Myocardial Bridging Leading to Cardiac Collapse in a Marathon Runner.

Myocardial bridging (MB) is a congenital coronary anomaly, which is defined as cardiac muscle overlying a portion of a coronary artery. Although traditionally considered benign in nature, increasing attention is being given to specific subsets of MB. Sports medicine recognizes MB as a cause of sudden death among young athletes. We present a case of a 30-year-old man who suddenly collapsed during a marathon running. Diagnostic workup with coronary computed tomography angiography revealed the presence of three simultaneous myocardial bridges in this patient, possibly explaining the exercise-induced syncope. The other diagnostic tests excluded seizures, cranioencephalic lesions, ionic or metabolic disturbances, acute coronary syndromes, cardiomyopathies, myocarditis, or conduction disturbances. Exertional syncope is a high-risk complaint in the marathon runner. In the context of intense physical activity, the increased sympathetic tone leading to tachycardia and increased myocardial contractility facilitates MB ischemia. In this illustrative case, the patient's syncope might probably be associated with an ischemia-induced arrhythmia secondary to MB and potentiated by dehydration in the context of prolonged stress (marathon running). In conclusion, this case highlights that MB may be associated with dangerous complications (myocardial ischemia and life-threatening ventricular arrhythmias), particularly during intense physical activity and in the presence of a long myocardial bridge.

Kidney cancer. Heavy metals as a risk factor.

The association between exposure to heavy metals and cancer has been extensively studied, although the mechanisms involved are far from being completely understood. Concerning renal cell carcinoma, several heavy metals have been implicated as risk factors, namely cadmium (Cd) and lead (Pb). Herewith, we investigated the presence and distribution of heavy metals in samples of renal cell carcinoma, as well as adjacent renal tissue (control samples), in patients submitted to radical or partial nephrectomy for renal cell carcinoma. Samples from renal tumour and adjacent renal tissue were processed and observed by Scanning Electron Microscopy coupled with X-Ray Microanalysis (SEM-XRM), in order to detect and quantify heavy metals in situ, using the JEOL JSM-6301F microscope. Our results revealed a significant difference in the composition of heavy metals between the renal adjacent tissue (control) and the tumour tissue. No heavy metal particles were detected in the adjacent (control) tissue, by this technique, but the presence of heavy metals such as chromium (Cr), iron (Fe) and copper (Cu) were detected among other particles which could be seen in the tumour tissue samples. Our results might suggest a possible role of heavy metals in the oncogenic pathway of renal cell carcinoma. However, there is controversy regarding this topic: 1 - Is this anomalous sequestration of heavy metals just an epiphenomenon or is this a hint of a causal mechanism? 2 - Can heavy metals be used as biomarkers with potential diagnostic or prognostic interest? For example, could they be used to improve the diagnostic value of renal biopsy in clinical practice?

Autorregulação da motivação: crenças e estratégias de alunos portugueses do 7º ao 9º ano de escolaridade / Self-regulation of motivation: beliefs and strategies of students between 7th to 9th grade

A motivação é um tema essencial quando se reflete sobre a aprendizagem e o sucesso escolar. A autorregulação da motivação na aprendizagem (AMA) é identificada como um aspeto fundamental das competências de autorregulação da aprendizagem. O processo de AMA inclui o metaconhecimento sobre a motivação e as estratégias de regulação da motivação. Neste estudo, a Escala de Autorregulação da Motivação na Aprendizagem (EAMA) foi aplicada a 316 estudantes entre o 7º e o 9º ano de Escolaridade. Os resultados obtidos indicam que as expectativas de autoeficácia, o valor da tarefa e as metas de realização são bons preditores do uso de estratégias de AMA. Foram encontradas diferenças entre os géneros e o ano escolar na utilização de estratégias e nas crenças motivacionais.

Motivation is a key element regarding learning and school success. Self-regulation of motivation (SRM) is identified as a fundamental aspect of self-regulated learning. The SRM process includes metamotivational knowledge and regulation of motivation strategies. In this study, the Self-Regulation of Motivation in Learning Scale (SRMS) was applied to 316 students from 7th to 9th grades. Results demonstrate that self-efficacy expectations, task value, and achievement goals are good predictors for the use of SRM strategies. Gender and grade differences were found in the use of strategies and motivational beliefs.

[Consensus document on coding of cardiac magnetic resonance examinations in Portugal]. / Documento de consenso sobre codificação de exames de ressonância magnética cardíaca em Portugal.

One of the obstacles to more frequent and appropriate use of cardiac magnetic resonance (CMR) in Portugal has been the lack of specific codes that accurately describe these examinations as they are currently performed. In this consensus document, recommendations are made for updating and standardizing CMR codes in Portugal. Guidance on which techniques and codes should be used in the most common clinical scenarios is also provided.

[Anomalous origin of the right coronary artery and acute myocardial infarction: cause or coincidence?]. / Origem anómala da coronária direita e enfarte agudo do miocárdio: causa ou coincidência?

Congenital coronary artery anomalies are one of the causes of myocardial ischemia and sudden death in the young, mainly during sports. Origin of the right coronary artery from the left anterior descending artery is very rare, with a prevalence of 0.015%, corresponding to 1.2% of all coronary artery anomalies. The authors present the case of a 22-year-old man, with a history of cocaine use, admitted to hospital with a non-ST elevation acute myocardial infarction. Coronary angiography revealed the presence of this rare coronary anomaly and the absence of atherosclerotic luminal stenosis, and so it was assumed to be a type II infarction caused by cocaine-induced vasospasm of the anomalous vessel.

Enhancing impact: visualization of an integrated impact assessment strategy.

The environmental impact assessment process is over 40 years old and has dramatically expanded. Topics, such as social, health and human rights impact are now included. The main body of an impact analysis is generally hundreds of pages long and supported by countless technical appendices. For large, oil/gas, mining and water resources projects both the volume and technical sophistication of the reports has far exceeded the processing ability of host communities. Instead of informing and empowering, the reports are abstruse and overwhelming. Reinvention is required. The development of a visual integrated impact assessment strategy that utilizes remote sensing and spatial analyses is described.

The importance of multimodality cardiac imaging: Echocardiography and cardiovascular magnetic resonance imaging contributions to the diagnosis and management of a right ventricular mass.

Cardiac metastases from testicular tumors are rare. We report a case of a 42-year-old man with a cardiac mass incidentally found in a computed tomography-scan included in the workup for lumbago and a suspicious neoformation in the right testicle. Transthoracic echocardiography showed a large multilobular ill-defined mass infiltrating the right ventricle free wall, protruding to, and partially obstructing the right ventricular outflow tract resulting in considerable outflow obstruction. Cardiac magnetic resonance imaging favored a malignant nature, which was confirmed by marked regression of the tumor mass with chemotherapy and anatomopathologic study.

Acute coronary syndrome in young adults.

INTRODUCTION: The aim of this study was to assess the features of acute coronary syndrome (ACS) in patients younger than 46 years of age. METHODS: This was a retrospective study of clinical features, complications and diagnostic and therapeutic strategies of patients hospitalized between 1999 and 2007 with a diagnosis of ACS in a non-tertiary hospital. Data were collected from clinical records. RESULTS: The study population included 128 patients. The male/female ratio was 94%/6% and mean age was 40 +/- 3.9 years. The distribution of ACS was as follows: ST-elevation acute myocardial infarction (AMI) 69%, non-ST elevation AMI 20%, unstable angina 9%, AMI with undetermined ECG 1%, and Prinzmetal angina 1%. The prevalence of cardiovascular risk factors was as follows: smoking 82.8%, dyslipidemia 42.2%, hypertension 28.9%, and diabetes 4.7%. Thrombolysis was the main myocardial reperfusion therapy, used in 76.1%. Echocardiography during hospitalization revealed normal left ventricular (LV) function in 66.1%, mild LV dysfunction in 14.5%, moderate LV dysfunction in 10.5% and severe LV dysfunction in 8.9%. Predischarge exercise testing was performed in 64.1% of patients and was normal in 85.4%, abnormal in 13.4% and inconclusive in 1.2%. Only 3.9% underwent single photon emission computed tomography (SPECT) myocardial perfusion imaging, which was positive for ischemia in 60% and negative in 40%. Elective catheterization was performed in 22.7% of patients; 44.9% underwent percutaneous coronary intervention and 6.9% were referred for cardiac surgery. Medication prescribed at discharge was as follows: aspirin 97.7%, beta-blockers 90.6%, statins 84.4%, angiotensin-converting enzyme inhibitors 50% and clopidogrel 25%. Arrhythmias were the main complication of ACS and no deaths occurred during hospitalization. CONCLUSIONS: As expected, ACS in young adults had a higher incidence in males. ST-elevation AMI was the main type. Most patients were smokers. Thrombolysis was the main myocardial reperfusion therapy. Echocardiography and predischarge exercise testing were the main complementary diagnostic tests for risk stratification. Prescription rates of drugs that improve prognosis were high.

Evaluation of a manual-based programme for the promotion of social and emotional skills in elementary school children: results from a 4-year study in Portugal.

The promotion of socio-emotional skills in educational contexts is highly beneficial to individuals' global adjustment and development. Evaluation research suggests that interventions for the promotion of socio-emotional skills are effective. However, most of this work has been carried out in the USA and there is now a pressing need to evaluate interventions at the cross-cultural level. This 4-year study evaluated the effectiveness of a teacher manual-based intervention for the promotion of social and emotional skills in Portuguese elementary school children. Using a quasi-experimental design, teachers taught manual-based strategies to children in the experimental group, focusing on specific social and emotional skills. These strategies were integrated as part of the curricular activities. Results showed statistically significant differences between the experimental group and the control group on the evaluated outcomes (self-control, emotional differentiation, emotional regulation, social skills, and self-esteem). For each of the dimensions studied, effect sizes were large (above 0.80). Findings are similar to those reported by international research evaluating the effectiveness of programmes for the promotion of social and emotional skills in school-age children. This study is an important contribution in the establishment of evidence-based socio-emotional skills programmes at the cross-cultural level.

Constrictive pericarditis of tuberculous etiology in the HIV-positive patient: case report and review of the literature.

Pericardial inflammation secondary to Mycobacterium tuberculosis infection is a rare condition, but its incidence is increasing in parallel with human immunodeficiency virus infection. Recrudescence of various types of tuberculosis should alert the clinician to the possibility of tuberculous pericarditis. The authors present the case of a 27-year-old white male, seropositive for the human immunodeficiency virus, presenting with large volume pericardial effusion and unusual echocardiographic features, global heart failure and clinical suspicion of tuberculosis. After anti-tuberculous chemotherapy and systemic corticosteroids there was some clinical improvement but evolution to constriction. The patient underwent pericardiectomy with good results. The authors present a literature review on constrictive tuberculous pericarditis in human immunodeficiency virus seropositive and seronegative patients, discussing the role of corticosteroids and the contribution of different diagnostic tools.

A função pública da transmissão da psicanálise

A função pública da transmissão da psicanálise levanta a questão de como a psicanálise pode ser ensinada, transmitida e inscrita no campo social com a mesma eficácia de sua práxis stricto sensu. A tese fundamenta a operacionalidade do discurso analítico dentro dessa esfera, promovendo um novo modo de liame no qual se sustentam as condições para fazer surgir na fala o sujeito como efeito de verdade. Verifica-se que sua incidência excede o tratamento de sua prática intra-muros, uma vez que percebemos na psicanálise, através do conceito de sujeio, a confluência entre as dimensões pública e privada, embora não se trate de transportar a psicanálise para a cultura. Deve-se reconhecer no discurso psicanalítico e em sua ética, elaborados e formalizados por Lacan, o que já é indissociavelmente função pública. A tese sustenta e demonstra, ainda, que a transmissão da psicanálise relança o sujeito em sua dívida com a própria transmissão, analítica ou não, fazendo-o retomar para si a responsabilidade de garantir o social. No texto, refaz-se o caminho da constituição do laço social e demonstra-se que a psicanálise opera na contra-mão da egoificação e da paranoização - modos de resistência no sujeito neurótico à sua condição de submissão ao significante. São elaborados, por fim, os caminhos do gozo e do desejo como componentes da tessitura de nossos laços sociais. Na conclusão, afirma-se que a psicanálise nada tem a restituir ao social em sua função pública, a não ser habilitar o sujeito em sua própria condição, marcando-lhe a falha e a falta, o que pode fazer com que algo se movimente, estabelecendo na perda de gozo como trabalho do desejo, a possibilidade de desestabilizar o funcionamento discursivo ao afetar seus hábitos mais mortificantes (AU)

Salmonella in Brazilian and imported pet reptiles

The presence of salmonellae in fecal sample or cloacal swabs of 97 pet reptiles (15 snakes, 24 lizards and 58 chelonians) was investigated. Thirty seven animals had national origin and 60 were imported. Salmonella spp was detected in 39.1(per cent) of the reptiles, being 62.5(per cent) in lizards, 53.3(per cent) in snakes and 25.8( per cent) in chelonians. Strains belonged to subspecies I 44.7( per cent), II 10.5(per cent), IIIa 5.2(per cent), IIIb 21.0(per cent) and IV 18.5(per cent) of the enterica species, with predominance 55.3(per cent) of subspecies usually found in cold-blooded animals (II to IV). In the subspecies I, the serovars Albany, Enteritidis and Typhimurium predominated. The Trachemys scripta elegans imported turtles corresponded to 93.3(per cent) (14/15) of the salmonellae-positive chelonians. The national iguanas presented a high rate of colonozation 77.7(per cent-7/9). These animals pose a potencial risk to the human health, demanding sanitary control and more information to the public.