Effects of anabolic androgenic steroids in athletes on left ventricle systolic and diastolic function: a systematic review and meta-analysis

BACKGROUND: The use of anabolic androgenic steroids (AAS) among athletes has been linked to pathological structural and functional cardiac changes. However, the studies are small, and the results are inconsistent. METHODS: We conducted a systematic review and meta-analysis of echocardiographic outcomes comparing athletes with prolonged use of AAS (at least 2 years of use) versus sex and age- matched athletes who were did not use AAS. PubMed, Cochrane, and embase were searched. A random-effects model was used to calculate mean differences (MDs), with 95% confidence intervals (CI). Statistical analyses were performed using Review Manager 5.4.1. RESULTS: We included 17 studies comprising 1,023 athletes, of whom 543 (53%) were AAS users. The mean age ranged to 24.2 to 43 years. Compared with non-AAS users, athletes who used AAS exhibited a significant increase in interventricular septal wall thickness (MD 1.33 mm; 95% CI [0.8,1.89], p<0.001), a reduction in left ventricular ejection fraction (MD 2.77 %; 95% CI [-4.2,-1.34], p<0.001;Figure 1B) , and worsening of global longitudinal strain (MD 3.39%; 95% CI [2.88,3.91], p<0.001;Figure 1B). Additionally, there was a significant reduction in the E/A ratio (MD -0.21; 95% CI [-0.35,-0.07], p=0.003) and an increase in the E/e' ratio (MD 1.71; 95% CI [0.96,2.46], p<0.001). CONCLUSION: Our findings suggest that prolonged use of AAS in athletes is associated with increased left ventricular wall thickness and worsening of systolic and diastolic parameters.

Caso clínico: dispneia a esclarecer em criança: um desafio nem sempre fácil / Clinical case: dyspnea to be clarified in a child: a challenge that is not always easy

INTRODUÇÃO: A intolerância aos esforços é achado relevante dentre as queixas semióticas. Quando ocorre em crianças uma análise mais acurada é necessária para esclarecer os mecanismos da limitação ao esforço. Mesmo uma boa história clínica e um bom exame físico podem não ser suficientes. Assim, exames complementares guiarão para o diagnóstico mais preciso e uma conduta mais assertiva. CASO CLÍNICO: Masculino 10 anos, com dispneia aos esforços e asma desde a primeira infância e pouca resposta ao tratamento específico. Realizada investigação com Ressonância magnética que evidenciou duplo brônquio fonte a direita (acessório). Tal achado mostrou possível mecanismo de obstrução extrínseca para justificar o cansaço desproporcional em relação às demais crianças. Para melhor entendimento do quadro clínico e possíveis mecanismos limitantes à continuidade dos esforços foi realizado o teste cardiopulmonar de exercício (TCPE). O TCPE é o método ouro para investigar a dispneia aos esforços. Desse modo é possível identificar componentes cardiovascular, ventilatório, muscular periférico ou de troca-gasosa. Durante o esforço realizou-se manobras fluxo-volumétricas evidenciando redução de 390 ml da capacidade inspiratória (CI), queda de 15% em relação ao basal, além do deslocamento da alça fluxo-volume para esquerda, definindo critério de hiperinsuflação ou aprisionamento aéreo dinâmico. CONCLUSÃO: O relato revelou a importância do TCPE que através de abordagens de averiguação dos componentes diversos e possíveis limitantes, mostrou condicionamento físico aeróbico reduzido do paciente e foi decisivo no esclarecimento do predomínio do distúrbio ventilatório configurando um padrão compatível com broncoespasmo induzido pelo esforço (possivelmente atípico por ser de grandes vias aéreas).

Effect of 0.15% sodium hyaluronate on tear film breakup time in healthy anesthetized cats.

OBJECTIVES: This study aimed to evaluate the effect of 0.15% sodium hyaluronate (SH) on tear film breakup time (TFBT) in healthy anesthetized cats. PROCEDURES: Forty cats undergoing elective surgery were enrolled. TFBT was assessed before anesthesia to obtain baseline values. As a preanesthetic medication, cats received midazolam, tramadol, and cetamine combined in the same syringe. For anesthetic induction and maintenance, propofol and isoflurane were used. After a 15 min stabilization period to achieve the surgical anesthetic plane, one eye was treated with one drop of SH, while the other eye received saline and served as a control. TFBT was measured at the end of the general anesthesia (T40) and 35 (T75) and 80 min (T120) after the termination of the anesthesia. TFBT values were compared between the control and SH-treated eyes; both values were also compared with the baseline values (p < .05). RESULTS: In the control eyes, TFBT significantly decreased from baseline at all time points (p < .001), while in SH-treated eyes, TFBT significantly increased from baseline only at T40 (p < .0001). In SH-treated eyes, TFBT was significantly higher than that in the control eyes at all time points (p < .001). CONCLUSIONS: In healthy cats, TFBT decreases significantly after 40 min of general anesthesia, and one drop of 0.15% sodium hyaluronate was able to maintain the stability of the tear film for up to 75 min in treated eyes. However, the isolated effect of each drug used in our anesthetic protocol on TFBT should be executed in further studies.

The importance of a close follow up for athletes with congenital third degree block

Congenital third degree block (CHB) is a relative rare disorder. The manifestations of CHB can vary according to many aspects, including ventricular rate of the escape rhythm and ventricular function. The main therapeutic decision is the need for and the ideal timing of permanent pacemaker insertion. Patients with adequate ventricular heart rate increasing appropriately during exertion and no symptoms such as syncope or near syncope and a structurally normal heart and cardiac function can usually be followed without intervention, and therefore, they can selectively participate in competitive sports. Although, this is not a permanent recommendation, and these patients should be followed closely. Case report: 13-year-old asymptomatic male patient, with a previous diagnosis of CHB, who practices competitive soccer, in yearly follow up at the sports cardiology outpatient clinic, who presented a normal echocardiography, without structural alterations, normal Left Ventricle (LV) dimensions, a Left Ventricle End Diastolic Diameter (LVEDD) of 48 mm, and preserved LV function. His exercise test showed an excellent functional capacity (15 METS) despite a chronotropic insufficiency. However, on the 2021 clinical evaluation, he presented a significant worsening of the tests results, although remained asymptomatic. The new echocardiography presented LV dilatation with a LVEDD of 63 mm, but with preserved ejection fraction. The exercise test showed a worse functional capacity of 11 METS and chronotropic deficit. Therefore, it was indicated the insertion of a pacemaker. New tests were performed two months after the procedure. The echocardiography showed normal LV dimensions (LVEDD: 46 mm). At the cardiopulmonary exercise test, the patient reached 103% of the predicted VO2, showing a normal functional capacity. Although all these improvements, the practice of soccer was contraindicated due to the high risk of thoracic trauma. Nevertheless, the patient still may participate of other competitive and high intensity activities with low risk of lead dislocation and thoracic trauma. In CONCLUSION, the CHB is not a prohibitive condition of high intensity sports, as long as the patient remains without structural cardiac alterations, normal LV function, asymptomatic and with a normal functional capacity. However, these conditions can change in a relative short period, so the follow up must be done closely.

Derrame pericárdico após Covid 19 ­ sempre miopericardite? / Pericardial effusion after Covid 19 ­ always myopericarditis?

RELATO DE CASO: Paciente 44 anos, sexo feminino com história de COVID-19 há 4 meses, inicialmente com sintomas leves e sem necessidade de internação hospitalar. Há cerca de 6 semanas após resolução de quadro, apresentou dispneia progressiva a esforços, tendo sido diagnosticada com tromboembolismo pulmonar após angiotomografia de tórax e iniciada anticoagulação. À admissão em Pronto-Socorro de hospital terciário, apresentava-se dispneica, com turgência jugular e hipofonese de bulhas. Ecocardiograma na urgência confirmou a presença de derrame pericárdico importante com comprometimento hemodinâmico, tendo sido corroborado diagnóstico de tamponamento cardíaco. Foi realizada pericardiocentese e estabilização clínica. Após, prosseguida investigação diagnóstica com ressonância magnética (RM) que evidenciou miocardiopatia restritiva com padrão de endomiocardiofibrose. DISCUSSÃO: Ainda que no último ano tenha sido frequente o relato de casos de miopericardite, inclusive com ocorrência de derrame pericárdico, relacionados à infecção pelo Sars-Cov2, é necessário reforçar a importância da perseguição diagnóstica em casos de insuficiência cardíaca e/ou derrames cavitários recém-descobertos. A utilização de adequados métodos complementares, como o ecocardiograma transtorácico e a RM permitem o estabelecimento de diagnóstico etiológico adequado de endomiocardiofibrose, corroborando para seguimento e tratamento dos pacientes portadores desta entidade clínica.

The porcine corneal surface bacterial microbiome: A distinctive niche within the ocular surface.

PURPOSE: The ocular surface microbiome has been described as paucibacterial. Until now, studies investigating the bacterial community associated with the ocular surface through high-throughput sequencing have focused on the conjunctiva. Conjunctival samples are thought to reflect and be representative of the microbiome residing on the ocular surface, including the cornea. Here, we hypothesized that the bacterial community associated with the corneal surface was different from those of the inferonasal and superotemporal conjunctival fornices, and from the tear film. METHODS: Both eyes from 15 healthy piglets were sampled using swabs (inferonasal fornix, superotemporal fornix, and corneal surface, n = 30 each) and Schirmer tear test strips (STT, n = 30). Negative sampling controls (swabs and STT, n = 2 each) and extraction controls (n = 4) were included. Total DNA was extracted and high-throughput sequencing targeting the 16S rRNA gene was performed. Bioinformatic analyses included multiple contamination-controlling steps. RESULTS: Corneal surface samples had a significantly lower number of taxa detected (P<0.01) and were compositionally different from all other sample types (Bray-Curtis dissimilarity, P<0.04). It also harbored higher levels of Proteobacteria (P<0.05), specifically Brevundimonas spp. (4.1-fold) and Paracoccus spp. (3.4-fold) than other sample types. Negative control STT strip samples yielded the highest amount of 16S rRNA gene copies across all sample types (P<0.05). CONCLUSIONS: Our data suggests that the corneal surface provides a distinct environmental niche within the ocular surface, leading to a bacterial community compositionally different from all other sample types.

Accuracy of ARFI elastography in the differentiation of cataract stages in dogs

ABSTRACT: Objective was to evaluate the accuracy of elastography in the differentiation between normal and cataract lenses One hundred forty-five eyes of 98 dogs were divided into groups according to cataract stage. Forty-twoeyes were submitted to phacoemulsification. Biometric parameters, echogenicity and echotexture patterns of the anterior, posterior and vitreous chambers, lens and retina-choroid-sclera complexes were evaluated by ocular ultrasound in modes A and B. Deformability, and color (blue color = indicated less rigid structures, color red = more rigid structures) of the lenses were evaluated by the elastogram. The shear wave velocity (SWV; m/s) was calculated in three regions of the lens, both in the cortex and in the nucleus. The SWV of nucleus was statistically different between the normal lenses and with cataracts, and between the stages of cataract (P 0.001). Healthy lenses and incipient cataracts had a more rigid nucleus. Mature cataracts presented lowest nuclear rigidity (P 0.001). On cortical region the SWV was significantly higher (P 0.01) in intumescent and incipient cataracts. SWV less than 2.67m/s indicates cataract with a sensitivity of 72% and specificity of 94%. Values lower than 2.23m/s suggest mature cataract, with sensitivity of 71% and specificity of 76%. SWV greater than 2.66 m/s are associated with normal lenses or incipient cataract, presenting sensitivity of 94% and specificity of 84%. Qualitative method allowed differentiation between healthy and affected lenses and the classification of evolutionary stages. There was a correlation between the degree of stiffness of lens in cortical and nuclear regions (p=00165, r=0.37) and between the balanced saline solution quantitative and surgical time (P 0.01, r=0.73). Degree of stiffness of lens did not correlate with parameters of phacoemulsification. Elastographic proved feasible for evaluating the lens of dogs, characterizing the types of cataracts, and demonstrating increased stiffness of the diseased lenses.

RESUMO: O objetivo foi avaliar a precisão da elastografia na diferenciação entre lentes normais e de catarata. Cento e quarenta e cinco olhos de 98 cães foram divididos em grupos de acordo com o estágio de maturação da catarata. Quarenta e dois olhos foram submetidos à facoemulsificação. Parâmetros biométricos, ecogenicidade e padrões de ecotextura das câmaras anterior, posterior e vítrea, lente e complexos retina-coróide-esclera foram avaliados por ultrassonografia ocular nos modos A e B. A deformabilidade e a coloração (cor azul = indicou estruturas menos rígidas, cor vermelha = estruturas mais rígidas) das lentes foram avaliadas pelo elastograma. A velocidade da onda de cisalhamento (SWV; m/s) foi calculada em três regiões da lente, tanto no córtex quanto no núcleo. A SWV do núcleo foi estatisticamente diferente entre as lentes normais e com catarata e entre os estágios da catarata (P 0,001). Lentes saudáveis e cataratas incipientes tinham um núcleo mais rígido. Cataratas maduras apresentaram menor rigidez nuclear (P 0,001). Na região cortical, a SWV foi significativamente maior (P 0,01) nas cataratas intumescentes e incipientes. Uma SWV menor que 2,67m/s indica catarata com sensibilidade de 72% e especificidade de 94%. Valores inferiores a 2,23m/s sugerem catarata madura, com sensibilidade de 71% e especificidade de 76%. Uma SWV superior a 2,66m/s está associada à catarata normal ou incipiente, apresentando sensibilidade de 94% e especificidade de 84%. O método qualitativo permitiu a diferenciação entre lentes normais de olhos saudáveis e afetadas e a classificação dos estágios evolutivos. A elastografia se mostrara uma ferramenta viável para avaliar as lentes de cães, caracterizando os tipos de catarata e demonstrando maior rigidez das lentes doentes.

Accuracy of ARFI elastography in the differentiation of cataract stages in dogs / Acurácia da elastografia ARFI na diferenciação dos estágios da catarata em cães

Objective was to evaluate the accuracy of elastography in the differentiation between normal and cataract lenses One hundred forty-five eyes of 98 dogs were divided into groups according to cataract stage. Forty-twoeyes were submitted to phacoemulsification. Biometric parameters, echogenicity and echotexture patterns of the anterior, posterior and vitreous chambers, lens and retina-choroid-sclera complexes were evaluated by ocular ultrasound in modes A and B. Deformability, and color (blue color = indicated less rigid structures, color red = more rigid structures) of the lenses were evaluated by the elastogram. The shear wave velocity (SWV; m/s) was calculated in three regions of the lens, both in the cortex and in the nucleus. The SWV of nucleus was statistically different between the normal lenses and with cataracts, and between the stages of cataract (P<0.001). Healthy lenses and incipient cataracts had a more rigid nucleus. Mature cataracts presented lowest nuclear rigidity (P<0.001). On cortical region the SWV was significantly higher (P<0.01) in intumescent and incipient cataracts. SWV less than 2.67m/s indicates cataract with a sensitivity of 72% and specificity of 94%. Values lower than 2.23m/s suggest mature cataract, with sensitivity of 71% and specificity of 76%. SWV greater than 2.66 m/s are associated with normal lenses or incipient cataract, presenting sensitivity of 94% and specificity of 84%. Qualitative method allowed differentiation between healthy and affected lenses and the classification of evolutionary stages. There was a correlation between the degree of stiffness of lens in cortical and nuclear regions (p=00165, r=0.37) and between the balanced saline solution quantitative and surgical time (P<0.01, r=0.73). Degree of stiffness of lens did not correlate with parameters of phacoemulsification. Elastographic proved feasible for evaluating the lens of dogs, characterizing the types of cataracts, and demonstrating increased stiffness of the diseased lenses.(AU)

O objetivo foi avaliar a precisão da elastografia na diferenciação entre lentes normais e de catarata. Cento e quarenta e cinco olhos de 98 cães foram divididos em grupos de acordo com o estágio de maturação da catarata. Quarenta e dois olhos foram submetidos à facoemulsificação. Parâmetros biométricos, ecogenicidade e padrões de ecotextura das câmaras anterior, posterior e vítrea, lente e complexos retina-coróide-esclera foram avaliados por ultrassonografia ocular nos modos A e B. A deformabilidade e a coloração (cor azul = indicou estruturas menos rígidas, cor vermelha = estruturas mais rígidas) das lentes foram avaliadas pelo elastograma. A velocidade da onda de cisalhamento (SWV; m/s) foi calculada em três regiões da lente, tanto no córtex quanto no núcleo. A SWV do núcleo foi estatisticamente diferente entre as lentes normais e com catarata e entre os estágios da catarata (P<0,001). Lentes saudáveis e cataratas incipientes tinham um núcleo mais rígido. Cataratas maduras apresentaram menor rigidez nuclear (P<0,001). Na região cortical, a SWV foi significativamente maior (P<0,01) nas cataratas intumescentes e incipientes. Uma SWV menor que 2,67m/s indica catarata com sensibilidade de 72% e especificidade de 94%. Valores inferiores a 2,23m/s sugerem catarata madura, com sensibilidade de 71% e especificidade de 76%. Uma SWV superior a 2,66m/s está associada à catarata normal ou incipiente, apresentando sensibilidade de 94% e especificidade de 84%. O método qualitativo permitiu a diferenciação entre lentes normais de olhos saudáveis e afetadas e a classificação dos estágios evolutivos. A elastografia se mostrara uma ferramenta viável para avaliar as lentes de cães, caracterizando os tipos de catarata e demonstrando maior rigidez das lentes doentes.(AU)

Tissue fibrosis and its correlation with malignancy in canine mammary tumors / Fibrosis tisular y su correlación con malignidad en neoplasias mamarias caninas / Fibrose tecidual e sua correlação com a malignidade em neoplasias mamárias em cadelas

Abstract Background: Fibrosis is present in several pathologies associated with mammary carcinogenesis. Objective: To evaluate and quantify the fibrosis present in malignant and benign mammary neoplasms in bitches. Methods: Eighty-three samples were divided according to histopathological diagnosis into benign (n= 21) and malignant (n= 62) neoplasms. Haematoxylin-eosin and Masson's trichrome were used to locate the connective tissue, and the extent of fibrosis was assessed with image software. Results: Benign neoplasms were classified into adenomas (cystic, complex, and tubular), benign mixed tumor, and ductal and lobular hyperplasia. Malignant neoplasms were classified as carcinomas (complex, mixed tumor, in situ tubular, tubulopapillary, and solid). Grade I was the most prevalent histopathological class, followed by grade II and III. Fibrosis was classified as severe, moderate, or discrete. No significant (p >0.05) difference was observed for the percentage of fibrosis between malignant and benign group neoplasms. However, difference (p=0.028) was found for fibrosis percentage between histopathological subtypes of tumors. The benign subtype of lobular hyperplasia presented differences between cystic adenoma and benign mixed tumor. The in situ malignant tubular carcinoma subtype presented differences between solid and tubulopapillary carcinoma. Conclusions: Fibrosis in canine mammary tumors can be estimated with Massons's trichrome staining.

Resumen Antecedentes: La fibrosis está presente en diversas patologías asociadas con carcinogénesis mamaria. Objetivo: Analizar si existe una correlación entre fibrosis tisular y malignidad en tumores mamarios caninos. Métodos: 83 muestras de tejido mamario fueron divididas en masas benignas (n=21) y malignas (n=62), de acuerdo con sus características histopatológicas. En estas muestras se utilizaron las coloraciones de hematoxilina-eosina y tricromo de Masson para localizar el tejido conectivo y se analizó la proporción y cuantificación de fibrosis en los mismos con un software de imagen especializado. Resultados: Las masas mamarias benignas se diagnosticaron como adenomas (quístico, complejo y tubular), tumor mixto benigno, e hiperplasia ductal y lobular; las masas malignas, como carcinomas (complejo, tumor mixto, tubular in situ, túbulopapilar y solido). Los tumores grado I fueron los más prevalentes, seguidos por los grados II y III. La fibrosis se clasifico como discreta, moderada o severa. No se observó diferencia (p>0,05) en el porcentaje de fibrosis entre neoplasias benignas y malignas. No obstante, el porcentaje de fibrosis mostro diferencias (p=0,028) entre subtipos tumorales. La hiperplasia lobular fue diferente en relación a los adenomas quísticos y tumor mixto mamario. El subtipo maligno carcinoma tubular in situ fue diferente respecto a los carcinomas complejo, mixto maligno, sólido, y tubulopapilar. Conclusiones: La fibrosis en los tumores mamarios caninos se puede estimar por la tinción con tricromo de Masson.

Resumo Antecedentes: A fibrose participa em diversas patologias e ainda possui função adicional associada à carcinogênese mamária. Objetivo: Objetivou-se avaliar a fibrose e correlacionar com a malignidade nas neoplasias mamárias em cadelas. Métodos: 83 amostras foram divididas em dois grupos baseado no diagnóstico histopatológico: neoplasias benignas (n= 21) e neoplasias malignas (n= 62). Hematoxilina e eosina e Tricômico de Masson foram usadas para vizibilização de tecido conjuntivo e avaliação de fibrose através de programa de imagens. Resultados: As neoplasias benignas foram: adenoma (cístico, complexo e tubular), tumor misto benigno, hiperplasia ductal e lobular. As malignas foram: carcinoma complexo, em tumor misto maligno, tubular in situ, tubulopapilar e sólido. O grau histopatológico prevalente foi grau I, seguido do grau II e III. A fibrose nas neoplasias mamárias malignas foi classificada como severa, moderada e discreta. Não houve diferença significativa (p>0,05) na porcentagem de fibrose entre neoplasias malignas e benignas. A estatística revelou diferença significativa (p=0,028) na porcentagem de fibrose em relação ao diagnóstico histopatológico. O subtipo benigno hiperplasia lobular apresentou diferença entre o adenoma cístico e o tumor misto benigno. O subtipo maligno carcinoma tubular in situ apresentou diferença entre carcinoma complexo, misto maligno, sólido e tubulopapilar. Conclusões: A fibrose nos tumores mamários caninos pode ser estimada através da coloração de tricrômio de Masson.