Controversies regarding the effects of growth hormone on the heart

Growth hormone (GH) profoundly affects the developing and adult myocardium. Adult patients with GH deficiency (GHD) and GH excess (acromegaly) provide important models in which to understand the effects of GH in adult cardiac physiology. An increasing body of clinical and experimental evidence illustrates the specific physiological abnormalities that are likely associated with the excess cardiovascular mortality observed in both acromegaly and GHD. Because human GH replacement is now available to treat adults with GHD, new questions emerge about the long-term cardiovascular effects of replacement therapy. In multiple trials, GH therapy for congestive heart failure has been proved ineffective in the absence of preexisting GHD. Case reports suggest that, in the setting of GHD, GH therapy can exert a potent beneficial effect on congestive heart failure. Long-term studies addressing cardiovascular morbidity and mortality are needed to assess the role of GH therapy for GHD.

Feline aortic thromboembolism

Aortic thromboembolism is one of the most serious and difficult-to-manage complications. of feline cardiac disease. Most, but not all, cats presenting with signs of aortic thromboembolism are found to have underlying cardiac disease at the time of presentation. In most cases no underlying disease has been diagnosed prior to presentation with paresis/paralysis and profound anxiety. This article will review commonly used treatments for thromboembolism and agents proposed for prophylaxis. Many of the proposed treatments are themselves associated with a high morbidity rate and long term clinical trials are required to make comparative risk-to-benefit ratio assessments of these different options. In cats which do survive the initial treatment, clinicians are still faced with the perplexing problem of long term thrombus prevention, as a majority of cats have been shown to re-embolise despite prophylaxis.

Left ventricular dyssynchrony predicts benefit of cardiac resynchronization therapy in patients with end-stage heart failure before pacemaker implantation

We evaluated patients with end-stage heart failure who have a high likelihood of response to cardiac resynchronization therapy (biventricular pacing). It appears that 20% of patients do not respond to this expensive therapy despite the use of selection criteria (dilated cardiomyopathy, heart failure, New York Heart Association class II or IV, left ventricular election fraction 120 ms). The presence of left ventricular dys-synchrony is needed to result in improvement after cardiac resynchronization therapy. (C)2003 by Excerpta Medica, Inc.

Patients with early diabetic heart disease demonstrate a normal myocardial response to dobutamine

OBJECTIVES We sought to use quantitative markers of the regional left ventricular (LV) response to stress to infer whether diabetic cardiomyopathy is associated with ischemia. BACKGROUND Diabetic cardiomyopathy has been identified in clinical and experimental studies, but its cause remains unclear. METHODS We studied 41 diabetic patients with normal resting LV function and a normal dobutamine echo and 41 control subjects with a low probability of coronary disease. Peak myocardial systolic velocity (Sm) and early diastolic velocity (Em) in each segment were averaged, and mean Sm and Em were compared between diabetic patients and controls and among different stages of dobutamine stress. RESULTS Both Sm and Em progressively increased from rest to peak dobutamine stress. In the diabetic group, Sm was significantly lower than in control subjects at baseline (4.2 +/- 0.9 cm/s vs. 4.7 +/- 0.9 cm/s, p = 0.012). However, Sin at a low dose (6.0 +/- 1.3), before peak (8.4 +/- 1.8), and at peak stress (8.9 +/- 1.8) in diabetic patients was not significantly different from that of controls (6.3 +/- 1.4, 8.9 +/- 1.6, and 9.6 +/- 2.1 cm/s, respectively). The Em (cm/s) in the diabetic group (rest: 4.2 +/- 1.2; low dose: 5.0 +/- 1.4; pre-peak: 5.3 +/- 1.1; peak: 5.9 +/- 1.5) was significantly lower than that of controls (rest: 5.8 +/- 1.5; low dose: 6.6 +/- 1.5; pre-peak: 6.9 +/- 1.3; peak: 7.3 +/- 1.7; all p < 0.001). However, the absolute and relative increases in Sm or Em from rest to peak stress were similar in diabetic and control groups. CONCLUSIONS Subtle LV dysfunction is present in diabetic patients without overt cardiac disease. The normal response to stress suggests that ischemia due to small-vessel disease may not be important in early diabetic heart muscle disease. (C) 2003 by the American College of Cardiology Foundation.

Ventricular dysfunction in early diabetic heart disease: detection, mechanisms and significance

The detection of preclinical heart disease is a new direction in diabetes care. This comment describes the study by Vinereanu and co-workers in this issue of Clinical Science in which tissue Doppler echocardiography has been employed to demonstrate subtle systolic and diastolic dysfunction in Type 11 diabetic patients who had normal global systolic function and were free of coronary artery disease. The aetiology of early ventricular dysfunction in diabetes relates to complex intramyocardial and extramyocardial mechanisms. The initiating event may be due to insulin resistance, and involves abnormal myocardial substrate utilization and uncoupling of mitochondrial oxidative phosphorylation. Dysglycaemia plays an important role via the effects of oxidative stress, protein kinase C activation and advanced glycosylation end-products on inflammatory signalling, collagen metabolism and fibrosis. Extramyocardial mechanisms involve peripheral endothelial dysfunction, arterial stiffening and autonomic neuropathy. The clinical significance of the ventricular abnormalities described is unknown. Confirmation of their prognostic importance for cardiac disease in diabetes would justify routine screening for presymptomatic ventricular dysfunction, as well as clinical trials of novel agents for correcting causal mechanisms. These considerations could also have implications for patients with obesity and the metabolic syndrome.

Generation of aldehyde-derived protein modifications in ethanol-exposed heart

Background: Although excessive ethanol consumption is known to lead to a variety of adverse effects in the heart, the molecular mechanisms of such effects have remained poorly defined. We hypothesized that posttranslational covalent binding of reactive molecular species to proteins occurs in the heart in response to acute ethanol exposure. Methods: The generation of protein adducts with several aldehydic species was examined by using monospecific antibodies against adducts with malondialdehyde (MDA), acetaldehyde (AA), MDA-AA hybrids, and hydroxyethyl radicals. Specimens of heart tissue were obtained from rats after intraperitoneal injections with alcohol (75 mmol/kg body weight) with or without pretreatment with cyanamide (0.05 mmol/kg body weight), an aldehyde dehydrogenase inhibitor. Results: The amounts of MDA and unreduced AA adducts were found to be significantly increased in the heart of the rats treated with ethanol, cyanamide, or both, whereas no other adducts were detected in statistically significant quantities. Immunohistochemical studies for characterization of adduct distribution revealed sarcolemmal adducts of both MDA and AA in the rats treated with ethanol and cyanamide in addition to intracellular adducts, which were also present in the group treated with ethanol alone. Conclusions: These findings support the role of enhanced lipid peroxidation and the generation of protein-aldehyde condensates in vivo as a result of excessive ethanol intake. These findings may have implications in the molecular mechanisms of cardiac dysfunction in alcoholics.

Como anda a comunica????o p??blica?

A necessidade de descentraliza????o e de transpar??ncia dos procedimentos e decis??es governamentais e dos pactos de interesse coletivo levou, na Fran??a, ao desenvolvimento da comunica????o p??blica, a partir de 1989. Esse tipo de comunica????o deve ultrapassar os objetivos restritos do marketing de vendas das empresas privadas, no qual se inspira para ser a fonte de informa????o segura para o cidad??o. No entanto, esse ?? um desafio cotidiano, pois a comunica????o p??blica n??o pode ser confundida com a autopromo????o do pol??tico. Para isso, ?? fundamental desenvolver habilidades de comunica????o para os servidores p??blicos de modo que suas orienta????es para o cidad??o sejam claras, acuradas, ??ticas e justas.

Preliminary Validation of the Portuguese Version of the Eating Inventory for Athletes

The field of eating disorders among athletes has recently been Preliminary Validation of the Portuguese Version of the Eating Inventory for Athletes Palmeira, A.L.(1); Veloso, S.(1); Falcão, M.J.(1); and Dosil, J.(2) Table 2. Exploratory Factor Analysis and Cronbach’s Alpha the focus of several publications, reflecting a growing field of interest and research (Dosil, 2008). Some sports demand a strict compliance to restrictive diets at different times of the competitive season, while others like, some types of gymnastics emphasize the thinness of the athletes. Hence there is a need to develop sound measures to evaluate the athletes eating habits and possible eating disorders. The Cuestionario de Hábitos Alimentarios del Deportista (CHAD), is one of these measures. It comprises 5 dimensions: i) Weight Gain Anxiety (e.g. If I eat too much I regret it afterwards; 12 items); ii) Body Image Worries (e.g., I’m always thinking about my body; 6 items,); iii) Irritability (e.g., If the coach speaks about weight matters, I feel anxious; 7 items); iv) Satisfaction/Dissatisfaction with Body Image (e.g., I’m satisfied with my appearance; 5 items); and v) Dieting (e.g., When the season ends, I keep practicing so that I don’t gain weight, 4 items).

Chagas' disease and social security: a case-control study in an urban area, Goiás, Brazil

One hundred and twenty subjects with Chagas' cardiopathy and 120 non-infected subjects were randomly selected from first time claimants of sickness benefits in the National Institute of Social Security (INPS) in Goiás. Cases of Chagas' cardiopathy were defined based on serological test, history of residence in an endemic area and, clinical and/or electrocardiogram (ECG) alterations suggestive of Chagas' cardiomyopathy. Controls were defined as subjects with at least two negative serological tests. Case and controls were compared in the analysis for age, sex, place of birth, migration history, socio-economic level, occupation, physical exertion at work, age at affiliation and years of contribution to the social security scheme, clinical course of their disease and ECG abnormalities. Chagas' disease patients were younger than other subjects and predominantly of rural origin. Non-infected subjects presented a better socio-economic level, were performing more skilled activities and had less changes of job than cases. No important difference was observed in relation to age at affiliation to INPS. About 60% of cases have claimed for benefits within the first four years of contribution while among controls this proportion was 38.5%. Cases were involved, proportionally more than controls, in "heavy" activities. A risk of 2.3 (95%CL 1.5 - 4.6) and 1.8 (95%CL 1.2- 3.5) was obtained comparing respectively "heavy" and "moderate" physical activity against "light". A relative risk of 8.5 (95%CL 4.9 - 14.8) associated with the presence of cardiopathy was estimated comparing the initial sample of seropositive subjects and controls. A high relative risk was observed in relation to right bundle branch block (RR = 37.1 95%CL = 8.8 - 155.6) and left anterior hemiblock (RR = 4.4, 95%CL = 2.1 - 9.1).

Concepções e práticas de um centro de actividades ocupacionais

O presente trabalho tem como principal objectivo tentar conhecer e compreender as concepções educativas de um Centro de Actividades Ocupacionais face ao seu público-alvo em particular, as suas dimensões mais relevantes, os factores que as condicionam e os contextos que as limitam ou facilitam. Procurou-se conhecer as concepções e práticas dos actores educativos que intervêm na formação/educação junto de pessoas portadoras de deficiência mental adultas, clientes de um Centro de Actividades Ocupacionais, geograficamente situado em Lisboa. Para tal, elaborou-se um Estudo de Caso utilizando entrevistas semi estruturadas a sete profissionais do centro como técnica de recolha de dados, sendo estes posteriormente tratados através da análise de conteúdo. Assim, definiram-se como objectivos específicos do estudo: caracterizar as finalidades educativas do Centro de Actividades Ocupacionais; caracterizar as práticas de desenvolvimento para os adultos deficientes mentais; caracterizar o modo de participação dos clientes nas actividades: aspectos facilitadores e constrangimentos; identificar as dificuldades dos funcionários do Centro de Actividades Ocupacionais no atendimento aos clientes; caracterizar as iniciativas da instituição face à actualização profissional dos seus funcionários no sentido de fornecer respostas mais adequadas às necessidades dos clientes e, ainda, caracterizar de acordo com o ponto de vista dos actores educativos, a participação das famílias no processo de desenvolvimento dos clientes. Os resultados do estudo evidenciam que as actividades desenvolvidas no Centro de Actividades Ocupacionais se dividem entre as consideradas como socialmente úteis, como a montagem de material eléctrico, por exemplo, e as estritamente ocupacionais. Embora um dos objectivos do Centro de Actividades Ocupacionais seja a inserção do cliente na comunidade, da análise de dados ressalta que não existem muitas actividades que divulguem para o exterior o trabalho desenvolvido pelos adultos portadores de deficiência mental, promovendo pouca interacção dos indivíduos com a comunidade. As profissionais que participaram no estudo revelam motivação para trabalhar junto dos clientes e preocupação em melhorar o seu desempenho profissional, daí sentirem necessidade em adquirir formação contínua e partilhar experiências com outros profissionais. As famílias dos clientes são consideradas pelas participantes do estudo como sendo participativas no quotidiano do seu familiar, contudo existem factores que condicionam essa participação, como o envelhecimento dos progenitores. Abstract The present work aims to know and understand the educational conceptions of an Occupational Activities Center taking into consideration its target audience, particularly, its most relevant dimensions, the conditioning factors and its respective restrictive or facilitating contexts. The objective was to understand the concepts and daily practices of the educational actors that participate in the training/education of the mentally disabled adults who attend an Occupational Activities Center located in Lisbon. In that light, a Case Study was conducted using as the data collection technique semistructured interviews made to seven employees from the Center. This data was later on processed through content analysis. Thus, the following was defined as the study’s specific goals. To: characterize the educational purposes of the Occupational Activities Center; characterize development practices for the mentally disabled adults; characterize the clients’ participation process in the activities and the respective enabling and restrictive aspects; identify the Occupational Activities Center employees’ problems regarding client assistance; characterize the institution’s initiatives regarding the professional update of its employees in order to provide more adequate answers to its clients’ needs and, finally to identify from the educational actors’ perspective the participative role families’ take on when it comes to the clients’ development processes. The study results determine that the activities developed in the Occupational Activities Center are distinguished between the ones considered socially useful, such as the assembly of electric material, and the strictly occupational activities. Although one of the Occupational Activities Center goals is the insertion of the client within the community itself, the data analysis shows that there aren’t many activities that promote to the outside world the work performed by these mentally disabled adults, not advertising enough the individuals’ interaction with the community. The professional women who participated in the study show determination and motivation in working with the clients and also a concern in improving their professional performances, from this derives their need to attend continuous training and to share experiences with other professionals. The study's participants find the clients’ families involved in the daily routines of their relatives. Nonetheless, there are some factors that condition that involvement, such as the parents’ aging.

Basis invariant conditions for supersymmetry in the two-Higgs-doublet model

The minimal supersymmetric standard model involves a rather restrictive Higgs potential with two Higgs fields. Recently, the full set of classes of symmetries allowed in the most general two-Higgs-doublet model was identified; these classes do not include the supersymmetric limit as a particular class. Thus, a physically meaningful definition of the supersymmetric limit must involve the interaction of the Higgs sector with other sectors of the theory. Here we show how one can construct basis invariant probes of supersymmetry involving both the Higgs sector and the gaugino-Higgsino-Higgs interactions.

Health related quality of life in patients with refractory chronic heart failure undergoing cardiac resynchronization: type of therapeutic response

The benefits of cardiac resynchronization therapy (CRT) in the health-related quality of life (HRQL) are largely demonstrated in selected patients with severe congestive heart failure (CHF). However, the differences between responders and non-responders, with regard to the effect of CRT in the various dimensions that constitute HRQL are still a matter of discussion. Objective: To evaluate the impact of CRT on the HRQL of patients with CHF refractory to optimal pharmacological therapy, within 6 months after CRT. Methods: 43 patients, submitted to successful implantation of CRT, were evaluated in hospital just before intervention and in the outpatient clinic within 6 months after CRT. HRQL was analyzed based on the Kansas City Cardiomyopathy Questionnaire (KCCQ). Patients were classified as super-responders (ejection fraction of left ventricle - LVEF - ≥45% post-CRT), n=15, responders (sustained improvement in functional class and LVEF increased by 15%), n=19, and non-responders (no clinical or LVEF improvement), n=9. Results: In the group of super-responders, CRT was associated with an improvement in HRQL for the various fields and sums assessed (ρ<0.05); in responders, CRT has been associated with an improvement of HRQL in the various fields and sums, except in the self-efficacy dimension (ρ<0.05); in non-responders, CRT was not associated with improvement of HRQL. Conclusion: In a population with severe CHF undergoing CRT, the patients with clinical and echocardiographic positive response, obtained a favorable impact in all dimensions of HRQL, while the group without response to CRT showed no improvement. These data reinforces the importance of HRQL as a multidimensional tool for assessment of benefits in clinical practice.

Impact of flavor-changing neutral current top quark interactions on BR(t -> bW)

We study the effect that flavor-changing neutral current interactions of the top quark will have on the branching ratio of charged decays of the top quark. We have performed an integrated analysis using Tevatron and B-factories data and with just the further assumption that the Cabibbo-Kobayashi-Maskawa matrix is unitary, we can obtain very restrictive bounds on the strong and electroweak flavor-changing neutral current branching ratios Br(t -> qX)< 4.0x10(-4), where X is any vector boson and a sum in q=u, c is implied.

Monitorização da insuficiência cardíaca por parâmetros fisiológicos em portadores de cardioversor-desfibrilhador implantável e/ou sistema de ressincronização cardíaca: HF-PREDICT

Mestrado em Tecnologia de Diagnóstico e Intervenção Cardiovascular. Área de especialização: Intervenção Cardiovascular.