Oral microbiome homogeneity across diverse human groups from southern Africa: first results from southwestern Angola and Zimbabwe.

BACKGROUND: While the human oral microbiome is known to play an important role in systemic health, its average composition and diversity patterns are still poorly understood. To gain better insights into the general composition of the microbiome on a global scale, the characterization of microbiomes from a broad range of populations, including non-industrialized societies, is needed. Here, we used the portion of non-human reads obtained through an expanded exome capture sequencing approach to characterize the saliva microbiomes of 52 individuals from eight ethnolinguistically diverse southern African populations from Angola (Kuvale, Kwepe, Himba, Tjimba, Kwisi, Twa, !Xun) and Zimbabwe (Tshwa), including foragers, food-producers, and peripatetic groups (low-status communities who provide services to their dominant neighbors). RESULTS: Our results indicate that neither host genetics nor livelihood seem to influence the oral microbiome profile, with Neisseria, Streptococcus, Prevotella, Rothia, and Porphyromonas being the five most frequent genera in southern African groups, in line with what has been shown for other human populations. However, we found that some Tshwa and Twa individuals display an enrichment of pathogenic genera from the Enterobacteriaceae family (i.e. Enterobacter, Citrobacter, Salmonella) of the Proteobacteria phylum, probably reflecting deficient sanitation and poor health conditions associated with social marginalization. CONCLUSIONS: Taken together, our results suggest that socio-economic status, rather than ethnolinguistic affiliation or subsistence mode, is a key factor in shaping the salivary microbial profiles of human populations in southern Africa.

Influence of creep feeder position on the behavior and performance of preweaning piglets and sows in a hot climate environment.

The use of creep feeding for preweaning piglets is important to improve the performance of the piglets. The objective of this experiment was evaluate the effect of using or altering the position of piglet's creep feeder during lactation on piglet's performance and on behavior of piglets and sows kept in a hot climate environment. Forty-five sows and their litters at 10 days of lactation were randomly distributed into three treatments: front feeder (FF) - near the side of the sow's head; back feeder (BF) - near the side of the rump of the sow; and no feeder (NF). All piglets were weighed individually to evaluate the average weight, weight gain and coefficient of variation of the weight. Behavior assessments of the piglets and sows were recorded in 3 period. At 15 and 21 d, piglets of the FF treatment were heavier (P ≤ 0.0001) than piglets of the other treatments. At 10-21d piglets of FF treatment had 76.2% less belly nosing behavior than the NF piglets (P=0.015). The treatments had no impact on behavior of the sows. The creep feeders positioned in the front of the farrowing crate increased piglet growth rate and decreased frequency of belly nosing behavior.

Conservative management of a prosthetic valve thrombosis--report of a successful case.

Prosthetic valve thrombosis (PVT) refers to the presence of non infective material in valvular apparatus, interfering with its function. It is a potentially fatal complication of valvular replacement surgery. Treatment options include surgery, fibrinolysis and anticoagulation optimisation. The authors present the case of a young man, carrier of an aortic prosthetic mechanical valve, who didn't take his anticoagulant medicine, admitted for an acute obstructive PVT, with evidence of a large thrombotic mass on the aortic valve (> 1cm(2)). The patient refused surgical treatment and eventually presented a complete resolution of the acute PVT with anticoagulation optimisation.

Impact of genetic background as a risk factor for atherosclerotic cardiovascular disease: A protocol for a nationwide genetic case-control (CV-GENES) study in Brazil.

Atherosclerotic Cardiovascular Disease (ASCVD) represents the leading cause of death worldwide, and individual screening should be based on behavioral, metabolic, and genetic profile derived from data collected in large population-based studies. Due to the polygenic nature of ASCVD, we aimed to assess the association of genomics with ASCVD risk and its impact on the occurrence of acute myocardial infarction, stroke, or peripheral artery thrombotic-ischemic events at population level. CardioVascular Genes (CV-GENES) is a nationwide, multicenter, 1:1 case-control study of 3,734 patients in Brazil. Inclusion criterion for cases is the first occurrence of one of the ASCVD events. Individuals without known ASCVD will be eligible as controls. A core lab will perform the genetic analyses through low-pass whole genome sequencing and whole exome sequencing. In order to estimate the independent association between genetic polymorphisms and ASCVD, a polygenic risk score (PRS) will be built through a hybrid approach including effect size of each Single Nucleotide Polymorphism (SNP), number of effect alleles observed, sample ploidy, total number of SNPs included in the PRS, and number of non-missing SNPs in the sample. In addition, the presence of pathogenic or likely pathogenic variants will be screened in 8 genes (ABCG5, ABCG8, APOB, APOE, LDLR, LDLRAP1, LIPA, PCSK9) associated with atherosclerosis. Multiple logistic regression will be applied to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI), and population attributable risks will be calculated. Clinical trial registration: This study is registered in clinicaltrials.gov (NCT05515653).

Mixed infection in the anteater Tamandua tetradactyla (Mammalia: Pilosa) from Pará State, Brazil: Trypanosoma cruzi, T. rangeli and Leishmania infantum.

Some Trypanosoma and Leishmania species are multi-host parasites whose distribution overlaps in several parts of the Brazilian Amazon basin. Despite being a common trait among wild mammals, mixed infections and their consequences for the host's health and parasite transmission are still a poorly known phenomenon. Here we describe a triple mixed infection - Trypanosoma cruzi, T. rangeli and Leishmania infantum - in a bone marrow sample from an anteater Tamandua tetradactyla captured in a house backyard from the endemic Abaetetuba municipality in the Amazon basin. T. cruzi was also isolated from blood samples. The mini-exon multiplex PCR characterization detected the infection by T. rangeli and T. cruzi (TcI genotype), while L. infantum infection was confirmed by an ITS-PCR followed by amplicon sequencing. This is the first description of T. rangeli isolation from bone marrow and the first report of L. infantum infection in xenarthrans. The implications of this finding are discussed considering the influence of mixed infections in the role of this mammal species as a putative reservoir host of these 3 trypanosomatid species.

Cardiac thrombus and conduction disorder in takotsubo cardiomyopathy.

Takotsubo cardiomyopathy is a reversible form of left ventricular dysfunction with an apparently benign natural history after left ventricular recovery. Rarely there are complications such as arrhythmias and apical thrombus. We describe a case of takotsubo cardiomyopathy complicated with apical thrombus and persistent complete atrioventricular block after improvement of left ventricular wall motion.

Age does not determine the physical, functional and psychosocial response to a cardiac rehabilitation program.

INTRODUCTION: Despite increasing prevalence of coronary heart disease among the elderly and their greater susceptibility to its clinical, functional and psychosocial sequelae, referral to and participation in cardiac rehabilitation programs (CRPs) remains low in this age group. We aimed to assess the effect of age on the hemodynamic, biochemical, anthropometric, functional and psychosocial response to a CRP. METHODS: We prospectively studied 105 patients admitted to a CRP within three months of a successful percutaneous cularization procedure after an acute coronary syndrome. The CRP included nutritional counseling, group psycho-educational sessions, and two months of twice-weekly supervised exercise sessions at an intensity of 60-80% of chronotropic reserve. Younger (<55 years) vs. older (> or = 55 years) patients were compared in terms of their baseline characteristics, differences after CRP and proportion of patients achieving secondary prevention goals at baseline and after CRP completion. RESULTS: At baseline older patients had a worse cardiovascular risk factor profile, with higher prevalence of previous coronary heart disease, hypertension, diabetes, overweight and inactivity, and lower functional capacity. The two groups showed similar improvements in anthropometric parameters (waist circumference: -1.20 cm [3.82], p < 0.05 in younger vs. -3.17 cm [3.49], p < 0.01 in older patients), lipid profile and quality of life scores (summary physical component: +3.65 [7.83], p < 0.01 vs. +3.23 [6.66], p < 0.01; summary mental component: +3.60 [10.01], p < 0.05 vs. +3.02 [11.92], p < 0.05, in younger and older patients, respectively). Neither group showed significant changes in blood pressure, high-density lipoprotein or depressive symptoms. Older patients, who were initially less physically active (median [interquartile range]: 693 [12.96-1929.5] vs. 2376 [205-4293] MET*min/week), showed a significant increase in physical activity (+267%, p < 0.001), which was not observed i younger patients (+4%, p = 0.68). The pro portion of patients achieving secondary prevention goals improved similarly in both groups for lipid profile, smoking cessation and minimum physical activity levels, with no improvement in blood pressure or anthropometric parameters. CONCLUSION: Participation in a CRP results in significant improvements in cardiovascular risk profile, functional capacity and quality of life, regardless of age. Specific strategies are needed to ensure adequate referral and participation of elderly patients in exercise-based CRPs.

Cardiac rehabilitation in older patients: Indication or limitation?

OBJECTIVE: To assess the clinical impact of a cardiac rehabilitation program in an older population. METHODS: This is a retrospective analysis of 731 coronary patients who attended phase 2 of a cardiac rehabilitation program between January 2009 and December 2016. We compared the response to the program of older (≥65 years) and younger (<65 years) patients, analyzing changes in metabolic profile (including body mass index, waist circumference and lipid profile), exercise capacity, cardiac autonomic regulation parameters (such as chronotropic index and resting heart rate), and health-related quality of life scores. RESULTS: Older patients represented 15.9% of our cohort. They showed significant reductions in waist circumference (male patients: 98.0±7.9 cm vs. 95.9±7.9 cm, p<0.001; female patients: 90.5±11.4 cm vs. 87.2±11.7 cm, p<0.001), LDL cholesterol (102.5 [86.3-128.0] mg/dl vs. 65.0 [55.0-86.0] mg/dl, p<0.001) and triglycerides (115.0 [87.8-148.5] mg/dl vs. 97.0 [81.8-130.0] mg/dl, p<0.001). Post-training data also showed a noticeable improvement in older patients' exercise capacity (7.6±1.8 METs vs. 9.3±1.8 METs, p<0.001), along with a higher chronotropic index and lower resting heart rate. Additionally, health-related quality of life indices improved in older subjects. However, our overall analysis found no significant differences between the groups in changes of the studied parameters. CONCLUSION: Older coronary patients benefit from cardiac rehabilitation interventions, similarly to their younger counterparts. Greater involvement of elderly patients in cardiac rehabilitation is needed to fully realize the therapeutic and secondary preventive potential of such programs.

Left ventricular pacing with a temporary pacemaker: Case report.

We report a case of temporary pacemaker lead malposition in the left ventricle crossing the interventricular septum (IVS). The majority of described cases occur due to a patent foramen ovale and are frequently incidental findings. A course across the IVS is rarely found and this complication with temporary leads is not even reported in the literature. This very rare location entails a risk of dangerous complications associated with left-to-right flow after lead removal. Echocardiography was an essential tool to diagnose the lead's course inside the heart and enabled secure removal of the lead with cardiac surgery backup.

Spatial distribution and colonization pattern of Bemisia tabaci in tropical tomato crops.

BACKGROUND: In precision integrated pest management, management tactics are implemented only where and when needed, by identifying the sites where the pest population has reached economic thresholds. Tomato, Solanum lycopersicum (Linn.), is a vegetable cultivated worldwide, but its production is reduced by insect pests such as the whitefly, Bemisia tabaci (Genn.). To improve management, there is a need to understand B. tabaci spatial dynamics in tomato fields, which will elucidate colonization patterns and may improve management of this pest. Thus, this study was conducted to assess the spatial autocorrelation, distribution, and colonization patterns of B. tabaci in 19 commercial tomato fields through the growing season. RESULTS: A total of 69 isotropic variograms were fit for B. tabaci. The insect distribution was aggregated with a strong level of spatial dependence. Ranges of spatial dependence varied from 0.53 to 19.05 m and 0.5 to 20 m for adults and nymphs, respectively. Overall, densities of adults and nymphs were higher and reached the economic threshold mainly at the field edges. CONCLUSION: Our results suggest a colonization pattern for B. tabaci starting at the edges and spreading inwards in to the tomato fields. This study can improve B. tabaci management in tomato fields, especially scouting and decision-making to treat fields. Scouting for this pest should be directed to the field edges, with sample points at least 20 m apart from each other for independent insect counts. © 2020 Society of Chemical Industry.

Pressure pain threshold of masticatory muscles in children and adolescents with and without intellectual disability: a pilot study.

PURPOSE: Pain is considered a stressful experience, related to real or possible tissue damage with emotional, sensory, social and cognitive components. The aim of the study was to evaluate and compare, using a digital algometer, the pressure pain threshold of temporal and masseter muscles of children and adolescents with and without intellectual disability. METHODS: A cross-sectional study was conducted. Data regarding gender and age were collected from the caregiver of children and adolescents with and without intellectual disability. The evaluations followed this sequence: pressure pain threshold of the masseter and temporal muscles, evaluation of pain on touch using the visual analog scale and signs and symptoms of Temporomandibular disorder. The χ2 test, the Kolgomorov-Smirnov test, Student t test and Mann-Whitney test were performed. The significance level was set at 5%. RESULTS: Two homogeneous groups by gender (P = 0.258) and age (P = 0.727) were evaluated, of which 25 children and adolescents presented intellectual disability and another 25 did not have intellectual disability. No significant difference was observed between groups on the pressure pain threshold of the masseter and temporal muscles, nor pressure average or exam time (P > 0.05). Regarding Temporomandibular dysfunction, no difference in signs or symptoms frequency was found (P > 0.05). However, the range of maximum mouth opening was smaller in the intellectual disability group (P = 0.006). CONCLUSION: Children and adolescents with intellectual disability and preserved basic functionalities do not present alterations in pain perception when evaluated with computerized pressure algometer and visual analog scale. They present similar threshold of pain to pressure as those reported by normative children and adolescents. These results emphasize the importance to treat these children and adolescents with intellectual disability with respect to their pain threshold.

Role of Left Ventricle Function in Cardiac Rehabilitation Outcomes in Stage B Heart Failure Patients.

PURPOSE: To study the role of left ventricle systolic function in cardiac rehabilitation program (CRP) response in stage B heart failure patients. METHODS: A retrospective analysis was completed of 691 patients with previous myocardial infarction that underwent a CRP, classified in 3 groups: preserved ejection fraction (pEF), mid-range ejection fraction (mrEF), and reduced ejection fraction (rEF). We compared the response to CRP analyzing the relative changes of estimated cardiorespiratory fitness (CRFe), resting heart rate (HR), and chronotropic index (CI). RESULTS: After exercise training (median [interquartile range]) mrEF (23.9% [9.7, 40.8]) and rEF (23.9% [9.7, 41.2]) groups had a better CRFe response to CRP than pEF groups (17.6% [0.0, 35.9]), P = .009. CI increased similarly in all groups. We found a small effect of CRP on resting HR. CONCLUSION: Exercise-based CRP yields notable benefits to mrEF and rEF groups and the magnitude of its benefits is, at least, similar to that found in pEF patients.

Cardiac metastasis of melanoma as first manifestation of disease.

BACKGROUND: Metastatic tumors of the heart are 20 to 40 times more common than primary tumors. Metastases originate mainly in carcinomas and melanomas, the latter having the greatest propensity for cardiac involvement. On rare occasions this type of tumor may first manifest itself as a cardiac metastasis. METHODS: The authors present clinical, laboratory and imaging data from a patient with a cardiac mass that was the first manifestation of a melanoma. No other tumor location was detected by imaging studies. RESULTS: The patient presented with exertional dyspnea and tachycardia and was found to have a large mass in the right atrium. He underwent surgical removal of the tumor, but curative excision was not possible. A diagnosis of cardiac metastasis from malignant melanoma was made. The patient died soon afterwards from disseminated metastatic disease. CONCLUSIONS: This case represents a rare manifestation of melanoma located in the right atrium, with unknown origin of the primary tumor. Although surgery may be useful to palliate symptoms and improve survival in certain patients, it may also be associated with dissemination of the disease.

Benefits of Cardiac Rehabilitation in Coronary Artery Disease: DOES WEIGHT MATTER?

PURPOSE: To evaluate the response of patients with obesity to a cardiac rehabilitation program (CRP), compared with patients without obesity. METHODS: We performed a retrospective analysis of 731 patients who completed phase II of a CRP after an acute coronary syndrome. The response to the CRP was assessed using the relative changes in exercise capacity (EC), resting heart rate (HR), and chronotropic index (CI). RESULTS: Only 23% of patients had obesity. Patients with obesity showed lower EC and CI at baseline and at the end of phase II of the CRP. Despite that, we reported a higher relative improvement for EC in patients with obesity (median [interquartile range], 23.9% [5.2, 40.8] vs 17.6% [8.1, 35.9], P = .043) and similar improvements in CI (10.9% [-1.4 to 34.2] vs 7.1% [-7.1 to 28.2], P = .100), compared with patients without obesity. There were no significant changes in resting HR. CONCLUSION: Regardless of their lower exercise performance at baseline, patients with obesity had a remarkably positive response to the CRP compared with patients without obesity.

Investigation of the lethal and behavioral effects of commercial insecticides on the parasitoid wasp Copidosoma truncatellum.

Copidosoma truncatellum (Hymenoptera: Encyrtidae) is an important parasitoid wasp of the soybean looper, Chrysodeixis includens, but its effectiveness can be severely curtailed by the application of certain insecticides. Therefore, to identify insecticides that are potentially compatible with C. truncatellum, the lethal and behavioral effects of nine chemicals used to control the soybean looper were evaluated for their toxicity to the wasp. Chlorantraniliprole, chlorfenapyr, flubendiamide, and indoxacarb were the least toxic insecticides to the parasitoid, resulting in mortalities of less than 25%. In contrast, cartap, deltamethrin, and methomyl caused 100% mortality, and acephate and spinosad caused 76% and 78% mortality, respectively. At least one of the detoxifying enzymes (monooxygenase, glutathione S-transferase, and/or esterases) may be involved in the mechanisms underlying the selectivity of chlorantraniliprole, chlorfenapyr, flubendiamide, and indoxacarb for the parasitoid based on the results for the insecticide plus synergist treatment. Changes in the behavioral patterns (walking time and resting time) of the parasitoid were found with exposure to acephate, flubendiamide, indoxacarb and methomyl, but behavioral avoidance was not observed. Our results indicate that the insecticides chlorantraniliprole and chlorfenapyr are the most suitable for inclusion in integrated pest management strategies for the control of C. includens.

Obesidade infantil em tempos de pandemia: uma revisão integrativa / Childhood obesity in pandemic times: an integrative review / Obesidad infantil en tiempos de pandemia: una revisión integradora

A obesidade é considerada um dos maiores problemas de saúde pública mundial, sendo caracterizada como uma epidemia global, e durante a pandemia de COVID-19, o isolamento social e as mudanças nos hábitos de vida podem ter influenciado para o aumento dos índices de obesidade em crianças e adolescentes. Assim, o objetivo do estudo é analisar na literatura de que forma a pandemia de COVID-19 pode ter influenciado no aumento da obesidade infantil. Trata-se de uma revisão integrativa da literatura, com busca feita nas bases de dados Cinahl, PubMed e Scopus, com uso de descritores e booleanos aplicados em cada base de dados. Ao todo 14 estudos foram incluídos nesta revisão. A maioria dos estudos tinha ênfase avaliação de intervenções, bem como comparação das taxas de obesidade antes e durante a pandemia, e os efeitos dessas mudanças a longo prazo. Além de enfatizar sobre a participação dos pais e a construção de políticas públicas no combate à epidemia global de obesidade infantil. A pandemia contribuiu para o aumento de casos de sobrepeso e obesidade, bem como agravou os casos de crianças que já apresentavam tais características. Desta forma compreender sobre a situação desse problema de saúde, após um longo período de confinamento, pode auxiliar e engajar os profissionais da saúde na construção e estabelecimento de estratégias no combate da obesidade infantil e incentivar a participação dos pais na promoção de mudanças no estilo de vida.

Obesity is considered a major public health problem worldwide, being characterized as a global epidemic, and during the COVID-19 pandemic, social isolation and changes in lifestyle habits may have influenced the increase in obesity rates in children and adolescents. Thus, the purpose of the study is to analyze in the literature how the COVID-19 pandemic may have influenced the increase in childhood obesity. This is an integrative literature review, with a search conducted in the Cinahl, PubMed, and Scopus databases, with the use of descriptors and booleans applied in each database. A total of 14 studies were included in this review. Most of the studies had an emphasis on evaluation of interventions, as well as comparison of obesity rates before and during the pandemic, and the long-term effects of these changes. In addition to emphasizing on parent participation and building public policy to combat the global epidemic of childhood obesity. The pandemic contributed to the increase of overweight and obesity cases, as well as worsened the cases of children who already presented such characteristics. Thus, understanding the situation of this health problem after a long period of confinement can help and engage health professionals in the construction and establishment of strategies to combat childhood obesity and encourage parental participation in promoting lifestyle changes.

La obesidad es considerada un importante problema de salud pública a nivel mundial, caracterizándose como una epidemia mundial, y durante la pandemia de COVID-19, el aislamiento social y los cambios en los hábitos de vida pueden haber influido en el aumento de las tasas de obesidad en niños y adolescentes. Así, el propósito del estudio es analizar en la literatura cómo la pandemia de COVID-19 pudo haber influido en el aumento de la obesidad infantil. Esta es una revisión integrativa de la literatura, con una búsqueda realizada en las bases de datos Cinahl, PubMed y Scopus, con el uso de descriptores y booleanos aplicados en cada base de datos. En esta revisión se incluyeron un total de 14 estudios. La mayoría de los estudios hicieron hincapié en la evaluación de las intervenciones, así como en la comparación de las tasas de obesidad antes y durante la pandemia, y los efectos a largo plazo de estos cambios. Además de enfatizar en la participación de los padres y construir políticas públicas para combatir la epidemia mundial de obesidad infantil. La pandemia ha contribuido al aumento de los casos de sobrepeso y obesidad, así como al empeoramiento de los casos de niños que ya presentan tales características. Por lo tanto, comprender la situación de este problema de salud después de un largo período de encierro puede ayudar y comprometer a los profesionales de la salud en la construcción y establecimiento de estrategias para combatir la obesidad infantil y fomentar la participación de los padres en la promoción de cambios en el estilo de vida.

Os caminhos do parkour em Vitória/es / The paths of parkour in Vitória/es

O Parkour é uma prática que vem ganhando espaço nas cidades brasileiras, uma vez que o mobiliário urbano apresenta um cenário perfeito para essa manifestação. O objetivo deste trabalho foi investigar o surgimento e o desenvolvimento do Parkour em Vitória, Espírito Santo. Trata-se de uma pesquisa qualitativa exploratória, na qual se utilizou para a coleta de dados a entrevista estruturada com um praticante de reconhecido envolvimento com o Parkour. Com base nos resultados, estabeleceram-se as categorias que trataram da história do Parkour na capital capixaba, os aspectos pedagógicos de seu ensino-aprendizado e o perfil de seus praticantes. Foi possível constatar que o Parkour surgiu em Vitória em 2004 sob forte influência midiática. Seus participantes são na maioria jovens e seu desenvolvimento ocorreu por meio da divulgação empírica entre os grupos de praticantes e como forma de lazer e confraternização.

Parkour is a practice that has been gaining ground in Brazilian cities which, with their urban furniture, form a perfect setting for its exercise. The objective of this work was to investigate the emergence and development of Parkour in Vitória/ES. This is an exploratory qualitative research. A structured interview with a practitioner with recognized involvement with Parkour was used for data collection. Based on the results, categories were established that dealt with the history of Parkour in Vitória, the pedagogical aspects of its teaching-learning and the profile of its practitioners. It was possible to verify that Parkour appeared in the capital of Espírito Santo in 2004 under strong media influence. Its participants are mostly young people and its development was based on empirical dissemination among groups of practitioners and as a form of leisure and socializing.

Critical revision of the medical treatment of gout in Brazil.

Gout is considered the most common form of inflammatory arthritis in men over 40 years. The authors present a brief review of the current treatment of gout and discuss the existing pharmacological limitations in Brazil for the treatment of this disease. Although allopurinol is still the main drug administered for decreasing serum levels of uric acid in gout patients in this country, the authors also present data that show a great opportunity for the Brazilian drug market for the treatment of hyperuricemia and gout and especially for patients using private and public (SUS) health care systems.

Troponin I as a marker of right ventricular dysfunction and severity of pulmonary embolism.

BACKGROUND: Cardiac troponin I (cTnI) is a specific marker which allows detection of minor myocardial cell damage. In patients with severe pulmonary embolism (PE), the rise in pulmonary artery pressure can lead to progressive right ventricular dysfunction (RVD), and clinical studies have demonstrated the presence of ischemia and even right ventricular infarction. Our aims were to determine the prevalence and diagnostic utility of cTnI in identifying patients with RVD and to ascertain whether it correlates with severity of PE. METHODS: We studied 77 patients with PE diagnosed by pulmonary angiography, ventilation-perfusion lung scan, spiral computed tomography scan or a combination of abnormal echocardiogram with clinical presentation suggestive of PE or with positive subsidiary exams (d-dimers, venous Doppler of the lower limbs, ECG, blood gas analysis). We further classified the PE according to the European Society of Cardiology severity levels, the PE being: 1) massive, if there was shock and/or hypotension; 2) submassive, if we found right ventricular hypokinesis on the echocardiogram; and 3) non-massive, in the remaining cases. We considered the highest cTnI serum value from the admission to 24 hours and a normal value of < 0.10 ng/ml. RESULTS: Among the 60 patients with cTnI measurements, 42 had elevated values. Among those with RVD, 26 (81.3%) had increased cTnI levels and only 14 (35%) with elevated cTnI values did not have RVD, indicating that positive cTnI tests were significantly associated with RVD (p = 0.038). Patients with positive cTnI tests had earlier onset of symptoms (24.0 vs. 144.0 hours, p=0.02), higher prevalence of emboli in proximal vessels (pulmonary trunk and right or left main pulmonary arteries) (OR = 12, CI= 1.6-88.7), and received more thrombolytic therapy (OR = 5.4, CI = 1.1-26.8) than those with normal cTnI tests. cTnI levels were higher among patients with submassive PE (median: 0.77 ng/ml) and lower in those with non-massive PE (0.08 mg/ml, p < 0.05). CONCLUSIONS: Around 70% of patients with PE have elevated cTnI values and this test is significantly associated with RVD. cTnI measurements provide additional information in the evaluation of patients with PE by identifying more severe cases and those at increased risk of hemodynamic deterioration, who can benefit from more aggressive therapeutic strategies.

Arrhythmic storm: Short-coupled variant torsade de pointes.

A 49-year-old woman, with no relevant family history, was admitted in 1996 for arrhythmic storm with polymorphic ventricular tachycardia (torsade de pointes) which degenerated into ventricular fibrillation. Iatrogenic causes were excluded, the electrocardiogram (ECG) was normal and there was no structural heart disease. She refused cardioverter-defibrillator implantation. Treatment was begun with amiodarone, which she took irregularly. She remained asymptomatic until 2014 when she was admitted for a new arrhythmic storm with torsade de pointes, refractory to antiarrhythmic therapy and aggravated by ventricular pacing (65 defibrillations). She had frequent ventricular extrasystoles (with short-coupled period <300 ms) preceding the tachycardia. After administration of isoprenaline infusion electric stability was maintained. In this setting and in the absence of structural heart disease or iatrogenic cause, a diagnosis of short-coupled variant torsade de pointes was established. A cardioverter-defibrillator was implanted and she was treated with verapamil, without recurrence of arrhythmias.