Myocardial protection: comparing histological effects of single-dose cardioplegic solutions-study protocol for a secondary analysis of the CARDIOPLEGIA trial.

Background: Myocardial protection is crucial for successful cardiac surgery, as it prevents heart muscle damage that can occur during the procedure. Prolonged hypoxia without proper protection can lead to adenosine triphosphate consumption, microvilli loss, blister formation, and edema. Custodiol, del Nido, and modified del Nido are single-dose cardioplegic solutions with proven safety and significance in modern surgery. While each has been independently assessed for patient outcomes, limited research directly compares them. This study aims to compare their myocardial protection using histological analysis. Methods: In a double-blind clinical trial, at least 90 patients will be randomly assigned to receive one of the three cardioplegic solutions. Myocardial biopsies will be collected before cardiopulmonary bypass and 15 minutes after reperfusion. The surgical, anesthetic and perfusion techniques will be the same for all patients, following the Institution's standard protocols. Discussion: The ideal cardioplegic solution does not exist, and its selection remains challenging for surgeons. In modern surgical practice, understanding the behavior of these solutions and the ischemic tissue damage caused during induced cardiac arrest allows for safer surgical procedures. The results of this clinical trial can help in understanding the behavior of cardioplegic solutions and their tissue effects. Thus, by selecting the best cardioplegic solution, ischemic damage can be minimized, enhancing the effectiveness of this essential technique in cardiac procedures. The study may aid in implementing clinical protocols in several institutions, aiming to choose the solution with a superior myocardial protection profile, increasing safety, and reducing expenses. Trial Registration: Brazilian Clinical Trials Registry (ReBEC, http://ensaiosclinicos.gov.br/): RBR-997tqhh. Registered: January 26th, 2022.

Comparison between Custodiol, del Nido and modified del Nido in the myocardial protection - Cardioplegia Trial: a study protocol for a randomised, double-blind clinical trial.

INTRODUCTION: Myocardial protection is essential for successful cardiac surgery, and the search for an ideal cardioplegic solution has continued since its beginning. In this context, Custodiol, del Nido and modified del Nido are single-dose cardioplegic solutions with good safety profiles and great relevance in modern surgical practice. While these solutions have all been evaluated for their impact on patient outcomes independently, limited research exists comparing them directly. Thus, the present study aims to examine the effects of these cardioplegic solutions on myocardial protection and clinical outcomes in adult patients undergoing elective cardiac surgery. The assessment of the increase in myocardial injury biomarkers in patients submitted to all treatment methods may be considered a major strength of our study. METHODS AND ANALYSIS: This is a clinical trial study protocol that will compare myocardial protection and clinical outcomes among three patient groups based on which cardioplegic solution was used. Patients will be randomised to receive del Nido (n=30), modified del Nido (n=30) or Custodiol (n=30). Myocardial injury biomarkers will be measured at the baseline and 2 hours, 12 hours and 24 hours after the cardiopulmonary bypass. Clinical outcomes will be assessed during the trans operative period and the intensive care unit stay, in addition to other haematological parameters. ETHICS AND DISSEMINATION: This protocol and its related documents were approved by the Research Ethics Committee of the Hospital Nossa Senhora da Conceição, Brazil, registered under no. 4.029.545. The findings of this study will be published in a peer-reviewed journal in the related field. TRIAL REGISTRATION NUMBER: RBR-7g5s66.

Listeriose como diagnóstico de febre de origem desconhecida em gestantes / Listeriosis as a diagnosis of unknown fever in pregnant women

Listeriose é a denominação de um grupo geral de desordens de transmissão alimentar causadas pela Listeria monocytogenes. Pode simular diversas situações clínicas, dificultando a conduta do médico. Na gestação é pouco considerada, mas relevante enquanto etiologia de perdas gestacionais e posterior acometimento fetal. Geralmente é assintomática, mas pode-se levantar suspeita da doença em gestante febril com sintomas gripais e gastrointestinais, sendo que o diagnóstico definitivo somente é realizado através da cultura sanguínea. Este trabalho tem por objetivo apresentar um caso de listeriose gestacional destacando os principais aspectos desta infecção e orientando quanto ao diagnóstico e tratamento precoces, uma vez que a terapêutica antimicrobiana pode evitar perdas ou sequelas fetais

Listeriosis is the name of a general group of disorders caused by foodborne Listeria monocytogenes. It can simulate various clinical situations, hindering the conduct of the physician. During pregnancy listeriosis is little considered, but it is significant as the etiology of miscarriage and subsequent fetal disease. It is usually asymptomatic, but it can be suspected in pregnant woman with fever and gastrointestinal and flu symptoms, and a definitive diagnosis can only be made by blood culture. This paper aims to present a case of gestational listeriosis highlighting the main aspects of this infection and guiding to early diagnosis and treatment, since antimicrobial therapy may prevent fetal loss or fetal sequelae

Trombólise no infarto agudo do miocárdio / Thrombolysis in acute myocardial infarction

Fez-se uma revisäo do uso de trombolíticos no infarto agudo do miocárdio, conceituando-se a trombose coronária, o mecanismo de açäo dos fibrinolíticos, a lógica para seu uso, e introduziu-se o protocolo que está sendo usado no Hospital Conceiçäo