Acute Myocarditis Associated with Acute Myocardial Infarction.

Concomitant acute myocarditis and acute coronary thrombosis is a rare presentation of acute chest pain in the emergency department, although the association between acute infections with a variety of pathogens and an increased risk of myocardial infarction has been reported. A case of acute myocardial infarction associated with acute myocarditis caused by coronavirus 229E in a middle-aged man without risk factors for coronary artery disease is described here. Coronary CT angiography with late enhancement protocol revealed areas of myocarditis and infarction, and cardiac MRI and coronary angiography were then performed. © RSNA, 2021.

Atypical chest pain due to multiple coronary arteries fistulas occluded with percutaneous interlock coils: A case report.

Coronary artery fistulas, although rare, should be included in the differential diagnosis of atypical chest pain, generally unveiled by cardiac catheterization or multidetector computed tomography. Such anatomical findings in conjunction with detectable ischemia and severe symptoms should prompt their closure. Transcatheter closure of fistulas is an attractive alternative to surgery, especially with the novel devices such as the interlock fibered detachable coils, which can be safely and effectively performed in a variety of circumstances, including the coronary arteries with tortuous anatomies. We present a case of atypical chest pain and large burden of ischemia in the stress scintigraphy, due to multiple coronary fistulas to the bronchial arteries successfully occluded with percutaneous interlock coils. .

Co-production of tannase and gallic acid by a novel Penicillium rolfsii (CCMB 714).

A novel tannase and gallic acid-producing Penicillium rolfsii (CCMB 714) was isolated from cocoa leaves from the South of Bahia. The influence of nutritional sources and the simultaneous effect of parameters involved in the fermentation process were available. Tannase (9.97 U mL-1) and gallic acid (9 mg mL-1) production were obtained in 48 h by submerged fermentation in non-optimized conditions. Among the carbon sources, tested gallic acid and tannic acid showed the highest tannase production (p<.05) when compared with methyl gallate and glucose. After optimization using the temperature and tannic acid concentration as variables with the Central Compound Rotational Design (CCRD), the maximal tannase production (25.6 U mL-1) was obtained at 29.8 °C and 12.7%, respectively, which represents an increase of 2.56 times in relation to the initial activity. The parameters optimized for the maximum production of gallic acid (21.51 mg mL-1) were 30 °C and 10% tannic acid. P. rolfsii CCMB 714 is a new strain with a high tannase and gallic acid production and the gallic acid produced is very important, mainly for its applications in the food and pharmaceutical industry.

Left Main Ostial Compression in a Patient with Pulmonary Hypertension: Dynamic Findings by IVUS.

BACKGROUND: Pulmonary artery dilatation is a common feature among patients with severe pulmonary hypertension. Left main coronary artery extrinsic compression by an enlarged pulmonary artery is a rare complication and a potential cause for chest pain and sudden cardiac death in patients with pulmonary hypertension. This situation is very rare and few reports have described it. Currently, the appropriate management of these patients remains unknown. CASE REPORT: In the present report we describe the case of a 39-year-old woman who presented with a 2-year history of cardiac symptoms related to exercise. The patient underwent a 64-slice multidetector computed tomography (MDCT) coronary angiography, which showed left main coronary artery (LMCA) compression by a markedly enlarged pulmonary artery trunk (44 mm), without intraluminal stenosis or coronary artery calcium, as determined by the Agatston score. This compression was considered to be the cause of the cardiac symptoms. To confirm and plan the treatment, the patient underwent cardiac catheterization that confirmed the diagnosis of pulmonary hypertension and LMCA critical obstruction. Taking into account the paucity of information regarding the best management in these cases, the treatment decision was shared among a "heart team" that chose percutaneous coronary intervention with stent placement. An intra-vascular ultrasound was performed during the procedure, which showed a dynamic compression of the left main coronary artery. The intervention was successfully executed without any adverse events. CONCLUSIONS: This case illustrates dynamic compression of the LMCA by IVUS, visually demonstrating the mechanism of the intermittent symptoms of myocardial ischemia in this kind of patient. It also shows that percutaneous stenting technique may be an appropriate treatment for this unusual situation.

Liposuction induces a compensatory increase of visceral fat which is effectively counteracted by physical activity: a randomized trial.

CONTEXT: Liposuction is suggested to result in long-term body fat regain that could lead to increased cardiometabolic risk. We hypothesized that physical activity could prevent this effect. OBJECTIVE: Our objective was to investigate the effects of liposuction on body fat distribution and cardiometabolic risk factors in women who were either exercise trained or not after surgery. DESIGN, SETTING, AND PARTICIPANTS: Thirty-six healthy normal-weight women participated in this 6-month randomized controlled trial at the University of Sao Paulo, Sao Paulo, Brazil. INTERVENTIONS: Patients underwent a small-volume abdominal liposuction. Two months after surgery, the subjects were randomly allocated into two groups: trained (TR, n = 18, 4-month exercise program) and nontrained (NT, n = 18). MAIN OUTCOME MEASURES: Body fat distribution (assessed by computed tomography) was assessed before the intervention (PRE) and 2 months (POST2), and 6 months (POST6) after surgery. Secondary outcome measures included body composition, metabolic parameters and dietary intake, assessed at PRE, POST2, and POST6, and total energy expenditure, physical capacity, and sc adipocyte size and lipid metabolism-related gene expression, assessed at PRE and POST6. RESULTS: Liposuction was effective in reducing sc abdominal fat (PRE vs. POST2, P = 0.0001). Despite the sustained sc abdominal fat decrement at POST6 (P = 0.0001), the NT group showed a significant 10% increase in visceral fat from PRE to POST6 (P = 0.04; effect size = -0.72) and decreased energy expenditure (P = 0.01; effect size = 0.95) when compared with TR. Dietary intake, adipocyte size, and gene expression were unchanged over time. CONCLUSION: Abdominal liposuction does not induce regrowth of fat, but it does trigger a compensatory increase of visceral fat, which is effectively counteracted by physical activity.

Resistance training with vascular occlusion in inclusion body myositis: a case study.

UNLABELLED: Inclusion body myositis (IBM) is a rare idiopathic inflammatory myopathy that produces remarkable muscle weakness. Resistance training with vascular occlusion has been shown to improve muscle strength and cross-sectional area in other muscle wasting conditions. PURPOSE: We evaluated the efficacy of a moderate-intensity resistance training program combined with vascular occlusion by examining functional capacity, muscle morphology, and changes in the expression of genes related to muscle protein synthesis and proteolysis in a patient with IBM. METHODS: A 65-yr-old man with IBM resistant to all proposed treatments underwent resistance training with vascular occlusion for 12 wk. Leg press one-repetition maximum; thigh cross-sectional area; balance, mobility, and muscle function; quality of life; and blood markers of inflammation and muscle damage were assessed at baseline and after the 12-wk program. The messenger RNA (mRNA) expression levels of mechanogrowth factor, mammalian target of rapamycin, atrogin-1, and muscle RING finger-1 were also quantified. RESULTS: After the 12-wk training program, the patient's leg press one-repetition maximum, balance and mobility function, and thigh cross-sectional area increased 15.9%, 60%, and 4.7%, respectively. All Short Form-36 Health Survey Questionnaire subscales demonstrated improvements as well, varying from 18% to 600%. mRNA expression of mechanogrowth factor increased 3.97-fold, whereas that of atrogin-1 decreased 0.62-fold. Muscle RING finger-1 and mammalian target of rapamycin mRNA levels were only slightly altered, 1.18- and 1.28-fold, respectively. Importantly, the exercise did not induce disease flare. CONCLUSIONS: We describe a novel, and likely the first, nonpharmacological therapeutic tool that might be able to counteract the muscle atrophy and the declining strength that usually occur in IBM.

Competitive sports for children and adolescents: should an electrocardiogram be required in the pre-participation physical examination?

The growing number of children and adolescents, aged 7 to 17 years, that participate in competitive sports requires preventive medical care. The pre-participation physical examination (PPE) requires appropriate medical knowledge to insure safe medical clearance. Recent sudden death events related to sports practice have raised doubts concerning the need for a medical evaluation based on medical tests, which due to the delay in its implementation may result in demotivation and abandonment of the sports practice. This is a review study, including data collected during a period of 30 years at the Olympic Training and Research Center (COTP) of the Municipal Secretary of Sports of São Paulo, where future athletes are identified, socially included and trained; and the objective of the study was to evaluate the need for the involvement of medical organizations in the preparation of a EPP protocol for the cardiovascular assessment of this population, according to the Brazilian reality. We had no normative standard, and so we relied on data collected from protocols that were established by other countries, but we defined which conduct to be taken with each of our individuals.

Esporte competitivo na criança e no adolescente - exame pré-participação: eletrocardiograma obrigatório? / Deporte competitivo en el niño y el adolescente - examen pre participación: ¿debería ser obligatorio el uso de electrocardiograma? / Competitive sports for children and adolescents: should an electrocardiogram be required in the pre-participation physical examination?

O crescente engajamento de crianças e adolescentes, na faixa etária de 7 a 17 anos, para a prática de esportes competitivos, exige cuidados médicos preventivos. o exame pré-participação (epp) requer o conhecimento médico adequado para a sua segura liberação. recentes acontecimentos de mortes súbitas, relacionados à prática esportiva, têm suscitado questões quanto à necessidade de avaliação médica baseada em exames complementares, os quais, devido à demora para sua realização, podem causar desmotivação e até o abandono do esporte por parte dos praticantes. este estudo de revisão, acrescido de dados colhidos por 30 anos no centro olímpico de treinamento e pesquisa (cotp) da secretaria municipal de esportes de são paulo - local de detecção, inclusão social e formação de futuros atletas -, objetiva a necessidade do envolvimento de entidades médicas na elaboração de um protocolo de epp, inserido na realidade brasileira, para a avaliação cardiovascular dessa população. por não dispormos de uma normativa, nos baseamos em protocolos estabelecidos por outros países para nos respaldarmos com informações, apesar de termos definido individualmente a conduta a ser tomada.

The growing number of children and adolescents, aged 7 to 17 years, that participate in competitive sports requires preventive medical care. The pre-participation physical examination (PPE) requires appropriate medical knowledge to insure safe medical clearance. Recent sudden death events related to sports practice have raised doubts concerning the need for a medical evaluation based on medical tests, which due to the delay in its implementation may result in demotivation and abandonment of the sports practice. This is a review study, including data collected during a period of 30 years at the Olympic Training and Research Center (COTP) of the Municipal Secretary of Sports of São Paulo, where future athletes are identified, socially included and trained; and the objective of the study was to evaluate the need for the involvement of medical organizations in the preparation of a EPP protocol for the cardiovascular assessment of this population, according to the Brazilian reality. We had no normative standard, and so we relied on data collected from protocols that were established by other countries, but we defined which conduct to be taken with each of our individuals.

El creciente compromiso de niños y adolescentes, en la franja de edad entre 7 y 17 años, con la práctica de deportes competitivos, exige cuidados médicos preventivos. El examen pre participación (EPP) requiere el conocimiento médico adecuado para su segura liberación. Recientes acontecimientos de muertes súbitas relacionados a la práctica deportiva, han suscitado cuestiones en cuanto a la necesidad de evaluación médica basada en exámenes complementarios, los que, debido a la demora para su realización, pueden ocasionar desmotivación e incluso el abandono del deporte por parte de los practicantes. Este estudio de revisión, añadido de datos recolectados durante 30 años en el Centro Olímpico de Entrenamiento e Investigación (COTP) de la Secretaría Municipal de Deportes de São Paulo -local de detección, inclusión social y formación de futuros atletas-, objetiva la necesidad de la implicación de entidades médicas en la elaboración de un protocolo de EPP, insertado en la realidad brasileña, para la evaluación cardiovascular de esa población. Por no disponer de una normativa, nos basamos en protocolos establecidos por otros países para respaldarnos con informaciones, a pesar de habernos definido individualmente la conducta a tomar.

National examination of Brazilian residents and specialization trainees in radiology and diagnostic imaging: a tool for evaluating the qualifications of future radiologists.

PURPOSE: This is a study of performance based on an In-training Examination for Radiology and Diagnostic Imaging targeting residents (R) and specialization trainees (ST) in Radiology. The radiological training may differ between R and ST in some centers. The authors present their experience and thoughts regarding the first three years of application of the In-training Examination administered by The Brazilian College of Radiology. METHODS: Three hundred and eight-six tests were analyzed in 1999, 715 in 2000, and 731 in 2001. The yearly tests consisted of multiple-choice answers, some with interpretation of digital images, and were divided into 9 specialties: neurology, thorax, physics, pediatrics, digestive system, urinary system, musculoskeletal system, mammography, and gynecology-obstetrics. Each specialty was analyzed separately. The tests were given simultaneously in 12 Brazilian cities. The subspecialty scores of examinees at different stages of training were compared (1st, 2nd, and 3rd year residents and specialization trainees), by the Kruskal-Wallis test (P<0.001). RESULTS: The 1999 examination did not reveal any significant difference between the R and ST groups (P>0.05). Generally, in 2000 and 2001, R achieved higher scores than ST (P<0.001). The performance in physics was poor for both groups for the 3 years covered by the study. CONCLUSION: The performance of residents was better than that of the specialization trainees in the majority of the subspecialties, mainly in the last two years. The In-training Examination provides a system for evaluating future specialists and identifying the centers that need to revise their teaching methods and the regional differences in radiological training.

National examination of Brazilian residents and specialization trainees in radiology and diagnostic imaging: a tool for evaluating the qualifications of future radiologists

PURPOSE: This is a study of performance based on an In-training Examination for Radiology and Diagnostic Imaging targeting residents (R) and specialization trainees (ST) in Radiology. The radiological training may differ between R and ST in some centers. The authors present their experience and thoughts regarding the first three years of application of the In-training Examination administered by The Brazilian College of Radiology. METHODS: Three hundred and eight-six tests were analyzed in 1999, 715 in 2000, and 731 in 2001. The yearly tests consisted of multiple-choice answers, some with interpretation of digital images, and were divided into 9 specialties: neurology, thorax, physics, pediatrics, digestive system, urinary system, musculoskeletal system, mammography, and gynecology-obstetrics. Each specialty was analyzed separately. The tests were given simultaneously in 12 Brazilian cities. The subspecialty scores of examinees at different stages of training were compared (1st, 2nd, and 3rd year residents and specialization trainees), by the Kruskal-Wallis test (P<0.001). RESULTS: The 1999 examination did not reveal any significant difference between the R and ST groups (P>0.05). Generally, in 2000 and 2001, R achieved higher scores than ST (P<0.001). The performance in physics was poor for both groups for the 3 years covered by the study. CONCLUSION: The performance of residents was better than that of the specialization trainees in the majority of the subspecialties, mainly in the last two years. The In-training Examination provides a system for evaluating future specialists and identifying the centers that need to revise their teaching methods and the regional differences in radiological training.

OBJETIVO: Estudo comparativo entre o desempenho dos residentes e especializandos em radiologia por meio da Prova Nacional dos Residentes e Especializandos em Radiologia e Diagnóstico por Imagem (PNRERADI), durante os três primeiros anos de sua aplicação. O ensino nos centros de formação em radiodiagnóstico pode diferir entre residentes e especializandos. MÉTODOS: Foram analisadas 386 provas em 1999, 715 em 2000 e 731 em 2001. As provas foram divididas em nove subespecialidades: neurologia, tórax, digestivo, física, pediatria, urinário, músculo-esquelético, mamografia e ginecologia-obstetrícia, cada uma delas avaliada separadamente, constando de testes de múltipla escolha, algumas com interpretação de imagens digitalizadas. As provas foram aplicadas simultaneamente em 12 cidades distribuídas no território nacional. As subespecialidades foram comparadas nos diversos níveis (residentes e especializandos de 1º, 2º e 3º anos) através do teste não-paramétrico de Kruskal-Wallis (p<0,001). RESULTADOS: Na prova de 1999 não foi observada diferença significativa entre residentes e especializandos na maioria das áreas. Em 2000 e 2001, no geral, os residentes apresentaram aproveitamento superior aos especializandos. O aproveitamento na área de física foi ruim para residentes e especializandos, durante esses três anos de aplicação da prova. CONCLUSÕES: O desempenho dos residentes em relação aos especializandos foi melhor na maioria das subespecialidades, principalmente nos dois últimos anos avaliados. A PNRERADI representa um meio de avaliação dos futuros especialistas, identificando os centros que necessitem de revisão do modelo de ensino, além de prover informação da diferença regional no treinamento da radiologia.