The Role of Omega-3 in Attenuating Cardiac Remodeling and Heart Failure through the Oxidative Stress and Inflammation Pathways.

Cardiac remodeling is defined as molecular, cellular, and interstitial changes that manifest clinically as alterations in the size, shape, and function of the heart. Despite the pharmacological approaches, cardiac remodeling-related mortality rates remain high. Therefore, other therapeutic options are being increasingly studied. This review highlights the role of omega-3 as an adjunctive therapy to attenuate cardiac remodeling, with an emphasis on its antioxidant and anti-inflammatory actions.

Estenosis Tricuspídea Severa secundaria a enfermedad carcinoide cardiaca: presentación de caso clínico y revisión de la literatura / Severe Tricuspid Stenosis Secondary to Cardiac Carcinoid Disease: Case Report and Literature Review

RESUMEN: La estenosis tricuspídea (ET) es una valvulopatía infrecuente cuyas principales etiologías son la enfermedad reumática y la endocarditis infecciosa. En raras ocasiones puede deberse a un fenómeno carcinoide subyacente, en lo que se conoce como la enfermedad carcinoide cardiaca (ECC). Esta condición lleva a la fibrosis del endocardio del ventriculo derecho, principalmente de sus válvulas, lo cual puede provocar falla cardiaca derecha, complicando el pronóstico. En este artículo se presenta un caso de una ET severa por una posible ECC, en conjunto con las imagenes ecocardiográficas obtenidas durante el abordaje diagnóstico (imágenes bidimensionales, imagen multiplanar y ecocardiografía en 3D). Se discuten las implicaciones clínicas, los retos diagnósticos, las opciones terapeuticas y el pronóstico de esta rara entidad.

ABSTRACT Severe Tricuspid Stenosis Secondary to Cardiac Carcinoid Disease: Case Report and Literature Review Tricuspid stenosis is an unfrequent valvulopathy that can be caused by multiple etiologies, including rheumatic disease and infectious endocarditis. In rare occasions, it occurs in the context of a carcinoid syndrome, in what is known as carcinoid heart disease. This condition causes fibrosis of the valves and the endocardium of the right ventricule, which can progress into right ventricular failure, worsening the patient's prognosis. In this article, we present a case of a severe tricuspid stenosis in which this ethiology is suspected. We show the echocardiographic images obtained for the diagnosis (two-dimensional imaging, multimodal imaging and 3D echocardiography), and we discuss the clinical and diagnostic implications, therapeutic options and prognosis of this rare condition.

Functional training improves peak oxygen consumption and quality of life of individuals with heart failure: a randomized clinical trial.

BACKGROUND: Functional training may be an effective non-pharmacological therapy for heart failure (HF). This study aimed to compare the effects of functional training with strength training on peak VO2 and quality of life in individuals with HF. METHODS: A randomized, parallel-design and examiner-blinded controlled clinical trial with concealed allocation, intention-to-treat and per-protocol analyses. Twenty-seven participants with chronic HF were randomly allocated to functional or strength training group, to perform a 12-week physical training, three times per week, totalizing 36 sessions. Primary outcomes were the difference on peak VO2 and quality of life assessed by cardiopulmonary exercise testing and Minnesota Living with Heart Failure Questionnaire, respectively. Secondary outcomes included functionality assessed by the Duke Activity Status Index and gait speed test, peripheral and inspiratory muscular strength, assessed by hand grip and manovacuometry testing, respectively, endothelial function by brachial artery flow-mediated dilation, and lean body mass by arm muscle circumference. RESULTS: Participants were aged 60 ± 7 years, with left ventricular ejection fraction 29 ± 8.5%. The functional and strength training groups showed the following results, respectively: peak VO2 increased by 1.4 ± 3.2 (16.9 ± 2.9 to 18.6 ± 4.8 mL.kg-1.min-1; p time = 0.011) and 1.5 ± 2.5 mL.kg-1.min-1 (16.8 ± 4.0 to 18.6 ± 5.5 mL.kg-1.min-1; p time = 0.011), and quality of life score decreased by 14 ± 15 (25.8 ± 14.8 to 10.3 ± 7.8 points; p time = 0.001) and 12 ± 28 points (33.8 ± 23.8 to 19.0 ± 15.1 points; p time = 0.001), but no difference was observed between groups (peak VO2: p interaction = 0.921 and quality of life: p interaction = 0.921). The functional and strength training increased the activity status index by 6.5 ± 12 and 5.2 ± 13 points (p time = 0.001), respectively, and gait speed by 0.2 ± 0.3 m/s (p time = 0.002) in both groups. CONCLUSIONS: Functional and strength training are equally effective in improving peak VO2, quality of life, and functionality in individuals with HF. These findings suggest that functional training may be a promising and innovative exercise-based strategy to treat HF. TRIAL REGISTRATION: NCT03321682. Registered date: 26/10/2017.

High-output Cardiac Failure: A Forgotten Phenotype in Clinical Practice.

INTRODUCTION: The knowledge on High-Output Cardiac Failure (HOCF) has greatly improved in the last two decades. One of the advances was the identification of a new phenotype of HOCF, characterized by the absence of ventricular dilation, already associated with liver disease, Arteriovenous Fistulas (AVF), lung disease, myelodysplastic syndromes, and obesity. However, it has been noted that any aetiology can present with one of the two phenotypes, depending on the evolution. OBJECTIVE: The study aims to describe, through an integrative review, the physiopathology and aetiologies of HOCF and to discuss phenotypes associated with this condition. METHODS: Revisions, guidelines, case-controls, cohort studies and clinical studies were searched in MEDLINE and LILACS, using the connectives in the "cardiac output, high" database (MeSH Terms) OR "high cardiac output" (All Fields). DISCUSSION: Two distinct phenotypes are currently described in the HOCF, regardless of the aetiology: 1) one with enlarged cardiac chambers; and 2) with normal heart chambers. The mechanisms related to HOCF are vasodilation, arteriovenous shunts that cause increased microvascular density, Reduced Systemic Vascular Resistance (RSVR), and high metabolism. These mechanisms lead to activation of the renin-angiotensin-aldosterone system, sodium and water retention, activation of neprilysin, of the sodium-glucose-2 transporter, which promote interstitial fibrosis, ventricular remodeling and a consequent increase in cardiac output >8L/min. CONCLUSION: Many aetiologies of HOCF have been described, and some of them are potentially curable. Prompt recognition of this condition and proper treatment may lead to better outcomes.

Management and Outcomes of Neonatal Arteriovenous Brain Malformations with Cardiac Failure: A 17 Years' Experience in a Tertiary Referral Center.

OBJECTIVES: To assess the management and outcomes of neonatal arteriovenous brain malformations (mostly vein of Galen malformations) complicated by cardiac failure in the era of prenatal diagnosis and endovascular treatment in a tertiary referral center. STUDY DESIGN: This observational study included 77 living newborn infants with arteriovenous brain malformations with cardiac failure, admitted to our referral center from 2001 to 2017. All infants underwent cardiovascular evaluation including echocardiogram and brain magnetic resonance imaging. Long-term survivors had standard neurocognitive assessments. RESULTS: Infants were admitted to the neonatal intensive care unit at a median of 5 days of age (including 18 inborn patients since 2009). Sixty transarterial shunt embolizations were performed in 46 patients during their first month (at a median age of 7.5 days) or postponed beyond the first month in another 10 long-term survivors. Embolization was not performed in 21 infants, including 19 nonsurvivors with severe brain injury, uncontrolled cardiac failure, or multiple organ failure. Cardiac failure requiring vasopressor infusion occurred in 48 patients (64%) during the hospitalization. Infants who survived the first month underwent a median of 3 embolization sessions. Among the 51 survivors, 21 had a good outcome and 19 had a poor outcome at follow-up (median age, 5.3 years); 11 children were lost to follow-up. CONCLUSIONS: In the era of multidisciplinary prenatal diagnosis, using a standardized care protocol, 47% of liveborn infants with an arteriovenous shunt malformation with cardiac failure experienced a favorable outcome.

Evidence related to sodium restriction in patients with heart failure / Pruebas relacionadas con la restricción de sodio en pacientes con insuficiencia cardíaca / Evidências relacionadas à restrição de sódio em pacientes com insuficiência cardíaca

ABSTRACT Objectives: to analyze the scientific production about sodium restriction in patients with heart failure. Methods: integrative literature review from articles published from 2007 to 2017, located in the CINAHL and Scopus databases. Results: thirteen studies were analyzed. Sodium intake restriction was associated with lower unfavorable clinical outcomes in patients with marked symptomatology. The 24-hour urine sodium dosage was the main tool to assess adherence to the low sodium diet. Conclusions: based on the studies included in this review, in symptomatic patients, dietary sodium restriction should be encouraged in clinical practice as a protective measure for health. However, in asymptomatic patients, it should be well studied.

RESUMEN Objetivo: analizar la producción científica sobre la restricción de sodio en pacientes con insuficiencia cardíaca. Métodos: revisión integral de la literatura de artículos publicados de 2007 a 2017, ubicados en las bases de datos CINAHL y Scopus. Resultados: se analizaron trece estudios. La restricción en la ingesta de sodio se asoció con resultados clínicos desfavorables más bajos en pacientes con marcada sintomatología. La dosis de sodio en orina de 24 horas fue la herramienta principal para evaluar el cumplimiento de la dieta baja en sodio. Conclusión: según los estudios incluidos en esta revisión, en pacientes sintomáticos, se debe fomentar la restricción de sodio en la dieta en la práctica clínica como medida de protección para la salud. Sin embargo, en pacientes asintomáticos, debe estudiarse bien.

RESUMO Objetivos: analisar a produção científica acerca da restrição de sódio em pacientes com insuficiência cardíaca. Métodos: revisão integrativa da literatura, a partir de artigos publicados no período de 2007 a 2017, localizados nas bases de dados CINAHL e Scopus. Resultados: foram analisados 13 estudos. A restrição no consumo de sódio se mostrou associada a menores desfechos clínicos desfavoráveis em pacientes com sintomatologia acentuada. A dosagem de sódio na urina coletada em 24 horas foi a ferramenta principal para avaliar adesão à dieta com baixo teor de sódio. Conclusões: com base nos estudos incluídos nesta revisão, em pacientes sintomáticos, a restrição de sódio na dieta deve ser encorajada na prática clínica como medida protetora à saúde. No entanto, em pacientes assintomáticos, deve ser bem estudada.

Miocardiopatía no compactada asociada a Defectos cardiacos congénitos. Reporte de caso Hnerm-Essalud / Non compacted miocardiopathy associated with congenital heart Defects. Case report Hnerm-Essalud

El presente caso corresponde a un paciente de un mes de vida, sexo masculino con diagnóstico de miocardiopatía no compactada asociada a defectos cardiacos congénitos. La miocardiopatía no compactada recién es incluida por la American Heart Association (AHA) como entidad propia a partir de la segunda mitad de la década pasada. El diagnóstico principalmente es ecocardiográfico. La sintomatología en menores de un año puede empezar con falla cardiaca. La evolución es variable con tendencia a la mejoría en algunos casos para finalmente en décadas posteriores se hace más pronunciada la falla cardiaca, eventos tromboembólicos, arritmias malignas y muerte súbita. El manejo esta en medicamentos para falla cardiaca, evitar arritmias malignas y eventos tromboembólicos.

The present case corresponds to a 1-month-old male patient with a diagnosis of non-compacted cardiomyopathy associated with congenital heart defects. Noncompacted cardiomyopathy is newly included by the AHA as its own since the second half of the last decade. The diagnosis is mainly echocardiographic. Symptoms in children under one year may start with heart failure. The evolution is variable and tends to improve in some cases. Finally, in later decades, heart failure, thromboembolic events, malignant arrhythmias and sudden death become more pronounced. The management is in medicines for heart failure, to avoid malignant arrhythmias and thromboembolic events.

Acceso venoso para hemodiálisis y repercusión crónica en el sistema cardiovascular / Hemodialysis venous access and chronic impact on cardiovascular system

En el tratamiento de enfermos renales en fase terminal, se realizan accesos vasculares para hemodiálisis. Son hechos habitualmente, en las venas de los miembros superiores, especialmente la técnica de Brecia y Cimino (fístula arteriovenosa latero lateral de la cefálica y la radial en la muñeca). La mayor complicación, directamente relacionada con un flujo excesivo por la fístula arteriovenosa, es la insuficiencia cardíaca congestiva. Se presenta el caso de un paciente con una fístula arteriovenosa (iatrogénica) que causó una insuficiencia cardiaca congestiva. El paciente, hipertenso conocido, tuvo un acceso venoso de más de 10 años de evolución (por un aparente diagnóstico y para una futura hemodiálisis que nunca fue efectuada). Acudió a consulta con disnea y edemas periféricos. Al examen físico se encontró la tensión arterial en 160 y 100 mm Hg, signos clínicos de cardiomegalia, edemas periféricos, ingurgitación yugular y hepatomegalia. Se palpó un thrill sistodiastólico en la muñeca izquierda, donde presentaba una cicatriz. Pudo observarse marcada dilatación y endurecimiento de todas las venas superficiales del plexo braquial de ese lado, (arterialización del árbol venoso del miembro superior izquierdo hasta las venas superficiales del hemitórax). Se diagnosticó una insuficiencia cardiaca de gasto alto, mejoró con el tratamiento habitual, pero continuó con la malformación venosa adquirida. Fue un caso muy llamativo, que muestra una complicación poco frecuente de los accesos venosos para hemodiálisis y también una causa mencionada, pero escasamente vista, de insuficiencia cardiaca de gasto elevado(AU)

In the treatment of renal patients in terminal phase. Vascular accesses are used for hemodialysis. They are usually performed in the veins of the upper limbs, especially using Brecia and Cimino technique (lateral arteriovenous fistula of the cephalic and radial at the wrist). The major complication, directly related to an excessive flow of arteriovenous fistula, is congestive heart failure. We present the case of a patient with an arteriovenous (iatrogenic) fistula that caused a congestive heart failure. He is hypertensive and had venous access for over 10 years of evolution (for an apparent diagnosis and for future hemodialysis, which was never performed). He went to the clinic with dyspnea and peripheral edema. Physical examination revealed blood pressure of 160 and 100 mm Hg, clinical signs of cardiomegaly, peripheral edema, jugular engorgement and hepatomegaly. We found a systodiastolic thrill on his left wrist, where there is a scar. A marked dilation and hardening of all the superficial veins of the brachial plexus on that side was observed, that is arterialization of the venous tree of the left upper limb to the superficial veins of hemitorax. The diagnosis was high output heart failure. He improved with the usual treatment, but the acquired venous malformation continued in an iatrogenic manner. It was a very striking case because of the infrequent complication of venous accesses for hemodialysis and because for rarely seen elevated heart failure(AU)

[Direct medical costs of hospitalization due to heart failure in the health plan of the Hospital Italiano de Buenos Aires.] / Costos médicos directos de las Internaciones por Insuficiencia Cardiaca en el Plan de Salud del Hospital Italiano de Buenos Aires.

Introduction: It is undeniable that costs of medical care in chronic diseases has increased. There are multiple reasons: population aging, associated pathologies late complications, available high cost health technologies. Heart failure is one of the main causes of global death and morbidity, being the final consequence of cardiac diseases and hypertension, fulfilling criteria of becoming a high costs pathology. We are going to evaluate direct medical costs of hospitalization due to heart failure from the vision of those who manage health resources. Materials and Methods: Observational, retrospective cohort using secondary databases from the Hospital Italiano de Buenos Aires. Adult population with diagnosed heart failure that required hospitalization with discharge diagnosis of heart failure between 2007 and 2011. Results: The main cost component was attributable to hospital bed, diagnostic and therapeutic interventions. The average incidence of hospitalizations during the period was 11.4 per 10,000 patients / year. Overall mortality in the episode rate was 0.25% per year and 28.8 % overall 60% Conclusion: The most important decision seems decide whether management can be done on an outpatient basis or not, using heart failures guidelines to optimize time of admission, auxiliary diagnostic methods and medications used.

Introducción: Es innegable el incremento de los costos de los cuidados médicos de las enfermedades crónicas. Existen múltiples razones: envejecimiento poblacional, complicaciones tardías de las patologías asociadas y disponibilidad de tecnologías sanitarias de alto costo. La insuficiencia cardiaca es una de las principales causas mundiales de mortalidad y morbilidad, siendo la consecuencia final de las enfermedades cardíacas y la hipertensión arterial, cumpliendo criterios para convertirse en una patología de gran consumo de recursos. En el presente trabajo estudiaremos los costos de la insuficiencia cardiaca desde la visión de quienes gestionan los recursos sanitarios. Materiales y Métodos: Estudio observacional, de cohorte retrospectiva utilizando bases de datos secundarias del Plan de Salud del Hospital Italiano de Buenos Aires. Población adulta con diagnóstico de insuficiencia cardiaca que hayan requerido internación con diagnóstico al egreso de insuficiencia cardiaca entre los años 2007 y 2011.ResultadosEl principal componente de los costos fue atribuible a la estadía hospitalaria, las intervenciones diagnósticas y terapéuticas. La incidencia media de internaciones durante el período fue de 11.4 por cada 10.000 pacientes/año. La mortalidad global en el episodio índice fue del 0,25%, al año 28,8% y global del 60%ConclusiónLa decisión más importante parece ser decidir si el manejo puede hacerse ambulatoriamente o no, poniendo en marcha guías de manejo de la insuficiencia cardiaca para optimizar tiempos de internación, métodos auxiliares de diagnóstico y los medicamentos utilizados. Resultados: El principal componente de los costos fue atribuible a la estadía hospitalaria, las intervenciones diagnósticas y terapéuticas. La incidencia media de internaciones durante el período fue de 11.4 por cada 10.000 pacientes/año. La mortalidad global en el episodio índice fue del 0,25%, al año 28,8% y global del 60% Conclusión: La decisión más importante parece ser decidir si el manejo puede hacerse ambulatoriamente o no, poniendo en marcha guías de manejo de la insuficiencia cardiaca para optimizar tiempos de internación, métodos auxiliares de diagnóstico y los medicamentos utilizados.

White muscle disease in three selenium deficient beef and dairy calves in Argentina and Uruguay / Doença do músculo branco em três bezerros para carne e leite deficientes em selênio na Argentina e Uruguai

White muscle disease (WMD), nutritional myodegeneration or enzootic muscular dystrophy, is a nutritional condition associated with selenium and/or vitamin E deficiency in ruminants. These elements are constituents of the major body antioxidant systems. Depletion of selenium results in oxidative damage to cardiac and skeletal muscle cells, resulting in myodegeneration and myonecrosis, typical lesions of WMD. Selenium deficiency is common in South America, but WMD is underreported. This research describes clinical, biochemical and pathological findings in two episodes of WMD associated with selenium deficiency in beef and dairy calves in Argentina and Uruguay with concurrent copper deficiency in one of them, which resulted in spontaneous calf mortality. Further studies are necessary to estimate the true incidence and economic impact of clinical and subclinical mineral deficiencies in livestock production systems in the southern cone of South America.(AU)

Doença do músculo branco (DMB), miodegeneração nutricional ou distrofia muscular enzoótica é uma condição nutricional associada à deficiência de selênio e/ou vitamina E em ruminantes. Esses elementos são constituintes dos principais sistemas antioxidantes do corpo. O esgotamento de selênio resulta em dano oxidativo às células musculares cardíacas e esqueléticas, resultando em miodegeneração e mionecrose, lesões típicas da DMB. A deficiência de selênio é comum na América do Sul, mas a DMB está subnotificada. Este trabalho descreve os achados clínicos, bioquímicos e patológicos em dois surtos de DMB associados à deficiência de selênio em bezerros para carne e leite na Argentina e Uruguai com concomitante deficiência de cobre em um surto, que resultaram em mortalidade espontânea de bezerros. São necessários mais estudos para estimar a verdadeira incidência e impacto econômico das deficiências minerais clínicas e subclínicas nos sistemas de produção pecuária no sul da América do Sul.(AU)

White muscle disease in three selenium deficient beef and dairy calves in Argentina and Uruguay / Doença do músculo branco em três bezerros para carne e leite deficientes em selênio na Argentina e Uruguai

ABSTRACT: White muscle disease (WMD), nutritional myodegeneration or enzootic muscular dystrophy, is a nutritional condition associated with selenium and/or vitamin E deficiency in ruminants. These elements are constituents of the major body antioxidant systems. Depletion of selenium results in oxidative damage to cardiac and skeletal muscle cells, resulting in myodegeneration and myonecrosis, typical lesions of WMD. Selenium deficiency is common in South America, but WMD is underreported. This research describes clinical, biochemical and pathological findings in two episodes of WMD associated with selenium deficiency in beef and dairy calves in Argentina and Uruguay with concurrent copper deficiency in one of them, which resulted in spontaneous calf mortality. Further studies are necessary to estimate the true incidence and economic impact of clinical and subclinical mineral deficiencies in livestock production systems in the southern cone of South America.

RESUMO: Doença do músculo branco (DMB), miodegeneração nutricional ou distrofia muscular enzoótica é uma condição nutricional associada à deficiência de selênio e/ou vitamina E em ruminantes. Esses elementos são constituintes dos principais sistemas antioxidantes do corpo. O esgotamento de selênio resulta em dano oxidativo às células musculares cardíacas e esqueléticas, resultando em miodegeneração e mionecrose, lesões típicas da DMB. A deficiência de selênio é comum na América do Sul, mas a DMB está subnotificada. Este trabalho descreve os achados clínicos, bioquímicos e patológicos em dois surtos de DMB associados à deficiência de selênio em bezerros para carne e leite na Argentina e Uruguai com concomitante deficiência de cobre em um surto, que resultaram em mortalidade espontânea de bezerros. São necessários mais estudos para estimar a verdadeira incidência e impacto econômico das deficiências minerais clínicas e subclínicas nos sistemas de produção pecuária no sul da América do Sul.

White muscle disease in three selenium deficient beef and dairy calves in Argentina and Uruguay / Doença do músculo branco em três bezerros para carne e leite deficientes em selênio na Argentina e Uruguai

White muscle disease (WMD), nutritional myodegeneration or enzootic muscular dystrophy, is a nutritional condition associated with selenium and/or vitamin E deficiency in ruminants. These elements are constituents of the major body antioxidant systems. Depletion of selenium results in oxidative damage to cardiac and skeletal muscle cells, resulting in myodegeneration and myonecrosis, typical lesions of WMD. Selenium deficiency is common in South America, but WMD is underreported. This research describes clinical, biochemical and pathological findings in two episodes of WMD associated with selenium deficiency in beef and dairy calves in Argentina and Uruguay with concurrent copper deficiency in one of them, which resulted in spontaneous calf mortality. Further studies are necessary to estimate the true incidence and economic impact of clinical and subclinical mineral deficiencies in livestock production systems in the southern cone of South America.

Doença do músculo branco (DMB), miodegeneração nutricional ou distrofia muscular enzoótica é uma condição nutricional associada à deficiência de selênio e/ou vitamina E em ruminantes. Esses elementos são constituintes dos principais sistemas antioxidantes do corpo. O esgotamento de selênio resulta em dano oxidativo às células musculares cardíacas e esqueléticas, resultando em miodegeneração e mionecrose, lesões típicas da DMB. A deficiência de selênio é comum na América do Sul, mas a DMB está subnotificada. Este trabalho descreve os achados clínicos, bioquímicos e patológicos em dois surtos de DMB associados à deficiência de selênio em bezerros para carne e leite na Argentina e Uruguai com concomitante deficiência de cobre em um surto, que resultaram em mortalidade espontânea de bezerros. São necessários mais estudos para estimar a verdadeira incidência e impacto econômico das deficiências minerais clínicas e subclínicas nos sistemas de produção pecuária no sul da América do Sul.

N-Acetylcysteine Influence on Oxidative Stress and Cardiac Remodeling in Rats During Transition from Compensated Left Ventricular Hypertrophy to Heart Failure.

BACKGROUND/AIMS: To evaluate the effects of the antioxidant N-acetylcysteine (NAC) on cardiac structure and function in rats with long-term ascending aortic stenosis (AS). METHODS: Four months after inducing AS, Wistar rats were assigned into the groups Sham, AS, and AS treated with NAC (AS-NAC) and followed for eight weeks. Cardiac structure and function were evaluated by echocardiogram. Myocardial antioxidant enzymes activity was measured by spectrophotometry and malondialdehyde serum concentration by HPLC. Gene expression of NADPH oxidase subunits NOX2, NOX4, p22 phox, and p47 phox was assessed by real time RT-PCR and protein expression of MAPK proteins by Western blot. Statistical analyzes were performed with Goodman and ANOVA or Mann-Whitney Results: NAC restored myocardial total glutathione (Sham 20.8±3.00; AS 12.6±2.92; AS-NAC 17.6±2.45 nmol/g tissue; p<0.05 AS vs Sham and AS-NAC). Malondialdehyde serum concentration was lower in AS-NAC and myocardial lipid hydroperoxide was higher in AS (Sham 199±48.1; AS 301±36.0; AS-NAC 181±41.3 nmol/g tissue). Glutathione peroxidase activity was lower in AS than Sham. Echocardiogram showed LV concentric hypertrophy with systolic and diastolic dysfunction before and after treatment; no differences were observed between AS-NAC and AS groups. NAC reduced p-ERK and p-JNK protein expression, attenuated myocardial fibrosis, and decreased the frequency of right ventricular hypertrophy. CONCLUSION: N-acetylcysteine restores myocardial total glutathione, reduces systemic and myocardial oxidative stress, improves MAPK signaling, and attenuates myocardial fibrosis in aortic stenosis rats.

Ensayo clínico aleatorizado con grupos paralelos para comparar los cambios en los niveles del pro-péptido natriurético cerebral (Pro-PNC 1-76 ) en pacientes con falla cardiaca crónica sometidos a un programa de ejercicio supervisado versus basado en la comunidad / Randomized clinical trial with parallel groups to compare changes in N-terminal prohormone of brain natriuretic peptide (ProBNP1-76) levels in patients with chronic heart failure subject to a supervised exercise program versus a community based exercise program

Resumen Objetivo: evaluar los niveles de pro-péptido natriurético cerebral (Pro-PNC - 76) de un grupo de pacientes con falla cardiaca crónica, quienes realizaron un programa de ejercicio protocolizado y compararlos con un grupo control con ejercicio basado en la comunidad. Diseño y métodos: ensayo clínico controlado con: doble enmascaramiento, diseño paralelo en pacientes mayores de 18 años, diagnóstico de falla cardiaca clasificación New York Heart Association (NYHA) II-IV para comparar el cambio en los niveles de pro-péptido natriurético cerebral (Pro-PNQ 1-76 ). Resultados: veintitrés pacientes ingresaron al grupo de intervención y 26 al grupo control. Fallecieron cinco pacientes, seis se rehusaron completar todas las evaluaciones y un paciente no logró realizar la prueba de esfuerzo cardiopulmonar. Los niveles de pro-péptido natriurético cerebral (Pro-PNC1-76) y el consumo de oxígeno (VO2) no se modificaron en el grupo de intervención de forma estadísticamente significativa al compararlo con el grupo control. La calidad de vida relacionada con la salud mejoró significativamente en el grupo de intervención en las dimensiones de cambio en la percepción del estado de salud (p=0.007), desempeño emocional (p=0.011), desempeño físico (p=0.006), función física (p=0.024), salud mental (p=0.009) y salud general (p=0.01). Conclusión: la aplicación de un programa de ejercicio supervisado en pacientes con falla cardiaca no modificó los niveles de péptido natriurético cerebral, ni el consumo de oxígeno a las ocho semanas, pero fue efectivo para mejorar la calidad de vida relacionada con la salud (Clinical trials número NCT02087670). (Acta Med Colomb 2017: 42: 180-188).

Abstract Objective: To evaluate ProBNP 1-76 levels of a group of patients with chronic heart failure, who performed a protocolized exercise program and compare them with a control group with community-based exercise program. Design and Methods: Controlled clinical trial with double masking, parallel design in patients older than 18 years with diagnosis of heart failure, New York Heart Association (NYHA) II-IV Classification, to compare the change in Pro-Brain Natriuretic Peptide (ProBNP 1-76 ) Results: Twenty-three (23) patients were admitted to the intervention group and 26 to the control group. Five patients died, six refused to complete all assessments and one patient failed to perform the cardiopulmonary exercise test. ProBNP1-76 levels and oxygen consumption (VO2) were not altered significantly in the intervention group when compared to the control group. Health-related quality of life improved significantly in the intervention group in the dimensions of change in the perception of health status (p = 0.007), emotional performance (p = 0.011), physical performance (p = 0.006), physical function (p = 0.024), mental health (p = 0.009) and general health (p = 0.01). Conclusion: The application of a supervised exercise program in patients with heart failure did not modify brain natriuretic peptide levels or oxygen consumption at eight weeks, but was effective in improving health-related quality of life (Clinical trials number NCT02087670). (Acta Med Colomb 2017: 42: 180-188).

Retrospective study of jellyfish envenomation in emergency wards in Guadeloupe between 2010 and 2016: When to diagnose Irukandji syndrome?

BACKGROUND: In Guadeloupe (French West Indies), many marine envenomation cases by jellyfish are observed. Some of them might induce an Irukandji syndrome (IS). The aim of this study was to analyse the clinical features of IS from the envenomation cases in the two public hospitals in Guadeloupe, and to compare them to non-IS stings. METHODS: All jellyfish envenomation cases between the 1st of January 2010 and the 1st of September 2016, from the emergencies data-base, have been extracted. The primary endpoint was the existence of an IS defined by a jellyfish sting followed by one of the symptoms among: severe lumbosacral, thoracic or abdominal pain, muscle cramps of the four limbs, profuse sweating, anxiety, restlessness, nausea, or vomiting. RESULTS: Two hundred and eleven envenomation cases have been extracted, 45.0% of them happened between the 22nd and the 26th day of the lunar phase during a period from June to September. Ninety five patients had an IS. Three of them had Quincke's edema and one a cardiopulmonary failure. Other clinical signs have been associated with IS compared to other sting cases, including hypertension (51.6% vs 18.1%, p < 0.001), tremor (32.6% vs 14.7%, p = 0.0014), paresthesia (20.0% vs. 10.3%, p = 0.049), dyspnea (13.7% vs 3.4%, p = 0.006), and the pain evaluation by the visual analogue pain scale (7.5 ± 2.6 and 6.0 ± 2.6, p = 0.001). CONCLUSION: Jellyfish envenomation is frequently associated with IS in Guadeloupean emergency wards. The IS cases were probably due to the species Alatina alata, and their periodicity can be determined according to the cycle of the moon. If patients showed symptoms slightly less severe than those in Australian studies, a case of cardiac decompensation, the first out of the Pacific, was observed. Based on our results, new definition of IS and severe IS are proposed.

Neonatal and pediatric extracorporeal membrane oxygenation in developing Latin American countries / Oxigenação por membrana extracorpórea neonatal e pediátrica em países emergentes da América Latina

Abstract Objective: To review the principles of neonatal-pediatric extracorporeal membrane oxygenation therapy, prognosis, and its establishment in limited resource-limited countries in Latino America. Sources: The PubMed database was explored from 1985 up to the present, selecting from highly-indexed and leading Latin American journals, and Extracorporeal Life Support Organization reports. Summary of the findings: Extracorporeal membrane oxygenation provides “time” for pulmonary and cardiac rest and for recovery. It is used in the neonatal-pediatric field as a rescue therapy for more than 1300 patients with respiratory failure and around 1000 patients with cardiac diseases per year. The best results in short- and long-term survival are among patients with isolated respiratory diseases, currently established as a standard therapy in referral centers for high-risk patients. The first neonatal/pediatric extracorporeal membrane oxygenation Program in Latin America was established in Chile in 2003, which was also the first program in Latin America to affiliate with the Extracorporeal Life Support Organization. New extracorporeal membrane oxygenation programs have been developed in recent years in referral centers in Argentina, Colombia, Brazil, Mexico, Perú, Costa Rica, and Chile, which are currently funding the Latin American Extracorporeal Life Support Organization chapter. Conclusions: The best results in short- and long-term survival are in patients with isolated respiratory diseases. Today extracorporeal membrane oxygenation therapy is a standard therapy in some Latin American referral centers. It is hoped that these new extracorporeal membrane oxygenation centers will have a positive impact on the survival of newborns and children with respiratory or cardiac failure, and that they will be available for an increasing number of patients from this region in the near future.

Resumo Objetivo: Analisar os fundamentos, o prognóstico e o estabelecimento da terapia de oxigenação por membrana extracorpórea ECMO neonatal-pediátrica em países da América Latina com recursos limitados. Fontes: A base de dados PubMed foi explorada de 1985 até hoje, selecionamos os principais periódicos da América Latina e relatos da Organização de Suporte de Vida Extracorpóreo. Resumo dos achados: A oxigenação por membrana extracorpórea proporciona “tempo” para descanso pulmonar e cardíaco e para recuperação. Ela é usada no campo neonatal-pediátrico como terapia de resgate, com mais de 1.300 pacientes com insuficiência respiratória e cerca de 1.000 pacientes com cardiopatias por ano. Os melhores resultados de sobrevida de curto e longo prazo são de pacientes com doenças respiratórias isoladas, o que estabelece uma terapia padrão em centros de encaminhamento para pacientes de alto risco. O primeiro programa de oxigenação por membrana extracorpórea neonatal/pediátrico na América Latina foi estabelecido no Chile em 2003, que também foi o primeiro programa na América Latina a se afiliar à Organização de Suporte de Vida Extracorpóreo. Novos programas de oxigenação por membrana extracorpórea foram desenvolvidos nos últimos anos em centros de encaminhamento em Argentina, Colômbia, Brasil, México, Peru, Costa Rica e Chile, que atualmente fundam a seção da América Latina da Organização de Suporte de Vida Extracorpóreo. Conclusões: Os melhores resultados de sobrevida de curto e longo prazo são de pacientes com doenças respiratórias isoladas. Atualmente, a terapia de oxigenação por membrana extracorpórea é uma terapia padrão em alguns centros de encaminhamento da América Latina. Esperamos que esses novos centros de oxigenação por membrana extracorpórea tenham um impacto positivo sobre a sobrevida de neonatos e crianças com insuficiência respiratória ou cardíaca e que estejam disponíveis para um número cada vez maior de pacientes de nossa região no futuro próximo.

Experimental poisoning by Niedenzuella stannea in cattle and corresponding detection of monofluoroacetate / Intoxicação experimental por Niedenzuella stannea em bovinos e correspondente detecção de monofluoroacetato

In Brazil sodium monofluoroacetate (MFA) containing plants are represented by 16 species that belong to three principle genera: Palicourea ( Rubiaceae ), Amorimia ( Malpighiaceae ), and Tanaecium ( Bignoniaceae ). These plants can cause acute cardiac failure often referred to as sudden death syndrome. The objective of this paper was to determine if N. stannea contains MFA and to report the clinical signs and pathology of cattle experimentally poisoned by this plant. MFA was detected in all N. stannea plant parts except mature leaves. Niedenzuella stannea was dosed to cattle at single doses of 15-30g kg-1 bw. Clinical signs and pathology observed were similar to those reported by other MFA-containing plants. Animals showed marked tachycardia, labored breathing, muscle tremors, loss of balance, ataxia, falling, recumbence, pedaling movements, and opisthotonous leading to death in few minutes. Gross lesions included engorgement of the large veins, severe lung edema, and petechiae , ecchymosis and suffusions in the pericardium, epicardium and pleura. Histologically, hydropic vacuolar degeneration and necrosis of epithelial cells of the kidney were observed. Cattle that received daily doses of 4g kg-1 body weight for 24 days showed no clinical signs. In summary, this is the first report that N. stannea contains monofluoroacetate and causes sudden death in cattle. (AU)

No Brasil as plantas que contêm monofluoroacetato de sódio (MFA) são representadas por 16 espécies e pertencem a três principais gêneros: Palicourea ( Rubiaceae ), Amorimia ( Malpighiaceae ) e Tanaecium ( Bignoniaceae ). Estas plantas podem causar falha cardíaca aguda que frequentemente é referida como síndrome da morte súbita. O objetivo deste trabalho é determinar se N. stannea contêm MFA e relatar os sinais clínicos e patológicos em bovinos associados à intoxicação experimental por esta planta. Monofluoroacetato foi detectado em todas as partes da N. stannea , exceto em folhas maduras. Niedenzuella stannea foi fornecida a bovinos em doses únicas de 15-30g kg-1 peso vivo. Os sinais clínicos e patológicos observados foram similares aos relatados pelas intoxicações por outras plantas que contêm monofluoroacetato. Os animais apresentaram taquicardia acentuada, respiração profunda, tremores musculares, perda de equilíbrio, ataxia, queda, decúbito, movimentos de pedalagem e opistótono, seguido de morte em poucos minutos. As lesões macroscópicas observadas foram ingurgitamento de grandes vasos, edema pulmonar acentuado, petéquias, equimoses e sufusões no pericárdio, epicárdio e pleura. Histologicamente foi observado degeneração hidrópica vacuolar e necrose de células do epitélio renal. Bovinos que receberam doses diárias de 4g kg-1 peso vivo por 24 dias seguidos não apresentaram sinais clínicos. Este é o primeiro relato que N. stannea contêm MFA e causa morte súbita em bovinos. (AU)

Experimental poisoning by Niedenzuella stannea in cattle and corresponding detection of monofluoroacetate / Intoxicação experimental por Niedenzuella stannea em bovinos e correspondente detecção de monofluoroacetato

In Brazil sodium monofluoroacetate (MFA) containing plants are represented by 16 species that belong to three principle genera: Palicourea ( Rubiaceae ), Amorimia ( Malpighiaceae ), and Tanaecium ( Bignoniaceae ). These plants can cause acute cardiac failure often referred to as sudden death syndrome. The objective of this paper was to determine if N. stannea contains MFA and to report the clinical signs and pathology of cattle experimentally poisoned by this plant. MFA was detected in all N. stannea plant parts except mature leaves. Niedenzuella stannea was dosed to cattle at single doses of 15-30g kg-1 bw. Clinical signs and pathology observed were similar to those reported by other MFA-containing plants. Animals showed marked tachycardia, labored breathing, muscle tremors, loss of balance, ataxia, falling, recumbence, pedaling movements, and opisthotonous leading to death in few minutes. Gross lesions included engorgement of the large veins, severe lung edema, and petechiae , ecchymosis and suffusions in the pericardium, epicardium and pleura. Histologically, hydropic vacuolar degeneration and necrosis of epithelial cells of the kidney were observed. Cattle that received daily doses of 4g kg-1 body weight for 24 days showed no clinical signs. In summary, this is the first report that N. stannea contains monofluoroacetate and causes sudden death in cattle.

No Brasil as plantas que contêm monofluoroacetato de sódio (MFA) são representadas por 16 espécies e pertencem a três principais gêneros: Palicourea ( Rubiaceae ), Amorimia ( Malpighiaceae ) e Tanaecium ( Bignoniaceae ). Estas plantas podem causar falha cardíaca aguda que frequentemente é referida como síndrome da morte súbita. O objetivo deste trabalho é determinar se N. stannea contêm MFA e relatar os sinais clínicos e patológicos em bovinos associados à intoxicação experimental por esta planta. Monofluoroacetato foi detectado em todas as partes da N. stannea , exceto em folhas maduras. Niedenzuella stannea foi fornecida a bovinos em doses únicas de 15-30g kg-1 peso vivo. Os sinais clínicos e patológicos observados foram similares aos relatados pelas intoxicações por outras plantas que contêm monofluoroacetato. Os animais apresentaram taquicardia acentuada, respiração profunda, tremores musculares, perda de equilíbrio, ataxia, queda, decúbito, movimentos de pedalagem e opistótono, seguido de morte em poucos minutos. As lesões macroscópicas observadas foram ingurgitamento de grandes vasos, edema pulmonar acentuado, petéquias, equimoses e sufusões no pericárdio, epicárdio e pleura. Histologicamente foi observado degeneração hidrópica vacuolar e necrose de células do epitélio renal. Bovinos que receberam doses diárias de 4g kg-1 peso vivo por 24 dias seguidos não apresentaram sinais clínicos. Este é o primeiro relato que N. stannea contêm MFA e causa morte súbita em bovinos.

Experimental poisoning by Niedenzuella stannea in cattle and corresponding detection of monofluoroacetate

ABSTRACT: In Brazil sodium monofluoroacetate (MFA) containing plants are represented by 16 species that belong to three principle genera: Palicourea ( Rubiaceae ), Amorimia ( Malpighiaceae ), and Tanaecium ( Bignoniaceae ). These plants can cause acute cardiac failure often referred to as sudden death syndrome. The objective of this paper was to determine if N. stannea contains MFA and to report the clinical signs and pathology of cattle experimentally poisoned by this plant. MFA was detected in all N. stannea plant parts except mature leaves. Niedenzuella stannea was dosed to cattle at single doses of 15-30g kg-1 bw. Clinical signs and pathology observed were similar to those reported by other MFA-containing plants. Animals showed marked tachycardia, labored breathing, muscle tremors, loss of balance, ataxia, falling, recumbence, pedaling movements, and opisthotonous leading to death in few minutes. Gross lesions included engorgement of the large veins, severe lung edema, and petechiae , ecchymosis and suffusions in the pericardium, epicardium and pleura. Histologically, hydropic vacuolar degeneration and necrosis of epithelial cells of the kidney were observed. Cattle that received daily doses of 4g kg-1 body weight for 24 days showed no clinical signs. In summary, this is the first report that N. stannea contains monofluoroacetate and causes sudden death in cattle.

RESUMO: No Brasil as plantas que contêm monofluoroacetato de sódio (MFA) são representadas por 16 espécies e pertencem a três principais gêneros: Palicourea ( Rubiaceae ), Amorimia ( Malpighiaceae ) e Tanaecium ( Bignoniaceae ). Estas plantas podem causar falha cardíaca aguda que frequentemente é referida como síndrome da morte súbita. O objetivo deste trabalho é determinar se N. stannea contêm MFA e relatar os sinais clínicos e patológicos em bovinos associados à intoxicação experimental por esta planta. Monofluoroacetato foi detectado em todas as partes da N. stannea , exceto em folhas maduras. Niedenzuella stannea foi fornecida a bovinos em doses únicas de 15-30g kg-1 peso vivo. Os sinais clínicos e patológicos observados foram similares aos relatados pelas intoxicações por outras plantas que contêm monofluoroacetato. Os animais apresentaram taquicardia acentuada, respiração profunda, tremores musculares, perda de equilíbrio, ataxia, queda, decúbito, movimentos de pedalagem e opistótono, seguido de morte em poucos minutos. As lesões macroscópicas observadas foram ingurgitamento de grandes vasos, edema pulmonar acentuado, petéquias, equimoses e sufusões no pericárdio, epicárdio e pleura. Histologicamente foi observado degeneração hidrópica vacuolar e necrose de células do epitélio renal. Bovinos que receberam doses diárias de 4g kg-1 peso vivo por 24 dias seguidos não apresentaram sinais clínicos. Este é o primeiro relato que N. stannea contêm MFA e causa morte súbita em bovinos.

Regurgitación mitral funcional severa, Manejo percutáneo con clip mitral, una ósegura para pacientes que no pueden ser llevados a cirugía / Severe functional mitral regurgitation, Percutaneous mitral valve repair with the mitraclip system, a safe option for patients who can not be taken to surgery

Resumen La regurgitación mitral funcional (RMF) es una complicación frecuente en pacientes que cursan con una falla cardiaca dilatada, se desarrolla como consecuencia de la remodelación y crecimiento de cavidades que lleva a un incremento de las fuerzas que traicionan el aparato valvular mitral causando su mal funcionamiento. La RMF es una causa conocida de disnea, deterioro funcional, isquemia miocárdica y de disfunción ventricular, a pesar de la terapia medica disponible, causa deterioro de la calidad de vida de los pacientes y de ingresos frecuentes a los servicios de urgencias por descompensaciones. Reportamos un caso de RMF con riesgo alto para cirugía correctiva, con deterioro de su calidad de vida, llevada a implante de clip mitral de forma exitosa y sin complicaciones.

Abstract Functional mitral regurgitation (MR) is a common complication in patients with dilated cardiac failure. It develops as a consequence of the remodeling and growth of cavities leading to an increase in the forces that pull the mitral valve apparatus causing its malfunction. Functional MR is a known cause of dyspnea, functional deterioration, myocardial ischemia and ventricular dysfunction. Despite the available medical therapy it causes deterioration of the quality of life of the patients and frequent admissions to the emergency services due to decompensation. A case of functional MR with high risk for corrective surgery with deterioration of the quality of life that led to a successful mitral valve implant without complications, is presented.