WHF Position Statement on COVID Vaccination.

The current COVID-19 pandemic has challenged health systems and communities globally. As such, several countries have embarked on national COVID-19 vaccination programmes in order to curb spread of the disease. However, at present, there isn't yet enough dosages to enable vaccination of the general population. Different vaccine prioritization strategies are thus being implemented in different communities in order to permit for a systematic vaccination of individuals. Here, on behalf of the World Heart Federation, we emphasize the need for individuals with Cardiovascular disease to be prioritized in national vaccine prioritization programmes as these are high risk individuals.

Lifespan trajectories of relative corpus callosum thickness: Regional differences and cognitive relevance.

The cerebral hemispheres are specialized for different cognitive functions and receive divergent information from the sensory organs, so that the interaction between the hemispheres is a crucial aspect of perception and cognition. At the same time, the major fiber tract responsible for this interaction, the corpus callosum, shows a structural development across the lifespan which is over-proportional. That is, compared to changes in overall forebrain volume, the corpus callosum shows an accentuated growth during childhood, adolescence, and early adulthood, as well as pronounced decline in older age. However, this over-proportionality of growth and decline along with potential consequences for cognition, have been largely overlooked in empirical research. In the present study we systematically address the proportionality of callosal development in a large mixed cross-sectional and longitudinal sample (1867 datasets from 1014 unique participants), covering the human lifespan (age range 4-93 years), and examine the cognitive consequences of the observed changes. Relative corpus callosum thickness was measured at 60 segments along the midsagittal surface, and lifespan trajectories were clustered to identify callosal subsections of comparable lifespan development. While confirming the expected inverted u-shaped lifespan trajectories, we also found substantial regional variation. Compared with anterior clusters, the most posterior sections exhibited an accentuated growth during development which extends well into the third decade of life, and a protracted decline in older age which is delayed by about 10 years (starting mid to late 50s). We further showed that the observed longitudinal changes in relative thickness of the mid splenium significantly mediates age-related changes in tests assessing verbal knowledge and non-verbal visual-spatial abilities across the lifespan. In summary, we demonstrate that analyzing the proportionality of callosal growth and decline offers valuable insight into lifespan development of structural connectivity between the hemispheres, and suggests consequences for the cognitive development of perception and cognition.

Hipertensión y diarrea: un solo diagnóstico / Hypertension and diarrhea: a single diagnosis

Una mujer de 53 años fue remitida a nuestra consulta para un estudio de hipertensión. Se detectó elevación de catecolaminas, metanefrinas y vanilmandélico en orina. En tomografía axial computarizada abdominal se demostró un nódulo suprarrenal de 3,3 cm, compatible todo ello con feocromocitoma. Cuatro meses después la paciente consulta por un cuadro de diarrea acuosa y pérdida de peso. Tras la realización de adrenalectomía laparoscópica remitió el cuadro de diarrea. Ante la sospecha de vipoma (tumor secretor de péptido intestinal vasoactivo [VIP]) se procedió a la realización de VIP en la pieza quirúrgica mediante técnicas inmunohistoquímicas; el resultado fue positivo. El diagnóstico final fue de feocromocitoma secretor de VIP

A 53 year-old woman referred to our consultation for study of hypertension. Catecholamines, metanephrines and vanilmandelic acid in urine was detected. Abdominal CT scan demonstrated a 3.3 cm adrenal node, all with pheochromocytoma. Months after, the patient consulted for a picture of watery diarrhea and weight loss. After performing laparoscopic adrenalectomy, the diarrhea picture remitted. Due to the suspicion of vipoma (VIP secreting tumor), vasoactive intestinal peptide (VIP) was visualized in surgical pieces using immunohistochemical techniques, this being positive. The final diagnosis was VIP secreting pheochromocytoma

Calpain-induced proteolysis after transient global cerebral ischemia and ischemic tolerance in a rat model.

The activation of the [Ca(2+)]-dependent cysteine protease calpain plays an important role in ischemic injury. Here, the levels of two calpain-specific substrates, p35 protein and eukaryotic initiation factor 4G (eIF4G), as well as its physiological regulator calpastatin, were investigated in a rat model of transient global cerebral ischemia with or without ischemic tolerance (IT). Extracts of the cerebral cortex, whole hippocampus and hippocampal subregions after 30 min of ischemia and different reperfusion times (30 min and 4 h) were used. In rats without IT, the p35 levels slightly decreased after ischemia or reperfusion, whereas the levels of p25 (the truncated form of p35) were much higher than those in sham control rats after ischemia and remained elevated during reperfusion. The eIF4G levels deeply diminished after reperfusion and the decrease was significantly greater in CA1 and the rest of the hippocampus than in the cortex. By contrast, the calpastatin levels did not significantly decrease during ischemia or early reperfusion, but were upregulated after 4 h of reperfusion in the cortex. Although IT did not promote significant changes in p35 and p25 levels, it induced a slight increase in calpastatin and eIF4G levels in the hippocampal subregions after 4 h of reperfusion.

Usefulness of echocardiography and doppler echocardiography in endomyocardial fibrosis.

OBJECTIVE: Our goal was to demonstrate the usefulness of echocardiography and cardiac Doppler echocardiography (echo-Doppler) in the diagnosis of endomyocardial fibrosis, an unusual restrictive cardiomyopathy in Argentina. METHODS: Between 1980 and 1998, we studied 10 women (aged 27 to 58 years) with endomyocardial fibrosis confirmed by surgery and/or endomyocardial biopsy. Of the 10 cases of endomyocardial fibrothrombosis, 8 were biventricular and 2 were left ventricular. Six patients had only an echocardiographic study, and the last 4 patients (after 1987) had an echo-Doppler study also; 3 had a transesophageal echocardiography examination as well. Seven patients had grade III-IV dyspnea, 2 had an edematous-ascitic syndrome, and 1 had right heart failure at the first examination. Four patients died of heart failure and 1 of overimposed sepsis. Surgery was successful in 2 patients with the biventricular form of the disease. In one of them, fibrotic decortication was performed in both ventricles together with tricuspid and mitral replacement. In the other, the right side was not surgically treated because of its mild engagement. One patient was lost to follow-up, and 3 patients are awaiting surgery at this writing. RESULTS: In all 10 patients, echocardiography was the first diagnostic tool used. In M-mode echocardiography, the typical image showed the "square root" sign in the septum and posterior wall in addition to the "merlon" sign, characterized by a hypercontractile basal ventricle opposing an obliterated apex. In 2-dimensional echocardiography, inversion of the normal sized heart with obliterated ventricles and dilated atria were seen in the whole group. In 1 patient, the fibrous thrombus was limited to the apex of the right ventricle (Shaper's type 1) in a biventricular form, whereas in the left side of this patient and in the other 9 patients, the fibrous thrombus that initially occupied the apex engaged the posterior papillary muscle, pulling the posterior valve downward (Shaper's type 2) and generating tricuspid and/or mitral regurgitation that was always mild or moderate. The fibrous thrombus never altered the movement of the underlying myocardium. There were hypoechoic and hyperdense echoes inside the fibrotic material (the latter compatible with calcium), and in all 10 patients, different grades of pericardial effusion were found. Echo-Doppler showed the same minimal percentage of change in mitral and tricuspid velocities as found in healthy patients, which clearly differentiates endomyocardial fibrosis from constrictive pericarditis. Furthermore, a restrictive pattern was observed on both atrioventricular valves when both sides were engaged with a markedly short tricuspid deceleration time. Pulmonary veins showed a markedly diastolic D wave and a broad reversal A wave (the latter presented a low velocity when the wall of the left atrium was diseased) caused by an increased end-diastolic left ventricular pressure to the same extent throughout the respiratory cycle. Hepatic veins showed a markedly deep diastolic forward wave throughout the respiratory cycle and a marked reversal with inspiration. CONCLUSIONS: We showed (1) echocardiographic studies of a significant number of patients with this unusual disease, (2) the characteristic diagnostic signs in M-mode and 2-dimensional echocardiography, and (3) the common echo-Doppler patterns shared by all subjects studied with this technique.

Rupture of mitral chorda tendinea following blunt chest trauma.

Acute mitral insufficiency, originated from rupture of mitral chordae tendineae secondary to nonpenetrating thoracic trauma, is an unusual condition. This diagnosis is difficult to establish because physical examination, electrocardiogram, and cardiac enzymes are neither sensitive nor specific. The diagnosis of rupture must be quickly established because this disorder may be fatal. This paper reports the case of a patient with acute mitral insufficiency secondary to a mitral valve chord rupture a week after a nonpenetrating thoracic trauma.

Effect of left and right lateral decubitus positions on Doppler mitral flow patterns in patients with severe congestive heart failure.

Patients with severe congestive heart failure (SCHF) complain of increasing dyspnea when adopting left lateral decubitus (LLD) position that improves when turning over to the right lateral decubitus (RLD) position (trepopnea). We hypothesize that this clinical sign is due to changes in left ventricular (LV) preload and such changes would modify mitral flow. This study analyzes the effect of RLD and LLD positions on LV filling pattern assessed by Doppler echocardiography in patients with SCHF. Seventeen men and seven women (aged 56.22 +/- 18.52 years) with SCHF in New York Heart Association functional class III-IV and nine normal control subjects (eight men and one woman aged 56.96 +/- 18.14 years) were studied. We analyzed early (E) and late (A) LV filling velocities, E/A ratios, deceleration time, mitral time-velocity integral in each decubitus position, and the differences between them. Patients with SCHF have smaller mitral time-velocity integral, shorter deceleration time, greater E velocity and E/A ratio, and lower A velocity in LLD position than do normal control subjects. On assuming RLD position, patients with SCHF show decreases in E velocity and E/A ratio and lengthening of the deceleration time, suggesting a decrease in LV preload on changing position. This pathophysiologic mechanism may explain why patients with SCHF willingly adopt RLD position.