��ǿ��Ƥ�ʼ��صĹ淶Ӧ�ê�

??Abstract??Glucocorticoids have been widely used in a variety of diseases because of its potent anti-inflammatory??immunosuppressive??anti-toxicity and anti-shock activities.However??its indications are not strictly followed and glucocorticoids have been excessively prescribed.Moreover??glucocorticoids have great diversity of generics??formulas??routes of admiration and dosage options.Its adverse effects and complications have been one of the challenges for both clinician and patients.Therefore??in 2011??National Health Ministry released the Guidelines for Clinical Applications of Glucocorticoids.     

Anemia e deficiência de ferro na insuficiência cardíaca

Heart failure is a common problem and a major cause of mortality, morbidity and impaired quality of life. Anemia is a frequent comorbidity in heart failure and further worsens prognosis and disability. Regardless of anemia status, iron deficiency is a common and usually unidentified problem in patients with heart failure. This article reviews the mechanisms, impact on outcomes and treatment of anemia and iron deficiency in patients with heart failure.     

Le schwannome malin du grêle: cas rare

Introduction

Primary malignant schwannoma of the small bowel is an extremely rare pathology, with only 24 cases described in English language literature. We report a case of this rare occurrence with a review of the literature. Observation: The case involves a 63-year-old female patient presenting with an abdominopelvic mass. An abdominopelvic scan showed a bulky abdominopelvic mass, which appeared to originate in the uterus, with hepatic metastasis. The patient was treated by surgical excision despite the presence of a diffuse carcinoma. She died three months later.

Discussion

The clinical signs of small bowel schwannoma are not obvious. Radiological examinations reveal a tumoral syndrome. Diagnosis is generally by histological analysis after laparotomy. Surgery is the basic treatment. The role of chemotherapy is not well defined as yet.

Conclusion

Primary malignant schwannoma is an extremely rare pathology. The treatment is primarily surgical. Chemotherapy probably has a beneficial role to play.     

Mort subite,en quête d’une explication

Sudden cardiac death, mostly related to ventricular arrhythmia, is a major public health issue, with still very poor survival at hospital discharge. Although coronary artery disease remains the leading cause, other etiologies should be systematically investigated. Exhaustive and standardized exploration is required to eventually offer specific therapeutics and management to the patient as well as his/her family members in case of inherited cardiac disease. Identification and establishing direct causality of the detected cardiac anomaly may remain challenging, underlying the need for a multidisciplinary and experimented team.     

A tête-à-tête comparison of ejection fraction and regional wall motion abnormalities as measured by echocardiography and gated sestamibi SPECT

Determination of ejection fraction and regional wall motion abnormalities (RWMAs) consistent with stunned, hibernating, or infarcted myocardium can be noninvasively determined by both echocardiography and nuclear cardiac imaging. Prior comparisons between the 2 methods have been limited to Tc 99m pertechnetate or to stress images with attention to RWMAs only. To determine the relationship between results seen with echocardiography and gated single photon emission computed tomography (SPECT) using sestamibi, 26 individuals with varying degrees of coronary artery disease were prospectively studied with both techniques. Five individuals had single-vessel disease, 10 had 2-vessel disease, and 11 had triple-vessel disease. Each individual underwent 2-D, M-mode, and Doppler echocardiography (echo) as well as gated SPECT imaging using rest and stress (high-dose dipyridamole/HDD) sestamibi imaging. The results were statistically different when ejection fractions (EFs) and RWMAs were compared. There were no statistical differences between EFs determined at rest when either echo or nuclear imaging was used. However, patients with EFs <70-80% were overestimated by echo, with echo underestimating EFs >70-80% (p=0.001). There was a high correlation (r=0.76) between resting echocardiographic EFs and SPECT resting gated sestamibi images in patients with single-vessel disease, and a moderate correlation (r=0.68 and r=0.68) in patients with 2- and 3-vessel disease, respectively. Differences in the detection of RWMAs were statistically different for patients with 2-vessel disease (p=0.04) and approached significance in 3-vessel disease (p=0.56) with more RWMA being detected by resting gated SPECT imaging than by echo. Greater differences in RWMAs were seen in patients with 1-, 2-, and 3-vessel disease when resting echo was compared with HDD gated SPECT sestamibi imaging. These differences were statistically greater in 2- (p=0.0027) and 3- (p=0.0003) vessel disease. Differences between stress and resting images are expected in individuals with severe coronary artery disease. Comparison of noninvasive assessment of EFs and RWMAs by gated SPECT sestamibi and echocardiography showed different results when looking at EFs, with echo reporting greater EFs for people with EFs <70-80%. Patients with two and 3-vessel disease were statistically more likely to have RWMAs detected by gated SPECT sestamibi than by echo.     

Encerramento percutâneo do apêndice auricular esquerdo para profilaxia de tromboembolismo na fibrilhação auricular em doentes com contraindicação ou falência da hipocoagulação oral: experiência de um serviço

IntroductionIn non-valvular atrial fibrillation 90% of thrombi originate in the left atrial appendage (LAA). Percutaneous LAA closure has been shown to be non-inferior to warfarin for prevention of thromboembolism.ObjectiveTo evaluate the initial experience of a single center in percutaneous LAA closure in patients with high thromboembolic risk and in whom oral anticoagulation was impractical or contraindicated or had failed.MethodsPatients with non-valvular atrial fibrillation and CHADS2 score ≥2 in whom oral anticoagulation was impractical or contraindicated or had failed underwent percutaneous LAA closure according to the standard technique. After the procedure, dual antiplatelet therapy was maintained for one month, followed by single antiplatelet therapy indefinitely. Patients were followed by clinical assessment and transthoracic and transesophageal echocardiography.ResultsThe procedure was performed in 22 of the 23 selected patients (95.7%), mean age 70±9 years, CHADS2 score 3.2±0.9 and CHA2DS2-VASC score 4.7±1.4. Intraprocedural device replacement was necessary only in the first patient, due to oversizing. The following periprocedural complications were observed: one femoral pseudoaneurysm, three femoral hematomas and two minor oropharyngeal bleeds, resolved by local hemostatic measures. During a 12±8 month follow-up a mild peri-device flow and a thrombus adhering to the device, resolved under with enoxaparin therapy, were identified. The rate of transient ischemic attack (TIA)/stroke was lower than expected according to the CHADS2 score (0 vs. 6.7±2.2%).ConclusionsIn our initial experience, this procedure proved to be a feasible, safe and effective alternative for atrial fibrillation patients in whom oral anticoagulation is not an option. Only relatively minor complications were observed, with a lower than expected TIA/stroke rate.     

Arrêt cardiaque extrahospitalier et pandémie de la COVID-19

Since the appearance of the COVID-19 pandemic in 2020, the direct mortality related to COVID-19 infections has been monitored worldwide, with a daily count of the number of deaths due to COVID-19. Several measures have been undertaken in the societal and professional field, and the healthcare systems have been reorganized to limit the virus spread, and to cope with the surge of hospital admissions for COVID-19. Questions have been raised regarding the indirect effect of the pandemic, with uncertainties regarding the impact of delays in non-COVID diseases management, due to lockdown, postponement of non-urgent medical consultations and interventions, and decrease in screening. Sudden cardiac death could have been impacted by all those changes, and is generally a good surrogate of public health. In the current article, we review the impact of the COVID-19 pandemic on the epidemiology and outcome of sudden cardiac death.     

Polymorphisme et asthme: intérêt en pharmacogénétique

The efficacy of drug therapy in asthma varies widely between patients. Inter-subject variability may be due to environmental factors, differences in patient compliance, biological variations involved in the mechanisms of the disease or in the mode of action of drugs, some of which may be genetic in origin. The study of genetic factors determining treatment response to a given drug defines pharmacogenetics, a science in its infancy at the dawn of this new millennium. In asthma, a comprehensive screen of genes likely to be important in determining treatment response has not yet been performed. This paper will review the recent data regarding two good examples of polymorphisms apparently determining treatment response to two classes of drugs, the β₂-agonists and the anti-leukotrienes.     

Prevalência de hipertensão arterial em adolescentes portugueses da cidade de Lisboa

AimsTo determine the prevalence of pre-hypertension (pre-HTN) and hypertension (HTN) in Portuguese adolescents in Lisbon and to ascertain the relationship between blood pressure (BP) levels and the risk factors of gender, obesity, smoking, alcohol consumption, exercise and family history of HTN.MethodsThis was a cross-sectional study in a non-randomized sample of 234 adolescents of both sexes, aged between 16 and 19 years. Information on habits and family history of HTN was obtained through a self-completed structured questionnaire.ResultsThe study included 234 adolescents, mean age 16.4 ± 0.9 years, 57% male. The prevalence of HTN was 34%, higher in males (44% vs. 21%, p = 0.001) and 12% of pre-HTN, higher in females (13% vs. 10%, p = 0.001). Higher body mass index was associated with significantly higher prevalence of pre-HTN (normal weight 9.40%, overweight 16.10%, and obesity 22.70%) and HTN (normal weight 30.4%, overweight 45.2%, and obesity 45.5%). With a family history of HTN, the prevalence of HTN and pre-HTN was approximately double (41% vs. 28% and 18% vs. 9%, respectively). Regular exercise, smoking and alcohol consumption were not significantly associated with BP values.ConclusionThe prevalence of pre-HTN and HTN in the sample studied was high. Of the risk factors evaluated, only gender, obesity and family history of HTN were significantly associated with BP values.