Abstract: Radiofrequency ablation is an effective and safe technique for the treatment of different types of arrhythmias. Radiofrequency ablation is performed using fluoroscopy, a standard navigation guide, which is related to radiation exposure and its well-known harmful effects on patients and laboratory staff. In the last decade, electroanatomic mapping systems have noted a steep development. Despite their indisputable advantages, they do not include information obtained by real-time fluoroscopy. This important limitation is tackled by the new CARTO-UNIVU™ module as it seamlessly combines fluoroscopy images with three-dimensional (3D) electroanatomic mapping into a single accurate 3D view, enabling a pronounced reduction in radiation exposure. We report four cases of our single center first experience of the new CARTO-UNIVU™ module.

Resumen: La ablación por radiofrecuencia es una técnica eficaz y segura para el tratamiento de diferentes tipos de arritmias. La ablación por radiofrecuencia se realiza mediante fluoroscopia, una guía de navegación estándar, que está asociada con la exposición a la radiación y sus efectos nocivos bien reconocidos para los pacientes y para el personal de laboratorio. En la última década, los sistemas de mapeo electroanatómico han experimentado un fuerte desarrollo. A pesar de sus indiscutibles ventajas, no incluyen información obtenida por fluoroscopia en tiempo real. El módulo CARTO-UNIVU™ aborda esta importante limitación, ya que combina imágenes de fluoroscopia con el mapeo eletroanatómico tridimensional (3D) en una sola vista 3D, lo que permite una reducción pronunciada de la exposición a la radiación. Presentamos cuatro casos de nuestra primera experiencia en un solo centro con el nuevo módulo CARTO-UNIVU™.

Abstract: Introduction: Pre-participation screening aimed at the detection of disorders associated with sudden cardiac death is universally supported by major medical societies. However, the best method for screening remains controversial. The aim of this study was to evaluate the prevalence of structural cardiac lesions identified by echocardiography in apparently healthy athletes referred for pre-participation screening. Material and methods: We conducted an observational retrospective study (January 2017-December 2019) performed in a single center. We evaluated echocardiograms of athletes under 35 years of age, performed in the first evaluation for pre-participation screening. Results: A total of 1,981 different athletes’ echocardiograms were included; 36 exams (1.8%) reported structural cardiac lesions. The most common cardiac lesions found were mitral valve prolapse (n = 5), atrial septal aneurysm (n = 5) and atrial septal defect (n = 4). The bicuspid aortic valve and left ventricular hypertrophy were each present in 3 athletes (n = 3); ventricular septal defects, left ventricular noncompaction, aortic dilatation and dilated cardiomyopathy were each found in 2 athletes (n = 2). Less frequent lesions were present in only one athlete, such as hypertrophic cardiomyopathy, surgically-corrected transposition of the great arteries, and pulmonary valve stenosis. Notably, among 36 patients with structural abnormalities in echocardiography, only 6 (16.7%) had positive standard pre-participation screening (combining personal and family history, physical examination and electrocardiogram). Conclusions: Echocardiography plays an important role in detecting cardiac structural abnormalities that would otherwise escape standard screening protocols and could be left unnoticed. This study suggests a potential benefit of including echocardiography in the first evaluation for pre-participation screening of competitive athletes.

Resumen: Introducción: Las principales sociedades médicas respaldan universalmente el cribado previo a la participación destinado a la detección de trastornos asociados con la muerte súbita cardiaca. Sin embargo, el mejor método para la detección sigue siendo controvertido. El objetivo de este estudio fue evaluar la prevalencia de lesiones cardiacas estructurales identificadas por ecocardiografía en atletas aparentemente sanos, referidos para tamizaje pre-participación. Material y métodos: Realizamos un estudio observacional retrospectivo (enero 2017-diciembre 2019) de un único centro. Se evaluaron ecocardiogramas de atletas menores de 35 años, realizados en la primera evaluación para tamizaje pre-participación. Resultados: Se incluyeron en total 1,981 ecocardiogramas de atletas diferentes; 36 exámenes (1.8%) reportaron lesiones cardiacas estructurales. Las lesiones cardiacas más frecuentes encontradas fueron prolapso de la válvula mitral (n = 5), aneurisma del tabique interauricular (n = 5) y comunicación interauricular (n = 4). La válvula aórtica bicúspide y la hipertrofia ventricular izquierda estuvieron presentes cada una en tres atletas (n = 3); defectos del tabique ventricular, miocardiopatía por ventrículo izquierdo no compacto, dilatación aórtica y miocardiopatía dilatada se encontraron cada uno en dos atletas (n = 2). Las lesiones menos frecuentes se presentaron en un solo atleta, e incluyeron miocardiopatía hipertrófica, transposición de grandes arterias corregida quirúrgicamente, estenosis de válvula pulmonar, entre otras. En particular, entre 36 pacientes con anomalías estructurales en la ecocardiografía, sólo 6 (16.7%) tuvieron un examen estándar previo a la participación positivo (combinando antecedentes personales y familiares, examen físico y electrocardiograma). Conclusiones: La ecocardiografía transtorácica juega un papel importante en la detección de anomalías estructurales cardiacas que de otro modo escaparían a los protocolos de detección estándar y podrían pasar desapercibidas. Este estudio sugiere un beneficio potencial de incluir la ecocardiografía en la primera evaluación para la detección previa a la participación de atletas competitivos.

Resumo Os cuidados paliativos, através de uma abordagem global e humanizada, visam melhorar a qualidade de vida de quem enfrenta uma doença incurável - pessoa doente, seus cuidadores e familiares. O reconhecimento precoce destas circunstâncias possibilita minorar o sofrimento, tanto físico, como psicológico, emocional ou espiritual. Temática ainda amiude temida e evitada, pelo que as concepções gerais em seu redor foram objecto de um questionario fundamentado na Lei de Bases dos Cuidados Paliativos.

Abstract Palliative care, through a global and humanized approach, aims to improve the quality of life of those who face an incurable disease - the sick person, their caregivers and family members. The early recognition of these circumstances makes it possible to alleviate suffering, either physical, psychological, emotional or spiritual. This thematic is still often feared and avoided, thus the general concepts around it were the subject of a questionnaire based on the Basic Law of Palliative Care.

The role of uric acid as an independent risk factor for chronic kidney disease development and progression is still a matter of discussion. Several observational studies showed a positive association between hyperuricemia and the progression of kidney dysfunction, but others did not, which probably derived from different biases and studies insufficiencies. Moreover, the results from studies on patients in hemodialysis and peritoneal dialysis are even more controversial, with some evidence pointing towards a protective role of uric acid in hemodialysis patients, but not in peritoneal dialysis. In addition to most evidence suggesting a role of uric acid in chronic kidney disease pathogenesis and progression, pharmacological treatment of asymptomatic hyperuricemia is still not indicated, with no consensus on either the uric acid level at which treatment would be beneficial, or the target-level to achieve. There are several studies on the renal benefits of xanthine oxidase inhibitors allopurinol and febuxostat, with heterogeneous results. Most of them showed a renoprotective effect of both drugs, delaying renal disease progression. However, the different results found in other studies makes it difficult to draw definitive conclusions. Despite recent evidence pointing toward an important role of uric acid in the pathogenesis and progression of kidney disorders, and the benefits of its treatment, there are still several unanswered questions, and well-conducted studies are needed to make valid conclusions.

Partindo da constatação de que, na actualidade, o poder atractivo do casamento parece diminuir por parte das pessoas heterossexuais enquanto aumenta por parte das pessoas homossexuais, examinaram-se as representações do casamento heterossexual e do casamento homossexual de 240 adultos heterossexuais portugueses, que responderam a um questionário constituído por questões abertas e questões fechadas. Os resultados sugerem que ambas as formas de casamento são consideradas como tendo por finalidade principal cimentar o amor, mas que constituir família será uma melhor justificação para o casamento heterossexual do que para o casamento homossexual. Os discursos acerca das duas formas de casamento apresentam apenas uma dimensão comum, que remete para a partilha e o companheirismo. Enquanto a representação do casamento heterossexual engloba referências à família, às relações amorosas e aos compromissos, a representação do casamento homossexual esvazia-se na problemática dos direitos e dos preconceitos. De acordo com os resultados habitualmente encontrados na literatura, as mulheres e as pessoas com nível de educação mais elevado apresentam uma representação do casamento homossexual mais positiva mas, contrariamente ao esperado, este não é o caso das pessoas mais jovens.

On the basis of the observation that, nowadays, the attractive power of marriage seems to diminish among heterosexual individuals whereas it increases among homosexual people, we examined the representations of heterosexual marriage and of homosexual marriage of 240 heterosexual adults from Portugal, who answered a questionnaire that was composed of open and close questions. Results suggest that both types of marriage are considered to have the main aim of sealing spouses’ love, but that constituting family is a better justification for heterosexual marriage than for homosexual marriage. Respondents’ discourses about the two types of marriage present only one common dimension, which refers to sharing and companionship. Whereas the representation of heterosexual marriage includes references to family, to romantic relationships and to commitments, the representation of homosexual marriage comes down to the question of rights and prejudice. In line with the findings usually presented in the literature, female participants and respondents with higher educational level have a more positive representation of homosexual marriage, but, contrary to what was expected, this is not the case for the younger respondents.