Evaluation of right ventricle systolic function after tetralogy of Fallot repair: A systematic review comparing cardiac magnetic resonance and global longitudinal strain.

BACKGROUND: Most patients who undergo tetralogy of Fallot (TOF) repair experience late right ventricle (RV) dysfunction due to pulmonary valve regurgitation (PVR). Cardiac magnetic resonance (CMR) is the gold standard method for evaluating RV during follow-up. Global longitudinal strain (GLS) has been introduced as a novel method for the assessment of RV dysfunction. We aimed to compare the feasibility of GLS and CMR for assessing RV function after TOF repair. METHODS: We systematically reviewed the English literature using PubMed, SciELO and Google Scholar for articles published between January 1, 2015, and December 31, 2020. Articles evaluating RV function comparing by GLS and CMR after TOF repair were included. RESULTS: Nine studies including 465 patients were analyzed. Most patients were men (280; 60%), the male:female ratio was 1.5:1, and the age range was .8 to 57.7 years. The mean follow-up time was 6 to 32 months. The correlation between RV GLS and RV ejection fraction (EF) by CMR was negative for the articles and varied from moderate to strong (r = -.45, r = -.60, r = -.76). CONCLUSION: Right ventricle GLS can be considered for routine follow-up of TOF repair patients, even though CMR remains the noninvasive gold standard method. Using a single parameter may not allow comparison of the accuracy of 3D RV EF by using CMR and GLS. Further studies with a larger number of patients undergoing TOF repair are required to evaluate the correlation between these examinations.

Estratégias terapêuticas e atualizações no tratamento de vitiligo / Therapeutic strategies and updates for treatment of vitiligo

O vitiligo é uma desordem dermatológica complexa, cuja patogênese ainda não é totalmente esclarecida. Apesar de não apresentar complicações funcionais no organismo dos pacientes acometidos, o vitiligo pode resultar em um grande impacto psicossocial. Desse modo, é importante que os médicos saibam como conduzir o tratamento dessa patologia. O objetivo deste estudo foi documentar as terapias disponíveis para o tratamento do vitiligo, assim como apontar pesquisas que relataram a utilização dessas opções terapêuticas e os dados resultantes. As terapias abordadas foram corticoides tópicos e sistêmicos, fototerapia e fotoquimioterapias, antioxidantes, imunomoduladores, fenilalanina, despigmentação, procedimentos cirúrgicos e novas abordagens. A monoterapia parece ser menos eficaz no tratamento do vitiligo. A associação de medicação tópica e/ou sistêmica com o uso da fototerapia ultravioleta B de banda estreita parece ser o padrão-ouro para a repigmentação da pele dos pacientes. Medicamentos novos estão em estudo, porém sua eficácia e o estudo dos possíveis efeitos colaterais, principalmente a longo prazo, têm que ser melhores investigados. É necessário que o médico dermatologista, em conjunto com o paciente, escolha a melhor terapia dentre as disponíveis, de acordo com critérios clínicos e a possibilidade de acesso ao tratamento pelo portador. O acompanhamento e a abordagem por uma equipe multiprofissional também são importantes. (AU)

Vitiligo is a complex dermatological disorder, whose pathogenesis has not yet been fully elucidated. Although it does not present functional complications in the affected patients' body, vitiligo can result in a great psychosocial impact. Therefore, it is important that physicians know how to conduct its treatment. This study aimed at documenting the available therapies for the treatment of vitiligo, as well as pointing out studies reporting the use of these therapeutic options and their resulting data. The therapies addressed were topical and systemic corticosteroids, phototherapy, and photochemotherapies, antioxidants, immunomodulators, phenylalanine, depigmentation, surgical procedures, and new approaches. Monotherapy appears to be less effective in the treatment of vitiligo. The combination of topical and/or systemic medication with the use of narrowband ultraviolet B phototherapy seems to be the gold standard for the patients' skin repigmentation. New drugs are under study, but their effectiveness and study of possible side effects, especially in the long run, have to be better investigated. It is necessary that the dermatologist, together with the patient, choose the best therapy among those available, according to clinical criteria and the possibility of access to treatment by the patient. Monitoring and approach by a multiprofessional team is also important. (AU)

Extensive pulmonary embolism as complication of oligosymptomatic COVID-19: case report.

Although the pathophysiology of coagulopathy associated with the 2019 coronavirus disease (COVID-19) is not well known, occurrence of pulmonary embolism (PE) is frequently observed. However, few cases have been described in the literature in which patients who had asymptomatic COVID-19, with no risk factors for venous thromboembolism (VTE), presented extensive acute PE. We report the case of a patient with asymptomatic COVID-19, complicated by deep vein thrombosis and later by extensive acute PE, suggesting that these conditions should be systematically considered, even in asymptomatic COVID-19 patients with no known risk factors for VTE.

Embolia pulmonar aguda extensa como complicação de COVID-19 oligossintomática: relato de caso / Extensive pulmonary embolism as complication of oligosymptomatic COVID-19: case report

Resumo Apesar de a fisiopatologia da coagulopatia associada à doença do coronavírus 2019 (COVID‐19) não ser bem conhecida, a ocorrência de embolia pulmonar (EP) é frequentemente observada. No entanto, foram descritos na literatura poucos casos de pacientes que tiveram COVID-19 oligossintomática, sem nenhum fator de risco para tromboembolismo venoso (TEV) e que apresentaram EP aguda extensa. Relatamos um caso de paciente com COVID-19 oligossintomática, complicada por trombose venosa profunda e, posteriormente, EP aguda extensa, sugerindo que esses quadros devem ser considerados de forma sistemática mesmo em pacientes com COVID-19 oligossintomática e sem fatores de risco conhecidos para TEV.

Abstract Although the pathophysiology of coagulopathy associated with the 2019 coronavirus disease (COVID-19) is not well known, occurrence of pulmonary embolism (PE) is frequently observed. However, few cases have been described in the literature in which patients who had asymptomatic COVID-19, with no risk factors for venous thromboembolism (VTE), presented extensive acute PE. We report the case of a patient with asymptomatic COVID-19, complicated by deep vein thrombosis and later by extensive acute PE, suggesting that these conditions should be systematically considered, even in asymptomatic COVID-19 patients with no known risk factors for VTE.