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Arq Bras Cardiol ; 114(1): 98-99, 2020 Jan.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32049175
Autops Case Rep ; 9(4): e2019135, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31807438


Hepatocellular carcinoma (HCC) is among the five most frequent causes of cancer death worldwide, according to the WHO. The disease is related to alcohol abuse, viral infections, and other causes of cirrhosis, and unfortunately, in some developed countries, the incidence shows an increasing trend. Although the diagnosis of the HCC often relies upon the context of a chronic hepatopathy, some cases may present a silent course, and the initial symptoms ensue when the disease is in an advanced stage with no chance for any therapeutic attempt. The clinical picture of the HCC is varied, and unexpected forms may surprise the clinician. One of the unusual presentations of the HCC is shock by the blockage of the venous return to the right atrium by the inferior vena cava infiltration. Herein we present a case of an old patient who sought medical care complaining of dyspnea. The clinical workup disclosed a right thorax pleural effusion and imaging exams depicted a mass in the right hepatic lobe, invasion of the inferior vena cava (IVC) and the right atrium (RA). During the attempts of clinical investigation, the patient passed away. The autopsy disclosed an HCC involving the right hepatic lobe, with the invasion of the IVC and the RA. The authors highlight the importance of recognizing the bizarre presentation of not so rare diseases.

Diagn. tratamento ; 24(4): [158-160], out - dez. 2019.
Artigo em Português | LILACS | ID: biblio-1049387
Diagn. tratamento ; 24(3): [98-99], jul - set. 2019.
Artigo em Português | LILACS | ID: biblio-1026691
Clin Infect Dis ; 2019 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-30949690


BACKGROUND: 18Fluorodeoxyglucose positron emission tomography (18F-FDG-PET/CT) has emerged as a useful diagnostic tool for suspected infective endocarditis (IE) in patients with prosthetic valves or implantable devices. However, there is limited evidence regarding the use of 18F-FDG-PET/CT for the diagnosis of native valve IE (NVE). METHODS: Between 2014 and 2017, 303 episodes of left-sided suspected IE (188 prosthetic valves/ascending aortic prosthesis and 115 native valves) were studied. 18F-FDG-PET/CT accuracy was determined in the subgroups of patients with NVE and prosthetic valve endocarditis (PVE) / ascending aortic prosthesis infection (AAPI). Associations between inflammatory infiltrate patterns and 18F-FDG-PET/CT uptake were investigated in an exploratory ad hoc histological analysis. RESULTS: Among 188 patients with PVE/AAPI, the sensitivity, specificity, and positive and negative predictive values of 18F-FDG-PET/CT focal uptake were 93%, 90%, 89%, and 94%, respectively, while among 115 patients with NVE, the corresponding values were: 22%, 100%, 100%, and 66%. The inclusion of abnormal 18F-FDG cardiac uptake as a major criterion at admission enabled a re-categorization of 76% (47/62) of PVE/AAPI cases initially classified as "possible" to "definite" IE. In the histopathological analysis, a predominance of PMN inflammatory infiltrate and reduced extent of fibrosis were observed in the PVE group only. CONCLUSIONS: The addition of 18F-FDG-PET/CT at the initial presentation of patients with suspected PVE increases the diagnostic capability of the Modified Duke criteria. In patients presenting with suspected NVE, the use of 18F-FDG-PET/CT is less accurate, and could only be considered a complementary diagnostic tool for a specific population of patients with NVE.

Int J Cardiol Heart Vasc ; 21: 45-49, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30294660


Background: Physiological pathways such as bradykinin, renin-angiotensin, neurohormones and nitric oxide have been shown to play an important role in the regulation of cardiovascular function. Genetic variants of these pathways may impact blood pressure and left ventricular (LV) mass in different populations. To evaluate associations of genetic polymorphisms of bradykinin B2 receptor (BDKRB2), alpha-adrenergic receptors (ADRA) and endothelial nitric oxide synthase (eNOS) on the modulation of the blood pressure and the left ventricular mass. Methods: We enrolled 758 individuals without overt heart disease. Blood pressure was estimated by auscultatory method during the clinical examination. Left ventricular (LV) mass was assessed by echocardiography. Genotypes for ADRA1A rs1048101, ADRA2A rs553668, ADRA2B rs28365031, eNOS rs2070744, eNOS rs1799983, and BDKRB2 rs5810761 polymorphisms were assessed by high-resolution melting analysis. Results: BDKRB2 polymorphism rs5810761 was associated with blood pressure. Carriers of DD genotype had higher levels of SBP and DBP than carrier of II genotype (p = 0.013 and p = 0.007, respectively). eNOS polymorphism rs1799983 was associated with DBP. Carriers of GT genotype had lower levels of DBP than carriers of GG genotype (p = 0.018). eNOS polymorphism rs2070744 was associated with LV mass. Carriers of TC genotype had higher LV mass than carriers of TT genotype (p = 0.028). Conclusions: In a cohort of individuals without overt heart disease, the BDKRB2 rs5810761 polymorphism (DD genotype carriers) were associated higher systolic and diastolic blood pressures, and the eNOS rs1799983 polymorphism (T allele carriers) were associated with lower diastolic blood pressure. The eNOS rs2070744 polymorphism (C allele carriers) was associated with higher left ventricular mass. These data suggest that eNOS and bradykinin receptor genetic variants may be potential markers of common cardiovascular phenotypes.

Diagn. tratamento ; 23(4): [134-136], out-dez 2018.
Artigo em Português | LILACS | ID: biblio-987468

Int J Infect Dis ; 77: 48-52, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30248465


OBJECTIVE: To compare the clinical and epidemiological features, treatments, and outcomes of patients with isolated right-sided and left-sided fungal endocarditis and to determine the risk factors for in-hospital mortality in patients with Candida sp endocarditis. METHODS: A retrospective review of all consecutive cases of fungal endocarditis from five hospitals was performed. Clinical features were compared between patients with isolated right-sided and left-sided endocarditis. In the subgroup of fungal endocarditis due to Candida species, binary logistic regression analysis was performed to determine variables related to in-hospital mortality. RESULTS: Seventy-eight patients with fungal endocarditis were studied. Their median age was 50 years; 55% were male and 19 patients (24%) had isolated right-sided endocarditis. Overall, cardiac surgery was performed in 46 patients (59%), and in-hospital mortality was 54%. Compared to patients with left-side fungal endocarditis, patients with isolated right-sided endocarditis had lower mortality (32% vs. 61%; p=0.025) and were less often submitted to cardiac surgery (37% vs. 66%; p=0.024). The most frequent etiology was Candida spp (85%). In this subgroup, acute heart failure (odds ratio 5.0; p=0.027) and exclusive medical treatment (odds ratio 11.1; p=0.004) were independent predictors of in-hospital death, whereas isolated right-sided endocarditis was related to a lower risk of mortality (odds ratio 0.13; p=0.023). CONCLUSIONS: Patients with isolated right-sided fungal endocarditis have particular clinical and epidemiological features. They were submitted to cardiac surgery less often and had better survival than patients with left-sided fungal endocarditis. Isolated right-sided endocarditis was also a marker of a less harmful illness in the subgroup of Candida sp endocarditis.

Endocardite/mortalidade , Insuficiência Cardíaca/mortalidade , Micoses/mortalidade , Adulto , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Candida/efeitos dos fármacos , Candida/isolamento & purificação , Equinocandinas/uso terapêutico , Endocardite/tratamento farmacológico , Feminino , Fluconazol/uso terapêutico , Seguimentos , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/microbiologia , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Micoses/tratamento farmacológico , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
PLoS One ; 13(9): e0204246, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30235300


BACKGROUND: Premature complexes are common electrocardiographic findings in daily clinical practice that require further evaluation. Investigation may sometimes be complex and expensive. The aim of our study was to analyze variables associated with premature beats identified in outpatients referred from a primary care facility. MATERIALS AND METHODS: We performed a cross-sectional study of 407 outpatients (aged 55.8±11years; 56% women) who were followed by general practitioners and were referred for resting 12-lead electrocardiograms for a routine clinical follow-up. After signing informed consent, patients answered a questionnaire and underwent physical examinations, laboratory diagnostics, transthoracic echocardiograms and 24-hour Holter monitoring to evaluate for the presence of premature complexes. After the univariate analyses, logistic regression analyses were performed with adjustment for age, sex, and cardiovascular diseases. RESULTS: Premature complexes distribution revealed that they were frequent but with low density. Premature atrial complexes (≥ 4/hours) were associated with age (Odds Ratio (OD) = 1.030, Confidence Interval (CI) 95% = 1.002 ─ 1.059, p = 0.029), brain natriuretic peptide (BNP) levels > 20mg/dL (OR = 4.489, 95%CI = 1.918 ─ 10.507, p = 0.0005), intraventricular blocks (OR = 4.184, 95%CI = 1.816 ─ 9.406, p = 0.0005) and left atrial diameter (OR = 1.065, 95%CI = 1.001 ─ 1.134, p = 0.046). Premature ventricular complexes (≥ 5/hour) were related to age (OR = 1.032, 95%CI = 1.010 ─ 1.054, p = 0.004), the use of calcium channel blockers (OR = 2.248, 95%CI = 1.019 ─ 4.954, p = 0.045), HDL-cholesterol levels (OR = 0.971, 95%CI = 0.951 ─ 0.992, p = 0.007), BNP levels > 20mg/dL (OR = 2.079, 95%CI = 0.991 ─ 0.998, p = 0.033), heart rate (OR = 1.019, 95%CI = 1.001 ─ 1.038, p = 0.041), left ventricular hypertrophy (OR = 2.292, 95%CI = 1.402 ─ 3.746, p = 0.001) and left ventricular ejection fraction (OR = 0.938, 95%CI = 0.900 ─ 0.978, p = 0.002). CONCLUSIONS: Premature complexes had low density and were associated with BNP levels > 20mg/dL, lower levels of HDL-cholesterol, left atrial enlargement and ventricular hypertrophy. The identification of premature complexes on 24-hour Holter monitor recordings of outpatients in a primary public healthcare setting was associated with uncontrolled cardiovascular risk factors that may be addressed with medical advice and therapy in a primary care setting.

Complexos Atriais Prematuros/fisiopatologia , Eletrocardiografia Ambulatorial/métodos , Complexos Ventriculares Prematuros/fisiopatologia , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Atenção Primária à Saúde , Encaminhamento e Consulta , Inquéritos e Questionários
Diagn. tratamento ; 23(3): [94-95], jul.-set. 2018.
Artigo em Português | LILACS | ID: biblio-969290

Terapêutica , Medicina
Arq Bras Cardiol ; 111(1): 48-49, 2018 07.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30110044
Diagn. tratamento ; 23(2): 54-56, abr.-jun. 2018.
Artigo em Português | LILACS | ID: biblio-904896
Diagn. tratamento ; 23(1): 11-12, 06/04/2018.
Artigo em Português | LILACS | ID: biblio-882157

Int J Infect Dis ; 67: 3-6, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28935245


OBJECTIVE: To determine the annual incidence of prosthetic valve endocarditis (PVE) and to evaluate its current classification based on the epidemiological distribution of agents identified and their sensitivity profiles. METHODS: Consecutive cases of PVE occurring within the first year of valve surgery during the period 1997-2014 were included in this prospective cohort study. Incidence, demographic, clinical, microbiological, and in-hospital mortality data of these PVE patients were recorded. RESULTS: One hundred and seventy-two cases of PVE were included, and the global annual incidence of PVE was 1.7%. Most PVE cases occurred within 120days after surgery (76.7%). After this period, there was a reduction in resistant microorganisms (64.4% vs. 32.3%, respectively; p=0.007) and an increase in the incidence of Streptococcus spp (1.9% vs. 23.5%; p=0.007). A literature review revealed 646 cases of PVE with an identified etiology, of which 264 (41%) were caused by coagulase-negative staphylococci and 43 (7%) by Streptococcus spp. This is in agreement with the current study findings. CONCLUSIONS: Most PVE cases occurred within 120days after valve surgery, and the same etiological agents were identified in this period. The current cut-off level of 365days for the classification of early-onset PVE should be revisited.

Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/etiologia , Próteses Valvulares Cardíacas/efeitos adversos , Infecções Relacionadas à Prótese/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Endocardite Bacteriana/microbiologia , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecções Relacionadas à Prótese/microbiologia , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/etiologia , Adulto Jovem
Diagn. tratamento ; 22(4): 162-163, Out.-dez. 2017.
Artigo em Português | LILACS | ID: biblio-875473
Diagn. tratamento ; 22(3): 115-116, Jul.-Aug. 2017.
Artigo em Português | LILACS | ID: biblio-848010

Diagn. tratamento ; 22(2): 71-72, Abr.-Jun. 2017.
Artigo em Português | LILACS | ID: biblio-833692
Diagn. tratamento ; 22(1): 30-32, Jan.-mar. 2017.
Artigo em Português | LILACS | ID: biblio-832438
Diagn. tratamento ; 21(4): 170-171, Out.-Dez. 2016.
Artigo em Português | LILACS | ID: biblio-2498

Diagn. tratamento ; 21(3): 126-127, jul.-set. 2016.
Artigo em Português | LILACS | ID: biblio-1374