Calcified aneurysms in coronary arteries of a 48-year-old patient

This is a case report of a 48-year-old female patient with a compatible history of Kawasaki disease during childhood, who was admitted to the emergency coronary unit with unstable angina pectoris. Coronary angiography identified two coronary aneurysms, one causing right coronary occlusion and the other causing severe obstruction of the left anterior descending coronary artery. Coronary artery bypass surgery was indicated.

Histoplasmosis as a late infectious complication following heart transplantation in a patient with Chagas' disease

Infectious complications following heart transplantation are an important cause of morbidity and mortality. Generally, bacterial infections are predominant; however, fungal infections can be responsible for up to 25% of infectious events. We report the case of a patient who presented with histoplasmosis as an infectious complication five years after heart transplantation due to a chagasic cardiopathy. This association has rarely been reported in the international literature.

Evaluation of inflammatory response induced by different types of daily contact lenses

Dissertação de mestrado em Genética Molecular

Morphofunctional study of the junction between the left atrium and the pulmonary veins in patient with pulmonary hypertension

OBJECTIVE: To study the arrangement of the myocardial fiber bundles at the pulmonary venous left atrial junction in patients with pulmonary hypertension, and to discuss the pathophysiological importance of this element in the etiology of acute pulmonary edema. METHODS: We obtained 12 hearts and their pulmonary vein extremities from postmortem examinations of patients with the anatomicopathological diagnosis of acute pulmonary edema. The specimens, which had no grossly visible morphological cardiac alterations, were fixed in 10% formalin, and the muscular arrangement of the pulmonary venous left atrial junctions was analyzed. This material was then isolated, embedded in paraffin, underwent serial cutting (50 µm of thickness), and was stained with Azam's trichrome. RESULTS: We observed in our specimens that: a) the myocardial fiber bundles that originate in the atrial wall and involve the openings of the pulmonary veins were fewer than those observed in healthy material; b) the myocardial fiber bundles that extend into the pulmonary veins were shorter than those found in material originating from individuals with no pulmonary hypertension. CONCLUSION: Anatomical changes that result in a reduction in the amount of myocardial fiber bundles in the pulmonary venous left atrial junction, isolated or associated with other factors, may be the cause of disorders in pulmonary circulation, leading to an increase in pulmonary venous pressure, and, consequently, to acute pulmonary edema.

Corrected transposition of the great arteries with several associated anomalies in a 68-year-old patient

Few patients with corrected transposition of the great arteries survive past 50 years of age because of the association with congenital defects, development of total atrioventricular block, and right ventricular dysfunction. We report the case of a male patient with dextrocardia in situs solitus and corrected transposition of the great arteries associated with a wide atrial septal defect and severe pulmonary valvar and subvalvar stenoses. The patient also developed a large aneurysm on the pulmonary artery, total atrioventricular block diagnosed 8 years earlier, symptoms of dysfunction of the systemic ventricle in the previous 2 years, insufficiency of the left atrioventricular valve, and aortic regurgitation. Despite all these associated anomalies, the patient developed class III cardiac decompensation only at the age of 68 years, which makes this case a rarity. The patient was clinically treated, and was discharged from the hospital in good condition.

Pervasive patient timeline for intensive care units

This research work explores a new way of presenting and representing information about patients in critical care, which is the use of a timeline to display information. This is accomplished with the development of an interactive Pervasive Patient Timeline able to give to the intensivists an access in real-time to an environment containing patients clinical information from the moment in which the patients are admitted in the Intensive Care Unit (ICU) until their discharge This solution allows the intensivists to analyse data regarding vital signs, medication, exams, data mining predictions, among others. Due to the pervasive features, intensivists can have access to the timeline anywhere and anytime, allowing them to make decisions when they need to be made. This platform is patient-centred and is prepared to support the decision process allowing the intensivists to provide better care to patients due the inclusion of clinical forecasts.

A Real-Time intelligent system for tracking patient condition

Hospitals have multiple data sources, such as embedded systems, monitors and sensors. The number of data available is increasing and the information are used not only to care the patient but also to assist the decision processes. The introduction of intelligent environments in health care institutions has been adopted due their ability to provide useful information for health professionals, either in helping to identify prognosis or also to understand patient condition. Behind of this concept arises this Intelligent System to track patient condition (e.g. critic events) in health care. This system has the great advantage of being adaptable to the environment and user needs. The system is focused in identifying critic events from data streaming (e.g. vital signs and ventilation) which is particularly valuable for understanding the patient’s condition. This work aims to demonstrate the process of creating an intelligent system capable of operating in a real environment using streaming data provided by ventilators and vital signs monitors. Its development is important to the physician because becomes possible crossing multiple variables in real-time by analyzing if a value is critic or not and if their variation has or not clinical importance.

Multiple Embolism in a Female Patient with Infective Endocarditis: Low Back Pain and Hematuria as the Initial Clinical Manifestations

A 59-year-old female patient with mitral valve prolapse and a previous history of lumbosacral spondyloarthrosis and lumbar disk hernia had an episode of infective endocarditis due to Streptococcus viridans, which evolved with peripheral embolism to the left kidney, spleen, and left iliac artery, and intraventricular cerebral hemorrhage. Her clinical manifestations were low back pain and hematuria, which were initially attributed to an osteoarticular condition. Infective endocarditis is a severe polymorphic disease with multiple clinical manifestations and it should always be included in the differential diagnosis by clinicians.

The influence of patient's consciousness regarding high blood pressure and patient's attitude in face of disease controlling medicine intake

OBJECTIVE: To assess the relation between blood pressure control and the following: the Morisky-Green test, the patient's consciousness regarding high blood pressure, the patient's attitude in face of medicine intake, the patient's attendance at medical consultations, and the subjective physician's judgment. METHODS: We studied 130 hypertensive patients with the following characteristics: 73% females, 60±11 years, 58% married, 70% white, 45% retired, 45% with incomplete elementary schooling, 64% had a familial income of 1 to 3 minimum wages, body mass index of 30±7 kg/m², consciousness regarding the disease for a mean period of 11±9.5 years, and mean treatment duration of 8 ±7 years. RESULTS: Only 35% of the hypertensive individuals had blood pressure under control and a longer duration of treatment (10±7 vs 7±6.5 years; P<0.05). The retiree predominated. The result of the Morisky-Green test did not relate to blood pressure control. In evaluating the attitude in face of medicine intake, the controlled patients achieved significantly higher scores than did the noncontrolled patients (8±1.9 vs 7 ±2, P<0.05). The hypertensive patients had higher levels of consciousness regarding their disease and its treatment, and most (70%) patients attended 3 or 4 medical consultations, which did not influence blood pressure control. The physicians attributed significantly higher scores regarding adherence to treatment to controlled patients (6±0.8 vs 5±1.2; P<0.05). CONCLUSION: Consciousness regarding the disease, the Morisky-Green test, and attendance to medical consultations did not influence blood pressure control.

Aspergillus infection in the ascending aorta of a patient with aortic and mitral valve prostheses

We report the case of implantation of metallic mitral and aortic valve prostheses 6 months earlier, with subsequent multiple embolic episodes. The anatomicopathological examination of the thrombus of the third embolic episode was compatible with Aspergillus sp, which was treated with amphotericin B, followed by oral itraconazole. On the fourth embolism, vegetations were visualized in the ascending aorta on echocardiography and resonance imaging, and the patient underwent replacement of the aortic segment by a Haemashield tube and exploration of the aortic prosthesis, which was preserved, because no signs of endocarditis were found. Four months later, the patient died due to cardiogenic shock secondary to acute myocardial infarction caused by probable coronary embolism and partial dysfunction of the aortic prosthesis.

Fisiología de la Transferencia Pasiva de Inmunidad en Equinos. Physiology of the Transfer of Passive Immunity in Equine.

El reconocimiento temprano de anormalidades en la transferencia pasiva de inmunidad en equinos es importante para un manejo satisfactorio de los potrillos. La placenta de la yegua, epiteliocorial, no permite el pasaje de inmunoglobulinas.(Igs). La ingesta de calostro es vital ya que provee las Igs necesarias para alcanzar una concentración sérica de IgG mayor a 800 mg por ciento. Se considerara falla parcial con niveles de IgG entre 400 y 800 mgpor ciento; y total con niveles menores a 400 mg por ciento. La absorción de las Igs es máxima hasta 8 hs después del nacimiento y disminuye hasta hacerse nula a las 24 hs posparto. Los objetivos son: a) estudiar la cinética de la transferencia pasiva de Igs determinando la concentración de IgG sérica en potrillos en el primer trimestre de vida. b) relacionar la concentración de IgG del suero y calostro de la yegua con la concentración sérica de IgG en el potrillo. c) Relacionar en calostro la concentración de inmunoglobulina G con la densidad específica y la determinación semicuantitativa de inmunoglobulina G. d) Relacionar en el suero del potrillo a las 18 - 24 hs posparto la concentración de inmunoglobulina G con la densidad específica y la determinación semicuantitativa de inmunoglobulina G. Material y método: Diseño de estudio: de cohorte, observacional, descriptivo. Animales: 70 yeguas y 70 potrillos de raza Puro Polo. Calostros: 70 muestras Toma de muestras: Yeguas: se tomará una muestra de sangre en el periparto y una muestra de calostro posparto, antes del calostrado del potrillo. Potrillos: se tomarán muestras de sangre seriadas: al nacimiento (precalostrado), 6 hs posparto, 12 hs, 18 hs y 24 hs posparto y a los 21, 60 y 90 días posparto. Determinación de IgG (Suero y calostro): a) Técnica de inmunodifusión radial simple, los resultados se expresará en mg por ciento, en muestras seriadas en intervalos de tiempo preestablecidos. b)Refractometría (con refractómetro Modelo RHC-200/ATC- Arcano). c) Test de gluteralehído, Inmuno -G test. Análisis estadístico: Comparaciones de medias con prueba t apareada o de diferencia de medias, Se considera p significativa < 0,05. Se realizará un análisis de componentes principales. Se correlacionará la concentración de Ig G de suero y calostro de la yegua con la concentración en suero de potrillo. Con los resultados de este trabajo se determinarán los valores de inmunoglobulina en las yeguas y potrillos y su comportamiento en el tiempo, y se validará la sensibilidad y especificidad de las técnicas diagnósticas utilizadas. Los resultados permitirán obtener conocimientos para un manejo racional, desde la perspectiva inmunológica, de los potrillos, al establecer mediante técnicas cuantitativas y semicuantitativas los niveles de Igs séricos alcanzados, favoreciendo un diagnóstico precoz de inmunodeficiencia por fracaso de la transferencia de anticuerpos que pondría en riesgo la vida del potrillo.

Transfer of radionuclides from soil to vegetation in selected Irish ecosystems

This thesis details the findings of a study relating the transfer of 238U, 228Ra (232Th), 226Ra, and 137Cs from soil to vegetation in an Atlantic blanket bog, upland blanket bog and semi-natural grassland situated along the north-west coast of Ireland. The results of this study provide information on the uptake of these radionuclides by the indigenous vegetation found present in these ecosystems. The ecosystems chosen are internationally recognizable ecosystems and provide a wide variety of vegetation species and contrasting soil physiochemical properties which allow the influence of these parameters on radionuclide uptake to be assessed. The levels of radionuclides in the soil and vegetation were measured using gamma spectrometry, alpha spectrometry and ICP-MS. The nutrient status of the vegetation and soil physiochemical properties were measured using atomic absorption, flame photometry and other analytical techniques. The results of the study indicate that the uptake of 238U and 228Ra (232Th) by vegetation from all three ecosystems was negligible as the levels in all vegetation was below the limits of detection for the methods used in this study. These results appear to indicate that the vegetation studied do not possess the ability to accumulate significant levels of these radionuclides however this assumption cannot be upheld in the case of the Atlantic blanket bog as the levels in the soil of this ecosystem were too low for detection. Similar results were obtained for 226Ra uptake in both the Atlantic blanket bog and grassland for all vegetation with the exception of H. lanatus from the grassland ecosystem. Radium-226 uptake in upland blanket bog was higher and was detectable in the majority of vegetation indigenous to this ecosystem. Transfer factor values ranged from 0.07 to 2.35 and the TF values for E. tetralix were significantly higher than all other vegetation studied. This species of heather demonstrated the ability to accumulate 226Ra to a greater extent than all other vegetation. The uptake of 226Ra by upland blanket bog vegetation appears to be significantly influenced by a range of soil physiochemical properties. The nutrient status of the vegetation, in particular the calcium content in the vegetation appears to have a negative impact on the uptake of this radionuclide. Potassium-40 was detectable in all vegetation present in the three ecosystems and the levels in the grassland soil were significantly higher than the levels in both bogland soils. Transfer factor values for Atlantic blanket bog vegetation ranged from 0.9 to 13 .8 and were significantly higher in E. vaginatum in comparison to C. vulgaris. Potassium-40 TF values for upland blanket bog vegetation on average ranged from 1.4 for C. vulgaris (stems) to 5.2 for E. vaginatum and were statistically similar for all species of vegetation. Transfer factor values for grassland vegetation ranged from 0.7 to 3.8 and were also statistically similar for all species of vegetation indicating that the transfer of 40K to vegetation within the upland bog and grassland ecosystem is not dependent on plant species. Comparisons of 40K TF values for all three ecosystems indicate that the uptake in E. vaginatum from the Atlantic blanket bog was statistically higher than all other vegetation studied. This appears to indicate that E. vaginatum has the ability to accumulate 40K, however, this species of vegetation was also present in the upland blanket and did not demonstrate the same behaviour. The uptake of 40K by vegetation from all three ecosystems was significantly affected by a range of soil physiochemical properties and in some cases the results were contradictory in nature possibly indicating that the affect of these parameters on 40K uptake is species dependent. The most obvious trend in the data was the influence of soil CEC and magnesium levels in vegetation on 40K TF values. A positive correlation was apparent between the CEC of the soil and 40K uptake in vegetation from both the Atlantic blanket bog and grassland ecosystem. A similar trend was apparent between magnesium levels in vegetation and 40K TF values for the upland blanket bog and grassland vegetation. Caesium-13 7 levels were found to be significantly higher in the two bogland soils in comparison to the grassland soil and levels of 137Cs decreased with increasing soil depth. Transfer factor values for Atlantic blanket bog vegetation ranged from 1.9 to 9.6 and TF values were significantly higher in the leaves o f C. vulgaris in comparison to all other vegetation from this ecosystem. Caesium-13 7 TF values for the upland blanket bog vegetation on average ranged from 0.29 for E. tetralix to 1.6 for C. vulgaris. Uptake by the leaves of C. vulgaris was significantly higher than all other vegetation present thereby supporting the trend found within the Atlantic blanket bog vegetation. These results appear to indicate that the leaves of C. vulgaris have the ability to accumulate significant quantities of 137Cs and also that the uptake of 137Cs by this vegetation is dependent on plant compartment as the stems of this vegetation contained significantly lower levels than the leaves in both ecosystems. The uptake of 137Cs by grassland vegetation was very low and was only detectable in a fraction of the vegetation sampled. Caesium-137 TF values for grassland vegetation were in general lower than 0.02. The impact of soil physiochemical properties and nutrient status of vegetation on 137Cs uptake by vegetation appears to be complex and in some cases contradictory. The most apparent trend in the data was the positive influence of vegetation nutrients on 137Cs uptake in particular the magnesium levels present in the vegetation and to a lesser extent the calcium levels present. The results in general indicate that the uptake of 226Ra, 40K and 137Cs by the chosen vegetation is varied and complex and is significantly dependent on the species of vegetation, soil radionuclide concentration, soil physiochemical properties and the nutrient status of the vegetation.