Diagnosis and treatment of myocarditis and inflammatory cardiomyopathy. Consensus document of the SEC-Working Group on Myocarditis.

Myocarditis is defined as myocardial inflammation and its etiology is highly diverse, including infectious agents, drugs, and autoimmune diseases. The clinical presentation also varies widely, extending beyond the classic clinical picture of acute chest pain, and includes cases of cardiomyopathy of unknown cause whose etiology may be inflammatory. Because certain patients may benefit from targeted treatments, the search for the etiology should begin when myocarditis is first suspected. There remain several areas of uncertainty in the diagnosis and treatment of this disease. Consequently, this consensus document aims to provide clear recommendations for its diagnosis and treatment. Hence, a diagnostic algorithm is proposed, specifying when non-invasive diagnosis with cardiac MR is appropriate vs a noninvasive approach with endomyocardial biopsy. In addition, more novel aspects are discussed, such as when to suspect an underlying genetic etiology. The recommendations cover the management of myocarditis and inflammatory cardiomyopathy, both for general complications and specific clinical entities.

Coronary computed tomographic angiography findings and their therapeutic implications in asymptomatic patients with familial hypercholesterolemia. Lessons from the SAFEHEART study.

BACKGROUND: Familial hypercholesterolemia (FH) confers an increased risk of premature atherosclerotic disease. Coronary computed tomographic angiography (CTA) can assess preclinical coronary atherosclerosis. OBJECTIVES: To describe coronary CTA findings in asymptomatic molecularly defined FH individuals, to identify those factors related to its presence and extension, and to assess the impact of these results in patients' care and estimated risk. METHODS: Four hundred and forty individuals with FH, without clinical cardiovascular disease, were consecutively enrolled and underwent a coronary CTA that was used to analyze coronary atherosclerosis based on coronary calcium score (CCS), sum of stenosis severity, and plaque composition sum (PCS). For FH patients, cardiovascular risk was estimated using the specific SAFEHEART risk equation. Follow-up was performed using a standardized protocol. RESULTS: Mean age was 46.4 years (231 women, 52%). Coronary calcium was present in 55%, mean CCS was 130.9, 46% had a plaque with lumen involvement, and mean PCS was 1.1. During follow-up, there were 17 (4%) nonfatal events and 2 (1%) fatal events. CCS was independently associated to the estimated risk and low-density lipoprotein-cholesterol life-years, sum of stenosis severity to the estimated risk, and PCS to the estimated risk and low-density lipoprotein-cholesterol life-years. CTA findings induced a positive change in patients' care and in their estimated risk. CONCLUSION: Coronary artery atherosclerosis is highly prevalent in asymptomatic patients with FH and it is independently associated to cardiovascular risk. More advanced disease on CTA was associated with subsequent intensification of therapy and reduction of estimated risk. Further longitudinal studies are required to know if these findings might improve the risk stratification in patients with FH.

Actividad antimicrobiana in vitro de Pteris vittata L / In vitro antimicrobial activity of Pteris vittata L

Introducción: las hojas de Pteris vittata L (helecho) son utilizadas por la población para el tratamiento de la candidiasis y en enfermedades producidas por bacterias en la piel. Objetivo: identificar preliminarmente las familias de metabolitos secundarios presentes en las hojas de la planta y evaluar su posible actividad antimicrobiana. Métodos: se recolectaron las hojas de Pteris vittata L. El material vegetal fue lavado, desinfectado, secado y seguidamente se procedió a su pulverización. Este polvo se utilizó en la elaboración de los diferentes extractos y tintura. La tintura obtenida se concentró y se fraccionó sucesivamente con n-hexano, cloroformo y acetato de etilo. A estos extractos se les realizó el tamizaje fitoquímico, ensayos microbiológicos y cromatografía de capa fina. Resultados: las pruebas in vitro efectuadas a los extractos obtenidos a partir de la tintura 20 por ciento, demostraron que éstos presentan actividad antimicrobiana frente a Escherichia coli, Staphylococcus aureus, destacándose los resultados obtenidos frente a Candida sp para los extractos de acetato de etilo y clorofórmico. En estas fracciones están presentes en mayor proporción alcaloides y quinonas, que podrían ser los responsables de esta actividad, lo cual se corrobora con la identificación de estos metabolitos secundarios mediante la cromatografía de capa fina y el tamizaje fitoquímico realizado. Conclusiones: el estudio combinado mediante la cromatografía de capa fina y el tamizaje fitoquímico de los extractos hexánico, acetato de etilo y clorofórmico permite inferir que la actividad antimicrobiana puede deberse a la presencia de quinonas y alcaloides(AU)

Introduction: Pteris vittata L. leaves (fern) are used by people on the candidiasis treatment and some skin illnesses caused by bacteria. Objective: to identify preliminarily the secondary metabolites present in the leaves of the plant and to evaluate their possible antimicrobial activity. Methods: Pteris vittata L. leaves were collected. The plant material was washed, disinfected, dried and pulverized. The powder obtained was used to make the various extracts and the tincture. The latter was concentrated and successively fractionated with n-hexane, chloroform, and ethyl acetate. The extracts underwent phytochemical screening, microbiological assays and thin-layer chromatography. Results: in vitro tests performed in the obtained extracts from the 20 percent tincture proved that they have antimicrobial activity against Escherichia coli and Staphylococcus aureus, emphasizing the accomplished results against Candida of the ethyl and chloroform acetate extracts. Alkaloids and quinones, which are found in large proportion in the extracts, would be responsible of the above- mentioned antibacterial activity. This was corroborated by the identification of these secondary metabolites through thin-layer chromatography and phytochemical screening. Conclusions: the combined study through thin-layer chromatography and phytochemical screening of the ethyl and chloroform acetate extracts showed that the antimicrobial activity could be possible due to the alkaloids and quinones presence(AU)

Tomografía computarizada cardiaca: Nuevas aplicaciones de una técnica en evolución / Cardiac computed tomography: New applications of an evolving technique

En los últimos años hemos sido testigos del continuo desarrollo de las técnicas de imagen en cardiología. Entre ellas, la tomografía computarizada cardiaca, técnica emergente y en continua evolución. Con la posibilidad actual de realizar estudios con muy baja radiación se han ampliado sus indicaciones más allá de la coronariografía no invasiva. En el presente trabajo de revisión repasamos las novedades técnicas de la tomografía computarizada cardiaca así como sus nuevas aplicaciones.

During the last years we have witnessed an increasing development of imaging techniques applied in Cardiology. Among them, cardiac computed tomography is an emerging and evolving technique. With the current possibility of very low radiation studies, the applications have expanded and go further coronariography In the present article we review the technical developments of cardiac computed tomography and its new applications.

Primary cardiac tumors: 32 years of experience from a Spanish tertiary surgical center.

INTRODUCTION: Primary cardiac tumors are rare entities with an autopsy frequency ranging between 0.001% and 0.3%. Our objective was to review 32 years of experience from a Spanish tertiary surgical center. METHOD: We collected data on 73 patients with a histopathological diagnosis of a primary cardiac tumor in a retrospective analysis from 1979 to 2012. Tissue samples were obtained either at surgery or from necropsy and subsequently divided into benign and malignant groups. RESULTS: Benign neoplasms accounted for 84.9% of cases. The average age at diagnosis was 61 years, and tumors were twice as frequent among women. It was an incidental finding in one quarter of patients. In symptomatic patients, the typical presentation was of cardioembolic stroke or of congestive symptoms. Myxoma (93.5%) was the most common diagnosis, typically affecting the left atrium (74.2%). Surgical resection was curative for 95% of these patients. Malignant tumors represented 15.1% of cases with an average age at diagnosis of 50 years. Over 90% of these patients were symptomatic at presentation with the cardinal symptom being heart failure. Undifferentiated sarcoma was the most frequent malignant tumor (36.4%). Less than 20% of patients were alive 1 year after diagnosis despite the treatment. CONCLUSIONS: In our study, primary cardiac tumors were insidious. The most common was left atrial myxoma in which surgical resection was considered curative. Undifferentiated sarcoma was the most frequent malignant tumor. Malignant neoplasms carried a worse prognosis with unsuccessful total excision and the presence of metastatic disease being markers of an adverse outcome.

Arteria coronaria única con origen en seno de Valsalva derecho: Utilidad de la angiotomografía coronaria con tomografía multicorte / Single coronary artery originated in the right Valsalva sinus: Usefulness of multislice coronary angiotomography

La arteria coronaria única con origen en el seno de Valsalva derecho es una anomalía coronaria congénita poco frecuente. Presentamos el caso de un hombre de 77 años remitido para coronariografía invasiva con diagnóstico de síndrome coronario agudo sin elevación del segmento ST de localización ínfero-lateral. En el estudio se demostró enfermedad significativa en el tercio proximal de la coronaria derecha. Durante el procedimiento no se logró cateterizar el ostium de la coronaria izquierda que aparentemente se rellenaba desde la coronaria derecha. Ante la sospecha de un origen anómalo de la misma, se realizó coronariografía no invasiva mediante tomografía multicorte de 64 cortes que confirmó la existencia de una arteria coronaria única con origen en el seno de Valsalva derecho.

Single coronary artery arising from the right sinus of Valsalva is a rare congenital coronary anomaly. We report the case of a 77- year- old man who was referred for invasive coronary angiography with a diagnosis of a non-ST-segment elevation acute coronary syndrome of inferior-lateral location. Significant lesion was detected in the proximal segment of the right coronary artery (RCA). During the procedure, it was impossible to catheterize the left coronary ostium, being the left anterior descending filled from the RCA. Given the suspicion of agenesis of the left main, 64-multidetector computed tomography was performed which confirmed the existence of a solitary coronary ostium with a single artery arising from the right sinus of Valsalva.

Evaluation of adalimumab therapy in multidisciplinary strategy for perianal Crohn's disease patients with infliximab failure.

BACKGROUND: Infliximab has improved the management of perianal Crohn's disease, but intolerance and loss of efficacy can occur. The use of a second antibody can be less effective. OBJECTIVE: Our aim was to determine if the use of adalimumab, based on a multidisciplinary strategy, can enhance outcomes for patients with fistulizing disease and infliximab failure. MATERIAL AND METHODS: Sixteen patients with perianal disease and infliximab failure were treated with adalimumab. Complex fistulas were assessed using magnetic resonance imaging (MRI). Patients with severe conditions as determined by radiology were examined under anesthesia, and seton placement was performed when appropriate. Setons were removed when external discharge had ceased and there was no radiological evidence of fistula activity. RESULTS: Nine patients (56%) underwent MRI. Setons were inserted in seven (43%). The baseline perianal disease activity index (PDAI) decreased after 4 weeks and remained at similar levels 24 and 48 weeks after treatment. The complete response rate was 50% after four weeks and 87.5% of these patients remained in remission after 48 weeks of treatment. CONCLUSIONS: For patients with Crohn's perianal fistulas and infliximab failure, adalimumab as a multidisciplinary approach to management, using MRI to guide surgical drainage when necessary, results in a favourable response and low recurrence rate.

CARD15 mutations in patients with Crohn's disease in a homogeneous Spanish population.

OBJECTIVES: Three mutations in CARD15 have been repeatedly shown to be involved in Crohn's disease susceptibility, mainly in Caucasian individuals. However, those findings were not replicated in all populations studied so far. In this work, we studied the role of CARD15 mutations in a relatively homogeneous population from the Northwest of Spain, Galicia. METHODS: One hundred and sixty-five patients with Crohn's disease and a similar number of healthy controls were recruited from a single center in Galicia. All individuals were genotyped for the three main Crohn's disease associated CARD15 variants (R702W, G908R, and 1007fs). Association analyses were performed to study the influence of those mutations on Crohn's disease overall and on clinical subphenotypes. RESULTS: The allele frequencies of CARD15 variants were lower in this population than in most of the European populations studied so far. G908R and 1007fs were significantly associated with overall susceptibility to Crohn's disease. However, these associations were lost after stratification to clinical subgroups, probably due to the small number of cases in these subgroups. Significant associations were found between G908R and 1007fs and the behavior of Crohn's disease, but they were due to the influence of years of disease on the behavior of the disease rather than being the result of a direct effect of these mutations on disease behavior. CONCLUSIONS: The CARD15 variants G908R and 1007fs, but not R702W, are associated with susceptibility to Crohn's disease in Galicia. Interestingly, the frequency of these mutations appears to be lower than in other Caucasian populations studied so far.