; HR 2.01; 95% CI 1.06-2.52, p=0.029 for EAEA+/-). CONCLUSION: In this population, having >30PACs/h was independently associated with a higher risk of AF and overall death but only subjects with >97PACs/h had a higher risk of ischemic stroke. In the majority of subjects with stroke and EAEA+, AF has not been detected before stroke event.

In-hospital acute myocardial infarction: A case of type II Kounis syndrome. / Enfarte agudo do miocárdio intra­hospitalar: um caso de síndrome de Kounis tipo II.

Kounis syndrome (KS) is the coincidental occurrence of acute coronary syndrome (ACS) and anaphylactic or allergic insult. It results from mast cell degranulation with subsequent release of numerous inflammatory mediators, leading to coronary vasospasm or atheromatous plaque rupture. Diagnosis is clinical and based on the temporal relationship between the two events. Despite the growing number of reported cases, especially in southern Europe, the lack of awareness of this association may lead to under-reporting in Portugal. Recognition of KS, even if retrospective, has clinical implications since individual atopy must be investigated and desensitization measures should be employed, if possible, to prevent future events. We report the case of a 70-year-old man who was admitted to hospital because of generalized exanthema and itching and onset of chest pain while under observation. Coronary angiography confirmed coronary artery disease and ACS and he was diagnosed as having type II KS.

Hypersensitivity to aspirin and urgent percutaneous coronary intervention: A therapeutic challenge. / Hipersensibilidade à aspirina e coronariografia urgente: desafio terapêutico.

Hypersensitivity reactions to nonsteroidal anti-inflammatory drugs are common and five types of reactions have been defined. The prevalence of such reactions in patients with myocardial infarction is unclear, and so antiplatelet therapy in this population is a challenge. Various desensitization protocols have been developed but there are no specific guidelines for their use. The authors present the case of a patient with acute coronary syndrome and aspirin hypersensitivity referred for urgent coronary angiography. Aspirin desensitization therapy is safe and successful in many patients, but more randomized trials are needed to confirm its benefits in coronary artery disease patients.

Prognostic Impact of Iron Metabolism Changes in Patients with Acute Coronary Syndrome / Impacto Prognóstico das Alterações do Metabolismo do Ferro em doentes com Síndrome Coronária Aguda

Abstract Background: Iron metabolism disorders have been associated with an increased risk of cardiovascular events. However, the prognostic impact on patients (pts) with acute coronary syndrome (ACS) has yet to be clarified. Objective: To determine the prognostic value of serum iron and ferritin levels in pts with ACS in the short and long-term. Methods: Consecutive pts admitted to a coronary care unit with a diagnosis of ACS, for a period of 2 years, were evaluated. The population was divided into tertiles of serum iron and ferritin distribution. The primary adverse events were the occurrence of in-hospital death or heart failure (HF) and death or HF at 1 year of follow-up. Results: We studied 280 pts (73% males; mean age 68 ± 13 years). The mean levels of serum iron and ferritin were 59 ± 34 mcg/dL and 205 ± 185 ng/mL, respectively. Patients included in the 1st tertile of serum iron (≤ 40 mcg/dL) had a higher rate of adverse events, in-hospital and after 1 year. Lower and higher levels of ferritin (1st and 3rd tertiles, ≤ 110; >219 ng/ml, respectively) were associated with a higher incidence of HF during hospitalization and death at 1 year. A ferritin value >316 ng /mL was an independent risk factor for death at 1 year (adjusted OR: 14; 95%CI: 2.6 to 75.9). Conclusion: In this population, iron metabolism alterations were associated with a higher rate of adverse events and higher ferritin levels constituted an independent mortality predictor in the long-term.

Resumo Fundamento: Alterações do metabolismo do ferro têm sido associadas a um aumento do risco de eventos cardiovasculares. No entanto, o impacto prognóstico em doentes (dts) com síndrome coronária aguda (SCA) encontra-se ainda pouco esclarecido. Objetivo: Determinar o valor prognóstico a curto e longo prazo dos níveis séricos do ferro e ferritina em dts com SCA. Métodos: Foram avaliados doentes consecutivos admitidos numa Unidade Coronária com o diagnóstico de SCA no período de 2 anos. A população foi agrupada segundo os tercis de distribuição de ferro e ferritina. Os eventos adversos primários foram a ocorrência de morte intrahospitalar e a 1 ano, bem como, insuficiência cardíaca (IC) intrahospitalar e a 1 ano de follow-up. Resultados: Estudaram-se 280 dts (73% sexo masculino; idade média de 68 ± 13 anos). O nível médio de ferro sérico e de ferritina foi 59 ± 34 mcg/dl e 205 ± 185 ng/ml, respetivamente. Os doentes incluídos no 1º tercil (≤ 40 mcg/dl) de ferro sérico apresentaram maior percentagem de eventos adversos intrahospitalares e a 1 ano. Níveis mais baixos e mais elevados de ferritina (1º e 3º tercil, respetivamente, ≤ 110; > 219 ng/ml) estiveram associados a uma maior ocorrência de IC em internamento e de morte a 1 ano. Um valor de ferritina > 316 ng/mL constituiu fator de risco independente de morte a 1 ano (OR ajustado 14 IC 95% 2,6-75,9). Conclusão: Nesta população alterações do metabolismo do ferro estiveram associadas a uma maior ocorrência de eventos adversos e níveis elevados de ferritina constituíram preditor independente de mortalidade a longo prazo.

"Enquanto minha mãe chora": estudo da relação mãe-feto no período gestacional / "While my mother cries": study of the relationship of mother-fetus in the gestational period

A gestação é uma experiência repleta de vulnerabilidade emocional, com sentimentos intensos e ambivalentes, o que poderá desencadear uma comorbidade depressiva. O diagnóstico de depressão na gestação é complexo pela dificuldade de diferenciar os sintomas desta patologia daqueles próprios da gravidez. A pesquisa teve como objetivos verificar a relação da mãe depressiva com seu feto, no período gestacional; verificar a compreensão da gestante frente ao diagnóstico de depressão; os sentimentos relacionados à gravidez e ao feto; as perspectivas de futuro, após o nascimento do bebê, bem como a idealização da mãe sobre o seu filho. A pesquisa utilizou-se das abordagens quantitativa e qualitativa e dividiu-se em três estudos. O objetivo do estudo 1, Apego Fetal de Mulheres Grávidas Depressivas foi verificar a relação mãe-feto, no período gestacional sendo as gestantes com sinais e/ou sintomas de depressão. A pesquisa foi realizada com 32 participantes divididas em dois grupos segundo sintomatologia depressiva (n=16) pré-diagnosticada e não depressivas (n=16). Todas responderam a entrevista (composta de dados sociodemográficos) e a Escala de Apego Materno Fetal. Os principais resultados deste estudo revelaram que os aspectos sociodemográficos, não possuem influência significativa no estabelecimento do vínculo mãe-bebê, mas que a construção do apego materno fetal, na gestação, sofre influência do estado mental das gestantes, sendo menor nas participantes com sintomas de depressão. Em relação ao estudo 2, Compreensão da Depressão de Mulheres Grávidas e as Perspectivas de Futuro, objetivou verificar a compreensão da gestante frente ao diagnóstico de depressão, na condição de grávida e as perspectivas de futuro que as mesmas possuem após o nascimento do bebê. O estudo evidenciou que as gestantes possuíam a compreensão da patologia da depressão e que precisaram interromper o uso de medicamentos devido o estado gravídico, mas que posteriormente ao nascimento do bebê, retornariam o tratamento para não sentirem novamente os sintomas depressivos. Em relação a perspectiva de futuro, as gestantes, apesar dos sintomas depressivos, possuíam projetos de iniciar um curso, retomar os estudos e ao trabalho para assim poder sustentar seus filhos e oferecer educação à eles. Tal fato pode ter ocorrido devido as gestantes reconhecerem a importância do papel materno no desenvolvimento e na criação do bebê. No que diz respeito ao estudo 3, Sentimentos Ambivalentes de Apego ao Bebê, o qual possuía como objetivo verificar a relação mãe-feto no período gestacional, sendo as gestantes com sinais e/ou sintomas de depressão, bem como os sentimentos maternos relacionados à gravidez e ao feto e a idealização que as mães possuem do seu bebê, os resultados demonstraram que as gestantes possuíam expectativas e idealizações em relação ao bebê, baseadas em características físicas, biológicas e comportamentais, o que possivelmente demonstra a falta de investimento afetivo das mães para com seus bebês. No que diz respeito aos sentimentos em relação a gravidez e ao feto, as gestantes demonstraram variados sentimentos como: rejeição, não aceitação, tristeza, medo, culpa, desesperança, o que corrobora com a vulnerabilidade de sentimentos em grávidas com sinais e/ou sintomas de depressão. Todavia, acreditavam que o sentimento de rejeição em relação ao bebê pudesse dar lugar ao amor maternal após o nascimento do filho

Pregnancy is an experience full of emotional vulnerability, with intense and ambivalent feelings, which may trigger depressive comorbidity. The diagnosis of depression in pregnancy is complex because of the difficulty in differentiating the symptoms of this condition from those of pregnancy. The research aimed to verify the relationship of the depressive mother with her fetus during the gestational period; verify the understanding of the pregnant woman facing the diagnosis of depression; feelings related to pregnancy and the fetus; future prospects after the birth of the baby, as well as the idealization of the mother over her child. The research used the quantitative and qualitative approaches and was divided into three studies. The objective of study 1, Fetal Attachment of Depressive Pregnant Women was to verify the mother-fetus relationship, during pregnancy and pregnant women with signs and/or symptoms of depression. The research was conducted with 32 participants divided into two groups according to pre-diagnosed depressive symptoms (n = 16) and non-depressive symptoms (n = 16). All answered the interview (composed of sociodemographic data) and the Fetal Maternal Attachment Scale. The main results of this study revealed that the sociodemographic aspects do not have a significant influence on the establishment of the mother-baby bond, but that the construction of the fetal maternal attachment during pregnancy is influenced by the mental state of the pregnant women, being lower in the participants with symptoms of breastfeeding depression. In relation to study 2, Understanding of Depression of Pregnant Women and the Prospects of the Future, this study aimed to verify the pregnant woman's understanding of the diagnosis of depression, as a pregnant woman, and their future prospects after the birth of the baby. The study showed that pregnant women had an understanding of the pathology of depression and had to discontinue use of drugs due to pregnancy, but that after the birth of the baby, would return to treatment to not feel depressive symptoms again. Regarding the future perspective, the pregnant women, despite their depressive symptoms, had projects to start a course, resume their studies and work so as to be able to support their children and offer them education. This may have occurred because pregnant women recognize the importance of the maternal role in the development and rearing of the baby. Regarding study 3, Ambivalent Feelings of Baby Attachment, which aimed to verify the mother-fetus relationship in the gestational period, with pregnant women with signs and / or symptoms of depression, as well as maternal feelings related to pregnancy. and the fetus and the mothers 'idealization of their baby, the results showed that pregnant women had expectations and idealizations regarding the baby, based on physical, biological and behavioral characteristics, which possibly demonstrates the mothers' lack of affective investment to with your babies. Regarding the feelings regarding pregnancy and the fetus, pregnant women showed various feelings such as: rejection, non-acceptance, sadness, fear, guilt, hopelessness, which corroborates the vulnerability of feelings in pregnant women with signs and / or symptoms. of depression. However, they believed that the feeling of rejection towards the baby could give rise to maternal love after the birth of the child

Processo de reparação de lesões da córnea e a membrana amniótica na oftalmologia / Repair process of corneal damage and the amniotic membrane in ophthalmology

Os eventos que fazem parte do processo de reparação de lesões da córnea ocorrem simultaneamente e envolvem proliferação, migração, diferenciação e apoptose celular, além da comunicação intercelular. Vários fatores solúveis, além de proteínas da matriz mesenquimal, proteoglicanos, enzimas proteolíticas e alguns tipos celulares são abordados nesta revisão, na qual explicam-se os processos de reparação de lesões superficiais ou penetrantes da córnea. A membrana amniótica, muito utilizada na cirurgia oftálmica, foi estudada por apresentar funções que colaboram com o processo de reparação. Entretanto, tais funções poderão ser perdidas quando tal tecido for submetido à conservação. Assim, torna-se importante conhecer o processo de reparação de lesões que envolvem, ou não, a córnea em toda a sua espessura e escolher a melhor forma de utilização da membrana amniótica quando ela for indicada na terapia para estas lesões.

The events included in the process of repair of corneal damage occur simultaneously and involve proliferation, migration, differentiation, cell apoptosis and intercellular communication. Several soluble factors, mesenchymal matrix proteins, proteoglycans, proteolytic enzymes and some cell types are covered in this review, which explains the processes of repair of corneal wounds, either superficial or penetrating. The amniotic membrane, used in ophthalmic surgery, was studied because of the contribution of its functions to the repair process. However, these functions may be lost when the amniotic membrane is subjected to conservation. Therefore, it is important to understand the repair process of lesions involving or not the entire thickness of the cornea, and choose the best use of the amniotic membrane, when it is indicated for the treatment of these lesions.

Radiographic diagnosis of traumatic urethrorectal fistula in dog / Diagnóstico radiográfico de fístula uretroretal traumática em cão

A dog with abdominal trauma had an urethrorectal fistula and secundary bilateral hidronephrosis and hydroureter, identified by urethrocistography and excretory urography. According to our researches, only two cases of traumatic urethrorectal fistula had been reported until now in veterinary medicine.

Um cão com trauma abdominal desenvolveu fístula uretroretal, hidronefrose e hidroureter bilaterais secundários, identificados por uretrocistografia e urografia excretora. Na literatura veterinária, há somente dois casos de fístulas uretroretais traumáticas descritos até o momento.