Single-Cell Mapping of Brain Myeloid Cell Subsets Reveals Key Transcriptomic Changes Favoring Neuroplasticity after Ischemic Stroke / 神经科学通报·英文版

Interactions between brain-resident and peripheral infiltrated immune cells are thought to contribute to neuroplasticity after cerebral ischemia. However, conventional bulk sequencing makes it challenging to depict this complex immune network. Using single-cell RNA sequencing, we mapped compositional and transcriptional features of peri-infarct immune cells. Microglia were the predominant cell type in the peri-infarct region, displaying a more diverse activation pattern than the typical pro- and anti-inflammatory state, with axon tract-associated microglia (ATMs) being associated with neuronal regeneration. Trajectory inference suggested that infiltrated monocyte-derived macrophages (MDMs) exhibited a gradual fate trajectory transition to activated MDMs. Inter-cellular crosstalk between MDMs and microglia orchestrated anti-inflammatory and repair-promoting microglia phenotypes and promoted post-stroke neurogenesis, with SOX2 and related Akt/CREB signaling as the underlying mechanisms. This description of the brain's immune landscape and its relationship with neurogenesis provides new insight into promoting neural repair by regulating neuroinflammatory responses.

¿Existe correlación metabólica hipoglucémica y el síndrome de Percheron? Reporte de caso / Is there a metabolic correlation between hypoglycemia and Percheron syndrome? Case report

Introducción: El síndrome de Percheron es causa de lesiones isquémicas talamicas bilaterales ocasionando una serie de anomalías clínicas como: alteración del estado de conciencia, oftalmoplejias, y alteraciones de la memoria. Caso clínico: Presentamos el caso de una mujer de 49 años con diabetes mellitus, mal control metabólico, episodios hipoglucémicos e hiperglucemicos repetitivos, quien cursa con sintomatologia inespecífica, se realizan estudios imagenológicos no invasivos documentado lesiones talamica bilaterales. Conclusiones: Los cuadros subagudos e isquémicos parciales que involucran la región paramediana del Talamo bilateral podrían tener alguna relación con episodios hipoglucémicos e hiperglucemicos repetitivos, que pueden llegar a cursar con sintomatología leve e inespecífica, lo cual lo convierte un reto diagnóstico para este síndrome.

Introduction: Percheron syndrome is the cause of bilateral thalamic ischemic lesions, causing a series of clinical abnormalities such as an altered state of consciousness, ophthalmoplegia, and memory alterations. Clinical case: We present the case of 49-year-old woman with diabetes mellitus, poor metabolic control, and repetitive hypoglycemic and hyperglycemic episodes with nonspecific symptoms, non-invasive imaging studies were performed, which documented bilateral thalamic lesions. Conclusions: Subacute and partial ischemic symptoms that involve the paramedian region of the bilateral thalamus could have some relationship with repetitive hypoglycemic and hyperglycemic episodes, and can lead to mild and nonspecific symptoms, which makes it a diagnostic challenge for this syndrome.

Association between Ferrokinetic and its Prognostic Role in Coronary Artery Disease in a South American Hospital / Asociación entre la ferrocinética y su papel pronóstico en enfermedad coronaria en un hospital suramericano / Associação entre a ferrocinética e seu papel prognostico na doença cardíaca coronária em um hospital da América do Sul

Introduction: Ferrokinetic alterations are associated with the worsening of cardiovascular diseases, their role being unknown in depth. Objective: To determine the association between ferrokinetic with acute myocardial infarction with and without ST elevation in patients with coronary disease. Methods: Analytical observational study in a sample of 72 patients who were admitted to a Coronary Care Unit of a fourth level Institution during the period from July 2017 to May 2018. The statistical association analysis was performed with the Chi-square test. Results: The main gender affected was male, in ages over 56 years. The main comorbidity was arterial hyperten-sion in 53.7% for ST-elevation infarction and in 74.2% for non-ST-elevation infarction. The prevalent ferrokinetic alteration was iron deficiency, in 36.6% of the patients with ST elevation and in 41.9% without ST elevation. Low hemoglobin levels were present on admission in 24.4% of patients with ST elevation and in 32.3% of those without ST elevation, associated with low hemoglobin values on day 7 of hospitalization. Deaths occurred in 2.77%, which presented low iron levels without anemia and infarction with ST elevation and shock. The gender variable presented a statistically significant association (p = 0.034) with the serum iron level. Conclusions: Iron deficiency is a very common disorder with a higher mortality rate, so these parameters should be evaluated in cardiovascular diseases

Introducción: Las alteraciones ferrocinéticas se asocian con un empeoramiento de las enfermedades cardiovasculares, pero se desconoce en profundidad su papel.Objetivo: Determinar la asociación entre la ferrocinética con el infarto agudo al miocardio con y sin elevación del segmento ST en pacientes con enfermedad coronaria. Métodos: Estudio observacional analítico en una muestra de 72 pacientes que ingresaron a una unidad de cuidados coronarios de una institución de cuarto nivel durante el lapso de julio de 2017 a mayo de 2018. El análisis de asociación estadística se realizó con la prueba de chi cuadrado. Resultados: El principal género afectado fue el masculino, en edades superiores a 56 años. La principal comorbilidad fue hipertensión arterial, en un 53,7 % para infarto con elevación del segmento ST, y en un 74,2 % para infarto sin elevación de dicho segmento. La alteración ferrocinética prevalente fue el déficit de hierro, en un 36,6 % de los pacientes con elevación del intervalo ST y en un 41,9 % sin elevación del segmento ST. Las concentraciones bajas de hemoglobina estuvieron presentes al ingreso en el 24,4 % de los pacientes con elevación del ST y en el 32,3 % de aquellos sin elevación del ST, aso-ciado con valores bajos de hemoglobina al séptimo día de hospitalización. Ocurrieron fallecimientos en el 2,77 %, con cantidades bajas de hierro sin anemia e infarto con elevación del segmento ST y choque. La variable género presentó asociación estadísticamente significativa (p = 0,034) con el nivel de hierro sérico. Conclusiones: La ferropenia es una alteración muy frecuente con una relación de mayor mortalidad, por lo que estos parámetros deberían evaluarse en enfermedades cardiovasculares

Introdução: Os distúrbios ferrocinéticos estão associados à piora da doença cardiovascular, mas seu papel é pouco conhecido. Objetivo: Determinar a associação entre a ferrocinética e o infarto agudo do miocárdio com e sem elevação do segmento ST em pacientes com doença cardíaca coronária. Métodos: Estudo observacional analítico em uma amostra de 72 pacientes admitidos em uma unidade de tratamento coronariano de uma instituição de quarto nível durante o período de julho de 2017 a maio de 2018. A análise de associação estatística foi realizada usando o teste do qui-quadrado. Resultados: O principal gênero afetado foi o masculino, com idade superior a 56 anos. A principal comorbidade foi a hipertensão, em 53,7% para infarto do miocárdio com elevação do segmento ST e 74,2% para infarto do miocárdio sem elevação do segmento ST. O distúrbio ferrocinético preva-lente foi a deficiência de ferro em 36,6% dos pacientes com elevação do segmento ST e 41,9% sem elevação do segmento ST. Concentrações baixas de hemoglobina estavam presentes na admissão em 24,4% dos pacientes com elevação do segmento ST e em 32,3% daqueles sem elevação do segmento ST, associadas a valores baixos de hemoglobina ao sétimo dia de hospitalização. Ocorreram mortes em 2,77%, com baixo teor de ferro sem anemia e infarto com elevação do segmento ST e choque. O gênero foi associado de forma estatisticamente significativa (p = 0,034) ao nível de ferro sérico. Conclusões: A deficiência de ferro é um distúrbio muito comum com uma associação com o aumento da mortalidade, por tanto, esses parâmetros devem ser avaliados em doenças cardiovasculares

Assistência de enfermagem ao paciente com infarto agudo do miocárdio no atendimento intra-hospitalar de urgência e emergência / Nursing care for patients with acute myocardial infarction in urgent and emergency in-hospital care / Cuidados de enfermería para pacientes con infarto agudo de miocardio en atención hospitalaria urgente y de emergência

Objetivo: analisar a assistência de enfermagem ao paciente com infarto agudo do miocárdio no atendimento intra-hospitalar de urgência e emergência. Método:Realizou-se uma revisão de literatura, de caráter bibliométrico, selecionando 7 estudos, por meio de check list previamente estabelecido. Resultados:Identificou-se que 85,7%dos estudos selecionados eram dissertações de mestrado, publicadas entre 2007 e 2019. A maioria foiproduzida na Universidade de São Paulo (42,8%). Quanto à publicação de artigos originados das teses e dissertações, 71,4% dos autores não publicaram. Conclusão:embora os métodos de diagnóstico do câncer de mama tenham avançado, a produção científica sobre o câncer de mama masculino ainda se faz incipiente no Brasil. Esse é um dado importante que pode auxiliar na elaboração de novos trabalhos, objetivando um melhor atendimento e prognóstico nesses pacientes.

Objective: to analyze nursing care for patients with acute myocardial infarction in urgent and emergency in-hospital care. Method:A literature review of bibliometric character was conducted, selecting 7 studies, through a previously established checklist. Results:It was identified that 85.7% of the selected studies were master's dissertations, published between 2007 and 2019. Most were produced at the University of São Paulo (42.8%). Regarding the publication of articles originated from theses and dissertations, 71.4% of the authors did not publish. Conclusion:although breast cancer diagnostic methods have advanced, scientific production on male breast cancer is still incipient in Brazil. This is an important data that can help in the elaboration of new studies, aiming at a better care and prognosis in these patients.

Objetivo: analizar la atención de enfermería a pacientes con infarto agudo de miocardio en atención hospitalaria de urgencia y emergencia.Método: Se realizó una revisión bibliográfica de carácter bibliométrico, seleccionando 7 estudios, a través de una lista de verificación previamente establecida.Resultados: Se identificó que el 85,7% de los estudios seleccionados fueron disertaciones de maestría, publicadas entre 2007 y 2019. La mayoría fueron producidos en la Universidad de São Paulo (42,8%). En cuanto a la publicación de artículos originados a partir de tesis y disertaciones, el 71,4% de los autores no publicaron.Conclusión: aunque los métodos de diagnóstico del cáncer de mama han avanzado, laproducción científica sobre el cáncer de mama masculino es todavía incipiente en Brasil. Se trata de un dato importante que puede ayudar en la elaboración de nuevos estudios, encaminados a una mejor atención y pronóstico en estos pacientes.

Migraine with aura and stroke - the role of warning signs in the context of secondary headaches: case report / Enxaqueca com aura e acidente vascular cerebral ­ o papel dos sinais de alerta no contexto das cefaleias secundárias: relato de caso

Introduction: Headache is a very common complaint in doctors' offices, with primary causes being the majority in relation to secondary ones. Despite this, the identification of secondary headaches is very relevant in clinical practice, since these can be a life-threatening condition, functionality or even a reversible cause. However, imaging screening for all individuals with headache is costly and unrewarding. Therefore, it is important to know the warning signs that, together with the clinical context, lead to a more precise indication of these exams and early and well-targeted therapeutic interventions. Clinical case: This is a 60-year-old man, previously dyslipidemic and smoker, with migraine with aura reported since childhood, who underwent treatment with sodium valproate, with headache attack suppression. About 4 months before admission, he presented with an alteration in the pain pattern, amaurosis fugax in the right eye, dizziness and mild paresis and hypoesthesia in the left side of the body, primarily treated by him as migraine crises, without improvement with the use of triptans. A new outpatient investigation was carried out, which showed multiple small infarcts in the right hemisphere secondary to atheromatous plaque in the right carotid bulb with an obstruction of approximately 85%. Diagnostic and therapeutic arteriography was performed, with stent implantation, uneventfully. Conclusion: The differential diagnosis between migraine with aura and a cerebrovascular event has already been widely reported in the literature and constitutes a pitfall in the routine of headaches, since a serious and potentially disabling condition can be overlooked. The joint evaluation of the alarm signs with the global context becomes an important tool in the propaedeutics of these patients, with knowledge of this casuistry being something relevant within clinical practice.

Introdução: A cefaleia é uma queixa muito comum nos consultórios médicos, sendo as causas primárias majoritárias em relação às secundárias. Apesar disso, a identificação de cefaleias secundárias é muito relevante na prática clínica, uma vez que estas podem ser uma condição potencialmente fatal, funcional ou mesmo uma causa reversível. No entanto, o rastreio imagiológico para todos os indivíduos com cefaleias é dispendioso e pouco recompensador. Portanto, é importante conhecer os sinais de alerta que, juntamente com o contexto clínico, levam a uma indicação mais precisa destes exames e a intervenções terapêuticas precoces e bem direcionadas. Caso clínico: Trata-se de um homem de 60 anos, previamente dislipidémico e fumador, com queixa de enxaqueca com aura desde a infância, que realizou tratamento com valproato de sódio, com supressão das crises de cefaleia. Cerca de 4 meses antes da internação apresentou alteração do padrão álgico, amaurose fugaz em olho direito, tontura e leve paresia e hipoestesia no lado esquerdo do corpo, tratada por ele primariamente como crises de enxaqueca, sem melhora com o uso de triptanos. Foi realizada nova investigação ambulatorial que evidenciou múltiplos pequenos infartos no hemisfério direito secundários a placa de ateroma no bulbo carotídeo direito com obstrução de aproximadamente 85%. Foi realizada arteriografia diagnóstica e terapêutica, com implante de stent, sem intercorrências. Conclusão: O diagnóstico diferencial entre enxaqueca com aura e evento cerebrovascular já foi amplamente relatado na literatura e constitui uma armadilha na rotina das cefaleias, uma vez que uma condição grave e potencialmente incapacitante pode ser negligenciada. A avaliação conjunta dos sinais de alarme com o contexto global torna-se uma ferramenta importante na propedêutica destes pacientes, sendo o conhecimento desta casuística algo relevante dentro da prática clínica.

Compound Danshen Dripping Pills pretreatment protects the heart from ischemia/reperfusion injury by enhancing autophagic flux

Abstract Compound Danshen Dripping Pills (CDDPs) have been used in clinical treatment to protect the heart from ischemia/reperfusion (IR) injury for many years. However, the underlying mechanism implicated in the protective effects remains to be explored. Here, we determined the effects of CDDPs in Sprague-Dawley rats with the IR model. Cardiac function in vivo was assessed by echocardiography. Transmission electron microscopy, histological and immunohistochemical techniques, Western blotting and recombinant adeno-associated virus 9 transfection were used to illustrate the effects of CDDPs on IR and autophagy. Our results showed that pretreatment with CDDPs decreased the level of serum myocardial enzymes and infarct size in rats after IR. Apoptosis evaluation showed that CDDPs significantly ameliorated the cardiac apoptosis level after IR. Meanwhile, CDDPs pretreatment increased myocardial autophagic flux, with upregulation of LC3B, downregulation of p62, and increased autophagosomes and autolysosomes. Moreover, the autophagic flux inhibitor chloroquine could increase IR injury, while CDDPs could partially reverse the effects. Furthermore, our results showed that the activation of AMPK/mTOR was involved in the cardioprotective effect exerted by CDDPs. Herein, we suggest that CDDPs partially protect the heart from IR injury by enhancing autophagic flux through the activation of AMPK/mTOR.

Histologia do miocárdio normal e infartado / Histology of normal and infarcted myocardial

Introdução: O infarto do miocárdio é uma patologia que apresenta grande morbidade e mortalidade. Ele é resultado da necrose de cadiomiócitos provocada por dificuldade de oxigenação. Objetivo: O objetivo deste estudo foi rever a histologia do miocárdio e suas alterações histológicas quando infartado. Método: Trata-se de uma revisão narrativa em livros técnicos e artigos cinetíficos publicados na SciELO e PubMed. Resultados: O miocárdio é formado por cardiomiócitos, que se contraem em função dos sarcômeros dispostos em suas miofibrilas e apresentam eficiente comunicação elétrica entre si por meio de junções comunicantes. O infarto do miocárdio promove morte dos cardiomiócitos, alterações em elementos citoplasmáticos e na condução elétrica além da formação de tecido cicatricial fibroso. Conclusão: Em conclusão, o miocárdio é altamente vascularizado e formado por cardiomiócitos contráteis alongados e de composição sarcométrica. Em condições isquêmicas, como no infarto do miocárdio, há uma remodelação histológica no tecido muscular cardíaco que leva à fibrose e perda das funções contráteis.

Introduction: Myocardial infarction is a pathology that presents high morbidity and mortality. It is the result of cardiomyocyte necrosis caused by oxygenation difficulties. Objective: The aim of this study was to review the histology of the myocardium and its histological changes when infarcted. Method: This is a narrative review of technical books and scientific articles published in SciELO and PubMed. Results: The myocardium is formed by cardiomyocytes, which contract due to the sarcomeres arranged in their myofibrils and present efficient electrical communication with each other through gap junctions. Myocardial infarction promotes the death of cardiomyocytes, alterations in cytoplasmic elements and electrical conduction, in addition to the formation of fibrous scar tissue. Conclusion: In conclusion, the myocardium is highly vascularized and formed by elongated contractile cardiomyocytes with a sarcometric composition. In ischemic conditions, such as myocardial infarction, there is histological remodeling in cardiac muscle tissue that leads to fibrosis and loss of contractile functions

Infarto omental como causa inusual de dolor abdominal: un reporte de caso / Omental infarction as an unusual cause of abdominal pain: a case report

Resumen El infarto omental es una causa infrecuente de abdomen agudo y de etiología no muy conocida, su presentación clínica inespecífica puede simular otras patologías más comunes, lo que hace su diagnóstico un reto clínico. Se presenta el caso de una mujer de 33 años que asiste a urgencias con clínica de dolor abdominal agudo, atípico, con hallazgos ecográficos sugestivos de apendicitis aguda, sin embargo, por la clínica inusual se realizó tomografía axial computarizada (TAC) de abdomen, con reporte sugestivo de diverticulitis. Ante la no concordancia clínica ni imagenológica, la paciente fue llevada a laparoscopia diagnóstica, como hallazgo intraoperatorio se evidenció isquemia del epiplón como único hallazgo, por lo cual se realizó omentectomía parcial. Siendo este un caso de importancia clínica debido a que el infarto omental debe considerarse entre los diagnósticos diferenciales de dolor abdominal agudo, en especial cuando la presentación es atípica y se han excluido las patologías más frecuentes. MÉD.UIS.2022;35(1): 43-8.

Abstract Omental infarction is an uncommon cause of acute abdomen and its etiology is not well known. Its nonspecific clinical presentation can simulate bibr more common pathologies which makes its diagnosis a clinical challenge. We present the case of a 33-year-old woman who attends the emergency room with symptoms of acute, atypical abdominal pain, ultrasound findings were suggestive of acute appendicitis, however, due to unusual symptoms, a computerized axial tomography (CT) of the abdomen was performed, with a suggestive report of diverticulitis. Given the clinical and imagenologycal findings mismatch, the patient underwent to diagnostic laparoscopy where omentum ischemia was evidenced as the only finding, partial omentectomy was performed. This is a case of clinical importance because the omental infarction should be considered among the differential diagnoses of acute abdominal pain, especially when the presentation is atypical and the most frequent pathologies have been excluded. MÉD.UIS.2022;35(1): 43-8.

Icariin improves renal interstitial fibrosis in a rat model of chronic renal failure by regulating mitochondrial dynamics / 中国中药杂志

This study aims to explore the effect of icariin(ICA) on mitochondrial dynamics in a rat model of chronic renal failure(CRF) and to investigate the molecular mechanism of ICA against renal interstitial fibrosis(RIF). CRF was induced in male Sprague-Dawley(SD) rats with 5/6(ablation and infarction, A/I) surgery(right kidney ablation and 2/3 infarction of the left kidney). Four weeks after surgery, the model rats were randomized into the following groups: 5/6(A/I) group, 5/6(A/I)+low-dose ICA group, and 5/6(A/I)+high-dose ICA group. Another 12 rats that received sham operation were randomly classified into 2 groups: sham group and sham+ICAH group. Eight weeks after treatment, the expression of collagen-Ⅰ(Col-Ⅰ), collagen-Ⅲ(Col-Ⅲ), mitochondrial dynamics-related proteins(p-Drp1 S616, p-Drp1 S637, Mfn1, Mfn2), and mitochondrial function-related proteins(TFAM, ATP6) in the remnant kidney tissues was detected by Western blot. The expression of α-smooth muscle actin(α-SMA) was examined by immunohistochemical(IHC) staining. The NRK-52 E cells, a rat proximal renal tubular epithelial cell line, were cultured in vitro and treated with ICA of different concentration. Cell viability was detected by CCK-8 assay. In NRK-52 E cells stimulated with 20 ng·mL~(-1) TGF-β1 for 24 h, the effect of ICA on fibronectin(Fn), connective tissue growth factor(CTGF), p-Drp1 S616, p-Drp1 S637, Mfn1, Mfn2, TFAM, and ATP6 was detected by Western blot, and the ATP content and the mitochondrial morphology were determined. The 20 ng·mL~(-1) TGF-β1-stimulated NRK-52 E cells were treated with or without 5 μmol·L~(-1) ICA+10 μmol·L~(-1) mitochondrial fusion promoter M1(MFP-M1) for 24 h and the expression of fibrosis markers Fn and CTGF was detected by Western blot. Western blot result showed that the levels of Col-Ⅰ, Col-Ⅲ, and p-Drp1 S616 were increased and the levels of p-Drp1 S637, Mfn1, Mfn2, TFAM, and ATP6 were decreased in 5/6(A/I) group compared with those in the sham group. The levels of Col-Ⅰ, Col-Ⅲ, and p-Drp1 S616 were significantly lower and the levels of p-Drp1 S637, Mfn1, Mfn2, TFAM, and ATP6 were significantly higher in ICA groups than that in 5/6(A/I) group. IHC staining demonstrated that for the expression of α-SMA in the renal interstitium was higher in the 5/6(A/I) group than in the sham group and that the expression in the ICA groups was significantly lower than that in the 5/6(A/I) group. Furthermore, the improvement in the fibrosis, mitochondrial dynamics, and mitochondrial function were particularly prominent in rats receiving the high dose of ICA. The in vitro experiment revealed that ICA dose-dependently inhibited the increase of Fn, CTGF, and p-Drp1 S616, increased p-Drp1 S637, Mfn1, Mfn2, TFAM, and ATP6, elevated ATP content, and improved mitochondrial morphology of NRK-52 E cells stimulated by TGF-β1. ICA combined with MFP-M1 further down-regulated the expression of Fn and CTGF in NRK-52 E cells stimulated by TGF-β1 compared with ICA alone. In conclusion, ICA attenuated RIF of CRF by improving mitochondrial dynamics.

Role of ACE and ACE-2 in abrogated cardioprotective effect of ischemic preconditioning in ovariectomized rat heart

Abstract Ischemic heart disease is the leading cause of death in postmenopausal women. The activity of heart ACE increases whereas the activity of ACE-2 decreases after menopause. The present study was designed to investigate the role of ACE and ACE-2 in the abrogated cardioprotective effect of IPC in OVX rat heart. The heart was isolated from OVX rat and mounted on Langendorff's apparatus for giving intermittent cycles of IPC. The infarct size was estimated using TTC stain, and coronary effluent was analyzed for LDH, CK-MB, and nitrite release. IPC induced cardioprotection was significantly attenuated in the ovariectomized rat heart as compared to the normal rat heart. However, this attenuated cardioprotection was significantly restored by perfusion of DIZE, an ACE-2 activator, and captopril, an ACE inhibitor, alone or in combination noted in terms of decrease in myocardial infarct size, the release of LDH and CK-MB, and also increase in the release of NO as compared to untreated OVX rat heart. Thus, it is suggested that DIZE and captopril, alone or in combination restore the attenuated cardioprotective effect of IPC in OVX rat heart which is due to an increase in ACE-2 activity and decrease in ACE activity after treatment.

Papel del ritmo circadiano en el infarto agudo de miocardio / Role of circadian rhythm in acute myocardial infarction

Múltiples investigaciones evidencian una máxima incidencia del infarto agudo de miocardio en la mañana. El objetivo de este artículo es revisar la organización del sistema circadiano, su importancia en la fisiología del sistema cardiovascular y su relación con el desarrollo del infarto agudo de miocardio. Se realizó una búsqueda bibliográfica en diferentes bases de datos para identificar artículos publicados durante los últimos 20 años, centrados en la variación circadiana del infarto agudo de miocardio y en la cronoterapia cardiovascular. Se preseleccionaron 115 artículos, de los cuales se escogieron 60. Se concluyó que la mayor incidencia matutina del infarto agudo de miocardio se explica por la acción conjunta de factores endógenos (aumento matutino de cortisol, catecolaminas, presión arterial, frecuencia cardiaca, resistencias vasculares) y exógenos (alteración en el ciclo sueño-vigilia, bipedestación, e inicio de la actividad) que predispone a ruptura de la placa ateromatosa y aparición de episodios trombóticos durante la mañana.

Multiple investigations show a maximum incidence of acute myocardial infarction in the morning. The objective of this article is to review the organization of the circadian system, its importance in the physiology of the cardiovascular system and its relationship with the development of acute myocardial infarction. A bibliographic search was carried out in different databases to identify articles published during the last 20 years, focused on the circadian variation of acute myocardial infarction and on cardiovascular chronotherapy. 115 articles were preselected, of which 60 were chosen. It was concluded that the higher morning incidence of acute myocardial infarction is explained by the joint action of endogenous factors (morning increase in cortisol, catecholamines, blood pressure, heart rate, vascular resistance) and exogenous (alteration in the sleep-wake cycle, standing, and onset of activity) that predisposes to rupture of the atheromatous plaque and the appearance of thrombotic episodes during the morning.

Predictors of dementia after first ischemic stroke / Preditores de demência após o primeiro acidente vascular isquêmico

ABSTRACT. Various mechanisms contribute to dementia after first ischemic stroke as lesions on strategic areas of cognition and stroke premorbidity. Objectives: Assessing clinical and neuroimaging predictors of dementia after first ischemic stroke and its relation to stroke location, subtypes and severity. Methods: Eighty first ischemic stroke patients were included. Forty patients with dementia after first stroke and forty patients without dementia according to DSM-IV diagnostic criteria of vascular dementia. All patients were subjected to general and neurological assessment, National Institute Health Stroke Scale (NIHSS) for stroke severity, Montreal Cognitive Assessment (MoCA) scale for cognition assessment, MRI brain and Trial of Org 10172 in acute stroke treatment (TOAST) classification for stroke subtypes. Results: Left hemispheric ischemic stroke, strategic infarctions, diabetes mellitus and stroke of anterior circulation were found to be independent risk factors for dementia after first ischemic stroke (OR=3.09, 95%CI 1.67-10.3, OR=2.33, 95%CI 1.87-8.77, OR=1.88, 95%CI 1.44-4.55, OR=1.86, 95%CI 1.45-6.54, respectively). Hypertension, dyslipidemia, smoking, ischemic heart disease, high NIHSS score and large vessel infarction were significantly higher among post stroke dementia patients. However, on binary logistic regression, they did not reach to be independent risk factors. Conclusion: Stroke location (left stroke, strategic infarction, anterior circulation stroke) and diabetes mellitus could be predictors of dementia after first ischemic stroke, but stroke severity, stroke subtypes, hypertension, dyslipidemia, smoking and ischemic heart could not.

RESUMO. Vários mecanismos contribuem para a demência após o primeiro acidente vascular cerebral (AVC) isquêmico como lesões em áreas estratégicas da cognição e morbidades pré-AVC. Objetivos: Avaliar os preditores clínicos e de neuroimagem de demência após o primeiro AVC isquêmico e sua relação com a localização, subtipos e gravidade do AVC. Métodos: Oitenta pacientes com primeiro AVC isquêmico foram incluídos. Quarenta pacientes com demência após o primeiro AVC e quarenta pacientes sem demência de acordo com os critérios diagnósticos do DSM-IV para demência vascular. Todos os pacientes foram submetidos à avaliação geral e neurológica, o National Institute Health Stroke Scale (NIHSS) para gravidade de AVC, a escala de Avaliação Cognitiva de Montreal (Montreal Cognitive Assessment - MoCA) para avaliação de cognição, ressonância magnética cerebral e classificação pelo Trial of Org 10172 in acute stroke treatment (TOAST) para subtipos de AVC. Resultados: AVC isquêmico do hemisfério esquerdo, infartos estratégicos, diabetes mellitus e AVC da circulação anterior foram considerados fatores de risco independentes para demência após o primeiro AVC isquêmico. (OR=3,09, IC95% 1,67-10,3, OR=2,33, IC95% 1,87-8,77, OR=1,88, IC95% 1,44-4,55, OR=1,86, IC95% 1,45-6,54, respectivamente). Hipertensão, dislipidemia, tabagismo, cardiopatia isquêmica, escore NIHSS alto e infarto de grandes vasos foram significativamente altos entre pacientes com demência pós-AVC. No entanto, na regressão logística binária, não chegaram a ser fatores de risco independentes. Conclusão: A localização do AVC (AVC esquerdo, infarto estratégico, AVC da circulação anterior) e diabetes mellitus podem ser preditores de demência após o primeiro AVC isquêmico, mas a gravidade do AVC, subtipos de AVC, hipertensão, dislipidemia, tabagismo e coração isquêmico podem não ser de risco.

https://www.scielo.br/j/jbn/a/XCDXYHCGzjjG8sWsb8KGB3R/ / Infarto renal bilateral em paciente com infecção grave por COVID-19

Abstract Thromboembolic events are frequent in patients with COVID-19 infection, and no cases of bilateral renal infarctions have been reported. We present the case of a 41-year-old female patient with diabetes mellitus and obesity who attended the emergency department for low back pain, respiratory failure associated with COVID-19 pneumonia, diabetic ketoacidosis, and shock. The patient had acute kidney injury and required hemodialysis. Contrast abdominal tomography showed bilateral renal infarction and anticoagulation was started. Kidney infarction cases require high diagnostic suspicion and possibility of starting anticoagulation.

Resumo Fenômenos tromboembólicos são frequentes em pacientes com infecção por COVID-19 e nenhum caso de infarto renal bilateral havia sido relatado. Apresentamos o caso de uma paciente do sexo feminino, de 41 anos, com diabetes mellitus e obesidade, que deu entrada no serviço de urgência por lombalgia, insuficiência respiratória associada à pneumonia COVID-19, cetoacidose diabética e choque. A paciente apresentava lesão renal aguda e demandava hemodiálise. A tomografia abdominal contrastada mostrou infarto renal bilateral e foi iniciada anticoagulação. Os casos de infarto renal requerem alta suspeita diagnóstica e possibilidade de iniciar a anticoagulação.

Validação de conteúdo: aplicativo móvel safe heart para monitoramento e identificação de risco de infarto / Validación de contenido: aplicación móvil safe heart para el seguimiento e identificación del riesgo de infarto / Content validation: safe heart mobile application for monitoring and identification of infarction risk

Objetivo verificar a validade de conteúdo do aplicativo móvel Safe Heart para monitoramento e identificação de risco de infarto. Método estudo de validação de conteúdo. Participaram do estudo 10 juízes. Foram avaliados 21 itens, por meio da escala de Likert. Para estimativa do grau de concordância, foi utilizado o cálculo do coeficiente alfa de Cronbach. Resultados a análise estatística com alpha de Cronbach 0,9573 consolidou o Safe Heart quanto à validade e à confiabilidade na consistência interna do conteúdo desenvolvido no aplicativo; os juízes apresentaram consistência válida nos itens observados. Conclusão a validade de conteúdo do aplicativo móvel Safe Heart foi aprovada para monitoramento e identificação de risco de infarto.

Objetivo verificar la validez de contenido de la aplicación móvil Safe Heart para el seguimiento e identificación del riesgo de infarto. Método estudio de validación de contenido. Diez jueces participaron en el estudio. Veintiún ítems fueron evaluados mediante la escala Likert. Para estimar el grado de concordancia, se calculó el coeficiente alfa de Cronbach. Resultados el análisis estadístico con Cronbach de alfa 0,9573 consolidó Safe Heart en cuanto a validez y confiabilidad en la consistencia interna del contenido desarrollado en la aplicación; los jueces presentaron consistencia válida en los ítems observados. Conclusión la validez de contenido de la aplicación móvil Safe Heart ha sido aprobada para el seguimiento e identificación del riesgo de infarto.

Objective to verify the content validity of the Safe Heart mobile app for monitoring and identification of infarction risk. Method content validation study. Ten judges participated in the study. Twenty-one items were evaluated using the Likert scale. To estimate the degree of agreement, Cronbach's alpha coefficient was calculated. Results Cronbach's alpha statistical analysis with 0.9573 consolidated Safe Heart regarding validity and reliability in the internal consistency of the content developed in the application; the judges presented valid consistency in the observed items. Conclusion the content validity of the Safe Heart mobile app has been approved for monitoring and identification of infarction risk.

Cardioprotective effect of eicosapentaenoic acid during ischemia and reperfusion / Efeito cardioprotetor do ácido eicosapentaenóico durante a isquemia e reperfusão

Objective: In this work, rats isolated hearts were infused EPA before the ischemia period and during reperfusion for available get well in parameter relatives to redox reactions. Methods: The effect of EPA was tested on isolated hearts induced to ischemia and reperfusion, treatment occurred at different times (ischemia or reperfusion). Antioxidant capacity against peroxyl radicals, glutathione cysteine ligase activity, glutathione concentration, lactate dehydrogenase, and creatine kinase concentration was analyzed. Results: Hearts treated with eicosapentaenoic acid had the minor generation of species reactive oxygen and lipid damage after reperfusion. The GSH concentration was higher when the hearts were treated with eicosapentaenoic acid in the period of reperfusion. Conclusion: In conclusion, this study demonstrates that the dose of EPA (20µM) used before ischemia can act as a cardioprotective antioxidant molecule, prevented damage heart from ischemic and reperfusion injury

Objetivo: Neste trabalho, corações isolados de ratos foram infundidos com EPA antes do período de isquemia e durante a reperfusão para obtenção de melhora em parâmetros relativos às reações redox. Métodos: O efeito do EPA foi testado em corações isolados induzidos a isquemia e reperfusão, o tratamento ocorreu em diferentes momentos (isquemia ou reperfusão). A capacidade antioxidante contra os radicais peroxil, atividade da glutationa cisteína ligase, concentração de glutationa, lactato desidrogenase e concentração de creatina quinase foi analisada. Resultados: Corações tratados com ácido eicosapentaenóico tiveram a menor geração de espécies reativas de oxigênio e danos lipídicos após a reperfusão. A concentração de GSH foi maior quando os corações foram tratados com ácido eicosapentaenóico no período de reperfusão. Conclusão: Em conclusão, este estudo demonstra que a dose de EPA (20µM) utilizada antes da isquemia pode atuar como uma molécula antioxidante cardioprotetora, prevenindo danos ao coração por isquemia e lesão de reperfusão.