Multimodal imaging in Ig G4- related aortitis: case report.

We present the case of a 56-year-old patient with fever of unknown origin associated with chest and lumbar pain. Multimodality imaging revealed diffuse peri-aortitis in the thoracic aorta without involvement of the aortic valve, contributing substantially to the diagnosis of Ig G4-associated aortitis. Immunosuppressive therapy was started. Follow-up at five months with cardiac magnetic resonance imaging showed a reduction in the inflammatory process in the thoracic aorta.

Presentamos el caso de un paciente de 56 años, con cuadro febril de origen desconocido asociado a dolor torácico y lumbar. La imagen multimodal demostró periaortitis difusa en la aorta torácica sin afectación de la válvula aórtica, lo que contribuyó sustancialmente al diagnóstico de aortitis asociada a Ig4. Se inició tratamiento inmunosupresor. El seguimiento a los 5 meses, la resonancia magnética cardíaca mostró una reducción del proceso inflamatorio en la aorta torácica.

Collection of cardiac masses. Up-to-date echocardiography and cardiac MRI tools.

Heart masses, including tumors (primary and secondary) and pseudotumor (cysts and thrombus), are rare entities, but of increasing interest in cardiac imaging areas. The clinical manifestations are related to the intracardiac effect of mass, embolization, and systemic symptoms in the case of tumors; however, some of them are detected incidentally. Nowadays, imaging techniques and the advancement of their tools perform the morphological, functional, and tissue characterization of the masses, and additionally know the anatomical relationships, which are crucial factors for the treatment and surgical planning.

[Imagen multimodal de la pericarditis constrictiva: reporte de un caso de cirrosis cardiaca]. / Multimodal imaging in constrictive pericarditis: a case report of cardiac cirrhosis.

Constrictive pericarditis is a rare cause of ascites and cardiac cirrhosis. We present the case of a 36-year-old male patient with a history of cirrhosis of unknown etiology, who consulted for refractory ascites, dyspnea, and lower limb swelling. Echocardiography determined constrictive pericarditis, which was corroborated by the findings of computed tomography. The clinical and hemodynamic worsening of the patient led to an emergency pericardiectomy with satisfactory recovery. This report shows a severe clinical consequence of constrictive pericarditis, cardiac cirrhosis, which was reversible with pericardial extirpation. Multimodal imaging was essential in the diagnosis of constrictive pericarditis.

Role of echocardiography in the management of ventricular septal rupture after acute myocardial infarction.

Ventricular septal rupture (VSR) is a rare and devastating complication of acute myocardial infarction. Early detection, assessment of the hemodynamic impact, and illustration of the pathophysiological context are crucial functions of echocardiography in decision-making for intensive management and reparative intervention. To evaluate this entity, echocardiography exhibits two strengths: its bedside nature and its multiple modalities. This document reviews the comprehensive use of echocardiography in the study of post-infarction VSR.

Williams-Beuren syndrome associated with hammock mitral valve: First case report.

Williams-Beuren syndrome (WBS) is a multisystem congenital disorder, whose cardiovascular defects are the leading cause of death. We present the case of a 38-year-old man with features of heart failure. The imaging studies showed a typical supravalvular aortic stenosis and a hammock mitral valve, this last, being a rare congenital disease. This is the first case reported of a hammock mitral valve in a patient with this chromosomopathy.

In vivo exclusion of giant aortic thrombus: Transesophageal echocardiography in thoracic endovascular aortic repair: A case report: Transesophageal echocardiography in thoracic endovascular aortic repair: A case report.

We present the case of a 53-year-old patient with a giant floating thrombus in the aortic arch associated with proximal stenosis of the left subclavian artery diagnosed by multimodal imaging. Left carotid-subclavian shunt and thoracic endovascular aortic repair (TEVAR) were successful. Transesophageal echocardiography (TEE) played a substantial role in the safety and efficacy of the endovascular procedure and should be considered as an additional guide to fluoroscopy for this type of procedure.

Cardiopulmonary Imaging Utilization and Findings among Hospitalized COVID-19 Patients in Latin America: (From "RIMAC: Registry IMAging Cardiopulmonary among Hospitalized COVID-19 Patients in LATAM").

Objectives: Describe the use and findings of cardiopulmonary imaging-chest X-ray (cX-ray), echocardiography (cEcho), chest CT (cCT), lung ultrasound (LUS), and/or cardiac magnetic resonance imaging (cMRI)-in COVID-19 hospitalizations in Latin America (LATAM). Background: There is a lack of information on the images used and their findings during the SARS-CoV-2 pandemic in LATAM. Methods: Multicenter, prospective, observational study of COVID-19 inpatients, conducted from March to December 2020, from 12 high-complexity centers, in nine LATAM countries. Adults (>18 years) with at least one imaging modality performed, followed from admission until discharge and/or in-hospital death, were included. Results: We studied 1,435 hospitalized patients (64% males) with a median age of 58 years classified into three regions: Mexico (Mx), 262; Central America and Caribbean (CAC), 428; and South America (SAm), 745. More frequent comorbidities were overweight/obesity, hypertension, and diabetes. During hospitalization, 58% were admitted to the ICU. The in-hospital mortality was 28%, and it was highest in Mx (37%).The most frequent images performed were cCT (61%), mostly in Mx and SAm, and cX-ray (46%), significant in CAC. The cEcho was carried out in 18%, similarly among regions, and LUS was carried out in 7%, with a higher frequently in Mx. Abnormal findings on the cX-ray were peripheral or basal infiltrates, and in cCT abnormal findings were the ground glass infiltrates, more commonly in Mx. In LUS, interstitial syndrome was the most abnormal finding, predominantly in Mx and CAC.Renal failure was the most prevalent complication (20%), predominant in Mx and SAm. Heart failure developed in 13%, predominant in Mx and CAC. Lung thromboembolism was higher in Mx while myocardial infarction was in CAC.Logistic regression showed associations of abnormal imaging findings and their severity, with comorbidities, complications, and evolution. Conclusions: The use and findings of cardiopulmonary imaging in LATAM varied between regions and had a great impact on diagnosis and prognosis.

[Rheumatic mitral aggression. Usefulness of 3d transesophageal echocardiography]. / Agresión mitral reumática. utilidad de la ecocardiografía transesofágica 3D.

Rheumatic heart disease is the leading cause of cardiovascular disease in children under 25 years of age worldwide, with the highest prevalence in low-income countries. The usual and distinctive finding of rheumatic aggression is mitral stenosis, which leads to serious cardiovascular consequences. International guidelines establish transthoracic echocardiography (TTE) as the diagnostic test for rheumatic heart disease; however, it has limitations in the measurement of planimetry and those inherent to Doppler. Transesophageal 3D echocardiography (TTE-3D) is a new modality that shows realistic images of the mitral valve and has the added value of accurately locating the plane of maximum stenosis and better determining commissural involvement.

[Comparative analysis of myocardial deformation in patients recovered from mild SARS-CoV-2 infection]. / Análisis comparativo de la deformación miocárdica en pacientes recuperados de infección leve por SARS-CoV-2.

Objectives: During acute infection by the SARS-CoV-2 virus, myocardial involvement has been demonstrated; it is unknown if cardiovascular sequelae in patients recovered from this infection and if these are associated with global morbidity and mortality. The objective of this study was to compare myocardial deformation in patients recovered from mild SARS-CoV-2 virus infection with healthy controls. Materials and methods: This was a cross-sectional observational study that included 33 subjects recovered from mild SARS-CoV-2 infection, who were diagnosed in the previous three to six months, and 31 healthy volunteers, both groups free of cardiovascular risk factors. The study of myocardial deformation was performed using echocardiography with the speckle tracking modality. Clinical and anthropometric variables were compared. Results: The 2D global longitudinal strain of the left ventricle was lower in the subjects recovered from mild SARS-CoV-2 infection than the controls (-20.2% ± 2.6 v -21.6% ± 2.4; p: 0.036). Both groups presented differences in the three ventricular levels, significant at the apical level (-21.2 ± 4.0 vs -23.4% ± 4.2; p: 0.044). The effect by levels shows an inverse Takotsubo pattern. The left ventricular ejection fraction was preserved in both groups (p: 0.153). Conclusions: Left ventricular myocardial deformation is affected in subjects recovered from mild SARS-CoV-2 infection, while the ejection fraction was found in normal ranges. Our study shows a potential role of global longitudinal strain in the detection of subclinical myocardial alterations in patients who had SARS-CoV-2.

Association of DEAR1 Tagging Single Nucleotide Polymorphisms With Breast Cancer in a Sample of Colombian Population: A Case Control Study.

PURPOSE: Ubiquitin ligase genes can act as oncogenes or tumor suppressor genes. They play a role in various diseases, including development and progression of breast cancer; the objective of this study was to evaluate the association of common variants in the ductal-epithelium-associated RING chromosome 1 (DEAR1) gene with breast cancer risk in a sample of Colombian population. METHODS: We carried out a case-control study to investigate associations of variants in DEAR1 with breast cancer in women from Colombia. Single nucleotide polymorphisms (SNPs) rs584298, rs2927970, rs59983645, and rs599167 were genotyped in 1022 breast cancer cases and 1023 healthy controls using the iPLEX® and Kompetitive Allele Specific PCR (polymerase chain reaction) (KASP) method. The associations between SNPs and breast cancer were examined by conditional logistic regression. The associations between SNPs and epidemiological/histopathological variables were examined by multinomial logistic regression. RESULTS: Associations were found between tag SNPs and breast cancer adjusted for the epidemiological risk factors rs584298 genotypes AG and GG (P = .048 and P = .004, respectively). The analysis of the disease characteristics showed that SNP rs584298 (genotype AG) (P = .015) shows association with progesterone receptor (PR) status and (genotype AA) (P = .048) shows association with human epidermal growth factor receptor 2 (HER2) status. CONCLUSIONS: The SNP rs584298 in DEAR1 showed associations with breast cancer and the expression of HER2 receptor; when this receptor is amplified, the result is aggressive tumoral subtype and expression of PR receptor that is associated with high-proliferative tumor grade. Validation of this SNP is important to establish whether this variant or the tagged variant is the cause for the risk association showed.

Detection of hearing loss in newborns: Definition of a screening strategy in Bogotá, Colombia.

OBJECTIVE: To describe the results from the hearing screening protocol adopted in a Hospital in Colombia emphasizing the importance of performing screening on an outpatient basis, when the newborn is more than 24 h old. METHODS: A prospective study at Hospital Universitario San Ignacio in Bogota, Colombia was carried out, from May 1st, 2016 to Nov 30th, 2017, the study sample included 2.088 newborns examined using transient otoacoustic emissions. RESULTS: We obtained written consent from the parents of 1.523 newborns and 24 individuals (1.6%) failed the first stage of the screening, nine cases unilateral and 15 bilateral. A total of nine neonates (0,6%) failed the second screening test, six cases unilateral and three bilateral. Four (0,3%) did not return to the second test. Our false altered screening rate was 0.7%. CONCLUSIONS: In a developing country with limited human and economic resources, in which newborn early discharge is the norm, a newborn hearing screening program linked to infants' check-ups, that uses otoacoustic emissions after 48 h of life, seems a feasible option compare to the standard US protocol aiming to conduct hearing screening prior to discharge.

Correction: Patterns of sedentary behavior in overweight and moderately obese users of the Catalan primary-health care system.

[This corrects the article DOI: 10.1371/journal.pone.0190750.].

Patterns of sedentary behavior in overweight and moderately obese users of the Catalan primary-health care system.

BACKGROUND AND OBJECTIVES: Prolonged sitting time (ST) has negative consequences on health. Changing this behavior is paramount in overweight/obese individuals because they are more sedentary than those with normal weight. The aim of the study was to establish the pattern of sedentary behavior and its relationship to health, socio-demographics, occupation, and education level in Catalan overweight/obese individuals. METHODS: A descriptive study was performed at 25 healthcare centers in Catalonia (Spain) with 464 overweight/moderately obese patients, aged25 to 65 years. Exclusion criteria were chronic diseases which contraindicated physical activity and language barriers. Face-to-face interviews were conducted to collect data on age, gender, educational level, social class, and marital status. Main outcome was 'sitting time' (collected by the Marshall questionnaire); chronic diseases and anthropometric measurements were registered. RESULTS: 464 patients, 58.4% women, mean age 51.9 years (SD 10.1), 76.1% married, 60% manual workers, and 48.7% had finished secondary education. Daily sitting time was 6.2 hours on working days (374 minutes/day, SD: 190), and about 6 hours on non-working ones (357 minutes/day, SD: 170). 50% of participants were sedentary ≥6 hours. The most frequent sedentary activities were: working/academic activities around 2 hours (128 minutes, SD: 183), followed by watching television, computer use, and commuting. Men sat longer than women (64 minutes more on working days and 54 minutes on non-working days), and individuals with office jobs (91 minutes),those with higher levels of education (42 minutes), and younger subjects (25 to 35 years) spent more time sitting. CONCLUSIONS: In our study performed in overweight/moderately obese patients the mean sitting time was around 6 hours which was mainly spent doing work/academic activities and watching television. Men, office workers, individuals with higher education, and younger subjects had longer sitting time. Our results may help design interventions targeted at these sedentary patients to decrease sitting time.

Evaluación del Modelo multicomponente de telecuidado de apoyo a personas con prediabetes y obesidad en Chile

Antecedentes: la prediabetes es una condición reversible y su tratamiento una oportunidad para modificar prácticas no saludables. Objetivo: evaluar la efectividad del Modelo Multi-componente de Telecuidado para apoyo a personas con prediabetes y obesidad en Chile. Método: ensayo clínico controlado en centros de atención primaria, Santiago, Chile. Se realizó un muestreo y asignación aleatoria en cada uno de los 5 centros de salud participantes. Participantes: 70 adultos con pre-diabetes, IMC: 25-34 y acceso a telefonía móvil. GI (n = 33), recibió modelo: consejerías telefónicas, envío de SMS, material educativo y equipos auto-monitoreo; y GC (n = 32) atención habitual atención habitual y equipos de auto-monitoreo. Medición pre y post intervención de los conocimientos sobre Prediabetes, alimentación no saludable, actividad física, peso, circunferencia de cintura, Glicemia, Triglicéridos y Colesterol Total. Resultados: en el GI, la intervención fue efectiva en mantener estable el nivel de conocimientos sobre pre-diabetes y disminuir nivel de triglicéridos. El modelo no superó a la atención habitual en disminución del peso, circunferencia de cintura, glicemia y colesterol total.

Background: Prediabetes is a reversible condition and its treatment a chance to change unhealthy practices. Objective: to evaluate the effectiveness of a multi-component tele-care model to support people with pre-diabetes and obesity in Chile. Method: a randomized clinical trial in primary care setting, Santiago, Chile. Participants: 70 adults with pre-diabetes: BMI between 25 and 34 and access to mobile phone. GI (n = 33) received telephone counseling, SMS, educational materials and self-monitoring equipment and GC (n = 32) usual care and self-monitoring equipment. Measures of knowledge of prediabetes, unhealthy diet, physical activity, weight, waist circumference, glucose, triglycerides and total cholesterol were made pre and post intervention. Results: in GI the intervention to maintain stable knowledge level about pre-diabetes, and decrease triglycerides level was effective. The model did not exceed usual care for decrease in weight, waist circumference, glucose and cholesterol.

Validación de la Escala Rapid Assessment of Physical Activity (RAPA) en población chilena adulta consultante en Atención Primaria / Validation of the Rapid Assessment of Physical Activity Scale (RAPA) in an Adult Chilean Population Seeking Primary Care / Validação da escala Rapid Assessment of Physical Activity (Rapa) em população chilena idosa consultante em Atenção Primária

Introducción: la práctica de actividad física es esencial para el cuidado de la salud. Se requiere contar con instrumentos que permitan medirla y monitorear los cambios en las personas que la practican. Objetivos: adaptar culturalmente el cuestionario Rapid Assessment of Physical Activity (RAPA), y estimar sus propiedades psicométricas, su validez y confiabilidad, para medir el nivel de actividad física en personas adultas consultantes en centros de atención primaria en Santiago (Chile). Materiales y métodos: el RAPA adaptado fue aplicado a 180 adultos asistentes a 5 centros de salud. Se determinó su índice de masa corporal (IMC) y circunferencia de cintura (CC). Resultados: las puntuaciones en la escala RAPA se relacionaron en forma inversa y significativa con el perímetro de cintura y el IMC. Las personas categorizadas con bajo nivel de actividad física (Poco Activo y Poco Activo Regular Ligero) presentan un IMC promedio más elevado y son más frecuentemente categorizados con CC alterada. La confiabilidad del instrumento fue moderada (r = 0,61; K = 0,34). Conclusiones: el RAPA en su versión en español adaptada para Chile, es un instrumento de fácil aplicación, que pese a su moderada confiabilidad, logra ser sensible al desarrollo de actividad física, que presenta una relación coherente con los parámetros antropométricos de IMC y CC sensibles a dicha actividad.

Introduction: Physical activity is vital to health care and having instruments to measure and monitor changes in people who are physically active is essential. Objectives: Culturally adapt the Rapid Assessment of Physical Activity (RAPA) questionnaire and estimate its psychometric properties, validity and reliability as an instrument to measure the level of physical activity among adults seeking primary care at health centers in Santiago (Chile). Materials and Methods: The adapted RAPA was applied to 180 adults who were being treated at five health centers. Their body mass index (BMI) and waist circumference (WC) was determined. Results: The scores on the RAPA scale were inversely and significantly linked to waist circumference and BMI. Persons categorized as having low levels of physical activity (i.e., little activity and little regular light activity) have a higher BMI, on average, and are more often categorized with altered WC. The reliability of the instrument was moderate (r = 61; K = 0.34). Conclusions: The Spanish language version of the Rapid Assessment of Physical Activity (RAPA) questionnaire adapted for Chile is a user-friendly application. Despite being only moderately reliable, it is sensitive to the development of physical activity, which shows a coherent connection to the anthropometric parameters of BMI and WC that are sensitive to this kind of activity.

Introdução: a prática de atividade física é essencial para o cuidado da saúde. Requer-se contar com instrumentos que permitam medi-la e monitorar as mudanças nas pessoas que a praticam. Objetivos: adaptar culturalmente o questionário Rapid Assessment of Physical Activity (Rapa) e estimar suas propriedades psicométricas, sua validade e confiabilidade para medir o nível de atividade física em pessoas idosas consultantes em centros de atenção primária em Santiago (Chile). Materiais e método: o Rapa adaptado foi aplicado a 180 idosos frequentadores de cinco unidades de saúde. Determinou-se seu índice de massa corporal (IMC) e circunferência de cintura (CC). Resultados: as pontuações na escala Rapa se relacionaram em forma inversa e significativa com o perímetro de cintura e o IMC. As pessoas categorizadas com baixo nível de atividade física (pouco ativo e pouco ativo regular leve) apresentaram um IMC médio mais elevado e são mais frequentemente categorizadas com CC alterada. A confiabilidade do instrumento foi moderada (r = ,61; K = 0,34). Conclusões: o Rapa em sua versão em espanhol adaptada para o Chile é um instrumento de fácil aplicação, que, mesmo com sua moderada confiabilidade, consegue ser sensível ao desenvolvimento da atividade física, que apresenta uma relação coerente com os parâmetros antropométricos de IMC e CC sensíveis a essa atividade.

Prolonged Sitting Time: Barriers, Facilitators and Views on Change among Primary Healthcare Patients Who Are Overweight or Moderately Obese.

BACKGROUND AND OBJECTIVES: Prolonged sitting time has negative consequences on health, although the population is not well aware of these harmful effects. We explored opinions expressed by primary care patients diagnosed as overweight or moderately obese concerning their time spent sitting, willingness to change, and barriers, facilitators, goals and expectations related to limiting this behaviour. METHODS: A descriptive-interpretive qualitative study was carried out at three healthcare centres in Barcelona, Spain, and included 23 patients with overweight or moderate obesity, aged 25 to 65 years, who reported sitting for at least 6 hours a day. Exclusion criteria were inability to sit down or stand up from a chair without help and language barriers that precluded interview participation. Ten in-depth, semi-structured interviews (5 group, 5 individual) were audio recorded from January to July 2012 and transcribed. The interview script included questions about time spent sitting, willingness to change, barriers and facilitators, and the prospect of assistance from primary healthcare professionals. An analysis of thematic content was made using ATLAS.Ti and triangulation of analysts. RESULTS: The most frequent sedentary activities were computer use, watching television, and motorized journeys. There was a lack of awareness of the amount of time spent sitting and its negative consequences on health. Barriers to reducing sedentary time included work and family routines, lack of time and willpower, age and sociocultural limitations. Facilitators identified were sociocultural change, free time and active work, and family surroundings. Participants recognized the abilities of health professionals to provide help and advice, and reported a preference for patient-centred or group interventions. CONCLUSIONS: Findings from this study have implications for reducing sedentary behaviour. Patient insights were used to design an intervention to reduce sitting time within the frame of the SEDESTACTIV clinical trial.

Quantum effects in the optical response of extended plasmonic gaps: validation of the quantum corrected model in core-shell nanomatryushkas.

Electron tunneling through narrow gaps between metal nanoparticles can strongly affect the plasmonic response of the hybrid nanostructure. Although quantum mechanical in nature, this effect can be properly taken into account within a classical framework of Maxwell equations using the so-called Quantum Corrected Model (QCM). We extend previous studies on spherical cluster and cylindrical nanowire dimers where the tunneling current occurs in the extremely localized gap regions, and perform quantum mechanical time dependent density functional theory (TDDFT) calculations of the plasmonic response of cylindrical core-shell nanoparticles (nanomatryushkas). In this axially symmetric situation, the tunneling region extends over the entire gap between the metal core and the metallic shell. For core-shell separations below 0.5 nm, the standard classical calculations fail to describe the plasmonic response of the cylindrical nanomatryushka, while the QCM can reproduce the quantum results. Using the QCM we also retrieve the quantum results for the absorption cross section of the spherical nanomatryushka calculated by V. Kulkarni et al. [Nano Lett. 13, 5873 (2013)]. The comparison between the model and the full quantum calculations establishes the applicability of the QCM for a wider range of geometries that hold tunneling gaps.

Effectiveness of a primary care-based intervention to reduce sitting time in overweight and obese patients (SEDESTACTIV): a randomized controlled trial; rationale and study design.

BACKGROUND: There is growing evidence suggesting that prolonged sitting has negative effects on people's weight, chronic diseases and mortality. Interventions to reduce sedentary time can be an effective strategy to increase daily energy expenditure. The purpose of this study is to evaluate the effectiveness of a six-month primary care intervention to reduce daily of sitting time in overweight and mild obese sedentary patients. METHOD/DESIGN: The study is a randomized controlled trial (RCT). Professionals from thirteen primary health care centers (PHC) will randomly invite to participate mild obese or overweight patients of both gender, aged between 25 and 65 years old, who spend 6 hours at least daily sitting. A total of 232 subjects will be randomly allocated to an intervention (IG) and control group (CG) (116 individuals each group). In addition, 50 subjects with fibromyalgia will be included.Primary outcome is: (1) sitting time using the activPAL device and the Marshall questionnaire. The following parameters will be also assessed: (2) sitting time in work place (Occupational Sitting and Physical Activity Questionnaire), (3) health-related quality of life (EQ-5D), (4) evolution of stage of change (Prochaska and DiClemente's Stages of Change Model), (5) physical inactivity (catalan version of Brief Physical Activity Assessment Tool), (6) number of steps walked (pedometer and activPAL), (7) control based on analysis (triglycerides, total cholesterol, HDL, LDL, glycemia and, glycated haemoglobin in diabetic patients) and (8) blood pressure and anthropometric variables. All parameters will be assessed pre and post intervention and there will be a follow up three, six and twelve months after the intervention. A descriptive analysis of all variables and a multivariate analysis to assess differences among groups will be undertaken. Multivariate analysis will be carried out to assess time changes of dependent variables. All the analysis will be done under the intention to treat principle. DISCUSSION: If the SEDESTACTIV intervention shows its effectiveness in reducing sitting time, health professionals would have a low-cost intervention tool for sedentary overweight and obese patients management. TRIAL REGISTRATION: A service of the U.S. National Institutes of Health. Developed by the National Library of Medicine. ClinicalTrials.gov NCT01729936.