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Abstract Aims Acute myocardial infarction (AMI) resulting from unprotected left main coronary artery (LMCA) occlusion and subtotal occlusion is a life‐threatening condition. Although AMI management has improved in the past two decades, there is limited information on recent trends in patient characteristics, management, and outcomes for acute unprotected LMCA‐related AMI. This study aims to assess such trends over a 12 year period. Methods and results This retrospective multicentre study includes patients with unprotected LMCA occlusion/subtotal occlusion admitted to three tertiary hospitals between 2008 and 2020. The patients were divided into two groups based on the chronology of presentation: a ‘past group’ (January 2008 to December 2014) and a ‘contemporary group’ (January 2015 to December 2020). The study compares clinical characteristics, management approaches, and outcomes between the two groups. The study includes 128 patients, with 51 (40%) in the ‘past group’ and 77 (60%) in the ‘contemporary group’. Baseline risk factors did not show statistically significant differences between the two groups, except for hypertension (49% vs. 74%; P = 0.005). Chest pain was more frequent in the ‘past group’ (98% vs. 89%; P = 0.014), and a trend towards more cardiac arrests was observed in the ‘contemporary group’ (18% vs. 31%; P = 0.087). Revascularization type did not differ significantly (P = 0.419), but manual thrombectomy was less frequently used (41% vs. 23%; P = 0.032) and stent implantation showed a trend towards higher rates (66% vs. 78%; P = 0.150) in the ‘contemporary cohort’. There was a gradual shift from bare‐metal to drug‐eluting stents, with a significantly higher percentage of ticagrelor/prasugrel loading in the ‘contemporary cohort’ (5% vs. 79%; P

Barcelos is a historic city in Portugal with many tourist attractions, attracting more and more visitors who come to the city with the aim of exploring it. The main objective of this article is to boost tourism in the city of Barcelos, specifically highlighting tourist, historical and leisure spots, based on the development of a mobile application using augmented reality technologies and geolocation. This application intends to allow the users to know historical points of interest in Barcelos, as well as interact with a certain point. The results of this investigation were evaluated by testing the application by end users, with the aim of identifying whether the application meets their needs, in particular the promotion of tourist and historical points.

nformation and Communication Technologies (ICT) have assumed a key role in today's society. In fact, we are witnessing an increasingly widespread use of the Internet, a trend seen both at the level of individual citizens and companies, which more and more use these new technologies to promote their products and services. The state entities themselves are also dependent on ICT, due to a digitalisation of public services. In order to determine the impact that the dissemination of ICT can have on society, it is necessary to understand how people and businesses use the internet, namely the information they share or the use of e-commerce. This study frames Portugal's situation in the global context, making it pivotal in order to prevent/minimize risks, showing the habits of people and companies and, more importantly, the trends that can be seen. It can help chart the path to follow in order to prevent cyberattacks and, with this, ensure people's quality of life, which can be greatly affected by cyber risks.

Percutaneous mitral valve commissurotomy (PMC) is a viable alternative to mitral valve (MV) surgery in the treatment of patients with rheumatic mitral stenosis (RMS). In this single-center retrospective study of consecutive patients with RMS submitted to PMC from 1991 to 2008, we analyzed clinical, echocardiographic, and hemodynamic data and events during follow-up (FUP) until December 2021. Major adverse cardiovascular events (MACE) were a combined endpoint of all-cause death, cardiovascular hospitalization, and MV re-intervention. A total of 124 patients were enrolled: 108 (87.1%) were female, with a mean age at PMC of 46 [standard deviation (SD) 11] years. PMC was successful in 91.1%, with a mean reduction in invasive transmitral pressure gradient (TMPG) of 8 (SD 7) mmHg at PMC time. During the mean FUP of 20 (SD 6) years, 51 (41.1%) patients had MV re-intervention (86.3% surgery and 13.7% redo-PMC), 37 (29.8%) were hospitalized, and 30 (24.2%) died. Approximately 75% of patients remained MACE-free after 10 years, and this percentage decreased to around 40% after 20 years; at this time mark, about 8 in 10 patients were alive. A reduction of

Percutaneous closure of the patent foramen ovale (PFO) is increasingly performed in specific patients with cryptogenic stroke or clinical evidence of a paradoxical embolism. This study was performed to determine the safety of same-day discharge (SDD) following such procedures. This is a prospective, observational study of patients undergoing elective percutaneous PFO closure in a single tertiary center in Portugal between January 2020 and July 2023. AmplatzerTM devices (St. Jude Medical, St. Paul, MN, USA) and NobblestichTM EL (HeartStitch, Inc., Fountain Valley, CA, USA) were used. After 6 months, the following events were looked at: post-procedural paroxysmal atrial fibrillation, stroke, unplanned cardiac re-hospitalization, urgent cardiac surgery, major vascular complications, pericardial effusions, device embolization, and death. We studied 122 consecutive patients (52% female, 68; 48±12 years old) who had elective percutaneous closure with success and no complications. Forty-nine (40%) had SDD. AmplatzerTM devices were used more frequently in the SDD group, while NobblestichTM EL was more common in the overnight group. During the overnight group's follow-up period, there was one non-cardiovascular death; there were no further events. SDD after elective percutaneous closure of PFO was shown to be a safe and successful patient management method, including NobblestichTM, which we describe for the first time. Our results prove the safety of this same-day discharge strategy. We hypothesize that in the near future, in selected cases, PFO closure might become an ambulatory procedure.

Following the successful eradication of Wuchereria bancrofti, there are now just three species of conventional microfilaremic human filarial parasites endemic to the Brazilian Amazon region: Mansonella ozzardi, Mansonella perstans and Onchocerca volvulus. The zoonotic filarial parasite Dirofilaria immitis is also found in the Amazon region as are several sylvatic filarial parasites, some of which have been recorded causing zoonoses and some of which have never been recorded outside the region. Onchocerca volvulus is only found in the Amazonia onchocerciasis focus in the Brazilian state of Roraima where it affects the people of the Yanomami tribe living around the densely forested Venezuela border region. Mansonella ozzardi is by far the most common filarial parasite in Brazil and has a broad but patchy distribution throughout the western Amazon region. Recorded in the Brazilian states of Acre, Roraima, Matto Grosso, and within almost every municipality of Amazonas state, it is believed that pollution of the urban stream and river systems prevents the development of the simuliid vectors of M. ozzardi and explains the parasiteʼs reduced distribution within urban areas and an absence of recent reports from the state capital Manaus. Decades of WHO-led periodic ivermectin treatment of Yanomami tribeʼs people have resulted in the partial suppression of O. volvulus transmission in this focus and has also probably affected the transmission of M. ozzardi in the region. Mansonella perstans, O. volvulus and very probably M. ozzardi infections can all be treated and most likely cured with a 4–6-week treatment course of doxycycline. The Brazilian Ministry of Health does not, however, presently recommend any treatment for mansonellosis infections and thus parasitic infections outside the Amazonia focus are typically left untreated. While the long treatment courses required for doxycycline-based mansonellosis therapies preclude their use in control programmes, new fast-acting filarial drug treatments are likely to soon become available for the treatment of both onchocerciasis and mansonellosis in the Amazon region. Filarial disease management in the Brazilian Amazon is thus likely to become dramatically more viable at a time when the public health importance of these diseases is increasingly being recognized.

Introduction: In patients with cryptogenic stroke, one of the most frequently found abnormalities is patent foramen ovale (PFO). Percutaneous ‘deviceless’ systems based on surgical suture-mediated PFO closure have recently been introduced and show a favorable efficacy and safety profile with clear advantages. Objectives: To present procedural details of the technique and baseline characteristics of patients who underwent the procedure in our center. Methods: A single-center prospective observational registry was established between February 2020 and February 2021, to assess the safety, efficacy and possible advantages of a novel percutaneous PFO closure system (NobleStitch® EL). Patient and PFO characteristics as well as technical features were collected for analysis. Results: Twenty-three patients were considered suitable for this technique after transesophageal echocardiography. Their mean age was 51 years and 69.5% were women. Most patients (91.3%) had a history of cryptogenic stroke. PFO closure with the NobleStitch® system was successfully performed in all patients. All procedures were performed under local anesthesia and fluoroscopic monitoring. The mean duration of the procedure was 52 min and median contrast dose used was 187 ml. Median radiation dose absorbed per patient was 61.5 Gy cm2. All patients were discharged asymptomatic 24 hours after the procedure with no peri- or postprocedural complications recorded. Conclusion: Suture-mediated PFO closure represents a valid and safe alternative to traditional umbrella-like devices, and is feasible in the majority of PFO anatomies. Follow-up information, results of larger series and clinical trials may possibly validate this technique as the first choice for PFO closure. Resumo: Introdução: Em doentes com acidente vascular cerebral (AVC) criptogénico, uma das alterações mais frequentes é a presença de um foramen oval patente (FOP). A técnica percutânea de sutura baseada no encerramento de FOP através de sutura cirúrgica foi recentemente introduzida, mostrando eficácia e perfil de segurança vantajosos. Objetivos: Apresentar os detalhes desta técnica e documentar as características dos doentes do nosso centro. Métodos: Registo observacional prospetivo unicêntrico realizado entre fevereiro de 2020 e fevereiro de 2021, para avaliar segurança, eficiência e vantagens do novo sistema de encerramento de FOP (NobleStitch® EL). As características dos doentes e da técnica foram recolhidas para análise. Resultados: Após análise do ETE, 23 doentes foram considerados adequados para esta técnica. A idade média dos doentes foi 51 anos e 69,5% eram mulheres. A maioria dos doentes (91,3%) tinha história de AVC criptogénico. O encerramento de FOP com o sistema NobleStitch® foi realizado com sucesso em todos os doentes. Os procedimentos foram realizados com anestesia local e monitoração fluoroscópica. A duração média do procedimento foi 52 minutos e a mediana do contraste utilizado foi 187 ml. A dose média de radiação absorvida por doente foi 61,5 Gy cm2. Todos os doentes receberam alta assintomáticos 24 horas após o procedimento. Nenhuma complicação peri ou pós-procedimento foi registada. Conclusão: O encerramento de FOP por sutura representa uma alternativa válida e segura aos dispositivos tradicionais, viável na maioria das anatomias. Dados sobre seguimento, resultados de estudos maiores e ensaios clínicos poderão validar esta técnica como primeira escolha para o encerramento de FOP.

Introduction: The COVID-19 pandemic has imposed an unprecedented burden on healthcare systems worldwide, changing the profile of interventional cardiology activity. Objectives: To quantify and compare the number of percutaneous coronary interventions (PCIs) performed for acute and chronic coronary syndromes during the first COVID-19 outbreak with the corresponding period in previous years. Methods: Data on PCI from the prospective multicenter Portuguese Registry on Interventional Cardiology (RNCI) were used to analyze changes in PCI for ST-elevation myocardial infarction (STEMI), non-ST-elevation acute coronary syndromes (NSTE-ACS) and chronic coronary syndromes (CCS). The number of PCIs performed during the initial period of the COVID-19 outbreak in Portugal, from March 1 to May 2, 2020, was compared with the mean frequency of PCIs performed during the corresponding period in the previous three years (2017–2019). Results: The total number of PCIs procedures was significantly decreased during the initial COVID-19 outbreak in Portugal (−36%, p

Introduction and Objectives: Coronary artery fistulas (CAFs) are rare abnormalities, often detected incidentally during invasive coronary angiography (ICA). While most are clinically silent, they can cause significant morbidity. We aimed to investigate the clinical, angiographic and management features of CAFs in a population undergoing ICA. Methods: We retrospectively reviewed the data of all ICAs conducted in our department between May 2008 and January 2020 and selected those with CAFs. Clinical, angiographic, therapeutic and follow-up data were obtained from medical records. Results: A total of 55 patients with CAFs (35 male, median age 64 years) were identified among 32 174 ICAs. The majority (n=37) had a single fistula. CAFs arose most frequently from the left anterior descending artery (LAD), followed by the right coronary and left circumflex coronary arteries. The most frequent drainage site was the pulmonary artery. Fourteen patients had fistulas originating from both left and right coronary systems. Seven had concomitant congenital cardiovascular disorders. The majority (n=40) were incidental findings. Chest pain was the most common symptom attributable to CAFs and heart murmur the most frequent sign. Conservative management was the main approach (n=40). Eight patients underwent transcatheter closure and seven underwent surgical ligation (six of those during surgery for another heart condition), with no periprocedural mortality. Conclusions: In our series, the prevalence of CAFs was 0.2%. The majority originated from the LAD and the pulmonary artery was the main drainage site. In patients undergoing intervention, both percutaneous and surgical techniques were safe and effective. Resumo: Introdução e objetivos: As fistulas coronárias (FCs) são anomalias raras, detetadas frequentemente de forma incidental durante a angiografia coronária invasiva (ACI). Embora a maioria não cause sintomatologia, podem gerar morbilidade significativa. O nosso objetivo foi descrever as características clínicas e angiográficas das FCs detetadas numa população submetida a ACI, assim como o tratamento realizado. Métodos: Foram retrospetivamente revistos os dados de todas as ACIs realizadas no nosso Centro de maio de 2008 a janeiro de 2020 e selecionadas as que descreviam FCs. Os dados clínicos, angiográficos, terapêuticos e de follow-up foram obtidos de registos informáticos. Resultados: Entre 32 174 coronariografias, identificámos 55 doentes com FCs (35 homens, idade média 64 anos). A maioria (n=37) tinha uma fístula única. A origem mais frequente foi da artéria coronária descendente anterior (DA), seguido da artéria coronária direita e circunflexa. O local de drenagem mais frequente foi a artéria pulmonar. Catorze doentes tinham fístulas originadas da artéria coronária esquerda e direita. Sete tinham doenças cardiovasculares congénitas concomitantes. A maioria (n=40) foi descoberta incidentalmente. O sintoma e sinal mais frequentes foram a dor torácica e o sopro cardíaco. A abordagem terapêutica foi maioritariamente conservadora (n=40). Oito doentes realizaram encerramento percutâneo e sete tratamento cirúrgico (dos quais seis durante cirurgias por outra patologia cardíaca), sem mortalidade periprocedimento. Conclusões: A prevalência de FCs na nossa série foi de 0,2%. A maioria originou-se da DA, sendo a artéria pulmonar o local de drenagem mais frequente. Em doentes submetidos a intervenção, tanto as técnicas percutâneas como cirúrgicas foram seguras e eficazes.

É cada vez, mas comum que cada influenciador digital seja "especialista" onde terá seguidores que se interesse por esse determinado assunto, mostrando sua rotina, de alimentação. Cada influenciador demonstra interesse em um assunto e irá fazer com que seu público tenha interesse nesse determinado assunto, é o que acontece com as "blogueiras fitness". O objetivo desse estudo foi verificar a relação entre a persuasão dos influenciadores digitais e o uso de redes sociais e sua influência nos hábitos alimentares e na concepção do corpo ideal. Trata-se de um estudo quantitativo, descritivo e transversal. A amostra foi constituí­da por 213 pessoas, ambos os sexos, com idade de 18 a 35 anos (22,4 ± 3,8). Para realização dessa pesquisa, foi utilizado como técnica para coleta de dados a aplicação de um questionário online. Os dados coletados foram armazenados em uma planilha do Statistical Package for the Social Sciences. Houve um predomí­nio do sexo feminino (63,8%), quando questionados sobre qual tipo de perfil você prefere seguir, a maioria dos pesquisados seguir artistas (46,9%) seguidos de Blogueiras (24,4%), e uma minoria (17,4%) afirmaram buscar por nutricionistas. Ao final foi possí­vel depreender que existe uma influência da mí­dia nos hábitos alimentares e na concepção do corpo ideal das pessoas avaliadas.

Introduction: Patent ductus arteriosus, a persistent communication between the descending thoracic aorta and the pulmonary artery, is one of the most common congenital heart defects. Transcatheter occlusion is an effective alternative to surgery and is currently standard of care for most patients. The authors present the results from a single center after twelve years of experience using this technique. Methods: Retrospective analysis of medical records from all patients referred to a tertiary center for percutaneous ductus closure between January 2006 and September 2018. Results: A total of 221 patients were referred, with a mean age of 5.5 years-old (16 patients were infants, with the youngest aged four months). A Nit-Occlud® coil was used 139 times (62.9%), an Amplatzer™ duct occluder 79 times (35.7%), and vascular plugs were used three times. Percutaneous closure was achieved in every treated patient, with 1.4% maintaining residual shunting. Although higher overall coil device implantation was noted, duct occluder usage has been greater since 2011. Of all the coils, 55% were either 4x4 or 5x4 mm, and 73% of all Amplatzer duct occluders were either 6x4 or 8x6 mm, which correlates to the majority of patients having a small to moderately sized ductus. No complications were noted during the procedure, with a 1.8% post-procedure complication rate (one device embolization after 48 hours and three cases of loss of arterial pulse). Conclusions: Percutaneous patent ductus arteriosus closure was safe and effective in this setting, with a low global complication rate and similar outcomes to most equivalent centers. Resumo: Introdução: A persistência de canal arterial, uma comunicação entre a aorta descendente torácica e a artéria pulmonar, é uma das cardiopatias congénitas mais comuns. O encerramento percutâneo, uma alternativa eficaz à cirurgia, corresponde atualmente ao tratamento de eleição na maioria dos doentes. Os autores apresentam os resultados de um centro de referência após doze anos de experiência com esta técnica. Métodos: Análise retrospetiva dos registos eletrónicos de todos os doentes orientados para encerramento percutâneo num centro de referência entre janeiro de 2006 e setembro de 2018. Resultados: Foram referenciados 221 doentes, com média de 5,5 anos (16 lactentes, o mais novo com quatro meses de idade). Globalmente, 139 pacientes foram tratados com coil Nit-Occlud® (62.9%), 79 pacientes foram tratados com Amplatzer duct occluders (35,7%) e plugs vasculares foram utilizados três vezes. O encerramento percutâneo foi conseguido em todos os doentes tratados, com shunt residual em 1,4% dos casos. De todos os coils, 55% eram 4x4 ou 5x4 mm e 73% de todos os Amplatzer duct occluders eram 6x4 mm ou 8x6 mm, refletindo o facto de a maioria dos doentes apresentar canais arteriais de pequena-média dimensão. Não foram descritas complicações durante o procedimento, reportando-se uma taxa de complicações pós-procedimento de 1,8% (uma embolização de dispositivo após 48 horas e três casos de perda de pulso arterial). Conclusão: O encerramento percutâneo da persistência de canal arterial demonstrou ser seguro e eficaz neste contexto, com uma baixa taxa de complicações e resultados semelhantes a outros centros equivalentes.

Background: Several gastroenterology societies have created recommendations in order to reduce nonessential exposure to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Our aim is to evaluate the national gastroenterologists’ perspective on the impact of COVID-19 and the impact of reorganization of a gastroenterology department during the COVID-19 pandemic. Methods: For the first purpose, an online survey was distributed to gastroenterologists nationwide. For the second purpose, the authors conducted an analysis of some endoscopic procedures performed at the Gastroenterology Department of the Centro Hospitalar Vila Nova de Gaia/Espinho (CHVNG/E) between March 16 and May 8 during the years 2019 and 2020. Results: Sixty-seven gastroenterologists answered our survey. Only 14.9% were residents and 86.6% worked in a hospital with COVID-19 patients, with 16.4% assigned to assist those patients. All of the departments suffered modifications. Ninety percent of the residents affirmed that their activity had changed. Ninety-four percent declared having nonessential endoscopic procedures postponed, and 85.1% maintained in-person medical visits, 88.1% were already having remote consultations, and 11.9% did not have any clinical visit. In our gastroenterology unit, the number of endoscopic procedures decreased by 73.1% from 2019 to 2020. In 2020, the proportion of urgent procedures was higher compared to 2019. Conclusion: The advent of COVID-19 has led to important changes in gastroenterology activities in Portugal, and national gastroenterology units are complying with the recommendations. Furthermore, Portuguese gastroenterologists believed that the decrease in endoscopic activity can compromise residents’ education and training. The gastroenterology department at CHVNG/E has shown a significant reduction in the number of endoscopic procedures.

Abstract Aims Assessing reversibility of pulmonary vascular changes through vasoreactivity testing (VRT) optimizes end‐stage heart failure patient selection for heart transplant. All efforts should be made to unload the left ventricle and reduce pulmonary vascular resistance to effectively exclude irreversible pulmonary hypertension. Methods and results We reviewed our centre's cardiac transplant registry database (2009–2017) for VRT and compared haemodynamic responses with 40 ppm inhaled NO (n = 14), 14–17 μg inhaled iloprost (n = 7), and 24 h 0.1 μg/kg/min intravenous levosimendan (n = 14). Response to levosimendan was assessed by repeat right heart catheterization within 72 h. Baseline clinical and haemodynamic features were similar between groups. VRT was well tolerated in all patients. All drugs effectively reduced pulmonary artery pressures and transpulmonary gradient while increasing cardiac index, although levosimendan had a greater impact on cardiac index increase (P = 0.036). Levosimendan was the only drug that reduced pulmonary artery wedge pressure (P = 0.004) and central venous pressures (P

Introduction: The Portuguese National Registry of Transcatheter Aortic Valve Implantation records prospectively the characteristics and outcomes of transcatheter aortic valve implantation (TAVI) procedures in Portugal. Objectives: To assess the 30-day and one-year outcomes of TAVI procedures in Portugal. Methods: We compared TAVI results according to the principal access used (transfemoral (TF) vs. non-transfemoral (non-TF)). Cumulative survival curves according to access route, other procedural and clinical variables were obtained. The Valve Academic Research Consortium-2 (VARC-2) composite endpoint of early (30-days) safety was assessed. VARC-2 predictors of 30-days and 1-year all-cause mortality were identified. Results: Between January 2007 and December 2018, 2346 consecutive patients underwent TAVI (2242 native, 104 valve-in-valve; mean age 81±7 years, 53.2% female, EuroSCORE-II - EuroS-II, 4.3%). Device success was 90.1% and numerically lower for non-TF (87.0%). Thirty-day all-cause mortality was 4.8%, with the TF route rendering a lower mortality rate (4.3% vs. 10.1%, p=0.001) and higher safety endpoint (86.4% vs. 72.6%, p5% (p5% (p

Hybrid argon plasma coagulation (hAPC) is a novel technique that combines conventional argon plasma coagulation and waterjet submucosal expansion. The aims of this metanalysis were to evaluate the efficacy and safety of hAPC in the setting of Barret’s esophagus (BE) ablation and as an adjunct to colonic endoscopic mucosal resection (EMR). Four electronic databases were searched, and the results were analyzed by two independent authors. Random-effects meta-analyses of the proportions of endoscopic and histologic remission (for BE), recurrence, and post-procedure adverse events were performed using R. Studies’ reporting quality was also assessed. From the 979 identified records, 13 studies were included (10 regarding BE and three colonic EMR). The pooled percentages of endoscopic and histologic remission after hAPC for BE were 95% (95% confidence interval [CI] 91–99, I2 = 34) and 90% (95%CI 84–95, I2 = 46), respectively, while major adverse events and recurrence were registered in 2% (95%CI 0–5, I2 = 41) and 11% (95%CI 2–27, I2 = 11), respectively. Concerning hAPC-assisted EMR, the pooled percentages of major adverse events and recurrence were 5% (95%CI 2–10, I2 = 0) and 1% (95%CI 0–3, I2 = 40). Evidence suggests that the main advantages of hAPC are the increase in safety in the setting of BE ablation and the reduction of local recurrence after colonic EMR. Trials comparing hAPC with standard strategies are required to support its use for these indications.

Gastrointestinal stromal tumors account for the majority of the mesenchymal neoplasms of the gastric antrum, but other entities should also be considered. We present the case of a 70-year-old man with an ulcerated well-circumscribed polypoid submucosal mass in the gastric antrum which was proven to be a glomus tumor. CT showed progressive contrast enhancement. Magnetic resonance imaging showed a high T2 signal intensity and heterogeneous arterial contrast enhancement which became more homogeneous in later phases. We also present the case of a 50-year-old woman with a large polypoid mass occupying half the circumference of the distal gastric antrum that was proven to be a plexiform fibromyxoma. Contrast-enhanced CT and magnetic resonance imaging revealed a pattern of progressive and heterogeneous enhancement. Although gastrointestinal stromal tumors are the most frequent gastric mesenchymal neoplasms, other rare mesenchymal tumors such as glomus tumor and plexiform fibromyxoma may arise in the gastric antrum. Keywords: Gastric antrum, Glomus tumor, Plexiform fibromyxoma

Introduction: The standard of care for acute ST-elevation myocardial infarction (STEMI) includes the activation of a STEMI care network, the administration of adjuvant medical therapy, and reperfusion through primary percutaneous coronary intervention (PCI). While primary PCI is nowadays the first option for the treatment of patients with STEMI, antithrombotic therapy, including antiplatelet and anticoagulant agents, is the cornerstone of pharmacological treatment to optimize their clinical outcomes. Objective: The aim of this study was to describe contemporaneous real-world patterns of use of antithrombotic treatments in Portugal for STEMI patients undergoing primary PCI. Methods: An observational, retrospective cross-sectional study was performed for the year 2016, based on data from two national registries: the Portuguese Registry on Acute Coronary Syndromes (ProACS) and the Portuguese Registry on Interventional Cardiology (PRIC). Data on oral antiplatelet and procedural intravenous antithrombotic drugs were retrieved. Results: In 2016, the ProACS enrolled 534 STEMI patients treated with primary PCI, while the PRIC registry reported data on 2625 STEMI patients. Of these, 99.6% were treated with aspirin and 75.6% with dual antiplatelet therapy (mostly clopidogrel). GP IIb/IIIa inhibitors (mostly abciximab) were used in 11.6% of cases. Heparins were used in 80% of cases (78% unfractionated heparin [UFH] and 2% low molecular weight heparin). None of the patients included in the registry were treated with cangrelor, prasugrel or bivalirudin. Missing data are one of the main limitations of the registries. Conclusions: In 2016, according to data from these national registries, almost all patients with STEMI were treated with aspirin and 76% with dual antiplatelet agents, mostly clopidogrel. GP IIb/IIIa inhibitors were used in few patients, and UFH was the most prevalent parenteral anticoagulant drug. Resumo: Introdução: O tratamento do enfarte agudo do miocárdio com elevação do segment ST (EAMCSST) baseia-se na ativação da via verde coronária, na administração de terapêutica médica adjuvante e na reperfusão através de angioplastia primária percutânea. A angioplastia primária constitui o tratamento de primeira linha para o EAMCSST e a terapêutica antitrombótica, incluindo antiagregantes e anticoagulantes, a base do tratamento farmacológico, contribuindo para a melhoria do prognóstico. Objetivo: Descrever dados contemporâneos da vida real da utilização de terapêutica antitrombótica em Portugal, em doentes com EAMCSST submetidos a angioplastia primária. Métodos: Foi realizado um estudo observacional retrospetivo baseado nos dados de dois registos nacionais referentes ao ano de 2016: o Registo Nacional de Síndromes Coronárias Agudas (RNSCA) e o Registo Português de Cardiologia de Intervenção (RPCI). Foram colhidos dados relativos à utilização de antiagregantes plaquetários e terapêutica antitrombótica endovenosa utilizada na angioplastia primária. Resultados: Durante o ano de 2016 foram incluídos 534 doentes no RNSCA e 2625 doentes no RNCI com o diagnóstico de EAMCSST submetidos a angioplastia primária. Aproximadamente 99,6% dos doentes foram tratados com ácido acetilsalicílico (AAS) e 75,6% com terapêutica antiagregante dupla (principalmente clopidogrel). Os inibidores do recetor da GpIIbIIIa foram utilizados em 11,6% das angioplastias primárias (principalmente abxicimab). Relativamente à terapêutica anticoagulante, em 78% dos casos foi utilizada heparina não fracionada (HNF) e em 2% heparina de baixo peso molecular. Nenhum dos doentes incluído no registo foi tratado com cangrelor, prasugrel ou bivalirrudina. Os dados omissos são uma das principais limitações dos registos. Conclusões: Em 2016, de acordo com dados dos registos nacionais, quase todos os doentes foram tratados com AAS e 76% com terapêutica antiagregante dupla, na maioria dos casos incluindo o clopidogrel. Os inibidores dos recetors da GpIIbIIIa foram utilizados num número reduzido de doentes e a HNF foi o principal anticoagulante administrado. Keywords: Myocardial infarction, Antiplatelet, Anticoagulant, Antithrombotic, Adjuvant, Palavras-chave: Enfarte do miocárdio, Antiagregante, Anticoagulante, Antitrombótico, Adjuvante

Resumo: Introdução: A ecografia intravascular coronária tem ganhado importância nos laboratórios de hemodinâmica pela evidência de impacto prognóstico positivo para os doentes. Este trabalho tem como objetivo caraterizar a utilização de ecografia intravascular em intervenções coronárias percutâneas em Portugal. Métodos: Estudo observacional retrospetivo com base no Registo Nacional de Cardiologia de Intervenção da Sociedade Portuguesa de Cardiologia. De 2002 a 2016 caraterizou‐se o perfil clínico e angiográfico dos doentes submetidos a intervenção coronária percutânea, a percentagem de utilização de ecografia intravascular e as artérias coronárias avaliadas. Resultados: Foram incluídas 118 706 intervenções coronárias percutâneas, com utilização de ecografia intravascular em 2266 (1,9%). A evolução temporal caraterizou‐se por ausência em 2002 e uma utilização maioritariamente crescente de 2003 (0,1%) a 2016 (2,4%). O grupo de doentes com utilização de ecografia intravascular coronária tinha idade semelhante ao grupo de doentes sem utilização de ecografia intravascular coronária, com uma menor prevalência de doentes do sexo masculino e uma maior prevalência de fatores de risco cardiovasculares (hipertensão arterial, hipercolesterolemia, diabetes), enfarte agudo do miocárdio prévio, intervenção coronária percutânea prévia, doença coronária multivaso, lesões coronárias do tipo C ou em bifurcação e reestenose intra‐stent. A ecografia intravascular foi utilizada em 54,8% das intervenções coronárias percutâneas eletivas e em 19,15% das intervenções coronárias percutâneas do tronco comum. Conclusão: A ecografia intravascular coronária teve uma utilização crescente em Portugal desde 2003, ocorre preferencialmente em intervenções coronárias percutâneas eletivas, de doentes com maior risco cardiovascular, com lesões coronárias mais complexas e lesões do tronco comum. Abstract: Introduction: Coronary intravascular ultrasound (IVUS) is increasingly important in catheterization laboratories due to its positive prognostic impact. This study aims to characterize the use of IVUS in percutaneous coronary intervention (PCI) in Portugal. Methods: A retrospective observational study was performed based on the Portuguese Registry on Interventional Cardiology of the Portuguese Society of Cardiology. The clinical and angiographic profiles of patients who underwent PCI between 2002 and 2016, the percentage of IVUS use, and the coronary arteries assessed were characterized. Results: A total of 118 706 PCIs were included, in which IVUS was used in 2266 (1.9%). Over time, use of IVUS changed from none in 2002 to generally increasing use from 2003 (0.1%) to 2016 (2.4%). The age of patients in whom coronary IVUS was used was similar to that of patients in whom IVUS was not used, but in the former group there were fewer male patients, and a higher prevalence of cardiovascular risk factors (hypertension, hypercholesterolemia and diabetes), previous myocardial infarction, previous PCI, multivessel coronary disease, C‐type or bifurcated coronary lesions, and in‐stent restenosis. IVUS was used in 54.8% of elective PCIs and in 19.15% of PCIs of the left main coronary artery. Conclusion: Coronary IVUS has been increasingly used in Portugal since 2003. It is used preferentially in elective PCIs, and in patients with higher cardiovascular risk, with more complex coronary lesions and lesions of the left main coronary artery. Palavras‐chave: Ecografia intravascular, Intervenção coronária percutânea, Doença coronária, Cardiologia, Keywords: Intravascular ultrasound, Percutaneous coronary intervention, Coronary disease, Cardiology

Introduction: Crohn’s disease (CD) is characterized by segmental and transmural involvement of any portion of the gastrointestinal tract from the mouth to the anus. Duodenal CD is a rare clinical entity, with the majority of the patients being symptomless – its diagnosis requires a high level of clinical suspicion. Case Presentation: We present the case of a 29-year-old male patient with a 2-month history of weight loss, epigastric pain and postprandial vomiting. He underwent upper endoscopy, which revealed a circumferential duodenal ulcer causing non-transposable luminal stenosis and was medicated with proton pump inhibitors. While awaiting gastroenterology consultation, he presented at the emergency department for sudden onset of abdominal pain with dorsal irradiation, nausea and vomiting. Laboratory tests showed anaemia and increased liver enzymes, amylase and lipase. Abdominal computed tomography showed ectasia of the common bile duct (CBD) and intrahepatic biliary tract and a small amount of gas in the main pancreatic duct associated with duodenal thickening. The case was interpreted as probable CD complicated by pancreatitis and obstruction of the CBD, and he was hospitalized under antibiotic therapy and hydrocortisone with improvement of the condition. After discharge, he underwent colonoscopy that revealed several ulcers in the ileum and magnetic resonance imaging that showed distension of the stomach with reduction of the calibre of the transition from the duodenal bulb to the second portion of the duodenum in a 10- to 15-mm extension, as well as associated dilatation of the intrahepatic bile ducts and CBD and diffuse and regular ectasia of the main pancreatic duct. Combination therapy with azathioprine and infliximab was initiated; the patient presented clinical response at 12 weeks and endoscopic/imaging remission at 9 months. Discussion/Conclusion: Hepatobiliary and pancreatic manifestations are common in CD patients involving multiple mechanisms. In this case report, we pre­sent a patient with duodenal CD complicated with pancreatitis and CBD obstruction due to distortion phenomena by duodenal stenosis, a condition that is rarely described.

Articular cartilage is a highly specialized tissue found in diarthrodial joints, which is crucial for healthy articular motion. Despite its importance, articular cartilage has limited regenerative capacities, and the degeneration of this tissue is a leading cause of disability worldwide, with hundreds of millions of people affected. As current treatment options for cartilage degeneration remain ineffective, tissue engineering has emerged as an exciting approach to create cartilage substitutes. In particular, hydrogels seem to be suitable candidates for this purpose due to their biocompatibility and high customizability, being able to be tailored to fit the biophysical properties of native cartilage. Furthermore, these hydrogel matrices can be combined with conductive materials in order to simulate the natural electrochemical properties of articular cartilage. In this review, we highlight the most common conductive materials combined with hydrogels and their diverse applications, and then present the current state of research on the development of electrically conductive hydrogels for cartilage tissue engineering. Finally, the main challenges and future perspectives for the application of electrically conductive hydrogels on articular cartilage repair strategies are also discussed.

Introduction: There is a high heterogeneity in the structure of postgraduate medical training evaluation worldwide. However, in contrast to other countries, there have been no scientific studies of the final medical board examination, in Portugal. The present study aimed to evaluate the adequacy of the medical board examination including its validity as measured by its association with medical school grade average and national seriation examination. Material and Methods: Cross-sectional, observational study. We analyzed the final results on the medical board examination of 2439 physicians, across 47 specialties, who completed their training in 2016 and 2017, using measures of central tendency and variability. We assessed the association between these grades and the national exam to initiate residency, and the grade average in Medical School. Results: Measures of central tendency and variability, and consequent shape measures, revealed that the distribution of the scores of the final medical board exam is extremely negatively asymmetric and leptokurtic. A positive association was also found between the results in this exam and the score on national exam to initiate residency, and the grade average in Medical School. Conclusion: Although the medical board examination was, in general, positively associated with scores on the national exam to initiate residency, and the mean final Medical School grades, thus indicating its potential validity, our results demonstrate that this exam presents no satisfactory discriminative capacity. Therefore, there is room to improve the actual postgraduate medical examination model, including changes in its classification system and potentially consider other assessment models.

Abstract Background We aimed to evaluate the impact of thrombus aspiration (TA) during primary percutaneous coronary intervention (P-PCI) in ‘real-world’ settings. Methods We performed a retrospective study, using data from the National Registry of Interventional Cardiology (RNCI 2006–2012, Portugal) with ST-elevation myocardial infarction (STEMI) patients treated with P-PCI. The primary outcome, in-hospital mortality, was analysed through adjusted odds ratio (aOR) and 95% confidence intervals (95%CI). Results We assessed data for 9458 STEMI patients that undergone P-PCI (35% treated with TA). The risk of in-hospital mortality with TA (aOR 0.93, 95%CI:0.54–1.60) was not significantly decreased. After matching patients through the propensity score, TA reduced significantly the risk of in-hospital mortality (OR 0.58, 95%CI:0.35–0.98; 3500 patients). Conclusions The whole cohort data does not support the routine use of TA in P-PCI, but the results of the propensity-score matched cohort suggests that the use of selective TA may improve the short-term risks of STEMI.

Wasting disease in small ruminants is frequently detected at slaughterhouses. The wasting disorder is manifested by the deterioration of the nutritional and physiological state of the animal indicated by thinness, emaciation, and cachexia. Evidence of emaciation and cachexia, alone, are pathological conditions leading to carcass condemnation during an inspection. Several diseases are associated with a wasting condition, including scrapie, pseudotuberculosis, tuberculosis, paratuberculosis, Maedi Visna, and tumor diseases. On the other hand, parasitic diseases, nutrition disorders, exposure or ingestion of toxins, metabolic conditions, inadequate nutrition due to poor teeth, or poor alimentary diet are conditions contributing to poor body condition. Classical and atypical scrapie is naturally occurring transmissible spongiform encephalopathies in small ruminants. The etiological agent for each one is prions. However, each of these scrapie types is epidemiologically, pathologically, and biochemically different. Though atypical scrapie occurs at low incidence, it is consistently prevalent in the small ruminant population. Hence, it is advisable to include differential diagnosis of this disease, from other possibilities, as a cause of wasting conditions detected during meat inspection at the abattoir. This manuscript is a review of the measures in force at the abattoir for scrapie control, focusing on the differential diagnosis of gross lesions related to wasting conditions detected in small ruminants during meat inspection.

Most road pavements in Brazil are of low quality, safety and comfort. But the drawbacks go far beyond these more visible issues. Among the most important, we can highlight: sliding of asphalt plates caused by infiltrations, sudden narrowing of the track, collapsed barriers and worn bridges. These problems add up to others, causing accidents, delays, and road deaths in Brazil. As a result, the paper aims to present a comparative analysis to demonstrate the feasibility of using rubber asphalt compared to common asphalt. To answer the research objectives, the methodological choice was a bibliographical review of the integrative type. It was emphasized the importance of a study that considered, besides the cost-benefit, the environmental question, the comfort and the safety for the users of paved roads.

Resumo: Introdução e objetivos: Foi nosso objetivo reportar a evolução da angioplastia coronária no tratamento do enfarte agudo do miocárdio com supradesnivelamento do segmento ST (EAMCST), entre 2002‐2013. Métodos: Os dados prospetivos multicêntricos do Registo Nacional de Cardiologia de Intervenção (RNCI) e os dados oficiais da Direção Geral de Saúde (DGS) foram conjugados para estudar os procedimentos no EAMCST entre 2002 e 2013. Resultados: Em 2013 realizaram‐se 3524 angioplastias primárias (ICP‐P), representando um crescimento de 315% relativamente ao ano de 2002. Em 2002 a ICP‐P representava 16% do total de angioplastias coronárias, passando a representar 25% nos anos de 2012‐2013. Entre 2002‐2013 o número de procedimentos por milhão de habitantes aumentou de 106 para 338 e a angioplastia de recurso decresceu de 70,7 para 2%. Durante o período em análise, a utilização de stents eluidores de fármaco cresceu de 9,9 para 69,5%. Após 2008, observou‐se uma utilização crescente da trombectomia de aspiração, atingindo 46,7% em 2013. Os inibidores das glicoproteínas IIb/IIIa registaram um decréscimo no seu uso, sendo de 73,2% em 2002 e de 23,6% em 2013. O acesso radial cresceu de 8,3% em 2008 até 54,6% em 2013. Conclusões: Durante o período em análise, a taxa de angioplastia coronária por milhão de habitantes triplicou. A angioplastia de recurso foi ultrapassada pela angioplastia primária a partir de 2006. Observaram‐se novas tendências no tratamento do enfarte agudo do miocárdio com supradesnivelamento do segmento ST, salientando‐se a utilização de stents eluidores de fármacos e o acesso radial. Abstract: Introduction and Objectives: The aim of the present paper was to report trends in coronary angioplasty for the treatment of ST‐elevation myocardial infarction (STEMI) in Portugal. Methods: Prospective multicenter data from the Portuguese National Registry of Interventional Cardiology (RNCI) and official data from the Directorate‐General for Health (DGS) were studied to analyze percutaneous coronary intervention (PCI) procedures for STEMI from 2002 to 2013. Results: In 2013, 3524 primary percutaneous coronary intervention (p‐PCI) procedures were performed (25% of all procedures), an increase of 315% in comparison to 2002 (16% of all interventions). Between 2002 and 2013 the rate increased from 106 to 338 p‐PCIs per million population per year. Rescue angioplasty decreased from 70.7% in 2002 to 2% in 2013. During this period, the use of drug‐eluting stents grew from 9.9% to 69.5%. After 2008, the use of aspiration thrombectomy increased, reaching 46.7% in 2013. Glycoprotein IIb‐IIIa inhibitor use decreased from 73.2% in 2002 to 23.6% in the last year of the study. Use of a radial approach increased steadily from 8.3% in 2008 to 54.6% in 2013. Conclusion: During the reporting period there was a three‐fold increase in primary angioplasty rates per million population. Rescue angioplasty has been overtaken by p‐PCI as the predominant procedure since 2006. New trends in the treatment of STEMI were observed, notably the use of drug‐eluting stents and radial access as the predominant approach. Palavras‐chave: Registo, Cardiologia de intervenção, Enfarte do miocárdio, Coronariografia, Angioplastia primária, Stent, Keywords: Registry, Interventional cardiology, Myocardial infarction, Coronary angiography, Primary angioplasty, Stent

Resumo: Introdução e objetivos: Foi nosso objetivo estudar as tendências da intervenção coronária percutânea entre 2004‐2013 e comparar Portugal com outros países europeus. Métodos: Análise dos procedimentos coronários efetuados entre 2004‐2013 com base num registo prospetivo, multicêntrico, voluntário, doente a doente – Registo Nacional de Cardiologia de Intervenção (RNCI) da Associação Portuguesa de Intervenção Cardiovascular da Sociedade Portuguesa de Cardiologia (APIC‐SPC) – e dos dados oficiais publicados pela Direção Geral de Saúde (DGS). Resultados: Em 2013 realizaram‐se 36 810 cateterismos diagnósticos (3529 coronariografias por milhão de habitantes), representando um aumento significativo de 34% relativamente ao ano de 2007 (p

Background and Aims: This study aims to evaluate the role of an advanced endoscopist to study the entire colon after an incomplete colonoscopy. Methods: All patients with an elective incomplete colonoscopy performed under deep sedation in our department between January 2010 and October 2016 were included. Patients with a colonic stenosis, an inadequate bowel preparation, or a colonoscopy performed without deep sedation were excluded. Included patients were followed up to evaluate if and what type of subsequent examinations (colonoscopy by an advanced endoscopist, single-balloon enteroscopy [SBE], and/or CT colonography) was performed to complete the study of the entire colon. Lesions found during these subsequent examinations were also recorded. Results: Ninety-three patients had an incomplete colonoscopy, with no diagnosis of colorectal cancer (CRC) and a high-risk polyp rate of 5.4% (n = 5). Seventy-seven patients with incomplete colonoscopies underwent subsequent examinations, namely CT colonography in 45.5% (n = 35), colonoscopy by an advanced endoscopist in 53.2% (n = 41), and SBE in 13% (n = 10). In the 49 patients who performed either colonoscopy (n = 39) or SBE (n = 10) by an advanced endoscopist, the cecal intubation rate was 100%, and high-risk polyps were found in 26.5% (n = 13) and CRC in 4.1%. CT colonography revealed findings consistent with polyps and CRC in 22.9% (n = 8) and 2.9% (n = 1) of the cases, respectively. Colonoscopy was further repeated in 6 patients with suspected polyps in CT colonography, confirming the initial diagnosis in 5 patients. Conclusions: Colonoscopy by an advanced endoscopist achieved cecal intubation in all patients, representing a good choice after an incomplete colonoscopy.

Aim: The aim of this study was to determine the early and long-term results of percutaneous balloon mitral valvotomy (PBMV) in patients with Wilkins score (WS) between 9 and 11. Methods: We performed a retrospective review of clinical records of patients with rheumatic mitral stenosis who underwent PBMV between November 1991 and March 2008. Follow-up was obtained by telephone interview and/or clinical records. The procedure was considered unsuccessful when post-procedure mitral valve area was 8 and 55 mm [16.5% vs. 13.6%, p=1.00]; mitral regurgitation [46.5% vs. 37.5%, p=0.428]) or baseline transmitral gradient (13 mmHg [P25-P75: 10-19] vs. 13 mmHg [P25-P75: 7-20]). Improvements in mitral valve area by planimetry and in hemodynamic gradient were similar in the two groups (0.91±0.39 cm2 vs. 0.84±0.44 cm2, p=0.55; 8.8±5.3 mmHg vs. 7.3±5.9 mmHg, p=0.275, respectively). There were no significant differences in major complications or success rates (4.0 vs. 12.5 p=0.131; 89.9% vs. 95.8%, p=0.69) or in need for urgent surgery or future reintervention (2.0 vs. 8.3%, p=0.168; 22% vs. 27.3%, p=0.594). In-hospital mortality occurred only in patients in the WS gray zone (2 [8.3%] vs. 0%, p=0.04), one death (4.2% vs. 0%, p=0.194) possibly being related to a higher WS (secondary to stroke) and the other as a consequence of peripheral vascular complication. Improvements in NYHA functional class soon after the procedure and during follow-up were similar in the two groups. Total mortality was similar in the two groups (3.1 vs. 8.7%, p=0.244). Conclusions: PBMV was a safe and effective procedure in patients in the WS gray zone. Optimal results can be achieved in these patients if they are carefully selected and operated at experienced centers. Resumo: Objetivo: O objetivo deste estudo foi o de determinar os resultados a curto e longo prazo da valvulotomia percutânea mitral por balão em pacientes com score de Wilkins de 9 a 11. Métodos: Foi realizado um estudo retrospetivo através da recolha de dados de clínicos de doentes com estenose mitral reumática submetidos a valvulotomia mitral por balão, de novembro de 1991 a março de 2008. O follow-up foi obtido por meio de entrevista telefónica e/ou através dos registros clínicos. O procedimento foi considerado com sucesso quando a área valvular mitral 8 e 55 mm (16,5% versus 13,6%, p = 1,00), insuficiência mitral (46,5% versus 37,5%, p = 0,428)] ou no gradiente hemodinâmico transmitral (13 mmHg (P25-75: 10-19) vs 13 mmHg (P25-75: 7-20). A área valvular mitral (planimetria) e a melhoria do gradiente hemodinâmico foram semelhantes nos dois grupos (0,91 ± 0,39 cm2 versus 0,84 ± 0,44 cm2, p = 0,55; 8,8 ± 5,3 mmHg versus 7,3 ± 5,9 mmHg, p = 0,275, respetivamente). Não houve diferenças significativas na incidência de complicações major ou na taxa de sucesso (4,0 versus 12,5 p = 0,131; 89,9% versus 95,8%, p = 0,69), assim como na necessidade de cirurgia urgente ou futura reintervenção (2,0 versus 8,3%, p = 0,168; versus 22% 27,3%, p = 0,594). A mortalidade hospitalar ocorreu apenas em doentes com score de Wilkins na zona cinzenta [2 (8,3%) versus 0%, p = 0,04], sendo uma morte (4,2% versus 0%, p = 0,194) eventualmente correlacionados com uma maior pontuação Wilkins (secundária a acidente vascular cerebral), e a restante ocorreu em consequência de complicação vascular periférica. No que diz respeito à melhoria da classe funcional após o procedimento e durante o follow-up os resultados não foram estatisticamente significativos, tendo sido semelhantes entre os grupos. A mortalidade total foi semelhante em ambos os grupos (3,1 versus 8,7%, p = 0,244). Conclusões: A valvulotomia percutânea mitral por balão foi um procedimento seguro e eficaz em doentes na zona cinzenta do score de Wilkins. A seleção destes doentes para obtenção de melhores resultados deve ser criteriosa e cuidadosamente avaliada. A referenciação destes doentes é fundamental e deve ser realizada em centros com grande experiência nesta técnica. Keywords: Mitral stenosis, Percutaneous balloon valvotomy, Wilkins score, Palavras-chave: Estenose mitral, Valvuloplastia percutânea mitral por balão, Score de Wilkins

Churg–Strauss syndrome (CSS) is an unusual disease that presents as systemic vasculitis and peripheral eosinophilia in patients with an atopic constitution. Cardiac involvement is unusual and often not prominent on initial presentation, but is an important cause of morbidity and mortality in patients with CSS. We report the case of a young woman with severe acute myocarditis. Coronary arteriography demonstrated extensive focal vasculopathy, consistent with coronary vasculitis, and myocardial biopsy showed eosinophilic myocarditis. This presentation led to an initial diagnosis of CSS in this patient and appropriate therapy resulted in a spectacular remission of disease activity. Resumo: A Síndrome de Churg-Strauss é uma doença rara que se caracteriza por vasculite sistémica associada a eosinofilia periférica, tipicamente em doentes com constituição atópica. O envolvimento cardíaco é incomum e geralmente discreto na apresentação inicial mas constitui uma importante causa de morbilidade e mortalidade nestes doentes. Descrevemos o caso de uma mulher jovem admitida por miocardite aguda. A angiografia coronária mostrou lesões coronárias difusas sugestivas de vasculite coronária e a biópsia miocárdica mostrou a presença de miocardite eosinofílica. Esta apresentação clínica permitiu o diagnóstico inaugural de síndrome de Churg-Strauss nesta doente e a instituição de terapêutica adequada resultou na remissão completa da atividade da doença. Keywords: Churg–Strauss syndrome, Coronary vasculitis, Eosinophilic myocarditis, Complete reversal of cardiac involvement, Palavras-chave: Síndrome de Churg–Strauss, Vasculite coronária, Miocardite eosinofílica, Reversão completa do envolvimento cardíaco

Spontaneous coronary artery dissection is a rare cause of acute coronary events or sudden cardiac death. The clinical presentation is highly variable and prognosis varies widely, depending mainly on how rapidly it is diagnosed. Prompt treatment is also essential, and includes medical management, percutaneous coronary intervention and surgical revascularization.We describe the case of a young woman presenting with spontaneous coronary artery dissection of the left main coronary artery, first diagnosed as coronary thrombus, who underwent successful percutaneous coronary stenting. This report highlights the need to include spontaneous coronary artery dissection in differential diagnosis of chest pain in young women and that distinguishing between coronary thrombus and coronary artery dissection is not always straightforward. To our knowledge this is the fourth case of left main stenting in a patient with spontaneous coronary artery dissection described in the literature. Resumo: As disseções coronárias espontâneas são uma causa rara de eventos coronários agudos ou de morte súbita cardíaca. A sua apresentação clínica e prognóstico são altamente variáveis e dependem, principalmente, da rapidez com que o diagnóstico é feito. O tratamento imediato é também essencial, e inclui abordagem médica, intervenção coronária percutânea e revascularização cirúrgica.Descrevemos o caso de uma mulher jovem admitida com disseção espontânea do tronco comum da artéria coronária esquerda, primeiramente diagnosticada como trombo intracoronário. A paciente foi submetida a angioplastia percutânea mediante implantação de stent, com bom resultado angiográfico final. Este caso clínico enfatiza que a disseção coronária espontânea deve ser incluída no diagnóstico diferencial de dor torácica em mulheres jovens e, ainda, que a distinção entre trombo coronário e disseção coronária pode não ser simples. Este é o quarto caso de disseção do tronco comum tratado percutaneamente, mediante implantação de stent, que encontramos descrito na literatura. Keywords: Acute coronary syndrome, Cardiogenic shock, Coronary angiography, Stent, Palavras-chave: Síndroma coronária aguda, Choque cardiogénico, Angiografia coronária, Stent

Non-occlusion of the internal mammary artery side branches may cause ischemia due to flow diversion after coronary artery bypass grafting.The authors present the case of a 67-year-old man with recurrent angina after undergoing myocardial revascularization with a left internal mammary artery to left anterior descending bypass. He presented with impaired anterior wall myocardial perfusion in the setting of a patent left internal mammary artery side branch. Effective percutaneous treatment was carried out through coil embolization, with improved flow and clinical symptoms, confirmed through ischemia testing.Coronary steal through a patent mammary artery side branch is a controversial phenomenon and this type of intervention should be considered only in carefully selected patients. Resumo: A não oclusão de ramos laterais da artéria mamária interna após cirurgia de revascularização miocárdica pode causar isquemia devido ao desvio do fluxo coronário.Os autores apresentam o caso de um homem de 67 anos de idade, com angina recorrente após revascularização miocárdica com bypass da artéria mamária interna esquerda para a artéria descendente anterior. O doente apresentava redução da perfusão miocárdica na parede anterior na presença de um ramo patente da artéria mamária interna. Foi realizada de forma eficaz a embolização percutânea com coils deste ramo com melhoria do fluxo e dos sintomas clínicos, dados confirmados com testes de avaliação de isquemia.O roubo coronário através de ramos laterais patentes da artéria mamária ainda é um fenómeno controverso e este tipo de intervenção deve ser apenas considerada no tratamento de pacientes bem selecionados. Keywords: Patent left internal mammary artery side branch, Coronary steal syndrome, Coil embolization, Palavras-chave: Ramo patente da artéria mamária interna, Síndrome do roubo coronário, Embolização

O presente artigo discute o PARFOR - Plano Nacional de Formação de Professores da Educação Básica Pública no âmbito do ensino superior, particularmente no interior da Universidade Estadual do Oeste do Paraná – UNIOESTE. Examina as condições de sua realização e sua contribuição para a melhoria da educação básica da região Oeste do Paraná. Valemo-nos de relatos dos coordenadores, diálogos com os professoresformadores, alunos e visita in loco mediante entrevistas semi-estruturadas. Ainda que exigindo uma avaliação permanente, em razão de ser um programa vigente, consideramos que tal iniciativa tem subsidiado novas ações e procedimentos nos cursos de graduação e pós-graduação, com avanços qualitativos na formação docente e na relação da universidade com a educação básica.

The authors present a case report of successful treatment of pulmonary artery perforation by endovascular stent graft implantation. Resumo: Os autores descrevem um caso de sucesso do tratamento da rotura da artéria pulmonar com a implantação de um stent endovascular. Keywords: Swan-Ganz catheterization, Hemoptysis, Palavras-chave: Cateterização Swan-Ganz, Hemoptises

An 83-year-old man with severe organic mitral regurgitation underwent mitral valve surgery with implantation of a biologic prosthesis. Four months later he presented with hemolytic anemia and heart failure due to severe paravalvular regurgitation. Since the patient refused surgery, the paravalvular leak was closed percutaneously using two Amplatzer devices, with angiographic and clinical success. Two months after the intervention he developed heart failure again and embolization of one of the devices was documented, with significant worsening of paravalvular regurgitation. A redo percutaneous closure was attempted but although initially promising, was ultimately unsuccessful as heart failure symptoms and hemolytic anemia persisted. Surgical correction was the final solution for this case.This is the second case of late device embolization reported in the literature and highlights the importance of careful long-term follow-up of such patients, as late complications, although rare, may occur. Resumo: Um homem de 83 anos com insuficiência mitral orgânica severa foi submetido a cirurgia de substituição valvular com implantação de uma prótese biológica. Quatro meses após a cirurgia desenvolveu anemia hemolítica e insuficiência cardíaca justificadas por uma regurgitação paravalvular mitral severa. Após ter sido recusada cirurgia, foi realizado encerramento percutâneo, usando dois dispositivos Amplatzer, com bom resultado angiográfico e clínico. Dois meses após a intervenção desenvolveu novamente insuficiência cardíaca. Documentou-se a embolização de um dos dispositivos com consequente agravamento da regurgitação paravalvular. Foi tentado novo encerramento percutâneo, mas apesar de alguma melhoria inicial, manteve insuficiência cardíaca e anemia hemolítica. Efetuou-se, então, correção cirúrgica da regurgitação paravalvular com resolução do quadro clínico. Este é o segundo caso de embolização tardia de dispositivo descrito na literatura e demonstra a necessidade de um seguimento cuidado destes doentes, porque, apesar de raras, as complicações tardias ocorrem. Keywords: Paraprosthetic leak, Device embolization, Percutaneous intervention, Palavras-chave: Regurgitação periprotésica, Embolização de dispositivo, Intervenção percutânea

We analyse vibrational frequencies of 168 compounds with the AM1 model concerning its experimentally observed gaseous frequencies. Stretching of CH, NH, OH and CO bonds, its related bending frequencies, and the CC frame movements are the studied vibrations. The results show problems with the AM1 vibrational splittings. Often symmetric stretching frequencies, like in CH3, CH2 and NH3, appear switched with the corresponding antisymmetrical ones. Among the studied vibrations many stretchings are overestimated, while bendings oscillate around experimental values. Fluorine stretchings, NN, OO, CH, double and triples CC bonds and cyclic hydrocarbon breathing modes are always overestimated while torsions, umbrella modes and OH/SH stretching are, in average, underestimated. Graphical analysis show that compounds with the lowest molecular masses are the ones with the largest difference to the experimental values. From our results it is not possible to fit confortably the calculated frequencies by a simple linear relationship of the type, n(obs)=a*n(AM1). Better aggreement is obtained when different curves are adjusted for the stretching and bending modes, and when a complete linear function is used. Among our studies the best obtained statistical results are for CH, NH and OH. The conclusions obtained in this work will improve the AM1 calculated frequencies leading to accurate results for these properties.

No ano agrícola de 1991/92 em área experimental do Departamento de Solos da Universidade Federal de Santa Maria, Santa Maria, RS, foi conduzido um experimento em Planossolo da unidade de mapeamento Vacacaí, objetivando avaliar o efeito de sistemas de preparo do solo no crescimento inicial, estatura de plantas e rendimento de grãos do arroz irrigado, cv. BR IRGA 414. O delineamento experimental utilizado foi de blocos ao acaso com quatro repetições. Os resultados demostraram que a produção de massa seca do arroz foi influenciada pelos sistemas de preparo do solo no início do crescimento das plantas. No cultivo mínimo as plantas de arroz apresentaram crescimento inicial mais lento que aquelas contidas no preparo convencional. Em geral, nos diversos períodos amostrados, a estatura das plantas de arroz foi menor no cultivo mínimo do que no preparo convencional, exceto na determinação na ocasião da colheita. O sistema de cultivo mínimo não afetou o rendimento de grãos, mesmo alterando temporariamente os parâmetros de acúmulo de massa seca inicial e estatura de plantas.

Coronary angiography allows a direct evaluation of coronary anatomy. The aim of the present investigation was to search for correlations between the magnitude of coronary artery disease, as assessed by angiography, and a number of systemic parameters. A group of 116 patients (80 male, 36 female) with coronary heart disease diagnosed by angiography, aged 62.0+/-10.5 years, was the subject of an observational study. Correlation and linear regression analysis using coronary artery disease burden (CADB - sum of the percentage of the luminal stenosis encountered in all the lesions of the coronary arterial trees) as dependent variable, and age, sex, plasma calcium, phosphorus, magnesium, glucose, HDL cholesterol, LDL cholesterol, triglycerides, uric acid, estimated glomerular filtration rate and body mass index as independent variables, were carried out. Significant correlation values versus CADB were seen with age (r 0.19, p 0.04), uric acid (r 0.18, p 0.048) and fasting plasma glucose (r 0.33, p

O relato de um misterioso “vagalhão” ocorrido na praia do Cassino permitiu conjecturar que o fenômeno ocorrido possa ter sido um tsunami meteorológico – ondas com características similares às de tsunamis comuns (i. e., induzidos por atividade sísmica no oceano), mas que têm origem em efeitos meteorológicos. Mesmo sem dados medidos, foi possível especular que a onda possa ter sido originada por variações de pressão atmosférica associadas à passagem de uma linha de instabilidade sobre a costa. O mecanismo de ressonância necessário para amplificar a onda formada no mar em resposta a essa forçante é atribuído ao fato de a praia do Cassino ter “modos de vibração” de suas águas na forma de ondas de borda (edge waves) com características (período e velocidade) similares às da forçante atmosférica. São sugeridos estudos complementares para testar e aperfeiçoar as hipóteses apresentadas.