Sex-specific heart failure burden across the United States: Global burden of disease 1990-2019.

BACKGROUND: Heart failure (HF) has unique aspects that vary by biological sex. Thus, understanding sex-specific trends of HF in the US population is crucial to develop targeted interventions. We aimed to analyze the burden of HF in female and male patients across the US, from 1990 to 2019. METHODS: Using the Global Burden of Disease (GBD) study data from 2019, we performed an analysis of the burden of HF from 1990-2019, across US states and regions. The GBD defined HF through studies that used symptom-based criteria and expressed the burden of HF as the age-adjusted prevalence and years lived with disability (YLDs) rates per 100,000 individuals. RESULTS: The age-adjusted prevalence of HF for the US in 2019 was 926.2 (95% UI [799.6, 1,079.0]) for females and 1,291.2 (95% UI [1,104.1, 1,496.8]) for males. Notably, our findings also highlight cyclic fluctuations in HF prevalence over time, with peaks occurring in the mid-1990s and around 2010, while reaching their lowest points in around 2000 and 2018. Among individuals >70 years of age, the absolute number of individuals with HF was higher in females, and this age group doubled the absolute count between 1990 and 2019. Comparing 1990-1994 to 2015-2019, 10 states had increased female HF prevalence, while only 4 states increased male prevalence. Overall, Western states had the greatest relative decline in HF burden, in both sexes. CONCLUSION: The burden of HF in the US is high, although the magnitude of this burden varies according to age, sex, state, and region. There is a significant increase in the absolute number of individuals with HF, especially among women >70 years, expected to continue due to the aging population.

The Facts about Food after Cancer Diagnosis: A Systematic Review of Prospective Cohort Studies.

Nutritional guidelines suggest specific energy and protein requirements for patients with cancer. However, cancer patients, often malnourished, use self-made or web-based diets to ameliorate the prognosis of their disease. This review aimed to investigate the associations between post-diagnostic diet and prognostic outcomes in cancer patients. A systematic literature search was performed in Pubmed and Web of Science databases from inception to 30 October 2019, based on fixed inclusion and exclusion criteria. The risk of bias was assessed. A total of 29 prospective studies was identified. Breast (n = 11), colorectal (n = 9), prostate (n = 8) cancers are the most studied. Low- fat diet, healthy quality diet, regular consumption of fiber such as vegetables and high-quality protein intake are beneficial while Western diet (WD) and high consumption of saturated fats could be associated with a higher risk of mortality. Bladder (n = 1), gynecological (n = 1), lung, stomach, and pancreatic cancers still remain almost unexplored. This systematic review suggested that detrimental dietary patterns such as WD should be avoided but none of the food categories (meat, dairy products) should be eliminated in cancer patients' diet. Further large prospective studies are needed to assess the role of post-diagnostic diet in patients with cancer.

Valva aórtica quadricúspide: diagnótico ecocardiográfico / Quadricuspid aortic valve: echocardiographic diagnosis

Este é m artigo de relato de caso de valva aórtica quatricúspide (ou quadrivalvular), tipo AHurwitz e Roberts, com leve insuficiência e dilatação da aorta ascendente, em adulta assintomática diagnósticada em exame ecocadiográfico de rotina, confirmado à ecocardiografia transesofágica. Ao relato de caso e imagens correspondentes segue uma breve revisão da literatura. A valva aórtica quadrcúspide (VAQ) é rara, tem diagnóstico ecocardiográfico, em uma maioria assintomática. A importância do diagnóstico desta patologia justifica-se pelo risco de valvopatia aórtica de caráter progressivo, pelo potencial aumento de endocardite e pela possibilidade de origem anômala do óstio da coronária ou outras malformações associadas.

This article is a case report of a quadricuspid (or quadrivalve) aortic valve, type A of Hurwitz and Roberts, with mild insufficiency and dilatation of the ascending aorta, in an asymptomatic adult diagnosed during a routine echocardiography exam, confirmed by a transesophageal echocardiography. The article, with images, is followed by a brief literature revision. A quadricuspid aortic valve (QAV) is rare, and the diagnosis occur by an echocardiography exam, usually in an asymptomatic group. The importance of diagnosing this pathology is justified by the risk of progressive aortic valve disease, by the potential increase of endocarditis and possible association with anomalous origin of the coronary ostium or other associated malformations.

Vacuum-assisted venous drainage in cardiopulmonary bypass and need of blood transfusion: experience of service.

OBJECTIVE: To report the experience with the vacuum-assisted venous drainage (VAVD) technique in cardiopulmonary bypass (CPBP) and blood transfusion need. METHODS: A retrospective study was made about data from 111 patients who were operated, using VAVD between October 2006 and February 2008, at the Esperança Hospital, Recife, Pernambuco. The necessity of blood transfusion was verified on the single group of patients who underwent VAVD, comparing with sex, age and weigh, before the beginning of the CPBP and during the surgery, using Chi-square test and t-student test. RESULTS: Before the beginning of the CPBP only 10% of patients had need for blood transfusion and 12% during the surgery. It was observed that 17% of women received blood transfusion versus 4.7% of men before the beginning of CPBP (P=0.51), and 38% of women versus 9% of men during the surgery (P<0.001). The weight of patients who received blood transfusion were lower both before the beginning of the CPBP as during the surgery (P=0.049 e P=0.001, respectively). CONCLUSION: The VAVD technique has been used safely and satisfactorily, optimizing venous drainage during CPBP, in the hospital that conducted the study. However, prospective and comparative investigations between conventional drainage and VAVD are needed to better clarify this relation with blood transfusion.

Percutaneous closure of postoperative and post-traumatic ventricular septal defects.

Although uncommon, significant postoperative residual leaks may occur after repair of any type of ventricular septal defect (VSD). Post-traumatic VSDs are even rarer, but can be occasionally seen after penetrating or blunt chest trauma. When these defects are associated with significant left-to-right shunting (Qp/Qs > 1.5) with persistent left ventricular volume overload, intervention is generally recommended. Surgical treatment requires cardiopulmonary bypass with its attendant morbidity, increased hospital stay and possible long-term neurological impairment. With the evolving experience of transcatheter closure of postinfarction and native perimembranous and muscular VSDs, this less invasive method became an attractive alternative to manage these postoperative and post-traumatic defects. In this paper, we report on 3 patients with such residual leaks after repair of a perimembranous defect, which was closed using a perimembranous Amplatzer VSD occluded after a failed attempt using a NitOcclud coil. One patient had a mid-muscular post-traumatic defect after a penetrating chest wound, and another patient had a residual leak after a patch repair of a large post-traumatic muscular defect with outlet extension after a blunt chest trauma. Both defects were closed using muscular Amplatzer VSD occluders. All procedures were uncomplicated, and there were no technical difficulties with device implantation. All 3 patients' defects were completely closed at follow up. Percutaneous closure of traumatic and residual postoperative VSDs appears to be safe and effective. A larger number of patients and longer follow-up period are needed before the widespread use of this technique can be recommended.

Percutaneous closure of postoperative and post-traumatic ventricular septal deffects

Although uncommon, significant postoperative residual leaks may occur after repair of any type of a ventricular septal deffect (VSD). Post-traumatics VSDs are even rarer, but can be occasionally seen after penetrating or blunt chest trauma. When these defects are associated with significant left-to-rigth shunting (Qp/Qs > 1.5) with persistent left ventricular volume overload, intervention is generally recomended. Surgical treatment requires cardiopulmonary bypass with its attendent morbidity, increased hospital stay and possible long-term neurological impairment. With the envolving experience of transcatheter closure of postinfarction and native perimembranous and muscular VSDs, this less invasive method became an attractive alternative to manage these postoperative and post-traumatic deffects...