Handheld Echocardiography in a Clinical Practice Scenario: Concordances Compared to Standard Echocardiographic Reports.

BACKGROUND: The purpose of this study was to assess the utility of a handheld device (HH) used during common daily practice and its agreement with the results of a standard echocardiography study (STD) performed by experienced sonographers and echocardiographer. METHODS: A prospective follow-up was conducted in an adult outpatient echocardiography clinic. Experienced sonographers performed the STD and an experienced echocardiographer performed the HH. STD included 2-dimensional images, Doppler and hemodynamics analysis. Hemodynamic assessment was not performed with the HH device because the HH does not include such technology. The images were interpreted by blinded echocardiographers, and the agreement between the reports was analyzed. RESULTS: A total of 108 patients were included; and the concordance for left ventricle (LV) ejection fraction (EF), wall motion score index, LV and right ventricle (RV) function, RV size, and mitral and aortic stenosis was excellent with κ values greater than 0.80. Wall motion abnormalities had good concordance (κ value 0.78). The agreement for LV hypertrophy, mitral and aortic regurgitation was moderate, and tricuspid and pulmonary regurgitation agreements were low (κ values of 0.26 and 0.25, respectively). CONCLUSIONS: In a daily practice scenario with experienced hands, HH demonstrated good correlation for most echocardiography indications, such as ventricular size and function assessment and stenosis valve lesion analyses.

Endocardite fúngica por trichosporon Asahii: relato de um caso raro em imunocompetentes / Fungal endocarditis due to trichosporon Asahii: a rare case report in immunocompetent subject

Relatar o caso de um paciente com múltiplas trocas valvares aórticas, imunocompetente, com diagnóstico de endocardite fúngica por T. asahii. Relato do caso: Homem, 63 anos, com história de febre reumática e quatro trocas da valva aórtica que evoluiu com sintomas de insuficiência cardíaca aguda e febre. Não foi encontrada nenhuma evidência de imunossupressão. Os exames laboratoriais demonstraram anemia e plaquetopenia leves, com leucograma normal e elevação de lactato desidrogenase e proteína C reativa. O ecocardiograma revelou insuficiência aórtica importante e múltiplas vegetações na valva aórtica. T. asahii foi isolado em duas hemoculturas, sendo iniciada a administração de anfotericina B. O paciente necessitou de cirurgia de emergência para nova troca valvar por deterioração clínica. Em decorrência de complicações intraoperatórias, evoluiu para óbito. Discussão: O diagnóstico e o tratamento da endocardite por T. asahii não estão bem estabelecidos na literatura. Os antifúngicos disponíveis atualmente são triazóis e anfotericina B, com evidências que sugerem superioridade dos triazóis, mas a cirurgia é necessária por ineficácia desses fármacos isoladamente. Conclusões: Faltam dados sobre o tratamento medicamentoso mais eficaz e seguro para a endocardite por T. asahii. Neste caso, as trocas valvares prévias agregaram dificuldade técnica ao novo procedimento, que resultou em evolução desfavorável. Não há dados de literatura sobre o momento ideal para troca valvar em pacientes com múltiplas trocas valvares prévias

To present the case report of an immunocompetent patient with multiple aortic valve replacements, diagnosed with fungal endocarditis due to T. asahii. Case report: A 63-year-old male patient with a history of rheumatic fever and four aortic valve replacements, who progressed with symptoms of acute heart failure and fever. No evidence of immunosuppression was found. Laboratory tests detected mild anemia and thrombocytopenia, with normal leukogram and elevated lactate dehydrogenase and C-reactive protein levels. The echocardiogram revealed severe aortic insufficiency and multiple aortic valve vegetations. T. asahii was isolated in two blood cultures, and administration of amphotericin B was initiated. The patient required emergency surgery for a further valve replacement due to clinical deterioration. The patient later died as a result of intraoperative complications. Discussion: Diagnosis and treatment of T. asahii endocarditis are not well established in the literature. The currently available antifungals are triazoles and amphotericin B, with evidence suggesting superiority of the former, but surgery is required because of the ineffectiveness of these drugs alone. Conclusions: There is insufficient data on the safest and most effective pharmaceutical treatment for T. asahii endocarditis. In this case, the previous valve replacements added technical difficulty to the new procedure, which resulted in an unfavorable outcome. There is no data in the literature on the optimal timing for valve replacement in patients with multiple prior replacements

Impact of hypertension in liver regeneration in rats.

PURPOSE: To determine the impact of hypertension in liver regeneration, in rats by examining gain in liver mass and the replication of hepatocytes and stellate cells. METHODS: Forty Wistar rats were allocated into two groups of twenty, the control and experiment group. The experiment group animals were submitted to induction of renovascular hypertension. A week later, all the animals underwent a partial hepatectomy. Measurements were taken after 24 hours and seven days, when ten animals in each group were euthanized. Thus, four subgroups were obtained. The livers were excised and sent for histopathological analysis. RESULTS: The control group had a greater gain in liver mass than the experiment group seven days after partial hepatectomy (p=0.0051). The difference in the activate stellate cell count was not statistically significant following analysis after both 24 hours and seven days (p=1.0). A higher number of dividing hepatocytes was observed in the control group seven days after partial hepatectomy (p=0.0014). CONCLUSION: In rats, hypertension had no direct influence on stellate cell replication, but led to a delay in liver mass gain and were shown to be a reduction factor on hepatocyte replication seven days after partial hepatectomy.

Impact of hypertension in liver regeneration in rats / Repercussão da hipertensão arterial na regeneração hepática em ratos

PURPOSE: To determine the impact of hypertension in liver regeneration, in rats by examining gain in liver mass and the replication of hepatocytes and stellate cells. METHODS: Forty Wistar rats were allocated into two groups of twenty, the control and experiment group. The experiment group animals were submitted to induction of renovascular hypertension. A week later, all the animals underwent a partial hepatectomy. Measurements were taken after 24 hours and seven days, when ten animals in each group were euthanized. Thus, four subgroups were obtained. The livers were excised and sent for histopathological analysis. RESULTS: The control group had a greater gain in liver mass than the experiment group seven days after partial hepatectomy (p=0.0051). The difference in the activate stellate cell count was not statistically significant following analysis after both 24 hours and seven days (p=1.0). A higher number of dividing hepatocytes was observed in the control group seven days after partial hepatectomy (p=0.0014). CONCLUSION: In rats, hypertension had no direct influence on stellate cell replication, but led to a delay in liver mass gain and were shown to be a reduction factor on hepatocyte replication seven7 days after partial hepatectomy.

OBJETIVO: Determinar o impacto da hipertensão arterial sistêmica na regeneração hepática, em ratos, através da análise do ganho de massa hepática e da replicação dos hepatócitos e das células estreladas. MÉTODOS: Alocaram-se 40 ratos Wistar em dois grupos de 20 animais, os grupos controle e experimento. Os do grupo experimento submeteram-se a indução da hipertensão renovascular. Uma semana após, realizou-se hepatectomia parcial em todos os animais. Colheram-se os dados com 24 horas e sete dias, quando dez animais de cada grupo submeteram-se a eutanásia. Assim, obtiveram-se quatro subgrupos. Os fígados foram retirados e enviados para análise histopatológica. RESULTADOS: O grupo controle apresentou maior ganho de massa hepática do que o grupo experimento sete dias após a hepatectomia parcial (p=0,0051). A diferença na contagem das células estreladas ativadas não foi estatisticamente significante nas análises de 24 horas e de sete dias (p=1,0). Um maior número de hepatócitos em divisão foi observado no grupo controle, sete dias após a hepatectomia parcial (p=0,0014). CONCLUSÃO: Em ratos, a hipertensão não teve influência direta sobre a replicação de células estreladas, mas levou ao atraso no ganho de massa hepática e mostrou ser um fator de redução na replicação de hepatócitos sete dias após a hepatectomia parcial.