Abstract Takotsubo syndrome is a generally reversible cardiomyopathy often related to a stressor trigger, either physical or emotional. It is esti mated that this entity represents between 1 and 6% of the cases of suspected acute coronary syndrome without ST segment elevation in women. Coexistence with coronary artery disease has been a matter of long controversy. On this matter, we present the clinical case of a 79-year-old hypertensive and dyslipidemic female with smocking history, who was referred to our institution presenting an episode of chest pain with anginal characteristics. During the conducted interrogation, she reported having been overpassing a stressfull moment in her private life. The electrocardiogram showed deep and diffuse negative T waves with prolonged QT interval. Laboratory findings revealed dissociation of biomarkers (troponin/ProBNP), and the transthoracic Doppler echocardiogram showed left ventricular dysfunction with apical ballooning. Given the differential diagnoses of acute coronary syndrome and TakoTsubo syndrome, a coronary angiography was performed, which revealed multiple epicardial coronary disease. However, due to the strong suspicion of stress cardiomyopathy, a cardiac magnetic resonance imaging with gadolinium was performed, which showed an improvement in the ejection fraction prior to revasculariza tion with the presence of myocardial edema and absence of late gadolinium enhancement. The aforementioned characteristics led to the diagnosis of Takotsubo syndrome. The final decision of revascularization was based on the fact that the patient’s principal complaint was typical anginal symptoms.

Resumen El síndrome de Takotsubo es una miocardiopatía generalmente reversible y con frecuencia relacionada a un desencadenante estresor ya sea físico o emocional. Se estima que esta entidad representa entre el 1 y 6% de los cuadros de sospecha de síndrome coronario agudo sin elevación del segmento ST en mujeres. La coexistencia con enfermedad coronaria ha sido objetivo de debate durante mucho tiempo. Se pre senta el caso clínico de una mujer de 79 años, hipertensa, dislipémica y ex tabaquista que consulta a la guardia por presentar un episodio de dolor precordial con características anginosas. En el interrogatorio refirió situación estresante en su entorno familiar los días previos. El electrocardiograma mostró ondas T negativas profundas y difusas con prolongación del intervalo QT. En el laboratorio se observó disociación de marcadores (troponina/ ProBNP). En el ecocardiograma Doppler transtorácico se evidenció deterioro de la función ventricular con balo namiento apical. Ante los diagnósticos diferenciales de síndrome coronario agudo y síndrome de Takotsubo se realizó una cinecoronariografía en la cual se evidenció compromiso de las tres arterias coronarias epicárdicas. Pese a esto, por la fuerte sospecha de miocardiopatía por estrés se realizó una resonancia magnética cardíaca con gadolinio, la cual demostró mejoría de fracción de eyección previa a la revascularización con presencia de edema miocárdico y sin realce tardío de gadolinio. Las características mencionadas condujeron al diagnóstico de síndrome de Takotsubo. La decisión de revascularización, estuvo fundamentada en el hecho de que la consulta fue motivada por síntomas anginosos típicos con el esfuerzo.

Resumo A finalidade do presente estudo foi avaliar a presença de anticorpos anti- Toxocara, em frangos de corte naturalmente infectados (n = 189), no Norte do Paraná, Sul do Brasil. Os frangos foram criados em sistema semi-intensivo, em pequenas propriedades rurais (n = 7). Os testes sorológicos foram realizados pela técnica de ELISA, para detecção de anticorpos IgY (IgG), com pré-adsorção do soro com antígenos de Ascaridia galli. Foi observada uma prevalência de 67,7% (128/189; IC 95% = 61,1-74,4). A frequência de animais soropositivos por propriedade variou de 29,6% a 100%. Os valores da Densidade Ótica e do Índice de Reatividade observados no teste de ELISA indicaram uma possível cronicidade de infecção dos frangos avaliados. Não foi observada correlação entre a positividade dos animais, quando comparada a área (p = 0,382) e a densidade populacional de cães por propriedade (p = 0,785). O presente estudo verificou uma alta prevalência de anticorpos anti-Toxocara em frangos de corte criados em sistema semi-intensivo e oferece dados que apontam esses animais como bons indicadores de contaminação ambiental por agentes de larva migrans . Estudos futuros são necessários para avaliar os fatores de risco associados e a possibilidade da transmissão de toxocaríase ao ser humano pela ingestão de carne de frango.

Abstract The aim of this study was to evaluate the presence of anti-Toxocara antibodies in naturally infected broiler chickens (n = 189) from the state of Paraná, southern Brazil. The chickens were reared in a semi-intensive system by small family farmers (n = 7). An enzyme-linked immunosorbent assay (ELISA) was performed to detect the presence of anti- Toxocara spp. IgY after serum adsorption with Ascaridia galli antigens. An overall seroprevalence of 67.7% (128/189; 95% CI = 61.1-74.4) was observed. The frequency of positive animals by farm ranged from 29.6% to 100%. The optical density and reactivity index values observed in ELISA test indicated the possible chronicity of infection of the evaluated chickens. Associations between the presence of antibodies and the area where the chickens were reared (p = 0.382) or the population density of dogs on the farm (p = 0.785) were not observed. This study shows a high prevalence of Toxocara spp. antibodies in broiler chickens reared in semi-intensive systems and provides evidence that chickens are a good indicator of environmental contamination by larva migrans agents. Further studies are necessary to assess the risk factors associated with poultry infection and the likelihood of toxocariasis transmission to humans via the ingestion of free-range chicken meat.