Abstract Background Garlic is an herbal medicinal plant with several pharmacological properties used for the management of various ailments. However, its potential in the reversal of ischemic heart disease induced by combined oral contraceptive pills is not well reported. Objective This study investigated the cardioprotective potential of aqueous garlic extract against cardiotoxicity induced by oral contraceptive pills. Methods Forty-six rats were used for this study. Six were used to determine the lethal dose (LD50), and 40 rats were divided randomly into 5 groups of 8 rats each. Group A received feed and distilled water. Group B received 0.6 mg/kg of oral contraceptive pills. Group C received 500 mg/kg of garlic extract. Group D received 0.6 mg/kg of oral contraceptive pills + 500 mg/kg garlic extract. Group E received 0.6 mg/kg of oral contraceptive pills + 700 mg/kg garlic extract. The animals were sacrificed, and blood and tissue samples were collected for biochemical and histological analysis. Statistical analysis was done using SPSS, and p values < 0.05 were considered significant. Results The acute toxicity dose of combined oral contraceptive pills was 1.5 mg/kg for albino rats. Combined oral contraceptive pills induced ischemic necrosis as revealed by the photomicrographs, in addition to elevation of serum cardiac troponin-1, lactate dehydrogenase, creatine kinase, and malondialdehyde levels. Treatment with garlic extract demonstrated significant reduction in cardiac troponin-1 (p = 0.000), lactate dehydrogenase (p = 0.002), creatine kinase (p = 0.001), and malondialdehyde (p = 0.001) levels, as well as restoration of the cardiac cytoarchitecture changes caused by the combined oral contraceptive pills. Conclusion This study has demonstrated that aqueous garlic juice can reverse ischemic heart disease, lessen cytoarchitectural alterations of the heart caused by combined oral contraceptive pills, and thus ameliorate cardiac dysfunction. ailments However reported Fortysix Forty six LD50, LD50 LD , (LD50) 4 each water 06 0 6 0. mgkg mg kg 50 70 sacrificed SPSS 005 05 0.0 15 1 1. photomicrographs troponin1, troponin1 troponin 1, levels troponin- 0.000, 0000 0.000 000 0.000) 0.002, 0002 0.002 002 0.002) 0.001, 0001 0.001 001 dysfunction LD5 (LD50 7 00 0.00 (LD5 (LD

Abstract Fulminant necrotizing eosinophilic myocarditis (FNEM) is a rare form of EM characterized by biventricular heart failure with hemodynamic deterioration, often requiring inotropes or mechanical circulatory support. Here, we report a case of a 43-year-old healthy woman with FNEM who was admitted with acute heart failure that rapidly progressed to cardiogenic shock and electrical storm, culminating in cardiac arrest. Early diagnosis and prompt administration of corticosteroids in combination with veno-arterial extracorporeal membrane oxygenation allowed complete recovery of biventricular systolic function. (FNEM deterioration support Here 43yearold yearold 43 year old storm arrest venoarterial veno arterial function 4

Abstract Background Firefighters are regularly exposed to stress and have a high incidence of cardiovascular events. Investigating cardiovascular and autonomic reactivity to acute mental stress (AMS) and its association with adiposity may contribute to explaining the increased cardiovascular risk in these professionals. Objectives To evaluate cardiovascular and autonomic reactivity to AMS in firefighters while considering adiposity parameters. Methods This study recorded the blood pressure and heart rate (HR) of twenty-five firefighters (38±8 years) at rest, while performing the Stroop color-word test to induce AMS, and recovery. Cardiac autonomic modulation (HR variability), baroreflex sensitivity (BRS — sequential method), and adiposity (electrical bioimpedance) were assessed. One-way or two-way analysis of variance followed by Tukey’s post hoc test and multiple linear regression were performed. The significance level was P<0.05. Results The AMS increased mean arterial pressure (MAP — Δ16±13 mmHg) and HR (Δ14±7 bpm) ( P <0.05). These responses were associated with parasympathetic modulation withdrawal (RMSSD: baseline: 29.8±18 vs. AMS: 21.5±14 ms; High-frequency: baseline: 5.2±1.4 vs. AMS: 4.5±1.3 Ln ms 2 ; P <0.05) and decreased in the Up gain of the baroreflex (baseline: 8.9±5.1 vs. AMS: 6.3±3.0 mmHg/ms; P <0.05). Groups divided by HR reactivity peak showed parasympathetic modulation withdrawal only in firefighters with lower adiposity (RMSSD: baseline: 27.8±17.6 vs. AMS: 14.4±9.2 ms; High-Frequency: baseline: 5.3±1.2 vs. AMS: 3.8±1.4 Ln ms 2 ; P <0.05). Fat percentage (β = -0.499), BRS (β = 0.486), and sympathetic/parasympathetic balance (β = -0.351) were predictors of HR reactivity ( P <0.05). Conclusion Our results demonstrated that HR reactivity to AMS modulated by cardiac vagal withdrawal seems to be influenced by body composition in this group of firefighters. events (AMS professionals parameters twentyfive twenty five 38±8 388 38 8 (38± years rest colorword color word recovery variability, variability , variability) method, method method) electrical bioimpedance assessed Oneway One way twoway two Tukeys Tukey s performed P005 0 05 P<0.05 MAP Δ1613 Δ Δ16 13 Δ16±1 mmHg Δ14±7 Δ147 Δ14 7 (Δ14± bpm <0.05. 005 <0.05 . RMSSD (RMSSD baseline 29818 29 18 29.8±1 vs 21514 21 5 14 21.5±1 Highfrequency High frequency High-frequency 5214 1 4 5.2±1. 4513 3 4.5±1. (baseline 8951 9 8.9±5. 6330 6 6.3±3. mmHg/ms mmHgms 278176 27 17 27.8±17. 14492 14.4±9. HighFrequency Frequency High-Frequency 5312 5.3±1. 3814 3.8±1. β 0.499, 0499 0.499 499 -0.499) 0.486, 0486 0.486 486 0.486) sympatheticparasympathetic sympathetic 0.351 0351 351 -0.351 38± (38 P00 P<0.0 Δ161 Δ1 Δ16± Δ14± (Δ14 00 <0.0 2981 29.8± 2151 21.5± 521 5.2±1 451 4.5±1 895 8.9±5 633 6.3±3 27817 27.8±17 1449 14.4±9 531 5.3±1 381 3.8±1 049 0.49 49 -0.499 048 0.48 48 0.35 035 35 -0.35 (3 P0 P<0. (Δ1 <0. 298 29.8 215 21.5 52 5.2± 45 4.5± 89 8.9± 63 6.3± 2781 27.8±1 144 14.4± 53 5.3± 3.8± 04 0.4 -0.49 0.3 03 -0.3 P<0 (Δ <0 29. 21. 5.2 4.5 8.9 6.3 278 27.8± 14.4 5.3 3.8 0. -0.4 -0. P< < 5. 4. 8. 6. 27.8 14. 3. -0 27. -

Abstract Background The SARS-CoV-2 outbreak has led to radical transformation in social, economic, and healthcare systems. This may lead to profound indirect consequences on clinical presentation and management of patients with ST-segment–elevation myocardial infarction. Objectives The objective of this study was to describe the characteristics, management, and outcomes of patients admitted with acute myocardial infarction with ST-segment elevation (STEMI), in two tertiary reference hospitals during the SARS-CoV-2 outbreak and compare them with patients admitted in the previous year. Methods We analyzed data from a multicenter STEMI registry from reference centers in the South Region of Brazil from March 2019 to May 2021. The beginning of the COVID-19 outbreak was considered to be March 2020 and compared to the same period in 2019. Only patients with STEMI submitted to primary percutaneous coronary intervention (PCI) were included in the analysis. Mortality rates were compared with chi-square test. All hypothesis tests had a two-sided significance level of 5%. Results A total of 1169 patients admitted with STEMI were enrolled in our registry, 635 of whom were admitted during the pandemic period. The mean age of our sample was 61.6 (± 12.4) years, and 66.7% of patients were male. Pain-to-door time and door-to-balloon time were longer during the pandemic period. However, there was no difference in mortality rates or major adverse cardiovascular outcomes (MACE). Conclusions We observed a stable incidence of STEMI cases in our registry during the SARS-CoV-2 outbreak with higher pain-to-door time and door-to-balloon time, without any influence on mortality rates however. SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- social economic systems STsegment–elevation STsegmentelevation ST segment–elevation segment characteristics STsegment STEMI, , (STEMI) year 201 2021 COVID19 COVID 19 COVID-1 202 PCI (PCI analysis chisquare chi square test twosided sided 5 5% 116 63 616 61 6 61. ± ( 12.4 124 12 4 years 667 66 7 66.7 male Paintodoor Pain door doortoballoon balloon However MACE. MACE . (MACE) paintodoor pain however SARS-CoV segmentelevation (STEMI 20 COVID1 1 COVID- 11 12. 66. (MACE

Abstract Background: People with haemophilia (PwH) are living longer. Therefore, they can develop atherosclerotic cardiovascular disease (ASCVD). Electrocardiogram (ECG) alterations may be a sign of initial ASCVD before the occurrence of symptoms. Objective: To describe the prevalence of resting ECG alterations among PwH adults asymptomatic for ASCVD. Methods: PwH aged ≥ 30 years without previous ASCVD events were considered for the analysis. Resting ECG traces were analysed according to international reference values and the Brazilian Longitudinal Adult Health Study (ELSA-Brasil) results for asymptomatic Brazilian men. Based on the established normal values and using the QT index, we further described the altered ECGs as minor or major changes, according to the Minnesota Code. Differences between prevalences were evaluated by Pearson's χ2 test. Differences between medians were evaluated by the Mann-Whitney U test. A p-value < 0.05 was accepted as statistically significant. Results: A total of 64 PwH were included in the study. Median age was 44 years (interquartile range 35-52). Most patients had haemophilia A (81%) and 47% were severe. The prevalence of obesity, systemic arterial hypertension (SAH), diabetes mellitus (DM), and dyslipidaemia were 16%, 56%, 14%, and 72%, respectively. All the PwH had sinus rhythm, except for one, who had an implanted pacemaker due to idiopathic third-degree atrioventricular block. Altered ECGs were found in 25% and 30% of PwH, according to established criteria and ELSA-Brasil criteria, respectively. Major changes were found in eight (13%) PwH according to the Minnesota Code, including two ECGs with ischaemia-like wall inactivity. Conclusions: The prevalence of altered ECG varied from 25% to 30% among asymptomatic PwH. Background (PwH longer Therefore . (ASCVD) (ECG symptoms Objective Methods 3 analysis ELSABrasil ELSA Brasil (ELSA-Brasil men index Code Pearsons Pearson s χ test MannWhitney Mann Whitney pvalue p value 005 0 05 0.0 significant Results 6 study 4 interquartile 3552. 3552 35 52 35-52) 81% 81 (81% 47 severe obesity SAH, SAH , (SAH) DM, DM (DM) 16 16% 56 56% 14 14% 72 72% respectively rhythm one thirddegree third degree block 25 13% 13 (13% ischaemialike ischaemia like inactivity Conclusions (ASCVD 00 0. 355 5 35-52 8 (81 (SAH (DM 1 7 2 (13 35-5 (8 (1 35- (

Abstract Hemostasis is a complex set of biological processes responsible for blood fluidity within normal vessels and for the physiological interruption of bleeding in cases of vascular injury. Bothrops moojeni snake venom is rich in bioactive compounds of pharmacological and clinical interest since its protein components are capable of interfering with many points of the hemostatic process. Here, we present the B. moojeni venom proteins that affect hemostasis and discuss their pharmacological and clinical potential. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Data were obtained from the CAPES Journal Portal database, using the terms “Bothrops” AND “hemostasis”, in a search for scientific articles made available in the last 20 years. Many components isolated from B. moojeni snake venom are characterized for their effect on hemostasis and possible application in the diagnosis and treatment of hemostatic disorders. injury process Here B potential MetaAnalyses Meta Analyses PRISMA (PRISMA protocol database “Bothrops hemostasis, , “hemostasis” 2 years disorders “hemostasis

Abstract Breast cancer (BC) is the most common malignant neoplasia in women and is responsible for one in six deaths from cancer in the female population. Five years after diagnosis, BC survival rates currently exceed 80%. Cardiovascular disease (CVD) is a frequent cause of morbidity and mortality in BC, mainly in patients receiving cardiotoxic drugs (anthracyclines, immunotherapy) and radiotherapy (RT). CVD and BC have common risk factors (RF), which are related to aging, traditional and cardiometabolic RFs (obesity, dyslipidemia, consumption of alcoholic beverages), and others associated with sex and reproductive women's age, such as early menarche, late menopause, nulliparity, use of oral contraceptives, as well as hormone replacement therapy in postmenopause. Risk stratification and the promotion of an ideal state of cardiovascular (CV) health are fundamental in preventing CVD in survivors. Therapeutic management and follow-up of patients with BC require a multidisciplinary team to reduce complications and mortality of CV origin. (BC population diagnosis 80 80% (CVD anthracyclines, anthracyclines (anthracyclines immunotherapy RT. RT . (RT) RF, RF , (RF) aging obesity, obesity (obesity dyslipidemia beverages, beverages beverages) womens s age menarche menopause nulliparity contraceptives postmenopause (CV survivors followup follow up origin 8 (RT (RF

Abstract Background Biomarkers related to the pathogenesis of atrial fibrillation (AF) have attracted the attention of experts. One of these recently studied biomarkers is Fetuin-A. Objectives This study aimed to evaluate the relationship between serum Fetuin-A levels and AF. Methods This study used the convenience sampling method, based on inclusion criteria and consent to participate in the study. The Shapiro-Wilk test was used to confirm the normal distribution of all continuous variables. Categorical variables were presented using absolute and relative frequencies. Both groups (48 patients with AF and 47 controls) were compared in terms of biochemical, hematological, and echocardiographic findings and Fetuin-A. the Chi-square or Fisher's exact test were used to compare groups concerning categorical variables. Continuous variables were compared using the independent samples t-test. P<0.05 was considered statistically significant. Results Serum Fetuin-A values increased in AF patients when compared to the controls (544±49 μg/mL versus 484±46 μg/mL, p=0.001). Moreover, Fetuin-A level was independently associated with AF — AOR = 0.978, 95%; confidence interval (CI) 0.969-988, p < 0.001. The cut-off values in Fetuin-A levels in patients with AF were >511.80 μg/mL with a sensitivity of 75% and a specificity of 73% — area under the curve (AUC) = 0.804, 95% CI = 0.715 - 0.892. Conclusions According to this study, there was a relationship between serum Fetuin-A levels and AF, regardless of conventional cardiovascular risk factors. Therefore, Fetuin-A may play a role in the pathophysiology of AF. Prospectively designed cohort studies are necessary to assess whether or not the results can be generalized for other populations. (AF experts FetuinA. FetuinA Fetuin A. A method ShapiroWilk Shapiro Wilk frequencies 48 (4 4 biochemical hematological Chisquare Chi square Fishers Fisher s ttest. ttest t test. t-test P005 P 0 05 P<0.0 significant 544±49 54449 544 49 (544±4 μgmL μg mL 48446 484 46 484±4 p=0.001. p0001 p=0.001 . 001 p=0.001) Moreover 0978 978 0.978 95 (CI 0.969988, 0969988 0.969 988, 969 988 0.969-988 0001 0.001 cutoff cut off 51180 511 80 >511.8 75 73 AUC (AUC 0804 804 0.804 0715 715 0.71 0892 892 0.892 factors Therefore populations ( P00 P<0. 544±4 5444 54 (544± 4844 484± p000 p=0.00 00 097 97 0.97 9 969988 0.969988 096998 0969 0.96 96 98 0.969-98 000 0.00 5118 51 8 >511. 7 080 0.80 071 71 0.7 089 89 0.89 P0 P<0 544± 5 (544 p00 p=0.0 09 0.9 96998 0.96998 09699 096 0.969-9 0.0 >511 08 0.8 07 0. P< (54 p0 p=0. 9699 0.9699 0.969- >51 (5 p=0 >5 p= >

Abstract Background Congenital heart diseases (CHD) are one of the most prevalent malformations, and the screening tests to identify critical congenital heart disease (CCHD) is the pulse oximetry test, with subsequent investigation and treatment. Objective To quantify positive pulse oximetry tests and verify the prevalence of CCHD detected by it in asymptomatic newborns, ≥35 gestational weeks, in a Brazilian maternity hospital. Methodology This is an observational, retrospective, quantitative, analytical and cross-sectional study, conducted from October 2020 to May 2022, in a maternity hospital in southern Brazil, through the collection of records of positive oximetry pulse tests, following the norms of screening CCHD test of the Brazilian Society of Pediatrics (SBP), after they were evaluated with echocardiography for confirmation or exclusion of CHD. Results A total of 5,667 newborns were evaluated in this study, according to the inclusion criteria; 0.17% (n = 10) had a positive pulse oximetry test. Regarding the results of the echocardiography of the neonates with a positive test, two were normal, seven were cases of patent foramen ovale (PFO), and one was a case (0,017%) with interatrial communication (IAC) diagnosis. In the same period, five neonates with CCHD were born, symptomatic, diagnosed by physical examination, and referred to neonatal intensive care units (NICU) before taking the neonatal cardiac screening (< 24 hours of life). Conclusion The prevalence of positive pulse oximetry tests was 0.17% and none CCHD was detected. Five cases of CCHD were born in this period, but they were diagnosed before the recommend time to perform the screening test. CHD (CHD malformations (CCHD treatment 35 ≥3 weeks observational retrospective quantitative crosssectional cross sectional study 202 2022 Brazil SBP, SBP , (SBP) 5667 5 667 5,66 criteria 017 0 17 0.17 n 10 normal PFO, PFO (PFO) 0,017% 0017 (0,017% IAC (IAC diagnosis period symptomatic examination NICU (NICU < ( 2 life. life . life) 3 ≥ 20 (SBP 566 66 5,6 01 1 0.1 (PFO 0,017 001 (0,017 56 6 5, 0. 0,01 00 (0,01 0,0 (0,0 0, (0, (0

Abstract Cardiac amyloidosis (CA) can lead to progressive heart failure (HF) by depositing insoluble amyloid fibrils within the myocardial extracellular space, resulting in an infiltrative and restrictive cardiomyopathy. Although CA was previously perceived as rare and incurable, recent advances in diagnostics and emerging therapies have been changing this outlook. It is crucial to spread awareness about CA to facilitate earlier diagnosis and proper therapeutic interventions, enhancing patient prognosis and survival. Currently, there is an estimated delay of 2 years from symptom onset to diagnosis, typically involving consultation with an average of 5 different professionals. Advances in cardiovascular imaging have facilitated earlier and more accurate diagnosis, reducing the necessity for invasive procedures, such as endomyocardial biopsy. Presently, tafamidis is the only drug that has been shown to offer prognostic benefits in ATTR-CA. Tafamidis is a highly specific medication targeting the circulating TTR protein, stabilizing the TTR tetramer to prevent its dissociation into amyloidogenic monomers that deposit in the myocardium. Alongside specific amyloidosis therapy, supportive HF treatment may be required; however, managing CA with medications typically used for HF with reduced ejection fraction (HFrEF) can be challenging due to potential intolerance. The effectiveness of guideline-directed medical therapy (GDMT) remains undetermined and still requires evaluation through randomized controlled clinical trials (RCCTs). Thus, the treatment cornerstone remains the judicious use of loop diuretics and mineralocorticoid receptor antagonists to control volume overload. Due to the safety profile, not adversely affecting hemodynamics or renal function, sodium-glucose transport protein 2 (SGLT2) inhibitors may be an effective treatment for CA, but they also still require evaluation through RCCTs. (CA (HF space cardiomyopathy incurable outlook interventions survival Currently professionals procedures biopsy Presently ATTRCA. ATTRCA ATTR CA. ATTR-CA myocardium required however HFrEF (HFrEF intolerance guidelinedirected guideline directed GDMT (GDMT RCCTs . (RCCTs) Thus overload profile function sodiumglucose sodium glucose SGLT2 SGLT (SGLT2 (RCCTs (SGLT

Abstract This article provides a critical review of the diagnostic value of several echocardiographic findings in cardiac amyloidosis (CA). The importance of early and accurate detection of CA is emphasized, considering its challenging diagnosis and the need for a high index of suspicion by clinicians. Echocardiography is often the first choice for imaging assessment of cardiac structure and function when CA is suspected. The article encompasses several conventional echocardiographic features and speckle-tracking echocardiography-derived deformation parameters. Some of these indexes are grouped together to form scores, which can improve the accuracy of diagnosing CA. However, particularly in earlier stages, echocardiography has low specificity to distinguish amyloid from other hypertrophic phenotypes, highlighting the need for correlation with clinical red flags, laboratory tests, and additional cardiac imaging modalities. . (CA) emphasized clinicians suspected speckletracking speckle tracking echocardiographyderived derived parameters scores However stages phenotypes flags tests modalities (CA