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1.
Medicine (Baltimore) ; 98(38): e17212, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567975

RESUMO

RATIONALE: Anomalous Origin of Left Coronary Arteries from the Pulmonary Artery (ALCAPA), also known as Bland-White-Garland (BWG), is a rare form of coronary artery anomaly that is usually discovered in the first few months of life. Only rarely can patients with this anomaly reach adulthood without symptoms. PATIENT CONCERNS: A 28-year-old female was witnessed suddenly collapse with a seizure-like episode by her colleagues at work. DIAGNOSIS AND INTERVENTION: Routine cardiopulmonary resuscitation was performed by emergency medical service technologists. The patient was unable to be revived. Postmortem examination revealed the patient had ALCAPA with a focal chronic ischemic injury of the left ventricle. Moreover, a high take-off of the right coronary artery was also discovered. OUTCOMES: The patient passed away due to ALCAPA. The mechanism of death was cardiac arrhythmia being triggered by myocardial ischemic changes. LESSONS: In the rare cases where ALCAPA manifests in an asymptomatic adult, the mortality rate is very high. This case demonstrates the importance of awareness of such patients living under the tremendous risk of sudden cardiac death.


Assuntos
Anomalias dos Vasos Coronários/patologia , Artéria Pulmonar/anormalidades , Adulto , Arritmias Cardíacas/etiologia , Doenças Assintomáticas , Autopsia , Morte Súbita Cardíaca , Feminino , Humanos
2.
Medicine (Baltimore) ; 98(39): e17297, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574853

RESUMO

As a modifiable risk factor for cardiovascular disease, presence of hypertension (HT) necessitates the awareness of asymptomatic organ damage (AOD). The aim of this study was to measure plasma micro RNA-21 (miR-21) and the parameters that reflect AOD such as carotid intima-media thickness (CIMT), microalbuminuria (MAU) in hypertensive patients compared with healthy controls. In addition, the aim of this study was to evaluate plasma miR-21 levels in HT patients with AOD.This study was designed as a cross-sectional observational study. The study includes 2 groups: 32 patients with HT and 32 healthy controls. First, we compared these 2 groups. Then, to underline the relationship between plasma miR-21 and HT, hypertensive patients were divided into 2 groups: with AOD and without AOD.Sixteen patients with HT had AOD. MiR-21 levels significantly correlated with clinical systolic and diastolic blood pressure, MAU, C-reactive protein, and CIMT. CIMT, miR-21, and MAU levels were significantly higher in patients with AOD.Our study showed increased miR-21 levels in HT patients with AOD.


Assuntos
Albuminúria , Doenças Cardiovasculares , Hipertensão , MicroRNAs/sangue , Adulto , Albuminúria/diagnóstico , Albuminúria/etiologia , Doenças Assintomáticas/epidemiologia , Pressão Sanguínea/fisiologia , Proteína C-Reativa/análise , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Espessura Intima-Media Carotídea , MicroRNA Circulante/análise , Correlação de Dados , Estudos Transversais , Feminino , Humanos , Hipertensão/complicações , Hipertensão/diagnóstico , Hipertensão/genética , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Turquia/epidemiologia
3.
Medicine (Baltimore) ; 98(33): e16900, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415435

RESUMO

RATIONALE: Spontaneous closed extensor tendon rupture is a rare complication of Kienböck disease with only 23 cases reported in the English literature. PATIENT CONCERNS: We present a case of painless attritional rupture of the extensor tendons of the right fourth finger in a 69-year-old woman with Kienböck disease and review reported cases of Kienböck disease with subcutaneous closed tendon rupture. DIAGNOSES: Physical examination had shown mild painless swelling of the dorsum of the right hand. Plain radiographs showed a dorsally displaced fragment of collapsed lunate bone fracture (Lichtman grade IIIb). Although surgery was recommended, the patient did not desire surgery because she had no pain and no interference with the activities of daily living. Six months later, however, the patient returned to our hospital with complaints of loss of spontaneous extension of the fourth finger. CT and MRI showed aseptic necrosis and large dorsally displaced fragments of the lunate under the extensor tendons of the fingers, suggesting a subcutaneous fourth extensor tendon rupture. INTERVENTIONS: Surgery was performed to achieve functional recovery of the ring extensor and to prevent further subcutaneous tendon rupture. The extensor digitorum communis (EDC) of the ring finger was found to be ruptured and the EDCs to the third and fifth fingers were frayed due to attrition from the protrusion of the dorsal fragmented lunate bone. Inspection of the floor of the compartment revealed that the dorsally displaced fragment of the lunate bone had perforated the wrist capsule and protruded into the fourth compartment. The dorsal and volar fragments of the lunate bone were excised completely and scaphocapitate arthrodesis followed by the reconstruction of the fourth extensor tendon was performed. OUTCOMES: A year after the surgery, radiography showed complete union of the scaphocapitate arthrodesis. The joint motion reached 45% of normal without any pain and there was full active extension of the fourth finger. LESSONS: Because dorsally displacement of collapsed lunate bone fragments is a risk factor for attritional closed rupture of tendons, radiography, and MRI are essential to diagnose and to treat any closed tendon rupture.


Assuntos
Fraturas Ósseas/etiologia , Osso Semilunar/lesões , Osteonecrose/complicações , Ruptura Espontânea/etiologia , Idoso , Doenças Assintomáticas , Feminino , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Osso Semilunar/diagnóstico por imagem , Osso Semilunar/cirurgia , Osteonecrose/diagnóstico por imagem , Amplitude de Movimento Articular/fisiologia , Ruptura Espontânea/diagnóstico por imagem , Ruptura Espontânea/cirurgia , Tendões/cirurgia , Tomografia Computadorizada por Raios X
4.
Curr Sports Med Rep ; 18(6): 192-200, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31385834

RESUMO

Symptomatic tendinopathy can be a disabling condition for athletes. Common sites of tendinopathy in athletes include the rotator cuff (RTC), Achilles, and patellar tendons. Advanced imaging modalities, such as magnetic resonance imaging and ultrasound occasionally identify tendinopathic changes in asymptomatic individuals. Such asymptomatic changes have been documented in the RTC, Achilles, and patellar tendons of athletes. In the RTC, tendinopathy, partial-, and full-thickness tears have been demonstrated in asymptomatic athletes, though only small numbers of these athletes may develop symptoms despite prolonged periods of ongoing, competitive play. In the Achilles and patellar tendons, neovascularization, hypoechogenicity, and tendon thickening are commonly noted findings in asymptomatic athletes, and though all have been associated with tendon pain in the literature, there is some inconsistency as to which are the strongest predictors of future tendon pain. Evidence on how best to address or intervene upon such asymptomatic changes is limited.


Assuntos
Tendão do Calcâneo/patologia , Ligamento Patelar/patologia , Manguito Rotador/patologia , Tendinopatia/diagnóstico por imagem , Doenças Assintomáticas , Atletas , Humanos , Imagem por Ressonância Magnética , Tendinopatia/patologia , Ultrassonografia
5.
Medicine (Baltimore) ; 98(31): e16679, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374048

RESUMO

RATIONALE: Congenital portosystemic shunt (Abernethy malformation) is a rare entity causing the portal blood to drain directly into the systemic circulation, eluding the liver. These shunts arise through disturbances in the embryonic development. PATIENT CONCERNS: A 9-year-old male patient was referred to our department for further evaluation of a vascular malformation which was diagnosed in another facility when the patient was 2 years old, following a routine abdominal ultrasound. The patient had no complaints and the physical examination was normal at all times. DIAGNOSIS: Laboratory tests and esogastroduodenoscopy were normal. The abdominal ultrasound showed a side-to-side shunt between a short portal trunk and the inferior vena cava. A hepatic mass suggestive for focal noduar hyperplasia was seen in the left liver lobe. Abdominal angio-computed tomography (angio-CT) was performed and the ultrasonographic anomalies were confirmed. Multiple other vascular malformations were diagnosed-hepatic artery emerging from the superior mesenteric artery, with early division; hepatic veins forming a short common trunk before draining into the inferior vena cava; supranumerary right renal artery emerging from the aorta, tributary for the upper renal pole. Ecocardiography showed left superior vena cava persistence. The final diagnosis was Abernathy malformation type IB. In the meantime the patient was diagnosed with allergic asthma. INTERVENTIONS: No surgical cure was pursued because the malformation was an incidental discovery. OUTCOMES: The patient was followed-up closely from the final diagnosis (when he was 9 years old) to present (he is currently 10 years old) with no change in his status-he remained asymptomatic. LESSONS: Angio-CT should be the performed whenever a vascular malformation is suspected in order to establish a correct diagnosis, because portosystemic shunts carry a high risk of severe complications. Knowing that patients with portosystemic shunts may have pulmonary hypertension, respiratory complaints should be carefully evaluated-in this particular case, even though the most probable cause for the respiratory symptoms was pulmonary hypertension, it was ruled out by cardiac ultrasonography and further investigations confirmed the diagnosis of allergic asthma.


Assuntos
Achados Incidentais , Veia Porta/anormalidades , Malformações Vasculares/diagnóstico , Doenças Assintomáticas , Criança , Angiografia por Tomografia Computadorizada , Humanos , Fígado/irrigação sanguínea , Fígado/diagnóstico por imagem , Masculino , Veia Porta/diagnóstico por imagem , Ultrassonografia , Veia Cava Inferior/diagnóstico por imagem
7.
J Stroke Cerebrovasc Dis ; 28(9): 2376-2387, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31285116

RESUMO

BACKGROUND AND PURPOSE: Silent brain infarct (SBI), which has traditionally been considered clinically silent, has been proposed as a subclinical risk marker for future cognitive function decline. METHODS: We conducted a systematic review of literature in the Cochrane Library, MEDLINE, EMBASE, and the China National Knowledge Infrastructure database. RESULTS: In the end, 19 case-control studies, comprising 6712 participants, and 3 prospective cohort studies comprising 4433 participants, met all inclusion criteria and were included in the systematic review. Meta-analysis of 9 studies showed that SBI was an important factor in cognitive function decline (Mini-Mental State score) (standardized mean difference -.47, 95% confidence interval; -.72 to -.22). Another meta-analysis of 4 studies reported the SBI was an independent factor in cognitive dysfunction (Montreal Cognitive Assessment Scale) (standardized mean difference -3.36, 95% confidence interval; -5.90 to -.82). Ten studies further reported that SBI was associated with decreases in specific areas of cognitive function. CONCLUSIONS: These results suggest that rather than being clinically silent, SBI might be a factor inducing cognitive dysfunction.


Assuntos
Infarto Encefálico/complicações , Transtornos Cognitivos/etiologia , Cognição , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Infarto Encefálico/diagnóstico , Infarto Encefálico/psicologia , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Medição de Risco , Fatores de Risco , Fatores de Tempo
8.
J Stroke Cerebrovasc Dis ; 28(9): 2429-2433, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31296474

RESUMO

BACKGROUND: Intracranial arteriosclerotic disease (ICAD) is common in Asians and has been presumed to be largely associated with metabolic syndrome (MetS), but the risks for asymptomatic ICAD detectable in examinations of the brain, among other tests, are not well known. The present study is aimed at identifying the risks for asymptomatic ICAD using data on risk factors obtained in health checkups, including data from magnetic resonance imaging (MRI), chest computed tomography (CT), and neck echography. METHODS: Subjects comprised 103 examinees more than equal to 40 years old (56.9 ± 4.7 years, 93 men) who underwent head MRI, chest CT, and carotid echography in the same period in a workplace health checkup between April and September 2014. Subjects were evaluated for ICAD based on stenosis of bilateral middle cerebral arteries and the basilar artery on previously reported scores from magnetic resonance angiography. Evaluations for extracranial arteriosclerotic disease (ECAD) were based on findings from carotid echography, and total calcium scores were calculated based on the number, areas, and peak Hounsfield computed tomographic numbers of the aortic arch calcified lesion detected. RESULTS: ICAD, including mild cases with stenosis less than 50%, was seen in 21 subjects (20.3%); and MetS was evident in 12 subjects (11.7%). Logistic regression analysis with multivariate adjustment for major vascular risk factor demonstrated that echogenic of plaque was significantly associated with the ICAD (OR 3.69, 95%CI 1.02-13.3), however age was significant predictor of the risk profile in patients with ECAD. CONCLUSIONS: Carotid atherosclerosis could predict intracranial atherosclerosis in middle-aged people. However, further study with large sample size is warranted.


Assuntos
Artéria Basilar/diagnóstico por imagem , Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Arteriosclerose Intracraniana/diagnóstico por imagem , Imagem por Ressonância Magnética , Artéria Cerebral Média/diagnóstico por imagem , Saúde do Trabalhador , Tomografia Computadorizada por Raios X , Ultrassonografia , Local de Trabalho , Fatores Etários , Doenças Assintomáticas , Artéria Basilar/patologia , Artérias Carótidas/patologia , Doenças das Artérias Carótidas/epidemiologia , Doenças das Artérias Carótidas/patologia , Feminino , Humanos , Arteriosclerose Intracraniana/epidemiologia , Arteriosclerose Intracraniana/patologia , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/patologia , Projetos Piloto , Placa Aterosclerótica , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença
9.
J Med Microbiol ; 68(9): 1373-1382, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31329097

RESUMO

Introduction. Bacterial vaginosis (BV) is dysbiosis associated with an increased risk of several sexually transmitted infections. It is primarily diagnosed via Gram staining, although molecular analyses have presented higher diagnostic accuracy.Aim. This study aimed to evaluate the molecular epidemiology of BV in asymptomatic women to determine its association with several commensal and pathogenic micro-organisms of the genitalia.Methodology. The prevalence of BV was investigated through semiquantitative assessment of 201 women recruited during their routine gynaecological inspection at an outpatient clinic in Tabasco, Mexico.Results. Women with BV showed an increased prevalence of Chlamydia trachomatis (P=0.021) and Mycoplasma hominis (P=0.001). Of the BV-associated micro-organisms, Gardnerella vaginalis was significantly associated with C. trachomatis (P=0.005) and/or Ureaplasma parvum (P=0.003), whereas Atopobium vaginae and Megasphaera type 1 correlated significantly with Mycoplasma hominis (P=0.001). No significant association was observed between human papillomavirus (HPV) infection and BV, although there was increased prevalence of HPV59, HPV73, HPV52 and HPV58 in women displaying cervical cytological abnormalities.Conclusion. Identification of BV-associated micro-organisms via molecular analysis may help to distinguish recurrent cases from new infections and identify micro-organisms potentially associated with pharmacological resistance.


Assuntos
Bactérias/classificação , Bactérias/isolamento & purificação , Genitália Feminina/microbiologia , Epidemiologia Molecular , Vaginose Bacteriana/epidemiologia , Vaginose Bacteriana/microbiologia , Adolescente , Adulto , Doenças Assintomáticas , Bactérias/genética , Feminino , Genitália Feminina/virologia , Humanos , México/epidemiologia , Pessoa de Meia-Idade , Papillomaviridae/classificação , Papillomaviridae/isolamento & purificação , Prevalência , Adulto Jovem
10.
Medicine (Baltimore) ; 98(29): e16432, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335696

RESUMO

RATIONALE: Mesenteric cysts are benign gastrointestinal cystic lesions, with an incidence of <1/100 000. They usually develop in the small bowel mesentery, mesocolon (24%), retroperitoneum (14.5%), and very rarely originate from the sigmoid mesentery. Endometriomas represent a localized type of endometriosis and are usually within the ovary. Our case is unique because there are no reports in the literature of endometrial mesenteric cysts. PATIENT CONCERNS: We present a case of a 29-year-old woman who underwent a routine gynecologic control. DIAGNOSIS: Clinical examination and imaging identified 2 endometriomas on the left and posterior to the uterus. INTERVENTIONS: The patient underwent exploratory laparoscopy. Unexpectedly, a 10 cm mesenteric cyst was identified; this was associated with adhesions in the left adnexal area and a left ovarian endometrioma. The classic surgical approach which was necessary identified the mesenteric cyst with cranial mesosigmoid and ileal adhesions, as well as distal adhesions which included the uterus, ileum, left ovarian endometrioma, left hydrosalpinx, left ureter, and rectum. The cyst was removed completely and a left adnexectomy was performed because of the presence of the endometrioma and adhesions. OUTCOMES: The patient's outcome was favorable, with discharge at 72 hours after surgery. The histopathological report revealed that both the mesenteric and ovarian cysts were endometriomas. LESSONS: Our case is unusual in that a mesenteric cyst was identified in a patient with no clinical symptoms. Furthermore, the histopathological examination revealed the endometriotic origin of the mesenteric cyst which has not previously been reported in the literature.


Assuntos
Dissecação/métodos , Endometriose , Laparoscopia/métodos , Cisto Mesentérico , Cistos Ovarianos , Adulto , Doenças Assintomáticas , Endometriose/diagnóstico , Endometriose/diagnóstico por imagem , Endometriose/patologia , Endometriose/cirurgia , Feminino , Humanos , Achados Incidentais , Cisto Mesentérico/diagnóstico por imagem , Cisto Mesentérico/patologia , Cisto Mesentérico/cirurgia , Cistos Ovarianos/diagnóstico por imagem , Cistos Ovarianos/patologia , Cistos Ovarianos/cirurgia , Aderências Teciduais/diagnóstico , Aderências Teciduais/cirurgia , Resultado do Tratamento
11.
Rev. Asoc. Med. Bahía Blanca ; 19(2): 44-48, abril-junio 2019.
Artigo em Espanhol | LILACS | ID: biblio-968196

RESUMO

Introducción: La intususcepción rectal es un hallazgo frecuente en la defecografía tanto en individuos sintomáticos como en asintomáticos. Existe muy poca información con respecto al diagnóstico y tratamiento de esta anormalidad. También existe discrepancia entre las anormalidades anatómicas que pueden acompañar a esta patología, así como el grado de desarrollo de la intususcepción en pacientes asintomáticos. Objetivos: Describir la magnitud de la intususcepción en pacientes asintomáticos y comparar estos con los pacientes sin intususcepción. Materiales y Métodos: Medimos, con un instrumento graduado en centímetros y milímetros, la pared rectal que sobresale en forma circunferencial hacia distal del borde de un anoscopio circular.Pacientes: 50 pacientes operados de prolapso anal/ hemorroidal y 50 pacientes operados por otras patologías anales (fisura, ondilomas, estenosis anal). El 49% eran mujeres. El promedio de edad fue de 49.7 años (±4.5 años). Ningún paciente tenía síntomas de obstrucción defecatoria. Resultados: En los pacientes del grupo con prolapso anal/hemorroides encontramos una intususcepción promedio de 1.59 cm comparada con 0.23 cm en los pacientes del grupo operado por otra patología. Estos resultados son estadísticamente significativos (p=0.003). 33 pacientes del grupo estudiado presentaban intususcepción mayor a 1 cm, comparados con los sujetos controles (p=0.001). También fue significativa la diferencia entre aquellos que no tenían intususcepción y aquellos que sí la tenían aunque sea menores a 1 cm (p=0.004). No hubo diferencias significativas entre los dos grupos en cuanto a síntomas de obstrucción defecatoria o alguno que no tuviese relación con la patología por la cual iban a ser intervenidos quirúrgicamente (p=0.286). La longitud de la intususcepción fue de 0.5 a 2.5 cm y estuvo relacionada directamente a la patología subyacente por la cual se operaban los pacientes (fistulas, fisuras, condilomas, vs hemorroides, prolapso mucoso parcial y prolapso mucoso completo) (p = 0.003) e inversamente a los síntomas que presentaban (p < 0.001). Conclusiones: La intususcepción recto-rectal está presente, en diverso grado, en los pacientes con prolapso anal/hemorroidal, por lo que recomendaríamos realizar a todos estos pacientes una defecografía para evaluar el verdadero significado de esta patología. Se necesitan estudios a largo plazo para determinar la evolución real de esta entidad.


Introduction: Rectal intussusception is frequently found in defecography. Both in symptomatic and asymptomatic subjects. There is little information about the diagnose and treatment of this abnormality. There is also discrepancy about the anatomic abnormalities that can come with this pathology, and the degree of development of intussusception in asintomatic patients. Objetives: To describe intussusception size in asintomatic patients, and to compare them with patients without intussusception. Method: Using an instrument with centimetres and milimetres, we measured the rectal wall that protrudes, circumferencially to distally, from the edge of a circular anoscope. Patients: 50 patients who had been operated on anal / hemorrhoidal prolapse, and 50 patients who had been operated on other anal pathologies (fissures, fistulas, condilomas, anal stenosis). 49% of the patients were women. Age average was 48.7 years old (±4.5 years old. None of the patients had simptoms of defecatory obstruction. Results: Among patients from the anal/hemorrhoids prolapse, average intussusception of 1.59 cm was observed. Among patients operated on other pathologies, 0.23 cm. These results are statistically significant (p=0.003). 33 patients of the studied group showed intussusception bigger than 1 cm, compared to the control subjects (p=0.001). The difference among those without intussusception and those with it, even smaller than 1 cm (p=0.004), was also significant. There were no significant differences among the groups, as regards symptoms of defecatory obstruction or a symptom unrelated to the pathology that would cause their surgery (p=0.286). Intussusception length was 0.5 to 2.5 cm. It was directly related to the underlying pathology that caused their surgery (fistula, fisure, condiloma, vs. hemorrhoids, partial mucous prolapse and complete mucous prolapse) (p = 0.003). It was inversely related to the shown symptoms (p < 0.001). Conclusions: Rectum-rectal intussuspection is observed, in different degrees, in patients with ana/hemorrhoidal prolapse. Thus, we would recommend to perform a defecography to all these patients, to assess the true meaning of this pathology. Long term studies will be necessary to determine the true evolution of this entity.


Assuntos
Humanos , Intussuscepção , Defecografia , Doenças Assintomáticas , Obstrução Intestinal
12.
Eur J Vasc Endovasc Surg ; 57(6): 768-777, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31164272

RESUMO

OBJECTIVE: Neutrophil gelatinase associated lipocalin (NGAL) and matrix metalloproteinase (MMP)-9/NGAL complex were investigated in asymptomatic patients with carotid artery stenosis including gender specific differences aiming at vulnerable plaques prone to embolisation. METHODS: Serum NGAL and MMP-9/NGAL levels were analysed in 83 patients with asymptomatic carotid artery stenosis. Pre-operative ultrasound and post-endarterectomy histology of carotid atherosclerotic lesions were evaluated. RESULTS: Patients with vulnerable plaques, as determined by ultrasound (plaques with decreased echogenicity) and histological analysis (type VI according to the classification of the American Heart Association), displayed the highest levels of NGAL and MMP-9/NGAL complex (p = .0003 and p = .0078, respectively). Grade VI plaques were primarily detected in patients with "soft" plaques (12 type VI plaques in 25 patients), but also in patients with mixed (four of 19) and calcified (three of 39) plaques according to ultrasound. Higher grade carotid artery stenosis (≥90%) was not associated with elevated NGAL levels. The receiver operating characteristic curve analysis detecting grade VI lesions yields an area under the curve (AUC) = 0.85, with respect to soft plaque on ultrasound the AUC = 0.86. There were no gender specific differences in levels of NGAL 80.9 (37.7) ng/mL in women vs. 76.7 (36.3) ng/mL in men, p = .607) nor of MMP-9/NGAL 33.0 (18.2-55.5) ng/mL in women vs. 36.7 (20.2-54.0) ng/mL in men, p = .969. Likewise, there were no gender associated differences in vulnerable plaque characteristics: either for grade VI plaques (17.9% vs. 27.3%, p = .582) or for the presence of soft plaques as evaluated by ultrasound (35.9% vs. 25%, p = .503). CONCLUSION: Circulating NGAL and MMP-9/NGAL are significantly increased in asymptomatic patients with vulnerable carotid atherosclerotic plaques independent of gender. Accordingly, serum NGAL may be proposed as a valuable biomarker for the detection of unstable carotid plaques in asymptomatic patients, who can then be selected for early carotid endarterectomy or stenting.


Assuntos
Estenose das Carótidas/sangue , Lipocalina-2/sangue , Placa Aterosclerótica , Idoso , Doenças Assintomáticas , Biomarcadores/sangue , Biópsia , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas , Feminino , Humanos , Masculino , Metaloproteinase 9 da Matriz/sangue , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Fatores de Risco , Ruptura Espontânea , Ultrassonografia Doppler Dupla , Regulação para Cima
13.
J Shoulder Elbow Surg ; 28(6S): S154-S160, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31196510

RESUMO

BACKGROUND: Magnetic resonance imaging (MRI) findings in asymptomatic patients have been described for hips, knees, ankles, shoulders, and intervertebral disks. No such description exists for the elbow. METHODS: MRI scans of 189 asymptomatic elbows divided into 3 groups by age (group 1, 20-39 years; group 2, 40-59 years; and group 3, ≥60 years) were evaluated for abnormalities within 13 anatomic structures using a novel classification system. RESULTS: At least 1 variation was found in all elbows. Of the 13 structures, 8 showed an increase in the prevalence and intensity of signal changes with aging, 2 remained the same, and 2 showed a decrease. One anatomic structure showed no variations in any elbow. CONCLUSIONS: Elbow MRI variations may be seen regardless of symptoms. These changes appear to increase in prevalence and intensity with age. Results from this study can be used to help guide the clinician in interpreting MRI findings of the elbow. We hope this study helps provide a contextual background for discussing MRI findings with patients and differentiating age-related variations from true pathology.


Assuntos
Envelhecimento , Doenças Assintomáticas , Articulação do Cotovelo/diagnóstico por imagem , Imagem por Ressonância Magnética , Adulto , Idoso , Humanos , Pessoa de Meia-Idade
14.
Vasc Health Risk Manag ; 15: 101-107, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31190848

RESUMO

Introduction: Theoretically, first-degree relatives (FDRs) of type 2 diabetes mellitus (T2DM) are predisposed to have earlier and more severe atherosclerosis than non-FDR due to hereditary insulin resistance. A previous study reported that atherosclerotic plaques were found in 45.2% of young adults FDR of T2DM, but the study did not include non-FDR as control group. The aim of this study was to compare subclinical atherosclerosis (carotid intima-media thickness, CIMT) between FDR of T2DM and non-FDR. Method: This was a cross-sectional study involving 16 FDR subjects and 16 age-sex matched non-FDR subjects, aged 19-40 years, with normal glucose tolerance and no hypertension. Collected data included demographic characteristic, anthropometric measurement (BMI and waist circumference), laboratory analysis (fasting blood glucose, HbA1c, lipid profile), and CIMT examination (using B-mode ultrasound). Results: The mean of CIMT in the FDR group was higher than that in the non-FDR group (0.44 mm vs 0.38 mm, p=0.005). After adjusting for waist circumference, BMI, low-density lipoprotein cholesterol, and triglyceride, CIMT maintained significant difference between FDR and non-FDR subjects. BMI and waist circumference showed moderate correlation with CIMT. Conclusion: CIMT in young adult FDR of T2DM is thicker than that in age-and sex-matched non-FDR population.


Assuntos
Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Espessura Intima-Media Carotídea , Diabetes Mellitus Tipo 2/genética , Adulto , Doenças Assintomáticas , Biomarcadores/sangue , Glicemia/análise , Pressão Sanguínea , Artérias Carótidas/patologia , Doenças das Artérias Carótidas/genética , Doenças das Artérias Carótidas/patologia , Estudos de Casos e Controles , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/fisiopatologia , Feminino , Predisposição Genética para Doença , Hereditariedade , Humanos , Masculino , Linhagem , Fenótipo , Placa Aterosclerótica , Valor Preditivo dos Testes , Fatores de Risco , Adulto Jovem
15.
Vasc Health Risk Manag ; 15: 123-135, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31190850

RESUMO

Purpose: Disturbed metabolism of cholesterol and triacylglycerols (TGs) carries increased risk for coronary artery calcification (CAC). However, the exact relationship between individual lipid species and CAC remains unclear. The aim of this study was to identify disturbances in lipid profiles involved in the calcification process, in an attempt to propose potential biomarker candidates. Patients and methods: We studied 70 patients at intermediate risk for coronary artery disease who had undergone coronary calcification assessment using computed tomography and Agatston coronary artery calcium score (CACS). Patients were divided into three groups: with no coronary calcification (NCC; CACS: 0; n=26), mild coronary calcification (MCC; CACS: 1-250; n=27), or severe coronary calcification (SCC; CACS: >250; n=17). Patients' serum samples were analyzed using liquid chromatography-mass spectrometry in an untargeted lipidomics approach. Results: We identified 103 lipids within the glycerolipid, glycerophospholipid, sphingolipid, and sterol lipid classes. After false discovery rate correction, phosphatidylcholine (PC)(16:0/20:4) in higher levels and PC(18:2/18:2), PC(36:3), and phosphatidylethanolamine(20:0/18:2) in lower levels were identified as correlates with SCC compared to NCC. There were no significant differences in the levels of individual TGs between the three groups; however, clustering the lipid profiles showed a trend for higher levels of saturated and monounsaturated TGs in SCC compared to NCC. There was also a trend for lower TG(49:2), TG(51:1), TG(54:5), and TG(56:8) levels in SCC compared to MCC. Conclusion: In this study we investigated the lipidome of patients with coronary calcification. Our results suggest that the calcification process may be associated with dysfunction in autophagy. The lipidomic biomarkers revealed in this study may aid in better assessment of patients with subclinical coronary artery disease.


Assuntos
Doença da Artéria Coronariana/sangue , Dislipidemias/sangue , Metabolômica/métodos , Fosfolipídeos/sangue , Calcificação Vascular/sangue , Idoso , Doenças Assintomáticas , Autofagia , Biomarcadores/sangue , Cromatografia Líquida de Alta Pressão , Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/patologia , Dislipidemias/diagnóstico , Dislipidemias/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Espectrometria de Massas por Ionização por Electrospray , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/patologia
16.
Yonsei Med J ; 60(7): 619-625, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31250575

RESUMO

PURPOSE: To evaluate predictors of severe or moderate coronary artery disease (CAD) in individuals with zero or very low (<10) coronary artery calcium (CAC) scores. MATERIALS AND METHODS: The 1175 asymptomatic persons with zero or very low (<10) CAC scores were analyzed for CAD stenosis using coronary computed tomography angiography. Moderate and severe CADs were defined as having more than 50% and more than 70% stenosis in any of the major coronary arteries, respectively. Age, gender, body mass index, hypertension, type II diabetes, dyslipidemia, lipid profile, creatinine, and smoking status were evaluated as predictors for moderate and severe CAD. RESULTS: In the study population, moderate and severe CADs were found in 7.5% and 3.3%, respectively. Among evaluated risk factors, age [odds ratio (OR) 1.04, 95% confidence interval (CI) 1.02-1.07, p<0.001], current smoking status (OR 3.12, 95% CI 1.82-5.34, p<0.001), and CAC 1-9 (OR 1.80, 95% CI 1.08-3.00, p=0.024) were significantly associated with moderate CAD. Meanwhile, age (OR 1.05, 95% CI 1.02-1.08, p=0.003), low high density lipoprotein (HDL) (OR 0.96, 95% CI 0.93-0.99, p=0.003), and current smoking status (OR 2.34, 95% CI 1.14-5.30, p=0.022) were found to be significantly associated with severe CAD. Improvement of discrimination power for predicting severe CAD was observed when smoking and HDL cholesterol were serially added into the age model. CONCLUSION: Smoking showed significant correlations with moderate or severe CAD, and low HDL cholesterol also proved to be a predictor of severe CAD in asymptomatic individuals with extremely low CAC scores.


Assuntos
Doenças Assintomáticas , Cálcio/metabolismo , Doença da Artéria Coronariana/metabolismo , Vasos Coronários/metabolismo , Adulto , Idoso , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Fumar
17.
Int Heart J ; 60(4): 1006-1008, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31204377

RESUMO

Incomplete Kawasaki disease (iKD), which does not satisfy the standard KD diagnostic criteria because the required number of principal symptoms is not met, sometimes causes coronary aneurysms. Here we report the case of a patient with iKD who presented with only one principal symptom that resulted in the development of coronary aneurysm, as evidenced by angiography.


Assuntos
Aneurisma Coronário/etiologia , Vasos Coronários/diagnóstico por imagem , Febre/complicações , Síndrome de Linfonodos Mucocutâneos/complicações , Doenças Assintomáticas , Aneurisma Coronário/diagnóstico , Angiografia Coronária , Diagnóstico Diferencial , Ecocardiografia , Humanos , Lactente , Masculino
18.
Einstein (Sao Paulo) ; 17(2): eRC4514, 2019 May 09.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31090793

RESUMO

The left ventricular noncompaction is a congenital cardiomyopathy characterized by the presence of abnormal trabeculations in the left ventricle. The present study describes the case of a 14-year-old female Para athlete, who plays goalball. She was asymptomatic, with history of congenital nystagmus and mild visual impairment, who presented nonspecific electrocardiographic abnormalities during pre-competition screening. Cardiac magnetic resonance imaging showed left ventricular non-compaction (non-compacted to compacted layer ratio equal to 2.5) and mild biventricular systolic dysfunction. Initially, the patient was excluded from sports participation and clinical follow-up was performed every three months. Patient remained asymptomatic during the one-year follow-up, with no history of unexplained syncope, marked impairment of systolic function or significant ventricular arrhythmias at the exercise stress test. Finally, she was released for competitive goalball participation and clinical follow-up was continued every 6 months. There is no consensus regarding the eligibility criteria for sports participation in cases of left ventricular non-compaction. Thus, it is prudent to individualize the decision regarding practice of sports, as well as to consider participation in competitive sports for asymptomatic individuals and with no disease repercussions.


Assuntos
Miocárdio Ventricular não Compactado Isolado/diagnóstico por imagem , Adolescente , Arritmias Cardíacas/complicações , Doenças Assintomáticas , Atletas , Eletrocardiografia , Exercício , Feminino , Humanos , Miocárdio Ventricular não Compactado Isolado/complicações , Imagem por Ressonância Magnética , Nistagmo Congênito/complicações
19.
Plant Foods Hum Nutr ; 74(3): 316-321, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31119466

RESUMO

Inositol hexaphosphate (IP6), a food constituent with various health benefits, has been shown to suppress postprandial elevations of serum uric acid (SUA) levels in healthy adults by inhibiting purine nucleoside and base absorption. Here, we investigated the effect of repeated intake of IP6 on fasting SUA levels in hyperuricemic subjects. This randomized double-blind placebo-controlled crossover design study included 31 asymptomatic hyperuricemic subjects (fasting SUA level > 7.0 but <9.0 mg/dL). Subjects ingested placebo or IP6 drinks (600 mg twice daily) during two 2-week intervention periods with a 2-week washout period. The primary outcome was fasting SUA level; the secondary outcome was the urinary uric acid to creatinine ratio. Fasting SUA levels in the IP6 group were lower than those in the placebo group (p < 0.05). The urinary uric acid to creatinine ratio did not change between the placebo and IP6 groups (p > 0.05). This study showed that a 2-weeks supplementation period of 600 mg IP6 twice daily can improve fasting SUA levels in hyperuricemic subjects.


Assuntos
Hiperuricemia/tratamento farmacológico , Ácido Fítico/farmacologia , Ácido Úrico/sangue , Adulto , Doenças Assintomáticas , Estudos Cross-Over , Método Duplo-Cego , Jejum , Feminino , Humanos , Masculino , Adulto Jovem
20.
Pediatr Cardiol ; 40(5): 892-900, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31069431

RESUMO

The approach to pediatric asymptomatic Wolff-Parkinson-White (WPW) patients is controversial. The objective of this review is to update the last consensus of specialists of the Pediatric and Congenital Electrophysiology Society/Heart Rhythm Society on this subject in order to summarize the most recent evidence on the management of young patients with asymptomatic WPW pattern. A systematic review of the literature published between 2008 and 2018 was performed taking into account the protocol of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) in PubMed (including Cochrane), Embase, and Web of Science. Observational, experimental, and multicentric studies were included. Out of a total of 37 articles selected, 4 were considered eligible. Most studies considered a cutoff age of 8 or greater as recommended in the 2012 consensus. The identification of a shortest pre-excitatory RR interval (SPERRI) ≤ 250 ms seems to be the best predictor for risk stratification. The importance of routine isoprenaline use to improve the sensitivity of the electrophysiological study to identify patients at high risk of sudden death was consensual. Prophylactic ablative therapy has been indicated in asymptomatic children with an accessory pathway (AP) who have a low SPERRI and/or a low effective anterograde period of the AP and/or multiple APs. Despite the evidence found in the most recent studies, more studies are warranted in this setting.


Assuntos
Doenças Assintomáticas , Síndrome de Wolff-Parkinson-White/terapia , Feixe Acessório Atrioventricular/congênito , Adolescente , Criança , Consenso , Eletrocardiografia , Feminino , Humanos , Masculino , Síndrome de Wolff-Parkinson-White/diagnóstico por imagem , Síndrome de Wolff-Parkinson-White/mortalidade
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