Arrhythmogenic Left Ventricular Cardiomyopathy: A Successful Case of Extracorporeal Cardiopulmonary Resuscitation.

A 24-year-old man suffered a witnessed cardiac arrest after a padel game. Basic life support was immediately provided. The pre-hospital emergency services team continued the resuscitation efforts, and the patient was accepted for extracorporeal cardiopulmonary resuscitation. The return of spontaneous circulation was achieved in 45 minutes. The initial assessment revealed a ST-segment elevation in leads V4-V6 and a dilated left ventricle with severe systolic dysfunction. Coronary angiography was normal. An improvement in left ventricular systolic function was observed and extracorporeal cardiac support was discontinued after 48 hours. Cardiovascular magnetic resonance imaging demonstrated hypokinesia and subepicardial fatty infiltration of the left ventricle lateral wall. Genetic testing detected a variant of uncertain significance in the ANK2 gene. The diagnosis of arrhythmogenic left ventricular myocardiopathy did not fulfill all the current diagnostic criteria, but it is a very likely diagnosis. An implantable cardioverter-defibrillator was placed. The patient was discharged without physical or cognitive impairment.

Oxigenação por membrana extracorpórea de longa duração - da infecção por SARS-CoV-2 ao transplante pulmonar / Long-term extracorporeal membrane oxygenation - from SARS-CoV-2 infection to lung transplantation

RESUMO Mulher de 55 anos, saudável e não vacinada para SARS-CoV-2, foi admitida no hospital por infecção SARS-CoV-2 com rápida deterioração clínica. No 17º dia de doença, foi intubada e, no 24º dia, a paciente foi referenciada e admitida no nosso centro de oxigenação por membrana extracorpórea. Inicialmente, o suporte de oxigenação por membrana extracorpórea foi utilizado para possibilitar a recuperação pulmonar e permitir à paciente reabilitar e melhorar sua condição física. Apesar de apresentar uma condição física adequada, a função pulmonar não permitiu suspender a oxigenação por membrana extracorpórea, e a paciente foi aceita para transplante pulmonar. Um programa de reabilitação intensiva foi implementado para melhorar e manter o estado funcional da paciente em todas as fases. O curso de oxigenação por membrana extracorporal apresentou várias complicações que prejudicaram a reabilitação: falência ventricular direita, que exigiu oxigenação por membrana extracorpórea venoarterial-venosa durante 10 dias; seis infecções nosocomiais, sendo quatro com progressão para choque séptico; e hemartrose do joelho. Para reduzir o risco de infecção, sempre que possível removeram-se os dispositivos invasivos (ventilação mecânica invasiva, cateter venoso central e cateter vesical), mantendo-se apenas aqueles estritamente necessários à monitorização e tratamento. Após 162 dias de suporte de oxigenação por membrana extracorpórea sem outra disfunção orgânica, foi realizado o transplante pulmonar lobar bilateral. A reabilitação física e respiratória foi mantida para promover a autonomia nas atividades da vida diária. A paciente recebeu alta hospitalar 4 meses após a cirurgia.

ABSTRACT A healthy 55-year-old woman unvaccinated for SARS-CoV-2 was admitted to the hospital with a SARS-CoV-2 infection with rapid clinical deterioration. On the 17th day of disease, she was intubated, and on the 24th day, the patient was referred and admitted to our extracorporeal membrane oxygenation center. Extracorporeal membrane oxygenation support was initially used to enable lung recovery and allow the patient to rehabilitate and improve her physical condition. Despite an adequate physical condition, the lung function was not adequate to discontinue extracorporeal membrane oxygenation, and the patient was considered for lung transplantation. The intensive rehabilitation program was implemented to improve and maintain the physical status throughout all phases. The extracorporeal membrane oxygenation run had several complications that hindered successful rehabilitation: right ventricular failure that required venoarterial-venous extracorporeal membrane oxygenation for 10 days; six nosocomial infections, four with progression to septic shock; and knee hemarthrosis. To reduce the risk of infection, invasive devices (i.e., invasive mechanical ventilation, central venous catheter, and vesical catheter) were removed whenever possible, keeping only those essential for monitoring and care. After 162 days of extracorporeal membrane oxygenation support without other organ dysfunction, bilateral lobar lung transplantation was performed. Physical and respiratory rehabilitation were continued to promote independence in daily life activities. Four months after surgery, the patient was discharged.

Hemolymph Glycemia as an Environmental Stress Biomarker in the Invasive Red Swamp Crayfish (Procambarus clarkii).

AbstractSeveral freshwater crayfish species, including Procambarus clarkii, are both ecologically important and commercially important benthic macroinvertebrates, remarkable for their potential to adapt and reproduce but also for their unique abilities to face distinct abiotic and biotic environments and become successful invaders. While much work has been done to study crayfish introductions, less focus has been given to how crayfish cope with pollution and other environmental stressors, in terms of physiological responses, and whether crayfish responses can be used to assess the effective state of their living environment. Here, we used a mixed approach combining laboratory experiments with field data to validate the use of hemolymph glucose as a relevant biomarker of red swamp crayfish (Procambarus clarkii) stress response. Three meaningful sampling locations were chosen across southern Portugal that are representative of different environments where crayfish live and are frequently captured for human consumption but also correspond to different pollution levels. To reference field measurements of glucose levels, we performed two lab-based experiments: (a) crayfish were exposed to different levels of stress (stress challenge) and (b) crawfish were exposed to a maze dispersal test, with or without water. Crayfish glucose levels were responsive to induced stress but were not correlated with dispersal efforts. Wild crayfish's body condition and stress levels responded differently to environmental conditions, with more challenged individuals showing higher glycemia levels but similar body condition. The glucose levels of the more stressed wild crayfish were visually similar to lab-based crayfish subjected to the higher stress levels (electric shocks), while the levels of glucose of crayfish at the less polluted site corresponded to those measured before the start of the challenge (baseline). The maintenance of high levels of glycemia in crayfish inhabiting more challenging habitats is revealing of their higher energetic demand state. Since P. clarkii ia globally distributed and easily sampled invasive species, quantifying its hemolymph glucose levels can be a particularly useful proxy for assessing environmental quality.

Long-term extracorporeal membrane oxygenation - from SARS-CoV-2 infection to lung transplantation. / Oxigenação por membrana extracorpórea de longa duração - da infecção por SARS-CoV-2 ao transplante pulmonar.

A healthy 55-year-old woman unvaccinated for SARS-CoV-2 was admitted to the hospital with a SARS-CoV-2 infection with rapid clinical deterioration. On the 17th day of disease, she was intubated, and on the 24th day, the patient was referred and admitted to our extracorporeal membrane oxygenation center. Extracorporeal membrane oxygenation support was initially used to enable lung recovery and allow the patient to rehabilitate and improve her physical condition. Despite an adequate physical condition, the lung function was not adequate to discontinue extracorporeal membrane oxygenation, and the patient was considered for lung transplantation. The intensive rehabilitation program was implemented to improve and maintain the physical status throughout all phases. The extracorporeal membrane oxygenation run had several complications that hindered successful rehabilitation: right ventricular failure that required venoarterial-venous extracorporeal membrane oxygenation for 10 days; six nosocomial infections, four with progression to septic shock; and knee hemarthrosis. To reduce the risk of infection, invasive devices (i.e., invasive mechanical ventilation, central venous catheter, and vesical catheter) were removed whenever possible, keeping only those essential for monitoring and care. After 162 days of extracorporeal membrane oxygenation support without other organ dysfunction, bilateral lobar lung transplantation was performed. Physical and respiratory rehabilitation were continued to promote independence in daily life activities. Four months after surgery, the patient was discharged.

Mulher de 55 anos, saudável e não vacinada para SARS-CoV-2, foi admitida no hospital por infecção SARS-CoV-2 com rápida deterioração clínica. No 17º dia de doença, foi intubada e, no 24º dia, a paciente foi referenciada e admitida no nosso centro de oxigenação por membrana extracorpórea. Inicialmente, o suporte de oxigenação por membrana extracorpórea foi utilizado para possibilitar a recuperação pulmonar e permitir à paciente reabilitar e melhorar sua condição física. Apesar de apresentar uma condição física adequada, a função pulmonar não permitiu suspender a oxigenação por membrana extracorpórea, e a paciente foi aceita para transplante pulmonar. Um programa de reabilitação intensiva foi implementado para melhorar e manter o estado funcional da paciente em todas as fases. O curso de oxigenação por membrana extracorporal apresentou várias complicações que prejudicaram a reabilitação: falência ventricular direita, que exigiu oxigenação por membrana extracorpórea venoarterial-venosa durante 10 dias; seis infecções nosocomiais, sendo quatro com progressão para choque séptico; e hemartrose do joelho. Para reduzir o risco de infecção, sempre que possível removeram-se os dispositivos invasivos (ventilação mecânica invasiva, cateter venoso central e cateter vesical), mantendo-se apenas aqueles estritamente necessários à monitorização e tratamento. Após 162 dias de suporte de oxigenação por membrana extracorpórea sem outra disfunção orgânica, foi realizado o transplante pulmonar lobar bilateral. A reabilitação física e respiratória foi mantida para promover a autonomia nas atividades da vida diária. A paciente recebeu alta hospitalar 4 meses após a cirurgia.

Non-native freshwater fauna in Portugal: A review.

We present the most updated list of non-native freshwater fauna established in Portugal, including the Azores and Madeira archipelagos. This list includes 67 species at national level but corresponds to 84 species records, of which 53 are in the mainland, 23 in the Azores and 8 in Madeira archipelagos. We also discuss the progression of the cumulative number of introductions since 1800 and identify the most probable vectors of introduction, main taxonomic groups and their regions of origin. Furthermore, we review the existing knowledge about ecological and economic impacts, invasion risk and potential distribution of invaders, under present and future climatic conditions, and the applied management actions, including the production of legislation. Along the 20th century the number of successful introductions increased at an approximate rate of two new species per decade until the beginning of 1970s. Since then, this rate increased to about 14 new species per decade. These introductions were mainly a result of fisheries, as contaminants or for ornamental purposes. Fish and mollusks are the taxonomic groups with more established species, representing more than half of the total. Most species (>70%) are native from other regions of Europe and North America. Studies about ecological or socioeconomic impacts are more common for fish, crustaceans and mollusks. Impacts for most amphibians, reptiles and mammals are not thoroughly studied. A few studies on the impacts and management actions of health-threatening mosquitoes are also available. The potential distribution in the Portuguese territory was modelled for 26 species. Only a minority of these models provides projections of distributions under scenarios of future climate change. A comparison of the Portuguese and EU legislation shows large discrepancies in the invasive species lists. Using the EU list and a ranking procedure for the national context, we identify freshwater species of high national concern for which actions are urgently needed.