Assuntos

RESUMO

We report the case of a 61-year-old man who presented at the Emergency Department (ED), complaining of sudden-onset dyspnea and chest pain after a long flight from Tokyo to Houston. Considering his clinical stability and sPESI 0, enoxaparin 1 mg/kg BID was started for 24 h, and the patient was then considered for early discharge with apixaban 10 mg BID. Direct-factor Xa inhibition did not improve extensive thrombus burden and right ventricular dysfunction despite D-dimer measurement reduction. Because of the treatment failure, we considered thrombolysis. Currently, recommendations to use thrombolysis in patients under non-vitamin K antagonist oral anticoagulants (NOACs) do not exist. Hence, the one dose of apixaban was stopped, and 12 h later, we performed successful thrombolysis. A systematic review from 2007 to 2017 did not identify any cases related to NOACs failure to reduce thrombus burdens in patients with PE and persistent right ventricular dysfunction. We also did not find any evidence of cases that reported strategies for urgent thrombolysis in PE patients on NOACs. To the best of our knowledge, apixaban's failure to reduce thrombus burden, persistent right ventricular dysfunction, and a NOACs-thrombolysis bridge in patients with PE on apixaban has not been previously described. Both the bedside risk stratification and the therapeutic failures should alert clinicians in the ED to the potential limitations of low-molecular-weight heparin, NOACs therapy, and sPESI in the setting of intermediate-high-risk PE.

Assuntos

Assuntos

Assuntos

RESUMO

Resumen La reintroducción de especies desaparecidas de mamíferos en sus hábitats históricos ha sido recientemente de gran interés. Desde 1967 se han realizado varios intentos de reintroducción del berrendo en México, ninguno ha sido exitoso. El objetivo de este estudio es proveer información que contribuya a evaluar el éxito de la liberación. El estudio se sustentó en el monitoreo de 100 individuos (70 hembras y 25 machos) capturados en Nuevo México E.U.A. y liberados en Maderas del Carmen, Coahuila, en dos etapas, el primer grupo de 45 individuos (20 hembras, 25 machos) liberado en la vertiente occidental de Maderas del Carmen en marzo 2009 y el segundo grupo en marzo 2010 con 55 individuos más (50 hembra, 5 machos). Se comparó la dispersión y mortalidad entre el método de liberación de adaptación vs liberación inmediata. La liberación con adaptación para esta especie dio un resultado altamente significativo (χ2= 2, α= 0.05, p= 0.0001). Los resultados de los métodos de liberación inmediata fueron de 23 % de mortalidad y 46 % de dispersión y los de la liberación de adaptación fueron de 4 y 13 % respectivamente. El método de liberación de adaptación es más benévolo que la liberación inmediata ayudando a reducir la dispersión y mortalidad por miopatía en translocaciones de berrendo. Por lo que el método de liberación con adaptación se recomienda utilizarlo en futuras liberaciones de berrendo ya que demuestra que más del 50 % de los berrendos procedentes de liberaciones inmediatas mueren por estrés de captura o se dispersan y con ello, se reducen las posibilidades de éxito.

Abstract The reintroduction of missing mammal species in former habitats has recently been of high interest. In Mexico, there have been several attempts to reintroduce Antilocapra since 1967, but until now none of the trials has been successful. Nowadays, different releasing methods have been practiced for mammal species, including soft and hard release ones. The aim of this study was to provide new information, and to evaluate the success of a recent release. The study was based on the monitoring of 100 individuals (70 females, 30 males) captured in New Mexico, USA, to be released in Maderas del Carmen, Coahuila, Mexico, in two different groups. The first group (fast release) of 45 specimens (20 females, 25 males) was released in the valley at the beginning of March 2009. The second one (soft release), with 55 individuals (50 female, 5 male), was released in March 2010. For both groups, we compared the mortality rate between dispersal and soft-release vs. hard-release methods. Our results showed that the release with adaptation gave highly significant results (χ2= 2, α= 0.05, p= 0.0001)). The comparison of mortality and dispersion among both methods was highly contrasting: with soft-release we obtained 4 % and 13 % of success, against 23 % and 46 %, respectively. Considering these results, we recommend the soft-release method to be used in future reintroduction attempts of Antilocapra, since more than 50 % of specimens from hard-releases died because of capture stress, or were dispersed, and thus reduced the reintroduction success chances. Rev. Biol. Trop. 65 (3): 1208-1214. Epub 2017 September 01.

Assuntos

Assuntos

RESUMO

OBJECTIVE: To correlate the left ventricular parameters obtained with 64-slice Volumetric Computed Tomography (VCT) with those obtained with the reference standard, cardiovascular magnetic resonance (CMR) imaging. METHODS: VCT and a 3.0T MRI scanner were used. Results from both studies were independently evaluated by two cardiologists. A linear correlation and a paired Student's t test were used to analyze the data with a P<0.05 being considered significant. RESULTS: Thirty consecutive patients were evaluated with VCT and CMR. The left ventricular indices for CMR and VCT were, respectively, mass 86.4±25.8 vs. 82.7±27.6g (P=0.31); ESV 45.5±27.8 vs. 48.7±40.4ml (P=.405); EDV 101.3±32.7 vs. 105.1±44.0ml (P=0.475); SV 55.9±16.1 vs. 56.8±15.6ml (P=0.713); LVEF 57.5±13.2% vs. 56.9±12.4% (P=0.630). No differences in intraobserver variability for both methods were found, CT r=0.96, r(2)=0.92 P<0.0001 and MR r=0.96 r(2)=0.93 P<0.0001. There was no significant statistical difference in the presence of artifacts. CONCLUSION: There is a close correlation between CMRI and VCT in the evaluation of LV function. VCT is as useful as 3T CMR, and could be incorporated as another resource for evaluating LV function.

Assuntos

RESUMO

A 34-year-old man was admitted after an episode of aborted sudden cardiac death. The initial investigation including electrocardiogram, chest x-ray, transthoracic echocardiogram, and biomarkers were normal. Although coronary angiography showed nonsevere stenosis, optical coherence tomography revealed severe obstruction in the artery with a layered appearance of the vessel wall; it was consistent with the presence of mural thrombus.

Assuntos