Part 5: Allogeneic HSCT in refractory SJIA with lung disease; recent cases from centers in North America & Europe.

It has been increasingly recognized that there is a subset of patients with refractory systemic JIA, who have failed all available medications and may benefit from HSCT. The increasing experience with HSCT in SJIA, suggests that despite the complicated post-HSCT course, short-term, the transplanted patients either achieved SJIA remission or reduced burden of disease. Longer follow-up, however, is needed to better define the long-term outcomes. The discussion at the NextGen 2022 conference was focused on the optimal timing for the procedure, the need for a good control of inflammatory SJIA activity prior to HSCT, and the role of the reduced intensity conditioning regimens as there was a remote concern that such regimens might increase the risk of SJIA relapse after the transplantation. There was unanimous agreement about the importance of long-term registries to address these questions.

Reactor Designs and Configurations for Biological and Bioelectrochemical C1 Gas Conversion: A Review.

Microbial C1 gas conversion technologies have developed into a potentially promising technology for converting waste gases (CO2, CO) into chemicals, fuels, and other materials. However, the mass transfer constraint of these poorly soluble substrates to microorganisms is an important challenge to maximize the efficiencies of the processes. These technologies have attracted significant scientific interest in recent years, and many reactor designs have been explored. Syngas fermentation and hydrogenotrophic methanation use molecular hydrogen as an electron donor. Furthermore, the sequestration of CO2 and the generation of valuable chemicals through the application of a biocathode in bioelectrochemical cells have been evaluated for their great potential to contribute to sustainability. Through a process termed microbial chain elongation, the product portfolio from C1 gas conversion may be expanded further by carefully driving microorganisms to perform acetogenesis, solventogenesis, and reverse ß-oxidation. The purpose of this review is to provide an overview of the various kinds of bioreactors that are employed in these microbial C1 conversion processes.

New findings useful for clinical practice using swept-source optical coherence tomography angiography in the follow-up of active ocular toxoplasmosis.

BACKGROUND: Ocular toxoplasmosis is one of the most common causes of intraocular inflammation and posterior uveitis in immunocompetent patients. This paper aims to investigate swept-source optical coherence tomography angiography (SS-OCTA) findings in eyes with active toxoplasmic retinochoroiditis. METHODS: This case series was conducted from November 2017 through October 2019 in two Brazilian centers. 15 eyes of 15 patients with active toxoplasmic retinochoroiditis were included, and were imaged at baseline and after at least 4 weeks of follow-up. All patients underwent ophthalmic examinations and multimodal imaging including SS-OCT and SS-OCTA before and after treatment of ocular toxoplasmosis. The differential diagnoses included toxoplasmosis, syphilis, and human immunodeficiency virus, which were eliminated through serologic and clinical evaluations. RESULTS: All 15 patients presented with positive anti-Toxoplasma gondii immunoglobulin G titers and three also presented with positive anti-T. gondii immunoglobulin M titers. The mean age at examination was 32.4 years ± 12.7 years (range 15-59 years). Sixty percent of the patients were female. In all eyes, the inner retinal layers were abnormally hyperreflective with full-thickness disorganization of the retinal reflective layers at the site of the active toxoplasmic retinochoroiditis. At baseline, 80% of eyes had focal choroidal thickening beneath the retinitis area, and all eyes had a choroidal hyporeflective signal. Before treatment, SS-OCTA showed no OCTA decorrelation signal next to the lesion site in all eyes, and flow signal improvement was noticed after treatment. Three eyes presented with intraretinal vascular abnormalities during follow-up. SS-OCTA showed retinal neovascularization in one patient and a presumed subclinical choroidal neovascular membrane in another patient. CONCLUSIONS: SS-OCT and SS-OCTA are useful for assessing unexpected structural and vascular retinal and choroidal changes in active and post-treatment toxoplasmic retinochoroiditis and these findings are useful for clinical practice.

Association between Morphodynamic Variables by Transesophageal Echocardiography and CHA2DS2-Vasc Values

In atrial fibrillation (AF), the CHA2DS2-VASc score calculates the risk for stroke. Di Biase classified the left atrial appendage (LAA), using magnetic resonance imaging, into 4 morphological types and correlated it with cerebrovascular events. Transesophageal echocardiography (TEE) also evaluates LAA and is a more widespread technique. Objective: To evaluate, using TEE, the possibility of characterizing LAA and to analyze its morphological aspects using the CHA2DS2VASc score. Methodology: A total of 247 patients were divided into three groups considering the CHA2DS2-VASc score: Group 1: 0 and 1; Group 2: 2 and 3 and, Group 3: ≥ 4 points. TEE produced the echocardiographic data. LAA was classified into thrombogenic and non-thrombogenic morphologies. In the analysis of statistical tests, a significance level of 5% was adopted. Results: The average age was 50 and 16.2% presented AF. In Group 1, we observed normal variables with a lower prevalence of AF (8.7%, p < 0.001). In group 2, spontaneous contrast was detected in 26.7%, (p < 0.001), thrombus in 6.7% (p = 0.079) and flow velocity in LAA < 0.4 m/s in 22.7% (p < 0.001) of the cases. Group 3 presented the highest percentages of AF (31.8%, p < 0.001), stroke/TIA (77.3%, p < 0.001), EF < 55% (18.2%, p = 0.010) and higher prevalence of thrombogenic type LAA (72.7%, p = 0.014). A higher occurrence of stroke/TIA was observed in patients with thrombogenic LAA (25.2%) compared to the non-thrombogenic group (11.2%), (p = 0.005). Conclusions: The thrombogenic morphology of LAA identified in TEE presented a higher risk of stroke regardless of the CHA2DS2VASc score. Patients with higher scores had greater abnormalities in echocardiographic variables

Application of microbial fuel cell technology for vinasse treatment and bioelectricity generation.

OBJECTIVE: Our study evaluated the performance of different two-chambered microbial fuel cell (MFC) prototypes, operated with variable distance between electrodes and Nafion membrane and specific inoculum concentration, applied for vinasse treatment. RESULTS: The performance of the developed MFC resulted in a maximum current density of 1200 mA m-2 and power density of 800 mW m-2 in a period of 61 days. MFC performed a chemical oxygen demand removal at a rate ranging from 51 to 60%. CONCLUSIONS: Taking our preliminary results into consideration, we concluded that the MFC technology presents itself as highly promising for the treatment of vinasse.

Effects of Biofeedback in Preventing Urinary Incontinence and Erectile Dysfunction after Radical Prostatectomy.

In this study, we present a biofeedback method for the strengthening of perineal muscles during the preoperative procedures for radical prostatectomy, and we evaluate this technique as a prevention measure against complications such as urinary incontinence (UI) and erectile dysfunction (ED), which affect prostatectomy patients after surgery. In the experimental protocol, the patients performed specific exercises with the help of a device that provided the patient with visual biofeedback, based on a plot of the anal pressure. For the experimental protocol, we selected 20 male patients, with an average age of 64.0 years, and submitted them to ten therapeutic sessions each. A control group consisting of 32 men with an average age of 66.3 years, who were treated with the same surgical procedure but not with the preoperative procedures, also took part in the experiment. To evaluate UI and ED after the surgery in both control and experimental groups, we used two validated questionnaires-to assess UI, we used the King's Health Questionnaire (KHQ) and, for ED, we used the International Index of Erectile Function (IIEF-5) Questionnaire. We compared the variables associated with UI and ED after the surgery for the control and experimental groups. The occurrence of UI after radical prostatectomy in the control group (100% of the patients) was higher than that for the experimental group (5% of the patients), with p < 0.0001. Likewise, the occurrence of erectile dysfunction after prostatectomy in the control group (48.6% of the patients) was higher than that for the experimental group (5% of the patients), with p < 0.0001. The number of nocturia events also decreased as a consequence of the intervention (p < 0.0001), as did the number of disposable underwear units for urinary incontinence (p < 0.0001). Furthermore, we compared, only for the experimental group, the anal pressure before the biofeedback intervention and after the surgery, and we verified that the anal pressure after surgery was significantly higher (p < 0.0001). The results strongly suggest that the preoperative biofeedback procedure was effective in decreasing urinary incontinence and erectile dysfunction after radical prostatectomy. As future work, we intend to extend this analysis for larger samples and considering a broader age range.

The presence of plasmids in Aeromonas hydrophila and its relationship with antimicrobial and heavy metal-resistance profiles / Presença de plasmídeos em Aeromonas hydrophila e sua relação com perfis de resistência aos antimicrobianos e metais pesados

ABSTRACT: Aeromonas hydrophila is a common fish pathogen that causes extensive damage to aquaculture. To develop and implement a more adequate strategy to farm fish, it is crucial to understand the bacterial-resistance levels and their transference dynamics. The objective of this study was to analyze the resistance profile of isolated Aeromonas hydrophila to antimicrobial agents and heavy metals and draw a correlation of the observed profiles with the presence of plasmids. Resistance of the isolated bacteria to antimicrobial agents (oxacilin, gentamicin, tetracycline, and nalidixic acid) and heavy metals (cadmium, lead, copper, and manganese) was verified using the minimum bactericidal concentration (MBC) and minimum inhibitory concentration (MIC) standards. The Multiple Antibiotic Resistance Index (MAR Index) was calculated. Plasmids were extracted by using a common methodology described elsewhere. Mann-Whitney Test, implemented in the R environment, was used to determine the correlation between resistance and plasmids presence. A high resistance to almost all antimicrobial agents and heavy metals was observed, except to gentamicin and cadmium. The MAR index results showed resistance to all antimicrobial profiles. Of the isolated bacteria, 14 showed the presence of plasmids. However, no correlation was noted between the resistance profile and the plasmid presence for these isolates, indicating that the genes responsible for resistance to microbial agents and heavy metals are present in the cromossomic DNA, which in turn suggested the possibility of gene transfer between the isolated bacteria. The resistance to heavy metals can be linked to heavy utilization of fertilizers along the Sao Francisco River.

RESUMO: Bactérias da espécie Aeromonas hydrophila são patógenos que atacam peixes, causando grandes prejuízos à piscicultura. Entender os perfis de resistência dessa bactéria e a capacidade da mesma em transferir tal resistência é importante para implantação de um manejo adequado na produção de peixes. Os objetivos desse estudo foram analisar a resistência de isolados de Aeromonas hydrophila à antimicrobianos e metais pesados e, correlacionar os perfis encontrados com a presença de plasmídeos. A resistência dos isolados aos antimicrobianos (oxacilina, gentamicina, tetraciclina e ácido nalidíxico) e metais pesados (cádmio, chumbo, cobre e manganês) foi verificada pelas técnicas da Concentração Bactericida Mínima (CBM) e Concentração Inibitória Mínima (CIM). Foi calculado o Índice de Resistência Múltipla aos Antimicrobianos (IRMA). Os plasmídeos foram extraídos por metodologias descritas pela literatura. A relação entre a resistência aos antimicrobianos e metais pesados com a presença de plasmídeos foi determinada pelo teste de Mann-Whitney utilizando o ambiente R. Foi observada alta resistência aos antimicrobianos e metais pesados testados, com exceção à gentamicina e cádmio. No IRMA os isolados apresentaram resistência a todos os perfis de antimicrobianos possíveis. Quatorze isolados apresentaram plasmídeos, mas não foi encontrada relação dos perfis de resistência com a presença destes, o que indica que os genes de resistência a esses compostos estejam presentes no DNA cromossômico. Porém apontam a possibilidade de transferência dos genes de resistência entre os isolados. Estes resultados apontam alta resistência dos isolados e capacidade de transmissão dessa resistência a outras bactérias. A resistência aos metais pesados, pode estar ligada ao uso de fertilizantes nas plantações localizadas próximas as margens do Rio São Francisco.

Comparação entre Técnicas de Block-Matching e Optical Flow na análise do Strain pela Ecocardiografia / Comparison of Block-Matching and Optical Flow in Strain Echocardiography Analysis

Introdução: Diferentes tecnologias têm sido utilizadas para avaliar a função sistólica do ventrículo esquerdo. De particular interesse, está a ecocardiografia com strain bidimensional (2DSTE). Dois métodos diferentes têm sido usados para quantificar a deformação miocárdica (strain miocárdico) pela 2DSTE: block matching e optical flow. Ambos estão presentes em ecocardiógrafos comercialmente disponíveis. Entretanto, não há consenso a respeito se as medidas do strain longitudinal por estes métodos são sobreponíveis. Objetivo: Comparar os valores de pico do strain miocárdico longitudinal obtidos através da 2DSTE pelos dois diferentes métodos (block matching x optical flow). Método: Foram realizadas as medidas do strain em 16 segmentos miocárdicos do ventrículo esquerdo, conforme orientação da Sociedade Americana de Ecocardiografia pela técnica do block matching (Vivid 7, GE, Horten, Noruega) e, imediatamente após, pela técnica do optical flow (My Lab 60, Esaote, Florença, Itália) de forma randomizada e seus valores foram comparados. Resultados: Houve 28 indivíduos com idade 27,9 ± 7,7 anos, sendo 50% do sexo masculino e todos com fração de ejeção superior a 55%. A medida do strain longitudinal global foi maior pela técnica de block matching (p = 0,02). Na análise dos 16 segmentos, houve 10 segmentos com valores diferentes, em especial os segmentos apicais. Conclusão: Os valores do strain miocárdico longitudinal obtidos por métodos diferentes não são sobreponíveis e devem ser usados com cautela. Sendo assim, valores de normalidade também variam de acordo com o fabricante e o método utilizado

Introduction: Different technologies have been used to evaluate left ventricular systolic function. Of particular interest is the two-dimensional strain echocardiography (2DSTE). Two different methods have been used to quantify myocardial strain by 2DSTE: block matching and optical flow. Both are present in commercially available echocardiographs. However, there is no consensus as to whether the longitudinal strain measures using these methods are overlapping. Objective: To compare the longitudinal myocardial strain peak values obtained through 2DSTE using two different methods (block matching x optical flow). Method: Strain measurements in 16 left ventricular myocardial segments were taken as recommended by the American Society of Echocardiography using block matching (Vivid 7, GE, Horten, Norway) and, immediately after, using optical flow (My Lab 60, Esaote, Florence, Italy) in a randomized way and their values were compared. Results: There were 28 individuals aged 27.9 ± 7.7, of whom 50% were male and all with an ejection fraction greater than 55%. Global longitudinal strain was higher using block matching (p = 0.02). In the analysis of the 16 segments, 10 segments had different values, especially the apical segments. Conclusion: Longitudinal myocardial strain values obtained by different methods are not overlapping and must be used with caution. Normality values also vary according to the manufacturer and the method used

Indirect diagnostic tests for the detection of subclinical mastitis in dairy goats experimentally infected with Staphylococcus aureus / Testes diagnósticos indiretos na detecção da mastite subclínica em cabras leiteiras infectadas experimentalmente com Staphylococcus aureus

ABSTRACT: The aim of the present study was to assess two diagnostic techniques (California mastitis test (CMT) and the somatic cell count (SCC)) that can diagnose mastitis in dairy goats. Experimental infection was conducted using 20 mammary glands, a strain of Staphylococcus aureus, an infectious dose of 1.2x108CFU mL-1 and a volume of 1mL per mammary gland. The CMT and the SCC were used to detect subclinical mastitis. Bacterial culture (BC) was performed immediately after milk collection and was used as the gold standard. Four experimental time points were established (0, 24, 48 and 72 hours post-inoculation). Analysis of the ROC curve confirmed that the best combination of sensitivity and specificity were obtained with a cutoff point of 405.5, 6030.0 and 729.5x103 cells mL-1, respectively at M1, M2 and M3. Furthermore, considering the drop in sensitivity throughout the experimental time points, the use of serial bacterial cultures are recommended, particularly in herds with a high prevalence of S. aureus.

RESUMO: Neste trabalho, objetivou-se avaliar duas técnicas diagnósticas (California mastitis test (CMT) e a contagem de células somáticas (CCS)) disponíveis para o diagnóstico da mastite em cabras leiteiras. Realizou-se infecção experimental em 20 metades mamárias, utilizando-se cepa de S. aureus, em uma dose infectante de 1,2x108 UFC mL-1 e um volume de 1mL/metade mamária. Para detecção da mastite subclínica, foi utilizado o CMT e a CCS. A cultura bacteriológica (CB) foi empregada como padrão ouro, sendo realizada logo após a coleta do leite. Foram estabelecidos quatro momentos experimentais (0, 24, 48 e 72 horas pós-infecção). A análise da curva de ROC confirmou que a melhor combinação (sensibilidade e especificidade) foi obtida com ponto de corte de 405,5, 6030,0 e 729,5x103 cells mL-1, respectivamente, em M1, M2 and M3. Ademais, levando em consideração a queda da sensibilidade ao longo dos momentos experimentais, é relevante a realização da cultura bacteriológica seriada, principalmente em rebanhos com elevada prevalência de S. aureus.

A system for treatment of diabetic foot ulcers using led irradiation and natural latex

Abstract Introduction: We developed and tested a new system for inducing the healing of diabetic foot ulcers. The system relies on the regenerative properties of its two components: an insole with a sheet of natural latex and a device that contains a matrix of light emitting diodes with wavelength of 635 nm. Methods The electronic and latex based devices were developed, and a four weeks test was performed in one control group (CG) of five ulcers and one experimental group (EG) of eight ulcers. The CG was treated with a standard approach, based on a silver-releasing foam dressing, and the EG was treated with the system under test. For each ulcer, an index for quantifying the percentage ulcer recovery, named CRU(%), has been calculated; a CRU(%) = 0% means no healing, and a CRU(%) = 100% means total healing. Results There were statistically significant increases of CRU(%) of 51.8% (p = 0.022), for the CG, and of 78.4% (p < 0.001), for the EG. The increase in the EG was higher than the increase in the CG, and the difference was statistically significant (p < 0.001). The results showed that the proposed method had, for these particular sets of ulcers, faster healing rates, than for the standard method. Conclusion The results hint that the proposed method seems promising as a future treatment method. However, the technique must undergo further testing before it can be considered for extensive clinical applications.

Medidas do strain longitudinal endocárdico e epicárdico pela técnica do Xstrain®: existem diferenças entre seus valores? / Measures of endocardial and epicardial longitudinal strain by the tchnique of Xstrain®: are there differences between their values? / Medidas del strain longitudinal endocárdico y epicárdico por la técnica del Xstrain®: ¿existen diferencias entre sus valores?

Fundamento: A ecocardiografia pode avaliar a função ventricular de diversas maneiras: pela medida da fração de ejeção ventricular, pela análise visual da contratilidade, ou pela quantificação da deformação miocárdica. Strain é a variável preferida para a descrição da função local. Objetivo: Comparar os valores do strain longitudinal endocárdico e epicárdico do ventrículo esquerdo pela técnica do Xstrain® em voluntários saudáveis. Material e métodos: Foram avaliados 32 pacientes hígidos com idade média de 31,6 ± 9,8 anos, sendo 18 masculinos (56 por cento). Utilizamos o ecocardiógrafo modelo MyLab60® da Esaote (Firenze, Itália) com sonda multifrequencial (1,5 MHz a 2,6 MHz), e programa de computador para realização das novas técnicas ecocardiográficas (MyLab Desk, v 8.0, Esaote). Mediu-se o strain nas camadas endocárdica e epicárdica aos cortes apicais de 2, 3 e 4 câmaras. Resultados: Observou-se diferença estatística entre os valores de strain longitudinal endocárdico e strain longitudinal epicárdico em todos os segmentos estudados (p < 0,01).Conclusão: Os valores do strain longitudinal são diferentes nas camadas endocárdica e epicárdica do ventrículo esquerdo.

Background: Echocardiography can assess ventricular function in several ways: by measurement the ventricular ejection fraction, by visual analysis of contractility, or by the quantification of myocardial deformity. Strain is the preferred variable for the description of local function. Objective: To compare the values of the endocardial and epicardial longitudinal strain of the left ventricle by the technique of Xstrain® in healthy volunteers. Material and Methods: Thirty-two healthy patients were assessed with a mean age of 31.6 ± 9.8 years, being 18 men (56 percent). We used echocardiograph model MyLab60® of Esaote (Firenze, Italy) with multifrequency probe (1.5 MHz to 2.6 MHz), and computer program for the performance of new echocardiography techniques (MyLab Desk, v 8.0, Esaote). The strain was measured in the endocardiac and endocardiac layers to the apical 2, 3 and 4 chamber views. Results: There was a statistical difference between the values of endocardial and epicardial longitudinal strain and longitudinal epicardiac strain in all segments studied (p < 0.01).Conclusion: The values of longitudinal strain are different in endocardial and epicardial layers of the left ventricle.

Background: Echocardiography can assess ventricular function in several ways: by measurement the ventricular ejection fraction, by visual analysis of contractility, or by the quantification of myocardial deformity. Strain is the preferred variable for the description of local function. Objective: To compare the values of the endocardial and epicardial longitudinal strain of the left ventricle by the technique of Xstrain® in healthy volunteers. Material and Methods: Thirty-two healthy patients were assessed with a mean age of 31.6 ± 9.8 years, being 18 men (56%). We used echocardiograph model MyLab60® of Esaote (Firenze, Italy) with multifrequency probe (1.5 MHz to 2.6 MHz), and computer program for the performance of new echocardiography techniques (MyLab Desk, v 8.0, Esaote). The strain was measured in the endocardiac and endocardiac layers to the apical 2, 3 and 4 chamber views. Results: There was a statistical difference between the values of endocardial and epicardial longitudinal strain and longitudinal epicardiac strain in all segments studied (p < 0.01). Conclusion: The values of longitudinal strain are different in endocardial and epicardial layers of the left ventricle. (Arq Bras Cardiol:imagem cardiovasc. 2014;27(1):2-6)

Effects of very short pauses on electromyographic variables measured during fatiguing isometric contractions.

15 healthy men (26.6 ± 4.6 years old, weight of 70.7 ± 8.6 kg, and height of 1.750 ± 0.072 m) performed three 30-seconds isometric contractions at 60% MVC, with two 10-seconds resting intervals between them. The goal was to study the effect of the resting intervals on the variables that are most commonly used to analyze surface electromyographic (S-EMG) signals (conduction velocity [CV], root mean square [RMS], average rectified value [ARV], mean power frequency [MNF], and median power frequency [MDF]). For the first 30-second contraction, the S-EMG variables behaved exactly like described in the literature. However, after the first and second pauses, the CV variable ceased to behave like in the literature. In the first contraction, the conduction velocity had a statistically significant decreasing trend, in the second contraction, it had a statistically non-significant positive trend, and, in the third contraction, a statistically significant positive trend. These results suggest that short pauses between isometric constant-force contractions lead to changes in the recruiting strategies of the muscles involved in the contraction. The causes of these changes are not yet clear, and further work is needed in order to understand this effect.

Reabilitação nos pacientes submetidos às amputações maiores no Instituto Dante Pazzanese de Cardiologia / Rehabilitation in patients who underwent major amputations in Dante Pazzanese Institute of Cardiology

As amputações maiores de membros inferiores apresentam importante impacto na capacidade laborativa, piora na qualidade de vida e socialização dos pacientes. Como principais etiologias podemos citar a isquemia critica e a infecção. O objetivo deste estudo foi definir o índice de reabilitação dos pacientes submetidos às amputações maiores no período de Janeiro de 2011 a Dezembro de 2012 no Instituto Dante Pazzanese de Cardiologia, avaliando o impacto de uma revascularização prévia no sucesso da protetização...

A flat microbial fuel cell for decentralized wastewater valorization: process performance and optimization potential.

A very compact flat microbial fuel cell (MFC), with 64 cm2 each for the anode surface and the cathode surface and 1 cm3 each for the anode and cathode chambers, was tested for wastewater treatment with simultaneous electricity production with the ultimate goal of implementing an autonomous service in decentralized wastewater treatment systems. The MFC was operated with municipal wastewater in sequencing batch reactor mode with re-circulation. Current densities up to 407 W/m3 and a carbon removal of 83% were obtained. Interruption in the operation slightly decreased power density, while the re-circulation ratio did not influence power generation. The anode biofilm presented high conductivity, activity and diversity. The denaturing gradient gel electrophoresis band-pattern of the DNA showed the presence of several ribotypes with different species of Shewanellaceae and Geobacteraceae families.

Origem anômala da artéria coronária esquerda do tronco pulmonar em criança de sete meses: papel do strain miocárdico após oito anos de acompanhamento / Anomalous origin of the left coronary artery from the pulmonary trunk in a seven-months baby: role of myocardial strain after eight years follow-up / Origen Anómalo de la Arteria Coronaria Izquierda del Tronco Pulmonar en Niño de Siete Meses: Papel del Strain Miocárdico tras Ocho Años de Acompañamiento

Dentre algumas doenças descritas na literatura, a origem anômala da artéria coronariana esquerda é uma das causas de insuficiência cardíaca e isquemia miocárdica nos primeiros meses de vida. Neste relato, apresentamos caso de uma criança que aos sete meses, quando em franca insuficiência cardíaca, foi submetida a um ecocardiograma que evidenciou tronco da artéria coronariana esquerda com origem na artéria pulmonar e fluxo reverso nessa artéria ao mapeamento de fluxo em cores. Submetida a cirurgia corretiva com sucesso, foi seguida por oito anos, evoluindo com fibrose do músculo papilar e consequente insuficiência mitral moderada.

Among some pathologies described in the literature, the anomalous origin of the left coronary artery is a cause of heart failure and myocardial ischemia in the early months of life. Here we report a case of a child who at seven months, when in open heart failure underwent echocardiography showed that the left main coronary artery originating from the pulmonary artery and reverse flow in this artery flow mapping in color. Underwent corrective surgery has successfully been followed for eight years, evolving with papillary muscle fibrosis and moderate mitral regurgitation.

De entre algunas enfermedades descritas en la literatura, el origen anómalo de la arteria coronaria izquierda es una de las causas de insuficiencia cardíaca e isquemia miocárdica en los primeros meses de vida. En el presente informe, presentamos el caso de un niño que a los siete meses, cuando en franca insuficiencia cardíaca, se sometió a un ecocardiograma que evidenció tronco de la arteria coronaria izquierda con origen en la arteria pulmonar y flujo inverso en esta arteria al mapeo de flujo en colores. Sometido a la cirugía correctiva con éxito, fue acompañada por ocho años, evolucionando con fibrosis del músculo papilar y consecuente insuficiencia mitral moderada.

Quantificação da deformidade miocárdica longitudinal segmentar em atletas pela ecocardiografia (técnica do Speckle Tracking) / Myocardial strain quantification in athletes by speckle tracking echocardiography / Cuantificación de la Deformidad Miocárdica Longitudinal Segmentaria en Atletas por la Ecocardiografía (Técnica de Speckle Tracking

Introdução: A medida do strain indica o percentual de deformidade de um determinado segmento miocárdico. Objetivo: Estabelecer os valores normais de strain bidimensional nos diferentes segmentos miocárdicos do ventrículo esquerdo (VE), em atletas, por meio da ecocardiografia.Material e Métodos: Foram estudados 63 atletas (futebolistas profissionais), com idade média de 20,3 ± 5,9 anos e comparados com 63 indivíduos normais, pareados por idade e sexo. O strain bidimensional foi quantificado pela ecocardiografia, por meio da técnica do speckle tracking em 12 segmentos do ventrículo esquerdo, aos cortes apicais de 4 e 2 câmaras.Resultados: Os atletas avaliados apresentaram valores de strain bidimensional de 14,9 a 24,9 por cento. Os valores médios do strain por região, nos atletas analisados, foram: 17,1 por cento (região basal), 19,2 por cento (região medial), 23,3 por cento (região apical), evidenciando um aumento significativo da deformidade miocárdica da base para o ápice (p<0,005). Não foram observadas diferenças significativas quando comparados os valores encontrados em atletas com o grupo de indivíduos normais.Conclusão: Em futebolistas profissionais, os valores do strain bidimensional miocárdico do VE variam cerca de 15 a 25 por cento, aumentando da base para o ápice ventricular, sendo o mesmo comportamento observado na população normal.

Introduction: The measurement of strain indicates the deformity percentage of a particular myocardial segment. Objective: To establish the normal values of two-dimensional strain in the different myocardial segments of the left ventricle (LV) in athletes by echocardiography.Material and Methods: We studied 63 athletes (professional soccer players), with mean age of 20.3 ± 5.9 years, compared to 63 healthy subjects, matched for age and sex. The strain was quantified by two-dimensional echocardiography, by using the speckle tracking technique in 12 segments of the left ventricle, in apical views of 4 and 2 chambers.Results: The athletes showed high values of two-dimensional strain ranging from 14.9 to 24.9 percent. The average strain values by region in athletes studied were 17.1 percent (basal region), 19.2 percent (middle region), 23.3 percent (apical region), showing a significant increase in myocardial strain from the base to apex (p <0.005). No significant differences were observed when comparing the values found in athletes with the group of normal subjects.Conclusion: In professional soccer players, the values of the two-dimensional myocardial strain in the LV ranges around 15-25 percent, increasing from the ventricular base to apex and the same behavior is observed in normal population.

Introducción: La medida del strain indica el porcentual de deformidad de un determinado segmento miocárdico. Objetivo: Establecer los valores normales de strain bidimensional en los diferentes segmentos miocárdicos del ventrículo izquierdo (VI), en atletas, por medio de la ecocardiografía.Material y Métodos: Se estudiaron 63 atletas (futbolistas profesionales), con edad media de 20,3 ± 5,9 años y comparados con 63 individuos normales, igualados por edad y sexo. El strain bidimensional fue cuantificado por la ecocardiografía, por medio de la técnica del speckle tracking en 12 segmentos del ventrículo izquierdo, a los cortes apicales de 4 y 2 cámaras. Resultados: Los atletas evaluados presentaron valores de strain bidimensional de 14,9 a 24,9%. Los valores medios del strain por región, en los atletas analizados, fueron: 17,1% (región basal), 19,2% (región medial), 23,3% (región apical), evidenciando un aumento significativo de la deformidad miocárdica de la base hacia el ápice (p<0,005). No se observaron diferencias significativas al comparar los valores encontrados en atletas con los del grupo de individuos normales.Conclusión: En futbolistas profesionales, los valores del strain bidimensional miocárdico del VI varían entre el 15 y el 25%, aumentando de la base hacia el ápice ventricular, observándose el mismo comportamiento en la población normal