We report the clinical findings, pathophysiology, diagnostic characteristics, and surgical repair of anomalous origin of the left coronary artery from the pulmonary artery in a 26-year-old female patient with a clinical diagnosis of coronary heart disease.Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital defect, and its incidence is estimated in 1:300,000 live births 1 . The clinical evolution varies according to the degree of collateral coronary circulation developed after birth. Anomalous origin of the left coronary artery from the pulmonary artery results in elevated mortality during the first year of life, and only 10% to 15% of the individuals with this defect reach adulthood 2 . The objective of this study was to report the case of an adult with this rare anomaly. Case ReportA 26-year-old black female police officer reported that, 2 months prior to the diagnosis, she had been experiencing intense, sharp, precordial pain not related to physical exertion accompanied by fatigue on strenuous exertion and palpitations. As personal antecedents, she reported several hospitalizations during childhood due to "heart enlargement," and fatigue on great exertion during adolescence. She reported no risk factors for coronary atherosclerotic disease and no familial antecedents of heart disease.On physical examination, the patient was found to be in regular general condition, acyanotic, and had no characteristic facies. She weighed 57kg and was 1.80m tall. Her blood pressure was 112/70mmHg, and her heart rate was 80bpm. Her peripheral pulses were present, symmetric, and of normal amplitude. Her cardiac auscultation revealed rhythmic and normal cardiac sounds of regular intensity and an early-systolic murmur (+/4+) in the mesocardium. The respiratory tract revealed no abnormalities on examination.The chest X-ray revealed a slight enlargement in the cardiac area due to the left ventricle and normal pulmonary vessels.The electrocardiogram showed sinus rhythm, a heart rate of 85 bpm, QRS axis at -60°, Q waves in D1 and aVL with inverted T waves in these leads, indicating an inactive area in the high lateral wall, and a pattern suggestive of left ventricular hypertrophy.The exercise test was effective with no precordialgia, but revealed a 4-mm straightened depression of the ST segment at exertional peak, indicating myocardial ischemia.The two-dimensional echocardiogram showed a slight left ventricular dilation, moderate symmetric myocardial hypertrophy, preserved systolic performance, and prolapse of the mitral valve with slight valvular incompetence. No alterations in the great vessels, coronary arteries, or septal defects were observed.The patient then underwent cardiac catheterization for diagnostic clarification. The procedure was performed via the femoral route according to the technique of Seldinger. The manometry of the right and left chambers was normal. The right coronary artery was of a high caliber, tortuous, and, through collateral vessels, it retrogradely filled the left co...
Resumo O objetivo desta pesquisa foi relacionar a presença de ovos e/ou larvas de helmintos em elementos dos sanitários com a freqüência dos mesmos nas fezes de seus usuários. Três amostras das fezes de 1050 crianças em idade pré-escolar, examinadas pelo método de sedimentação, foram positivas para 184 ovos ou larvas de helmintos, em 162 crianças. Dos 465 elementos dos sanitários (assento, descarga, trinco, maçanetas e registro de torneira) de 12 pré-escolas municipais de Sorocaba examinados com fita adesiva transparente sobre lâmina de microscopia estavam contaminados, sendo encontrados 18 ovos de Ascaris lumbricoides, 1 de Enterobius vermicularis e 4 larvas de nematóides parcialmente alteradas. Não houve correlação significante entre a contaminação de elementos de sanitários e das fezes de seus usuários. Palavras-chaves: Helmintos. Helmintíases intestinais. Sanitários com ovos de helmintos. AbstractThe purpose of this research was to establish a relationship between the presence of helminth eggs in the water closet elements and the frequency of these eggs in the feces of their users. 1050 kindergarden children's feces were examinated by the spontaneous sedimentation method in three samples of feces, which were positive in 162 children presenting 184 eggs or helmints larvs. From the 465 water closet elements, constituted of : toilet seat, internal and external door knobs, latch, faucet handle and discharge valve, of 12 Infant Educational Centers of Sorocaba, examinated by sticking some transparent adhesive tape on microscopy slides, were found 18 eggs of Ascaris lumbricoides; 1 of Enterobius vermicularis and 4 larvs of nemathoids partially deformed were found in 23 infected elements. There wasn't significance relationship between the elements of water closets and user 's feces contamination. Key-words: Helminth. Intestinal helminthiasis. Water closets with helminth eggs. 2 . Devido o caráter flutuante da população estudada, os exames coproparasitológicos não foram realizados e, portanto, não foi possível a avaliação do grau de importância dessa contaminação.
Posttraumatic injury pain is commonly treated with oral nonsteroidal anti-inflammatory drugs. However, oral nonsteroidal anti-inflammatory drugs cause several adverse events, with topical formulations arising as an important alternative. Therefore, we aimed at evaluating the efficacy and safety of loxoprofen patch (LX-P) in the treatment of patients with posttraumatic pain. This phase III, randomized, double-blind, noninferiority study enrolled Brazilian patients aged 18 to 65 years diagnosed with lower and upper limb posttraumatic injury who were experiencing moderate or severe pain. Patients were assigned to active LX-P or to loxoprofen tablet (LX-T), and pain intensity was measured based on a visual analog scale score variation after 7 days of treatment. Data on clinical symptoms, rescue medication use, and adverse events were also collected. Visual analog scale score variation was compared using a 10% noninferiority margin. Two hundred forty-two patients were randomly assigned to LX-P (n = 123) or to LX-T (n = 119). The results showed a reduction in pain after 7 days of treatment: −49.96 (n = 118; SE 1.7) in the LX-P and −47.71 (n = 117; SE 1.6) in the LX-T groups (difference of −2.25; 95% CI: −5.97 to 1.47; P = 0.23). On the safety analysis, the LX-T group presented twice as many patients with treatment-emergent adverse events as the LX-P group (30.8% and 14.2%, respectively). A sensitivity analysis demonstrated that rescue medication use has not affected the primary end point. This study showed that LX-P has a comparable efficacy to LX-T, but with a better safety profile, being a therapeutic option for the treatment of posttraumatic injury pain.
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