RESUMO
RESUMEN: La estenosis tricuspídea (ET) es una valvulopatía infrecuente cuyas principales etiologías son la enfermedad reumática y la endocarditis infecciosa. En raras ocasiones puede deberse a un fenómeno carcinoide subyacente, en lo que se conoce como la enfermedad carcinoide cardiaca (ECC). Esta condición lleva a la fibrosis del endocardio del ventriculo derecho, principalmente de sus válvulas, lo cual puede provocar falla cardiaca derecha, complicando el pronóstico. En este artículo se presenta un caso de una ET severa por una posible ECC, en conjunto con las imagenes ecocardiográficas obtenidas durante el abordaje diagnóstico (imágenes bidimensionales, imagen multiplanar y ecocardiografía en 3D). Se discuten las implicaciones clínicas, los retos diagnósticos, las opciones terapeuticas y el pronóstico de esta rara entidad.
ABSTRACT Severe Tricuspid Stenosis Secondary to Cardiac Carcinoid Disease: Case Report and Literature Review Tricuspid stenosis is an unfrequent valvulopathy that can be caused by multiple etiologies, including rheumatic disease and infectious endocarditis. In rare occasions, it occurs in the context of a carcinoid syndrome, in what is known as carcinoid heart disease. This condition causes fibrosis of the valves and the endocardium of the right ventricule, which can progress into right ventricular failure, worsening the patient's prognosis. In this article, we present a case of a severe tricuspid stenosis in which this ethiology is suspected. We show the echocardiographic images obtained for the diagnosis (two-dimensional imaging, multimodal imaging and 3D echocardiography), and we discuss the clinical and diagnostic implications, therapeutic options and prognosis of this rare condition.
Assuntos
Humanos , Feminino , Idoso , Doença Cardíaca Carcinoide/diagnóstico por imagem , Estenose Coronária/diagnóstico , Costa Rica , Estenose Coronária/complicaçõesRESUMO
La fibrosis endomiocárdica (FEM) es una enfermedad rara y potencialmente letal caracterizada por la infiltración de tejido fibrótico en el endocardio y miocardio. Es más comúnmente observada en regiones tropicales y subtropicales, y se cree que es causada por la combinación de factores genéticos y ambientales. Su patogénesis aún no está del todo clara, pero es posible que esté relacionada con una respuesta inmune anormal ante múltiples estímulos, incluyendo infecciones virales, parásitos, trastornos hematológicos y deficiencias alimentarias. Esta condición es una de las principales manifestaciones de los síndromes hipereosinofílicos (SHE). Pese a los avances en el manejo, el pronóstico de los pacientes con FEM persiste siendo pobre, con un alto riesgo de recurrencia y de progresión hacia insuficiencia cardiaca. A continuación, presentaremos el caso de un paciente joven con un cuadro de insuficiencia cardiaca de predominio derecho en el contexto de un síndrome hipereosinofílico de base, en quien se establece el diagnóstico de FEM según lo documentado en las imágenes cardiacas.
Endomyocardial Fibrosis: Case Report and Literature Review. Endomyocardial fibrosis (EMF) is a rare and potentially life-threatening cardiac disorder characterized by the infiltration of fibrotic tissue into the endocardium and myocardium of the heart. It is most seen in tropical and subtropical regions, and it is believed to be caused by a combination of environmental and genetic factors. The exact pathogenesis of EMF is not fully understood, but it is thought to be related to an abnormal immune response to various stimuli, including viral infections, parasites, and dietary deficiencies. This condition is one of the main manifestations of hypereosinophilic syndromes. Despite advances in treatment, the prognosis for patients with EMF remains poor, with a high risk of recurrence and progression to heart failure. We present a case of a young male patient with an episode of right heart failure in the context of a chronic hypereosinophilic syndrome in which the diagnosis of EMF is made with the aid of cardiovascular imaging.
Assuntos
Humanos , Masculino , Adulto , Fibrose Endomiocárdica/diagnóstico por imagem , Insuficiência Cardíaca , Costa RicaRESUMO
Del 2006 al 2012, la política criminal del gobierno del presidente Felipe Calderón Hinojosa le dio preeminencia a la Secretaría de Seguridad Pública Federal, encarnada en la Policía Federal, a la que se dotó de una moderna plataforma tecnológica para la inteligencia; por lo tanto, esta contribución se centrará sobre la inteligencia policial y el derrotero de los últimos seis años de la inteligencia de la Policía Federal mexicana.
From 2006 through 2012, President Felipe Calderons criminal policy gave priority to the Federal Public Security Secretariat embodied in the Federal Police which was equipped with a modern technological platform for intelligence. Therefore, this contribution will focus on police intelligence and the path of the Mexican Federal Police in the past six years.
De 2006 a 2012, a política criminal do governo do presidente Felipe Calderón Hinojosa deu preeminência para o Secretariado da Segurança Pública Federal encarnada na Polícia Federal, que é dotada de uma moderna plataforma tecnológica para a inteligência; portanto, essa contribuição vai se centrar na inteligência da polícia e o curso dos últimos seis anos da inteligência da Policia Federal mexicana.
Assuntos
Inteligência/classificação , Polícia/classificação , Polícia/legislação & jurisprudência , Polícia/organização & administração , PolíciaRESUMO
Secondhand smoke is associated with a myriad of adverse health outcomes. Therefore, it is essential for clinicians to ask precise questions about exposures, particularly for children. We present 4 questions that incorporate several locations of exposure and provide a more comprehensive account of children's smoke exposures than maternal smoking alone.
Assuntos
Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Inquéritos e Questionários/normas , Poluição por Fumaça de Tabaco/efeitos adversos , Pré-Escolar , Cotinina/análise , Feminino , Seguimentos , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Ontário/epidemiologia , Gravidez , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal/metabolismo , Prognóstico , Radioimunoensaio , Fatores Socioeconômicos , Fatores de TempoRESUMO
OBJECTIVE: To examine risk factors for eczema at age 4 years. STUDY DESIGN: Beginning at 1 year of age, infants of atopic parents (n = 636) had annual clinical evaluations and skin prick tests (SPTs) to 15 aeroallergens and milk and egg. Parents completed validated surveys on eczema and environmental exposures. House dust samples were evaluated for allergens and endotoxin. Eczema was defined as a parental report of scratching, and redness, "raised bumps," or dry skin/scaling for 6 of the last 12 months. RESULTS: At age 4 years, a total of 90 children (14%) had eczema. Not having a dog before 1 year of age and being dog SPT+ at 1, 2, or 3 years of age conferred a 4-fold higher risk for eczema at age 4 years (adjusted odds ratio [aOR] = 3.9 [1.6-9.2]; P = .002). Among dog owners, however, dog SPT+ was not associated with significantly increased risk (aOR 1.3 [0.3-6.8]; P = .8). Among children with cats before 1 year of age, cat SPT+ conferred significantly increased risk for eczema (aOR = 13.3 [3.1-57.9]; P < .001). Among non-cat owners, cat SPT+ was not associated with increased risk (aOR = 1.1 [0.5-2.7]; P = .8). CONCLUSION: Dog ownership significantly reduced the risk for eczema at age 4 years among dog-sensitized children, cat ownership combined with cat sensitization significantly increased the risk.
Assuntos
Animais Domésticos/imunologia , Dermatite Atópica/imunologia , Eczema/imunologia , Exposição Ambiental/efeitos adversos , Imunização , Fatores Etários , Alérgenos , Análise de Variância , Animais , Gatos , Pré-Escolar , Estudos de Coortes , Intervalos de Confiança , Dermatite Atópica/diagnóstico , Dermatite Atópica/epidemiologia , Dermatite Atópica/genética , Cães , Eczema/epidemiologia , Eczema/genética , Feminino , Predisposição Genética para Doença , Humanos , Incidência , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Razão de Chances , Prognóstico , Medição de Risco , Testes CutâneosRESUMO
OBJECTIVE: To determine the impact of environmental exposures (diesel exhaust particle [DEP], environmental tobacco smoke [ETS], and mold) that may contribute to oxidative stress on persistent wheezing in the Cincinnati Childhood Allergy and Air Pollution Study (CCAAPS) birth cohort and to determine how the impact of these exposures is modified by the GST-P1 Ile105Val polymorphism. STUDY DESIGN: A land-use regression model was used to derive an estimate of each child's DEP exposure. ETS exposure was determined by questionnaire data. Each child's home was evaluated for visible mold by a trained professional. Children in the CCAAPS cohort were genotyped for the GST-P1 polymorphism (n = 570). Persistent wheezing was defined as wheezing at both 12 and 24 months. RESULTS: High DEP exposure conferred increased risk for wheezing phenotypes but only among the Val(105) allele carriers. Infants with multiple exposures were significantly more likely to persistently wheeze despite their genotype. CONCLUSION: There is evidence for an environmental effect of DEP among carriers of the GST-P1 Val(105) allele in the development of persistent wheezing in children. The protective effect of the GST-P1 Ile(105) genotype may be overwhelmed by multiple environmental exposures that converge on oxidative stress pathways.
Assuntos
Exposição Ambiental/efeitos adversos , Glutationa S-Transferase pi/genética , Sons Respiratórios/etiologia , Sons Respiratórios/genética , Pré-Escolar , Estudos de Coortes , Exposição Ambiental/análise , Feminino , Fungos/isolamento & purificação , Genótipo , Humanos , Lactente , Masculino , Polimorfismo Genético , Inquéritos e Questionários , Poluição por Fumaça de Tabaco/efeitos adversos , Poluição por Fumaça de Tabaco/análise , Emissões de Veículos/análiseRESUMO
OBJECTIVES: To determine whether infants exposed to environmental tobacco smoke (ETS) having the interleukin 4 (IL-4) or interleukin 13 (IL-13) gene polymorphisms were at increased risk of wheezing. STUDY DESIGN: A birth cohort of 758 infants was evaluated annually by a questionnaire, physical examination, and skin prick testing. DNA samples from 560 children were genotyped for IL-4 C-589T and IL-13 C-1112T. The relationship of ETS exposure and genotype with the outcome of wheezing was analyzed. RESULTS: At the time of evaluation, mean age was 13.4 +/- 2.2 months. The prevalence of sensitization was 29%, and wheezing without a cold was 26.2%. The interaction of ETS exposure and the CT/TT genotypes for IL-4 C-589T showed a significant association with wheezing (odds ratio: 10.84; 95% confidence interval: 1.12-104.64, P = .04) in African-American infants. CONCLUSIONS: In African-American infants with a family history of atopy, the interaction of ETS and IL-4 C-589T demonstrated a 10-fold risk associated with wheezing without a cold.
Assuntos
Negro ou Afro-Americano , Exposição Ambiental/efeitos adversos , Interleucina-4/genética , Polimorfismo de Nucleotídeo Único/genética , Sons Respiratórios/etiologia , Poluição por Fumaça de Tabaco/efeitos adversos , Estudos de Coortes , Feminino , Predisposição Genética para Doença/etnologia , Humanos , Lactente , Interleucina-13/genética , Masculino , Fatores SocioeconômicosRESUMO
OBJECTIVE: To present methodology to identify atopic parents and determine the prevalence of sensitization to 15 aeroallergens in their infant offspring. STUDY DESIGN: A birth cohort of infants was identified from birth records; an infant was enrolled if 1 of the parents reported allergy respiratory symptoms and had a positive skin prick test (SPT) to a common aeroallergen. At age 1 year, these infants were tested to the same aeroallergens. RESULTS: Of the 680 enrolled infants, 28.4% were SPT+ to 1 or more aeroallergens and/or food, and 18.0% were positive to 1 or more aeroallergens. By category of allergens, 9.7% were sensitized to pollens, 7.5% to molds, 4.3% to house dust mite and/or cockroach, and 3.4% to dog and/or cat. Of the infants who were positive to an aeroallergen, 65.7% remained positive at age 2 years. CONCLUSIONS: Infants born to atopic parents with percutaneous sensitization to aeroallergens are at increased risk for aeroallergen sensitization during infancy, which persists to age 2 years. These findings suggest that current clinical practices, which generally avoid skin testing before age 2 years, be reassessed in this population of high-risk children.