[An integrated model for the evaluation and risk management of tuberculosis infection and active tuberculosis in homeless people in the city of Rome (Italy)]. / Un modello integrato di valutazione e gestione del rischio di Infezione Tubercolare e di Tubercolosi attiva negli homeless nella città di Roma.

In this article we describe an integrated model for the evaluation and risk management of tuberculosis (TB) infection and active TB in socially disadvantaged populations in the city of Rome. We describe and discuss the clinical evaluation procedures performed and the data collection forms used; these tools are useful for the epidemiologic surveillance and clinical management of patients, particularly high risk patients such as the homeless.

Prolapso uretral, ¿es necesario el tratamiento quirúrgico? / Urethral prolapse, is surgical treatment necessary?

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Dysautonomia and ventricular dysfunction in the indeterminate form of Chagas disease.

BACKGROUND: The associations between autonomic function and biventricular function in patients with the indeterminate form of Chagas disease remains to be elucidated. METHODS: In 42 asymptomatic patients and 19 healthy volunteers, the autonomic function was assessed by time domain indices of heart rate variability (HRV), analyzed for 24 h; the right ventricular function was assessed by fraction area change, right ventricle shortening, and systolic excursion of the tricuspid valve; and the left ventricular function was assessed by ejection fraction and transmitral flow velocities. Data were expressed as mean+/-SD or medians (including the lower quartile and upper quartile). Groups were compared by Student's t or Mann-Whitney U test. Autonomic and ventricular function were correlated by Pearson's or Spearman's correlation coefficient. The level of significance was 5%. RESULTS: Right and left ventricular systolic function indexes were comparable between groups. Transmitral flow velocities were decreased in the Chagas disease group (p<0.05). The patients presented impaired HRV as indicated by the values of SDNN-day (80 (64-99) ms vs. 98 (78-127) ms; p=0.045), SDNNI-24 h (54 (43-71) vs. 65 (54-105) ms; p=0.027), SDNNI-day (49 (42-64) vs. 67 (48-76) ms; p=0.045), pNN50-day (2.2 (0.7-5)% vs. 10 (3-11)%; p=0.033); and pNN50-24 h (3 (1-7)% vs. 12 (8-19)%; p=0.013). There were no correlations between the left ventricular diastolic indices and autonomic dysfunctional indices (p>0.05). CONCLUSION: Patients with the indeterminate form of Chagas disease have both dysautonomia and left ventricular diastolic dysfunction. However, the right ventricular function is preserved. Importantly, ventricular diastolic dysfunction and dysautonomia are independent phenomena.

Abordagem clínica do paciente com insuficiência cardíaca aguda após infarto do miocárdio / Clinical management of the patients with acute heart failure after myocardial infarction

O aparecimento de insuficiência cardíaca após infarto agudo do miocárdio é evento comum e está associado com aumento tanto da morbidade como da mortalidade. A insuficiência cardíaca pode aparecer em três fases distintas: pré-hospitalar, logo após o infarto e mais tardiamente, relacionada ao processo de remodelação ventricular. Nos últimos anos, foram introduzidos avanços terapêuticos importantes no tratamento da disfunção ventricular crônica após o infarto do miocárdio. Por outro lado, os avanços no tratamento agudo, na fase hospitalar, da insuficiência cardíaca após infarto foram bem menos significantes. Recentemente, entretanto, algumas estratégias vêm ganhando destaque e parecem ser promissoras para esses pacientes. Este artigo discute os principais aspectos da abordagem clínica dos pacientes com insuficiência cardíaca, na fase hospitalar após infarto agudo do miocárdio.