Abstract Paradoxical embolism due to an isolated pulmonary arteriovenous malformation (PAVM) is a rare cause of ischemic stroke. PAVMs are abnormal high-flow connec tions between pulmonary arteries and veins, diverting deoxygenated blood into the systemic circulation and they represent a less common source of paradoxical embolisms, especially in young individuals. Endovascular embolization is the preferred treatment for clinically significant PAVMs. We present the case of a 34-year-old woman with a left thalamic ischemic stroke. Severe contrast passage was detected in cerebral arteries through transcranial Doppler. Intracardiac ultrasound did not reveal a patent foramen ovale, prompting further investigation with pulmonary CT angiography, confirming the presence of PAVM. The patient underwent successful endovascular treatment. It is essential to consider PAVM in the etiological di agnosis of ischemic stroke, especially in young patients with signs of abnormal right-to-left communication. Periodic follow-up imaging is recommended to assess potential recurrence or changes in PAVM, emphasizing the importance of appropriate management of these malformations.

Resumen La embolia paradojal debido a una malformación arteriovenosa pulmonar (MAVP) aislada es una causa in frecuente de accidente cerebrovascular (ACV) isquémico. Las MAVP son conductos anómalos de alta circulación entre arterias y venas pulmonares, desviando sangre desoxigenada hacia la circulación sistémica y represen tan una fuente menos común de embolias paradojales, especialmente en personas jóvenes. La embolización endovascular es el tratamiento preferido para MAVP clínicamente significativas. Presentamos el caso de una mujer de 34 años con ACV isquémico talámico izquierdo. Se detectó pasaje de burbujas “en cortina” en arterias cerebrales mediante Doppler transcraneal. En ecografía intracardíaca no se encontró foramen oval permeable, motivo por el cual se avanzó con realización de angiotomografía pulmonar, la cual confirmó la presencia de MAVP. La paciente recibió tratamiento endovascular exitoso. Es esencial considerar la MAVP en el diagnóstico etio lógico del ACV isquémico, especialmente en pacientes jóvenes con signos de comunicación anormal de derecha a izquierda. Se recomienda un seguimiento periódico mediante imágenes para evaluar la posible recurrencia o cambios en la MAVP, resaltando la importancia del manejo adecuado de estas malformaciones.

ABSTRACT Foundation: cerebrovascular disease is any alteration of one or more brain areas, whether temporary or permanent, secondary to a cerebral circulation disorder of ischemic or hemorrhagic origin. For many years it has been considered one of the main causes of death worldwide. It is among the main causes of death in Ecuador. Objective: to describe the risk factors for cerebrovascular diseases in adult patients diagnosed with cerebrovascular diseases at the Tulcán Sur Health Center over a period of 1 year. Methods: a descriptive and cross-sectional study was carried out at the Tulcán Sur Health Center, over a period of 1 year, from September 2022 to September 2023. The universe consisted of 130 patients. The sociodemographic variables were analyzed: age and sex; clinical: presence or absence of high blood pressure, smoking, alcoholism, diabetes mellitus, dyslipidemia, atrial fibrillation and sedentary lifestyle. The normality of the data distribution was analyzed using the Kolmogorov-Smirnov test. Categorical variables were expressed in absolute and relative frequencies. Quantitative variables were described using the mean and standard deviation. Results: the mean age of the population was 61.0 ± 16.5. The male sex predominated with 70 patients (53.8 %). High blood pressure, smoking and obesity were the most common cardiovascular risk factors with 73 (56.5 %), 79 (60.7 %), 64 (49.2 %) patients respectively. Conclusions: high blood pressure, smoking and obesity were the most prevalent risk factors.

RESUMEN Fundamento: la enfermedad cerebrovascular es toda alteración de una o varias áreas encefálicas, ya sea de forma transitoria o permanente, secundaria a un trastorno de la circulación cerebral de origen isquémico o hemorrágico. Por muchos años ha sido considerada una de las principales causas de muerte a nivel mundial. Está entre las principales causas de muerte en Ecuador. Objetivo: describir los factores de riesgo de enfermedades cerebrovasculares en pacientes adultos diagnosticados con enfermedades cerebrovasculares en el Centro de Salud Tulcán Sur en un periodo de 1 año. Métodos: se realizó un estudio descriptivo y transversal, en el Centro de Salud Tulcán Sur, en un periodo de 1 año, desde septiembre del 2022 a septiembre del 2023. El universo lo constituyeron 130 pacientes. Se analizaron las variables sociodemográficas: edad y sexo; clínicas: presencia o no de hipertensión arterial, tabaquismo, alcoholismo, diabetes mellitus, dislipidemia, fibrilación auricular y sedentarismo. La normalidad de la distribución de los datos fue analizada utilizando la prueba de Kolmogorov-Smirnov. Las variables categóricas fueron expresadas en frecuencias absoluta y relativa. Las variables cuantitativas se describieron utilizando la media y la desviación típica. Resultados: la media de edad de la población fue de 61,0 ± 16,5. El sexo masculino predominó con 70 pacientes (53,8 %). La hipertensión arterial, el tabaquismo y la obesidad fueron los factores de riesgo cardiovascular más frecuentes con 73 (56,5 %), 79 (60,7 %), 64 (49,2 %) pacientes respectivamente. Conclusiones: la hipertensión arterial, el tabaquismo y la obesidad fueron los factores de riesgo con más prevalencia.

Abstract: Sepsis is one of the main causes of admission to Intensive Care Units (ICU). The hemodynamic objectives usually sought during the resuscitation of the patient in septic shock correspond to macrohemodynamic parameters (heart rate, blood pressure, central venous pressure). However, persistent alterations in microcirculation, despite the restoration of macrohemodynamic parameters, can cause organ failure. This dissociation between the macrocirculation and microcirculation originates the need to evaluate organ tissue perfusion, the most commonly used being urinary output, lactatemia, central venous oxygen saturation (ScvO2), and veno-arterial pCO2 gap. Because peripheral tissues, such as the skin, are sensitive to disturbances in perfusion, noninvasive monitoring of peripheral circulation, such as skin temperature gradient, capillary refill time, mottling score, and peripheral perfusion index may be helpful as early markers of the existence of systemic hemodynamic alterations. Peripheral circulation monitoring techniques are relatively easy to interpret and can be used directly at the patient’s bedside. This approach can be quickly applied in the intra- or extra-ICU setting. The objective of this narrative review is to analyze the various existing tissue perfusion markers and to update the evidence that allows guiding hemodynamic support in a more individualized therapy for each patient.

Resumen: La sepsis es una de las principales causas de admisión a las Unidades de Cuidados Intensivos (UCI). Los objetivos hemodinámicos usualmente buscados durante la reanimación del paciente en shock séptico corresponden a parámetros macrohemodinámicos (frecuencia cardíaca, presión arterial, presión venosa central). No obstante, alteraciones persistentes del flujo sanguíneo microcirculatorio, a pesar de la restauración de los parámetros macrohemodinámicos, pueden ocasionar falla orgánica. Esta disociación existente entre los compartimentos macro y microcirculatorios origina la necesidad de evaluar la perfusión tisular orgánica, siendo los más empleados el débito urinario, lactatemia, saturación venosa central de oxígeno (SvcO2) y brecha veno-arterial de pCO2. Debido a que los tejidos periféricos, como la piel, son sensibles a las alteraciones en la perfusión, la monitorización no invasiva de la circulación periférica, como la gradiente de temperatura cutánea, tiempo de llene capilar, índice de moteado y de perfusión periférica pueden ser usados como marcadores precoces de la existencia de alteraciones hemodinámicas sistémicas. Las técnicas de monitorización de la circulación periférica son relativamente fáciles de interpretar y pueden ser usadas directamente al lado de la cama del paciente, enfoque que puede ser rápidamente aplicado en el ambiente intra o extra UCI. El objetivo de esta revisión narrativa es analizar los diversos marcadores de perfusión tisular existentes, y actualizar la evidencia que permita guiar el soporte hemodinámico en una terapia más individualizada en cada paciente.

Abstract: Sepsis is one of the main causes of admission to Intensive Care Units (ICU). The hemodynamic objectives usually sought during the resuscitation of the patient in septic shock correspond to macrohemodynamic parameters (heart rate, blood pressure, central venous pressure). However, persistent alterations in microcirculation, despite the restoration of macrohemodynamic parameters, can cause organ failure. This dissociation between the macrocirculation and microcirculation originates the need to evaluate organ tissue perfusion, the most commonly used being urinary output, lactatemia, central venous oxygen saturation (ScvO2), and veno-arterial pCO2 gap. Because peripheral tissues, such as the skin, are sensitive to disturbances in perfusion, noninvasive monitoring of peripheral circulation, such as skin temperature gradient, capillary refill time, mottling score, and peripheral perfusion index may be helpful as early markers of the existence of systemic hemodynamic alterations. Peripheral circulation monitoring techniques are relatively easy to interpret and can be used directly at the patient’s bedside. This approach can be quickly applied in the intra- or extra-ICU setting. The objective of this narrative review is to analyze the various existing tissue perfusion markers and to update the evidence that allows guiding hemodynamic support in a more individualized therapy for each patient.

Resumen: La sepsis es una de las principales causas de admisión a las Unidades de Cuidados Intensivos (UCI). Los objetivos hemodinámicos usualmente buscados durante la reanimación del paciente en shock séptico corresponden a parámetros macrohemodinámicos (frecuencia cardíaca, presión arterial, presión venosa central). No obstante, alteraciones persistentes del flujo sanguíneo microcirculatorio, a pesar de la restauración de los parámetros macrohemodinámicos, pueden ocasionar falla orgánica. Esta disociación existente entre los compartimentos macro y microcirculatorios origina la necesidad de evaluar la perfusión tisular orgánica, siendo los más empleados el débito urinario, lactatemia, saturación venosa central de oxígeno (SvcO2) y brecha veno-arterial de pCO2. Debido a que los tejidos periféricos, como la piel, son sensibles a las alteraciones en la perfusión, la monitorización no invasiva de la circulación periférica, como la gradiente de temperatura cutánea, tiempo de llene capilar, índice de moteado y de perfusión periférica pueden ser usados como marcadores precoces de la existencia de alteraciones hemodinámicas sistémicas. Las técnicas de monitorización de la circulación periférica son relativamente fáciles de interpretar y pueden ser usadas directamente al lado de la cama del paciente, enfoque que puede ser rápidamente aplicado en el ambiente intra o extra UCI. El objetivo de esta revisión narrativa es analizar los diversos marcadores de perfusión tisular existentes, y actualizar la evidencia que permita guiar el soporte hemodinámico en una terapia más individualizada en cada paciente.

Abstract Cardiovascular disorders, including acute myocardial infarction (AMI), often lead to blood clot formation, impacting blood circulation. Streptokinase, a cost-effective and widely available thrombolytic agent, is crucial in treating thrombosis. This study aimed to produce streptokinase from Streptococcus pyogenes EBL-48 and compare its efficacy with heparin in an animal model. We evaluated the clot-lysing effectiveness of streptokinase produced from Streptococcus pyogenes EBL-48, emphasizing its low cost and ease of production. Streptokinase was produced using pre-optimized fermentation media and purified through ion exchange and gel-filtration chromatography. In vivo analysis involved inducing clots in a trial animal model using ferric chloride, comparing streptokinase with heparin. Ultrasonography assessed the clot-lysing activity of streptokinase. Streptokinase (47 kDa) effectively lysed clots, proving its low cost, easy production, and minimal adverse effects. Ultrasonography confirmed its fibrinolytic efficacy. These findings highlight potential as an affordable and easily produced thrombolytic agent, particularly relevant in resource-limited settings. Streptokinase efficacy and minimal adverse effects make it a promising option for thrombolytic therapy, especially in economically constrained regions. Future studies could optimize production techniques, explore different strains, and conduct clinical trials for human validation. Comparative studies with other thrombolytic agents would enhance understanding of their advantages and limitations. disorders AMI, AMI , (AMI) formation circulation costeffective effective agent thrombosis EBL48 EBL 48 EBL-4 clotlysing lysing EBL48, 48, preoptimized pre optimized gelfiltration gel filtration chromatography chloride 47 (4 kDa resourcelimited resource limited settings therapy regions techniques strains validation limitations (AMI EBL4 4 EBL- (

Resumo Os distúrbios cardiovasculares, incluindo o infarto agudo do miocárdio (IAM), muitas vezes levam à formação de coágulos sanguíneos, afetando a circulação sanguínea. A estreptoquinase, um agente trombolítico de baixo custo e amplamente disponível, é crucial no tratamento da trombose. Este estudo teve como objetivo produzir estreptoquinase a partir de Streptococcus pyogenes EBL-48 e comparar sua eficácia com a heparina em modelo animal. A eficácia da estreptoquinase produzida a partir de Streptococcus pyogenes EBL-48 na lise de coágulos foi analisada, no qual foi possível observar seu baixo custo e facilidade de produção. A estreptoquinase foi produzida utilizando meios de fermentação pré-otimizados e purificada através de cromatografia de troca iônica e filtração em gel. A análise in vivo envolveu a indução de coágulos em um modelo animal experimental usando cloreto férrico, comparando estreptoquinase com heparina. A ultrassonografia avaliou a atividade de lise de coágulos da estreptoquinase. A estreptoquinase (47 kDa) lisava coágulos de forma eficaz, comprovando seu baixo custo, fácil produção e efeitos adversos mínimos. Além disso, a ultrassonografia confirmou sua eficácia fibrinolítica. Estas descobertas destacam o potencial como agente trombolítico acessível e de fácil produção, particularmente relevante em ambientes com recursos limitados. A eficácia da estreptoquinase e os efeitos adversos mínimos tornam-na uma opção promissora para terapia trombolítica, especialmente em regiões economicamente restritas. Estudos futuros poderão otimizar as técnicas de produção, explorar diferentes estirpes e realizar ensaios clínicos para validação em humanos. Estudos comparativos com outros agentes trombolíticos podem aprimorar a compreensão das suas vantagens e limitações. cardiovasculares IAM, IAM , (IAM) sanguíneos sanguínea disponível trombose EBL48 EBL 48 EBL-4 analisada préotimizados pré otimizados gel férrico 47 (4 kDa eficaz disso fibrinolítica limitados tornamna tornam trombolítica restritas humanos limitações (IAM EBL4 4 EBL- (

ABSTRACT Luis Tavares revolutionized cardiac surgery, always bringing the most modern instruments and equipment from his travels to England - surgical forceps, scissors, scalpels, etc. He always insisted that he was not just a thoracic surgeon, for his work extended over a wide field and created three important cardiac surgery centers which promoted a great development of cardiology. He carried out the first open heart surgery (atrial septal defect) employing extracorporeal circulation and closure of a ventricular septal defect with deep surface hypothermia of north and northeast Brazil. He promoted an intense scientific exchange program between Recife and England, resulting in significant advances in medicine, and participated directly in the creation of HEMOPE), leading to radical changes and improvements in blood therapy in the whole country. The PROCAPE, inaugurated in 2006, was the result of the cardiac center created by him in early 1970 at Hospital Oswaldo Cruz and can be considered the second largest public-university cardiology center in Brazil. He is thus widely regarded as an outstanding name in medicine in the 20th century and one of the fathers of modern cardiac surgery in Brazil. forceps scissors scalpels etc surgeon atrial Brazil HEMOPE, HEMOPE , HEMOPE) country PROCAPE 2006 197 publicuniversity public university th 200 19 20 1 2

ABSTRACT Purpose: XinJiaCongRongTuSiZiWan (XJCRTSZW) is a traditional Chinese medicine compound for invigorating the kidney, nourishing blood, and promoting blood circulation. This study aimed to explore the effect of XJCRTSZW on triptolide (TP)-induced oxidative stress injury. Methods: Adult female Sprague-Dawley rats and human ovarian granulosa cell lines were treated with TP and XJCRTSZW. Hematoxylin and eosin staining, enzyme-linked immunosorbent assay, flow cytometry, CCK-8, JC-1 staining, transmission electron microscopy, reverse transcription-quantitative polymerase chain reaction, and Western blotting were performed in this study. Results: XJCRTSZW treatment observably ameliorated the TP-induced pathological symptoms. Furthermore, XJCRTSZW treatment observably enhanced the TP-induced reduction of estradiol, anti-Mullerian hormone, progesterone, superoxide dismutase, ATP content, mitochondrial membrane potential, p62, and Hsp60 mRNA, and protein levels in vivo and in vitro (p < 0.05). However, TP-induced elevation of follicle stimulating hormone and luteinizing hormone concentrations, malondialdehyde levels, reactive oxygen species levels, apoptosis rate, mitophagy, and the mRNA and protein expressions of LC3-II/LC3-I, PTEN-induced kinase 1 (PINK1), and Parkin were decreased (p < 0.05). In addition, XJCRTSZW treatment markedly increased cell viability in vitro (p < 0.05). Conclusions: XJCRTSZW protects TP-induced rats from oxidative stress injury via the mitophagy-mediated PINK1/Parkin pathway. Purpose (XJCRTSZW kidney circulation TPinduced induced Methods SpragueDawley Sprague Dawley staining enzymelinked enzyme linked assay cytometry CCK8, CCK8 CCK 8, 8 CCK-8 JC1 JC JC- microscopy transcriptionquantitative transcription quantitative reaction Results symptoms Furthermore estradiol antiMullerian anti Mullerian progesterone dismutase content potential p62 p Hsp Hsp6 0.05. 005 0.05 . 0 05 0.05) However concentrations rate mitophagy LC3II/LC3I, LC3IILC3I LCIILCI LC3 II/LC3 I, II I LC LC3-II/LC3-I PTENinduced PTEN PINK1, PINK1 PINK , (PINK1) addition Conclusions mitophagymediated mediated PINK1Parkin PINKParkin pathway CCK- p6 00 0.0 LC3II LC3I LC3II/LC3I IILC IILC3 II/LC (PINK1 0. LCII LCI (PINK

ABSTRACT Introduction: The evidence for using del Nido cardioplegia protocol in high-risk patients with reduced ejection fraction undergoing isolated coronary surgery is insufficient. Methods: The institutional database was searched for isolated coronary bypass procedures. Patients with ejection fraction < 40% were selected. Propensity matching (age, sex, infarction, number of grafts) was used to pair del Nido (Group 1) and cold blood (Group 2) cardioplegia patients. Investigation of biomarker release, changes in ejection fraction, mortality, stroke, perioperative myocardial infarction, composite endpoint (major adverse cardiac and cerebrovascular events), and other perioperative parameters was performed. Results: Matching allowed the selection of 45 patient pairs. No differences were noted at baseline. After cross-clamp release, spontaneous sinus rhythm return was observed more frequently in Group 1 (80% vs. 48.9%; P=0.003). Troponin values were similar in both groups 12 and 36 hours after surgery, as well as creatine kinase at 12 hours. A trend favored Group 1 in creatine kinase release at 36 hours (median 4.9; interquartile range 3.8-9.6 ng/mL vs. 7.3; 4.5-17.5 ng/mL; P=0.085). Perioperative mortality, rates of myocardial infarction, stroke, or major adverse cardiac and cerebrovascular events were similar. No difference in postoperative ejection fraction was noted (median 35.0%; interquartile range 32.0-38.0% vs. 35.0%; 32.0-40.0%; P=0.381). There was a trend for lower atrial fibrillation rate in Group 1 (6.7% vs. 17.8%; P=0.051). Conclusion: The findings indicate that del Nido cardioplegia provides satisfactory protection in patients with reduced ejection fraction undergoing coronary bypass surgery. Further prospective trials are required. Introduction highrisk high risk insufficient Methods procedures 40 selected age, age (age sex infarction grafts 2 mortality stroke events, , events) performed Results 4 pairs baseline crossclamp cross clamp 80% 80 (80 vs 48.9% 489 48 9 P=0.003. P0003 P P=0.003 . 0 003 P=0.003) 3 median 4.9 49 3.89.6 3896 3.8 9.6 8 6 3.8-9. ngmL ng mL 7.3 73 7 4.517.5 45175 4.5 17.5 5 17 4.5-17. P=0.085. P0085 P=0.085 085 P=0.085) 35.0% 350 35 32.038.0% 320380 32.0 38.0% 32 38 32.0-38.0 32.040.0% 320400 40.0% 32.0-40.0% P=0.381. P0381 P=0.381 381 P=0.381) 6.7% 67 (6.7 17.8% 178 P=0.051. P0051 P=0.051 051 P=0.051) Conclusion required (8 48.9 P000 P=0.00 00 4. 89 3.89. 389 3. 96 9. 3.8-9 7. 517 4.517. 4517 175 17. 4.5-17 P008 P=0.08 08 35.0 038 32.038.0 32038 320 32. 380 38.0 32.0-38. 040 32.040.0 32040 400 40.0 32.0-40.0 P038 P=0.38 6.7 (6. 17.8 P005 P=0.05 05 ( 48. P00 P=0.0 3.89 3.8- 51 4.517 451 4.5-1 35. 03 32.038. 3203 38. 32.0-38 04 32.040. 3204 40. 32.0-40. P03 P=0.3 6. (6 P0 P=0. 4.51 4.5- 32.038 32.0-3 32.040 32.0-40 P=0 32.03 32.0- 32.04 32.0-4 P=

Abstract Background: Coronary collateral circulation (CCC) can effectively improve myocardial blood supply to the area of CTO (chronic total coronary occlusion) and can, thus, improve the prognosis of patients with stable coronary syndrome (SCS). The degree of inflammation and some inflammation markers were associated with the development of collaterals. Objective: To investigate whether prognostic nutritional index (PNI) has an association with the development of CCC in patients with SCS. Methods: A total of 400 SCS patients with the presence of CTO in at least one major epicardial coronary artery were included in this study. The patients were divided into two groups according to the Rentrop score. Scores of 0 to 1 were considered poor developed CCC, and scores of 2 to 3 were accepted as good developed CCC. Statistical significance was set as a p-value < 0.05 for all analyses. Results: The mean age of the study cohort was 63±10 years; 273 (68.3%) were males. The poor-developed CCC group had a significantly lower PNI level compared with the good-developed CCC group (38.29±5.58 vs 41.23±3.85, p< 0.001). In the multivariate analysis, the PNI (odds ratio 0.870; 95% confidence interval 0.822-0.922; p< 0.001) was an independent predictor of poorly developed CCC. Conclusion: The PNI can be used as one of the independent predictors of CCC formation. It was positively associated with the development of coronary collaterals in SCS patients with CTO. Background (CCC chronic occlusion thus . (SCS) Objective (PNI Methods 40 score pvalue p value 005 05 0.0 analyses Results 6310 63 10 63±1 years 27 68.3% 683 68 (68.3% males poordeveloped gooddeveloped 38.29±5.58 3829558 38 29 5 58 (38.29±5.5 4123385 41 23 85 41.23±3.85 0.001. 0001 0.001 001 analysis odds 0.870 0870 870 95 0.8220.922 08220922 0.822 0.922 822 922 0.822-0.922 Conclusion formation (SCS 4 00 0. 631 6 63± 68.3 (68.3 38.29±5.5 382955 (38.29±5. 412338 8 41.23±3.8 000 0.00 0.87 087 87 9 8220 0.8220.92 0822092 0822 0.82 0922 0.92 82 92 0.822-0.92 68. (68. 38.29±5. 38295 (38.29±5 41233 41.23±3. 0.8 08 0.8220.9 082209 082 092 0.9 0.822-0.9 (68 38.29±5 3829 (38.29± 4123 41.23±3 0.8220. 08220 09 0.822-0. (6 38.29± 382 (38.29 412 41.23± 0.8220 0.822-0 ( 38.29 (38.2 41.23 0.822- 38.2 (38. 41.2 38. (38 41. (3

Resumo Fundamento: A circulação colateral coronária (CCC) pode efetivamente melhorar o suprimento sanguíneo miocárdico para a área de OCT (oclusão coronariana total crônica) e pode, assim, melhorar o prognóstico de pacientes com síndrome coronariana estável (SCE). O grau de inflamação e alguns marcadores de inflamação foram associados ao desenvolvimento de colaterais. Objetivo: Investigar se o índice nutricional prognóstico (INP) tem associação com o desenvolvimento de CCC em pacientes com SCE. Métodos: Um total de 400 pacientes com SCE com presença de OTC em pelo menos uma importante artéria coronária epicárdica foi incluído neste estudo. Os pacientes foram divididos em dois grupos de acordo com o escore Rentrop. Escores de 0 a 1 foram considerados CCC pouco desenvolvidas e escores de 2 a 3 foram aceitos como CCC bem desenvolvidas. A significância estatística foi definida como um valor p < 0,05 para todas as análises. Resultados: A média de idade da coorte do estudo foi de 63±10 anos; 273 (68,3%) eram do sexo masculino. O grupo CCC pouco desenvolvido apresentou um nível de INP significativamente mais baixo em comparação com o grupo CCC bem desenvolvido (38,29±5,58 vs 41,23±3,85, p<0,001). Na análise multivariada, o INP (odds ratio 0,870; intervalo de confiança de 95% 0,822-0,922; p<0,001) foi um preditor independente de CCC pouco desenvolvida. Conclusão: O INP pode ser utilizado como um dos preditores independentes da formação do CCC. Foi positivamente associado ao desenvolvimento de colaterais coronárias em pacientes com SCE com OTC. Fundamento (CCC oclusão crônica assim . (SCE) Objetivo (INP Métodos 40 Rentrop 005 05 0,0 análises Resultados 6310 63 10 63±1 anos 27 68,3% 683 68 (68,3% masculino 38,29±5,58 3829558 38 29 5 58 (38,29±5,5 4123385 41 23 85 41,23±3,85 p<0,001. p0001 p<0,001 001 multivariada odds 0,870 0870 870 95 0,8220,922 08220922 0,822 0,922 822 922 0,822-0,922 desenvolvida Conclusão (SCE 4 00 0, 631 6 63± 68,3 (68,3 38,29±5,5 382955 (38,29±5, 412338 8 41,23±3,8 p000 p<0,00 0,87 087 87 9 8220 0,8220,92 0822092 0822 0,82 0922 0,92 82 92 0,822-0,92 68, (68, 38,29±5, 38295 (38,29±5 41233 41,23±3, p00 p<0,0 0,8 08 0,8220,9 082209 082 092 0,9 0,822-0,9 (68 38,29±5 3829 (38,29± 4123 41,23±3 p0 p<0, 0,8220, 08220 09 0,822-0, (6 38,29± 382 (38,29 412 41,23± p<0 0,8220 0,822-0 ( 38,29 (38,2 41,23 p< 0,822- 38,2 (38, 41,2 38, (38 41, (3

Abstract Introduction: Methylene Blue (MB) has been shown to attenuate oxidative, inflammatory, myocardial, and neurological lesions during ischemia-reperfusion and has great potential during cardiac arrest. This study aimed to determine the effects of MB combined with epinephrine during cardiac arrest on myocardial and cerebral lesions. Method: Thirty-eight male Wistar rats were randomly assigned to four groups: the sham group (SH, n = 5), and three groups subjected to cardiac arrest (n = 11 /group) and treated with EPI 20 μg.kg−1 (EPI), EPI 20 μg.kg−1 + MB 2 mg.kg−1 (EPI + MB), or saline 0.9% 0.2 ml (CTL). Ventricular fibrillation was induced by direct electrical stimulation in the right ventricle for 3 minutes, and anoxia was maintained for 5 minutes. Cardiopulmonary Resuscitation (CPR) consisted of medications, ventilation, chest compressions, and defibrillation. After returning to spontaneous circulation, animals were observed for four hours. Blood gas, troponin, oxidative stress, histology, and TUNEL staining measurements were analyzed. Groups were compared using generalized estimating equations. Results: No differences in the Returning of Spontaneous Circulation (ROSC) rate were observed among the groups (EPI: 63%, EPI + MB: 45%, CTL: 40%, p = 0.672). The mean arterial pressure immediately after ROSC was higher in the EPI+MB group than in the CTRL group (CTL: 30.5 [5.8], EPI: 63 [25.5], EPI+MB: 123 [31] mmHg, p = 0.007). Serum troponin levels were high in the CTL group (CTL: 130.1 [333.8], EPI: 3.70 [36.0], EPI +MB: 43.7 [116.31] ng/mL, p < 0.05). Conclusion: The coadministration of MB and epinephrine failed to yield enhancements in cardiac or brain lesions in a rodent model of cardiac arrest. Introduction (MB inflammatory ischemiareperfusion ischemia reperfusion Method Thirtyeight Thirty eight SH, SH (SH 5, , 5) 1 /group μgkg1 μgkg μg kg μg.kg− EPI, (EPI) mgkg1 mgkg mg mg.kg− MB, MB) 09 0 9 0.9 02 0. CTL. . (CTL) minutes CPR (CPR medications ventilation compressions defibrillation circulation hours gas stress histology analyzed equations Results (ROSC 63% 45 45% 40 40% 0.672. 0672 0.672 672 0.672) EPIMB (CTL 305 30 30. 5.8, 58 5.8 8 [5.8] 6 25.5, 255 25.5 25 [25.5] 12 31 [31 mmHg 0.007. 0007 0.007 007 0.007) 1301 130 130. 333.8, 3338 333.8 333 [333.8] 370 70 3.7 36.0, 360 36.0 36 [36.0] +MB 437 43 7 43. 116.31 11631 116 [116.31 ngmL ng mL ng/mL 0.05. 005 0.05 05 0.05) Conclusion μg.kg mg.kg 4 067 0.67 67 5. [5.8 25. [25.5 [3 000 0.00 00 13 333. 33 [333.8 37 3. 36. [36.0 116.3 1163 [116.3 0.0 06 0.6 [5. [25. [ [333. [36. 116. [116. [5 [25 [333 [36 [116 [2 [33 [11 [1

ABSTRACT Mucormycosis is a rare life-threatening opportunistic infection, with rhinocerebral mucormycosis (ROCM) being the most common presentation. Trichosporon asahii is an emerging pathogen that often causes fatal infections in patients with underlying hematologic malignancies due to its high drug resistance. We report a rare case of concomitant rhinocerebral mucormycosis and T. asahii fungemia secondary to Pseudomonas aeruginosa sepsis in a patient with neutropenia and acute lymphoblastic leukemia. A boy aged one year and two months was diagnosed with B-cell acute lymphoblastic leukemia on January 10 and underwent three courses of regular chemotherapy. He experienced neutropenia for 154 days and was hospitalized for vomiting, diarrhea and fever for 3 days. The day after hospitalization, Pseudomonas aeruginosa was isolated by blood culture and ceftazidime/avibactam was administered. Extracorporeal Membrane Oxygenation (ECMO) was used to provide continuous extracorporeal respiration and circulation for the patient. On day 8, the patient developed T. asahii fungemia. On day 10, he presented with necrotizing skin caused by Rhizopus delemar. He was treated with liposomal amphotericin B for Rhizopus delemar and voriconazole for T. asahii infection. Unfortunately, his health deteriorated and he died on day 11 due to the rapid progression of the infection and multiple organ failure. The management and treatment of such a complex infection requires a multidisciplinary approach and close monitoring of the patient’s condition. Therefore, it is imperative to continue to research and report rare cases such as this to further understand the complexities of mucormycosis and trichosporidiosis coinfection and improve patient outcomes. lifethreatening life threatening ROCM (ROCM presentation resistance T Bcell cell 1 chemotherapy 15 vomiting hospitalization ceftazidimeavibactam ceftazidime avibactam administered ECMO (ECMO 8 Unfortunately failure s condition Therefore outcomes

RESUMEN Introducción: La revascularización mediante intervención coronaria percutánea con colocación de stent, o cirugía de derivación coronaria, alivia la isquemia miocárdica. Sin embargo, las pruebas de estrés no invasivas y la angiografía coronaria no siempre proporcionan la información adecuada sobre la importancia funcional de las estenosis en las arterias coronarias. Objetivo: Describir las recomendaciones actuales de la literatura médica con respecto a la fisiología coronaria en la cardiopatía isquémica. Desarrollo: El índice de reserva fraccional de flujo se considera el estándar de oro para detectar la isquemia miocárdica. Su naturaleza invasiva se equilibra con la resolución espacial inigualable y su relación lineal con el flujo sanguíneo máximo. Los resultados clínicos de pacientes cuya estrategia de revascularización se basa en mediciones de reserva fraccional de flujo son decisivos en varios subconjuntos de diferentes lesiones. En la última década se ha propuesto la evaluación de la gravedad de la estenosis coronaria mediante índices no hiperémicos. Sin embargo, la precisión de estos índices para distinguir correctamente la isquemia miocárdica es solo del 80 %. Conclusiones: Actualmente, la hiperemia máxima se recomienda para una óptima toma de decisiones sobre la revascularización.

ABSTRACT Introduction: Revascularization by percutaneous coronary intervention with stenting, or coronary bypass surgery, alleviates myocardial ischemia. However, noninvasive stress testing and angiography do not always provide adequate information on the functional significance of coronary artery stenoses. Objective: To describe the recommendations of the medical literature regarding coronary physiology in ischemic heart disease. Development: The fractional flow reserve index is considered the gold standard for detecting myocardial ischemia. Its invasive nature is balanced by unmatched spatial resolution and its linear relationship to peak blood flow. The clinical outcomes of patients whose revascularization strategy is based on fractional flow reserve measurements are decisive in several subsets of other lesions. In the last decade, assessment of coronary stenosis severity by non-hyperemic indices has been proposed; however, the accuracy of these indices to correctly distinguish myocardial ischemia does not exceed 80%. Conclusions: Currently, maximal hyperemia is recommended for optimal revascularization decision making.

Abstract Babesiosis and Anaplasmosis are diseases associated with economic losses; ticks and blood-sucking flies are important zoonotic vectors and reservoirs. This study aimed to investigate the presence of anti-Babesia spp. and anti-Anaplasma marginale antibodies using enzyme-linked immunosorbent assay (ELISA), in ruminants at the Catimbau National Park. Blood samples were collected from 119 sheep, 119 goats, and 47 cattle. Rhipicephalus microplus ticks were collected from cattle. ELISA showed seropositivity of 34% (16/47), 20.3% (24/119), and 16% (19/119) for anti-Babesia bovis; 34% (16/47), 15.2% (18/119), and 9% (7/119) for anti-Babesia bigemina; and 34% (16/47), 35.6% (42/119), and 17% (20/119) for anti-A. marginale antibodies in cattle, goats, and sheep, respectively. The information collected using an epidemiological questionnaire showed that mostly are breed in a semi-intensive system, with access to Caatinga vegetation. The circulation of B. bovis, B. bigemina, and A. marginale was confirmed. Thus, based on the prevalence, this suggests this is an enzootic instability area and is prone to outbreaks. losses bloodsucking blood sucking reservoirs antiBabesia anti Babesia spp antiAnaplasma Anaplasma enzymelinked enzyme linked ELISA, , (ELISA) Park 11 sheep goats 4 cattle 34 16/47, 1647 16/47 16 (16/47) 203 20 3 20.3 24/119, 24119 24/119 24 (24/119) 19/119 19119 19 (19/119 bovis 152 15 2 15.2 18/119, 18119 18/119 18 (18/119) 9 7/119 7119 7 (7/119 bigemina 356 35 6 35.6 42/119, 42119 42/119 42 (42/119) 17 20/119 20119 (20/119 antiA. antiA A anti-A respectively semiintensive semi intensive system vegetation B confirmed Thus prevalence outbreaks (ELISA 1 164 16/4 (16/47 20. 2411 24/11 (24/119 19/11 1911 (19/11 15. 1811 18/11 (18/119 7/11 711 (7/11 35. 4211 42/11 (42/119 20/11 2011 (20/11 16/ (16/4 241 24/1 (24/11 19/1 191 (19/1 181 18/1 (18/11 7/1 71 (7/1 421 42/1 (42/11 20/1 201 (20/1 (16/ 24/ (24/1 19/ (19/ 18/ (18/1 7/ (7/ 42/ (42/1 20/ (20/ (16 (24/ (19 (18/ (7 (42/ (20 (1 (24 (18 ( (42 (2 (4

Resumo A Babesiose e a Anaplasmose são doenças associadas a grandes perdas econômicas, sendo carrapatos e moscas sugadoras de sangue importantes vetores e reservatórios zoonóticos dessas enfermidades. Este estudo teve como objetivo investigar a circulação de anticorpos anti-Babesia spp. e anti-Anaplasma marginale usando Ensaio de Imunoabsorção Enzimática (ELISA), e Babesia spp. em ruminantes no Parque Nacional do Catimbau. Foram coletados ectoparasitos e amostras de sangue de 119 ovinos, 119 caprinos e 47 bovinos. Carrapatos Rhipicephalus microplus foram coletados em bovinos. O teste ELISA mostrou soropositividade de 34% (16/47), 20,3% (24/119) e 16% (19/119) para anti-Babesia bovis; 34% (16/47), 15,2% (18/119) e 9% (7/119) para anti-Babesia bigemina; e 34% (16/47), 35,6% (42/119) e 17% (20/119) para anti-A. marginale em bovinos, caprinos e ovinos, respectivamente. As informações coletadas por meio de questionário epidemiológico mostraram a maioria com sistema semi-intensivo, com acesso à vegetação de Caatinga. A circulação de B. bovis, B. bigemina e A. marginale foi confirmada. Assim, com base na prevalência, essa área foi sugerida como de instabilidade enzoótica e propensa a surtos. econômicas enfermidades antiBabesia anti spp antiAnaplasma Anaplasma ELISA, , (ELISA) Catimbau 11 ovinos 4 bovinos 34 16/47, 1647 16/47 16 (16/47) 203 20 3 20,3 24/119 24119 24 (24/119 19/119 19119 19 (19/119 bovis 152 15 2 15,2 18/119 18119 18 (18/119 9 7/119 7119 7 (7/119 356 35 6 35,6 42/119 42119 42 (42/119 17 20/119 20119 (20/119 antiA. antiA anti-A respectivamente semiintensivo, semiintensivo semi intensivo, intensivo semi-intensivo Caatinga B confirmada Assim prevalência surtos (ELISA 1 164 16/4 (16/47 20, 24/11 2411 (24/11 19/11 1911 (19/11 15, 18/11 1811 (18/11 7/11 711 (7/11 35, 42/11 4211 (42/11 20/11 2011 (20/11 16/ (16/4 24/1 241 (24/1 19/1 191 (19/1 18/1 181 (18/1 7/1 71 (7/1 42/1 421 (42/1 20/1 201 (20/1 (16/ 24/ (24/ 19/ (19/ 18/ (18/ 7/ (7/ 42/ (42/ 20/ (20/ (16 (24 (19 (18 (7 (42 (20 (1 (2 ( (4

ABSTRACT: Cattle trypanosomiasis imposes significant economic burdens on the global livestock industry. The causative agents of this disease belong to the protozoan Trypanosoma genus. This study aims to perform detection (parasitological and molecular) and genetic characterization to analyze Trypanosoma spp. in cattle from 15 municipalities in the state of Rio de Janeiro, focusing on the 18S rDNA and Cathepsin-L (CatL) gene of Trypanosoma vivax and Trypanosoma theileri. A total of 389 blood samples from 15 dairy cattle farms in the state of Rio de Janeiro were collected, and DNA was extracted for subsequent PCR amplification of Trypanosoma spp. 18S rDNA and CatL genes. The resulting amplicons underwent sequencing and alignment for phylogenetic analysis, with comparisons made to GenBank isolates. Concerning parasitological analysis, blood smears presented 4.4% of positive cattle (n=17/389) for T. vivax and did not show any trypomastigote forms of T. theileri. The absolute frequency of Trypanosoma spp. through molecular detection targeting 18S rDNA was 11.6% (45/389). However, when performing species-specific PCRs, the T. vivax frequency, determined through CatL gene PCR, was 12.8%, and the T. theileri frequency was 3.6%. Phylogenetic analysis based on 18S rDNA revealed low diversity among T. vivax sequences, suggesting potential host segregation. This study emphasizes the high frequency of positive samples by PCR when compared to direct parasitological exams. Additionally, T. vivax phylogeny targeting 18S rDNA hints at sequence clustering related to host species. Importantly, this investigation unveils, for the first time in Rio de Janeiro’s cattle, the circulation of T. theileri lineage ThI, encompassing genotypes IIB and IF. This discovery expands our understanding of this parasite’s geographical distribution and genetic diversity. ABSTRACT industry genus spp 1 S CathepsinL Cathepsin L (CatL 38 collected genes isolates 44 4 4.4 n=17/389 n17389 n 17 (n=17/389 T 116 11 6 11.6 45/389. 45389 45/389 . 45 (45/389) However speciesspecific species specific PCRs 128 12 8 12.8% 36 3 3.6% sequences segregation exams Additionally Importantly unveils Janeiros s ThI IF parasites parasite 4. n=17/38 n1738 (n=17/38 11. 4538 45/38 (45/389 12.8 3.6 n=17/3 n173 (n=17/3 453 45/3 (45/38 12. 3. n=17/ n17 (n=17/ 45/ (45/3 n=17 n1 (n=17 (45/ n=1 (n=1 (45 n= (n= (4 (n (

RESUMO: A tripanossomíase bovina impõe significativos ônus econômicos à indústria pecuária global. Os agentes causadores dessa doença pertencem a protozoários do gênero Trypanosoma. Objetivou-se, com este estudo, realizar detecção (parasitológica e molecular) e caracterização genética de Trypanosoma spp. em bovinos de 15 municipalidades do estado do Rio de Janeiro, com foco na sequência 18S rDNA e no gene Cathepsin-L (CatL) de Trypanosoma vivax e Trypanosoma theileri. Um total de 389 amostras de sangue de 15 fazendas leiteiras no estado do Rio de Janeiro foram coletadas, e o DNA foi extraído para subsequente amplificação por PCR dos genes 18S rDNA e CatL de Trypanosoma spp. Os amplicons resultantes foram submetidos a sequenciamento e alinhamento para análise filogenética, com comparações realizadas com isolados do GenBank. No que se refere à análise parasitológica, os esfregaços de sangue apresentaram 4,4% de bovinos positivos (n=17/389) para T. vivax e não mostraram nenhuma forma tripomastigota de T. theileri. A frequência absoluta de Trypanosoma spp. através da detecção molecular visando 18S rDNA foi de 11,6% (45/389). No entanto, ao realizar PCRs específicos de espécies, a frequência de T. vivax, determinada por PCR do gene CatL foi de 12,8%, e a frequência de T. theileri foi de 3,6%. A análise filogenética com base no 18S rDNA revelou baixa diversidade entre as sequências de T. vivax, sugerindo uma possível segregação de hospedeiros. Este estudo enfatiza a alta frequência de amostra positiva pela PCR quando comparada com a parasitológica direta. Além disso, a filogenia de T. vivax direcionada ao 18S rDNA sugere agrupamento de sequências relacionado à espécie hospedeira. Importante destacar que esta investigação revela, pela primeira vez no gado do Rio de Janeiro, a circulação da linhagem ThI de T. theileri, abrangendo os genótipos IIB e IF. Esta descoberta amplia nosso entendimento sobre a distribuição geográfica e diversidade genética desse parasito. RESUMO global Objetivouse, Objetivouse Objetivou se, Objetivou-se spp 1 S CathepsinL Cathepsin L (CatL 38 coletadas GenBank 44 4 4,4 n=17/389 n17389 n 17 (n=17/389 T 116 11 6 11,6 45/389. 45389 45/389 . 45 (45/389) entanto espécies 128 12 8 12,8% 36 3 3,6% hospedeiros direta disso hospedeira revela IF parasito 4, n=17/38 n1738 (n=17/38 11, 4538 45/38 (45/389 12,8 3,6 n=17/3 n173 (n=17/3 453 45/3 (45/38 12, 3, n=17/ n17 (n=17/ 45/ (45/3 n=17 n1 (n=17 (45/ n=1 (n=1 (45 n= (n= (4 (n (

Abstract: Since May 2020, we have been conducting a comprehensive study to understand the natural history of SARS-CoV-2 infection in Rio de Janeiro, Brazil. Our focus has been on following families, systematically collecting respiratory tract swabs and blood samples, monitoring symptoms, and gathering data on vaccine status. This paper aims to describe the household cohort across five epidemic waves of SARS-CoV-2, providing an overview of the collected data and a description of the epidemiological, clinical, and immunological characteristics and incidence of SARS-CoV-2 infection. Our cohort includes 691 participants from 189 households. During the five epidemic waves, we detected 606 infections. The incidence density of SARS-CoV-2 infection ranged from 4 (Delta) to 56 (B.1.1.33) per 1,000 person-week, with a peak in wave B.1.1.33 in all age groups. The seroprevalence of SARS-CoV-2 antibodies (IgG anti spike protein) varied from 37%, in the pre-VoC period, to 99%, in the Omicron period, progressively increasing after each wave in a similar manner regardless of age. As we have monitored the cohort continuously since the beginning of the pandemic, we were able to collect data across different scenarios according to the predominant lineage in circulation. Via active monitoring of families, we were able to carry out an epidemiological surveillance on SARS-CoV-2, including its variants, persistence of symptoms, and changes in immunity over time in the population, contributing to knowledge of the natural history of SARS-CoV-2 infection.

Resumen: Desde mayo de 2020 se realiza un estudio exhaustivo con el fin de estimar el curso natural de la infección por SARS-CoV-2 en Río de Janeiro, Brasil. Se aplica un seguimiento a las familias en el cual se recolectan sistemáticamente muestras de sangre y de las vías respiratorias, se controlan los síntomas y se recogen datos sobre el estado de vacunación. Este artículo tiene como objetivo describir la cohorte de hogares durante cinco olas epidémicas de SARS-CoV-2, y proporcionar una visión general de los datos recopilados y una descripción de las características epidemiológicas, clínicas e inmunológicas, y de la incidencia de la infección por SARS-CoV-2. La cohorte incluyó a 691 participantes de 189 hogares. A lo largo de las cinco olas epidémicas, se detectaron 606 infecciones. La densidad de incidencia de la infección por SARS-CoV-2 varió de 4 (Delta) a 56 (B.1.1.33) por cada 1.000 personas por semana, y fue más alta en la ola B.1.1.33 en todos los grupos de edad. La seroprevalencia de anticuerpos contra el SARS-CoV-2 (proteína IgG antipico) varió del 37% en el período anti-VOC al 99% en el período Ómicron y aumentó ola tras ola de manera similar, independientemente de la edad de los participantes. El monitoreo continuo de la cohorte desde el comienzo de la pandemia permitió recopilar datos en diferentes escenarios según la cepa predominante en circulación. A partir del monitoreo activo de las familias, se realizó una vigilancia epidemiológica del SARS-CoV-2, sus variantes, la persistencia de los síntomas y los cambios en la inmunidad de la población a lo largo del tiempo, contribuyendo al conocimiento del curso natural de la infección por SARS-CoV-2.

Resumo: Desde maio de 2020, temos conduzido um estudo abrangente para entender a história natural da infecção por SARS-CoV-2 no Rio de Janeiro, Brasil. Nosso foco tem sido acompanhar as famílias das quais coletamos sistematicamente amostras de sangue e do trato respiratório, monitoramos os sintomas e reunimos dados sobre o status de vacinação. Este artigo tem como objetivo descrever a coorte de domicílios ao longo de cinco ondas epidêmicas de SARS-CoV-2, fornecendo uma visão geral dos dados coletados e uma descrição das características epidemiológicas, clínicas e imunológicas e da incidência da infecção por SARS-CoV-2. Nossa coorte inclui 691 participantes de 189 domicílios. Ao longo das cinco ondas epidêmicas, detectamos 606 infecções. A densidade de incidência da infecção por SARS-CoV-2 variou de 4 (Delta) a 56 (B.1.1.33) a cada 1.000 pessoas por semana e foi mais alta na onda B.1.1.33 em todas as faixas etárias. A soroprevalência de anticorpos contra o SARS-CoV-2 (proteína IgG anti-spike) variou de 37% no período pré-VoC a 99% no período Omicron e aumentou onda após onda de maneira semelhante, independentemente da idade dos participantes. Como monitoramos a coorte continuamente desde o início da pandemia, pudemos coletar dados em diferentes cenários, de acordo com a cepa predominante em circulação. Por meio do monitoramento ativo das famílias, conseguimos conduzir uma vigilância epidemiológica do SARS-CoV-2, de suas variantes, da persistência dos sintomas e das mudanças na imunidade da população ao longo do tempo, contribuindo para o conhecimento da história natural da infecção pelo SARS-CoV-2.