Perfil clínico-cirúrgico de pacientes operados por ruptura do septo interventricular pós-infarto do miocárdioClinical and surgical profile of patients operated for postinfarction ventricular septal rupture .9% (n = 13) were male. Rupture occurred on average 4.8 days after infarction. Cardiogenic shock was observed in 57.1% (n = 12), being risk factor for death (100% with shock vs 22,2% without shock; P<0.001). Survivors had a higher mean ejection fraction compared to deaths (66.29% ± 4.61% versus 42.71% ± 4.79%, P <0.001). All were classified as high risk by the EuroSCORE, and the survivors had lower mean score compared to deaths (6.57 ± 0.53 versus 10.93 ± 2.23; p <0.001). The majority (76.2%, n = 16) needed to use vasoactive drugs and 57.1% (n = 12) considered hemodynamically unstable. The need for vasoactive drugs was a risk factor for death (81.3% in the vasoactive drugs group versus 20% without vasoactive drugs group, P = 0.025). Hemodynamic instability was also a risk factor for death (100% in the unstable group versus 22.2% in the stable group; P <0.001). The rate of in-hospital mortality was 66.7% (n = 14).Conclusions: The need for vasoactive drugs, hemodynamic instability and cardiogenic shock were associated with higher rates of mortality. Patients who had adverse outcomes had less ventricular function and higher score in the EuroSCORE. Mortality rate remains high.Descriptors: Heart Septal Defects. Heart Rupture, PostInfarction. Myocardial Infarction. 342SÁ, MPBO ET AL -Clinical and surgical profile of patients operated for postinfarction ventricular septal rupture Bras Cir Cardiovasc 2010; 25(3): 341-349 Rev
GuaragnaSCORE prediz satisfatoriamente os desfechos em cirurgia cardíaca valvar em hospital brasileiroGuaragnaSCORE satisfactorily predicts outcomes in heart valve surgery in a Brazilian hospital Abstract Objective: The aim of this study is to evaluate the applicability of GuaragnaSCORE for predicting mortality in patients undergoing heart valve surgery in the Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco -PROCAPE, Recife, PE, Brazil.Methods: Retrospective study involving 491 consecutive patients operated between May/2007 and December/2010. The registers contained all the information used to calculate the score. The outcome of interest was death. Association of model factors with death (univariate analysis and multivariate logistic regression analysis), association of risk score classes with death and accuracy of the model by the area under the ROC (receiver operating characteristic) curve were calculated.Results: The incidence of death was 15.1%. The nine variables of the score were predictive of perioperative death in both univariate and multivariate analysis. We observed that the higher the risk class of the patient (low, medium, high, very high, extremely high), the greater is the incidence of postoperative AF (0%; 7.2%; 25.5%; 38.5%; 52.4%), showing that the model seems to be a good predictor of risk of postoperative death, in a statistically significant association (P <0.001). The score presented a good accuracy, since the discrimination power of the model in this study according to the ROC curve was 78.1%.Conclusions: The Brazilian score proved to be a simple and objective index, revealing a satisfactory predictor of perioperative mortality in patients undergoing heart valve surgery at our institution. Rev Bras Cir Cardiovasc 2012;27(1):1-6 Descriptors
Introduction: Proximal femur fractures affect the mortality and morbidity of elderly individuals. Recent studies have shown an association between fragility fractures and hyponatremia, a common fluid and electrolyte balance disorder. Objectives: This study aimed to investigate the occurrence of hyponatremia in patients with fragility fractures of the proximal femur. Methods: The authors looked into the data from the medical records of patients admitted to the emergency unit of the Real Hospital Português for fragility fractures of the proximal femur from 2014 to 2017. The study included patients with serum sodium levels recorded in their charts. Results: Fourteen of 69 (20.3%) patients with proximal femur fractures had hyponatremia. The main factors linked to hyponatremia were lung disease, and prescription of amiodarone and/or antidepressants. Conclusion: In elderly individuals, fragility fractures of the proximal femur may correlate with hyponatremia, particularly among patients on amiodarone or antidepressants.
We report the case of a 70-year-old man diagnosed with late-onset Wilson disease (WD) with mild neurological symptoms only and a new mutation in the ATP7B gene. A compound mutation of the ATP7B gene was found with the variant c.98T>C p(Met33Thr) in exon 2, in heterozygosis, and variant c.2224G>A (Val742Ile) in exon 8, in heterozygosis. Patient age should not be a determinant for excluding WD. Genetic sequencing is an important tool for the discovery of new genetic mutations.
BACKGROUNDSjögren's syndrome is a chronic multisystem autoimmune disease characterized by inflammation of the lacrimal and salivary glands, in addition to variable systemic manifestations, such as fatigue, musculoskeletal symptoms and involvement of internal organs. Coronavirus disease 2019 (COVID-19) is a disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), ranging from asymptomatic contamination to a severe acute respiratory disease with the possibility of long-term consequences. We aim to describe a case of Sjögren's syndrome started after an infection by SARS-CoV-2. CASE REPORTA 32-year-old woman with a history of low fever, oppressive headache, nausea, abdominal pain and diarrhea, with later onset of dyspnea, self-limited, a lasted for about seven days. Reverse transcription polymerase chain reaction (RT-PCR) was collected for COVID-19 by nasopharyngeal swab, the result of which was positive. About 20 days after improvement of the initial symptoms, she developed a feeling of dry mouth and eyes and altered bowel habit, alternating periods of diarrhea, without characteristics of invasion, self-limited, with constipation, recurrent and progressive condition. Subsequently, she evolved with diffuse myalgia and paresthesia in the distal segment of the lower and upper limbs, sometimes also affecting the perioral region. She has a positive personal history for Hashimoto's thyroiditis and a significant family history for autoimmune diseases, with a mother with Sjögren's syndrome and a brother with type 1 diabetes mellitus. The physical examination showed only palpable lymph nodes, submental and submandibular, small, mobile and not adhered to. Laboratory exams show 1/80 fine speckled nuclear pattern (antinuclear antibody) ANA and anti-Ro reagent, with a 240 titer, positive anti-TPO, but with other normal inflammatory markers and autoantibodies. Ophthalmological evaluation with Schirmer's test resulted in inflammatory dry eye. The patient was diagnosed with Sjögren's syndrome. In view of the close temporal relationship, the hypothesis of COVID-19 was considered as a triggering factor for autoimmune disease. Treatment with hydroxychloroquine 400 mg, artificial saliva and lubricating eye drops was started.
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