RESUMO
Ten-eleven translocation 2 (TET2) plays a pivotal role in epigenetic regulation, cell differentiation, and the inflammatory response. It also mediates the transcriptional regulation for inflammatory cytokines, particularly interleukin-6. While loss-of-function mutation in TET2 has been associated with hematological malignancies, it has been increasingly recognized to cause atherosclerotic disease. The increased atherogenicity is thought to be the result of increased production of pro-inflammatory interleukin-1ß cytokines following activation of NLRP3 inflammasomes. We present a unique case of recurrent atherothrombosis in an elderly man who was diagnosed with chronic myelomonocytic leukemia in the setting of TET2 mutation.
Assuntos
Dioxigenases , Embolia , Leucemia Mielomonocítica Crônica , Tromboembolia , Trombose , Masculino , Humanos , Idoso , Leucemia Mielomonocítica Crônica/complicações , Leucemia Mielomonocítica Crônica/genética , Leucemia Mielomonocítica Crônica/patologia , Epigênese Genética , Mutação , Citocinas/genética , Proteínas de Ligação a DNA/genética , Dioxigenases/genéticaRESUMO
Many argue that the concept of "work-life balance" is impossible to achieve for busy physicians. After spending years in medical training and building a career in health care, physicians often find their work encroaching upon other aspects of day-to-day life. Over the past decade, studies have shown that physician burnout, stress, depression, mental health, and general lack of well-being affect productivity, efficiency, and patient care. In this article, we will discuss the concept of "work-life balance" and recommend strategies to strive for a meaningful balance.
Assuntos
Esgotamento Profissional , Médicos , Humanos , Resultado do Tratamento , Esgotamento Profissional/prevenção & controle , Equilíbrio Trabalho-Vida , EficiênciaRESUMO
The diagnosis of pulmonary hypertension (PH) requires a right heart catheterization (RHC) that reveals a mean pulmonary artery pressure ≥ 25 mmHg. The pulmonary artery catheter traverse the right atrium and ventricle on its way to the pulmonary artery. The presence of abnormal right heart structures, i.e. thrombus, vegetation, benign or malignant cardiac lesions, can lead to complications during this procedure. On the other hand, avoidance of RHC delays the diagnosis and treatment of PH, an approach that might be associated with worse outcomes. This paper discusses the impact of right heart lesions on the diagnosis of PH and suggests an approach on how to manage this association.