Felipe Soares Torres

Absence of Association between Hypertension and Epistaxis: a Population-based Study

The association between epistaxis and hypertension is still disputed. In a cross-sectional study, we evaluated this association in a sample of 1174 individuals older than 18 years, representative of inhabitants of Porto Alegre, RS, Brazil. Epistaxis was defined as any episode of non-traumatic nosebleeding after 18 years of age. Hypertension was defined as the mean of two blood pressure readings ≥160/95u2005mmHg or the use of antihypertensive drugs. The prevalence of epistaxis and hypertension were 14.7% (95% confidence interval, CI 12.7-16.7) and 24.1% (95% CI 21.7-26.6), respectively. History of epistaxis in the adulthood (risk ratiou2005=u20051.24, 95% CI 0.83-1.85), and in the previous 6 months (risk ratio 0.79, 95% CI 0.40-1.56; pu2005=u20050.510) were not associated with hypertension after controlling for gender, age, race, history of allergic rhinitis or nasal abnormalities, alcohol abuse, smoking and years of study. History of epistaxis was positively associated with history of allergic rhinitis and inversely associated with years at school. In conclusion, we demonstrated that hypertension is not associated with history of epistaxis in the adulthood in free-living individuals.

Association between carotid intima-media thickness and retinal arteriolar and venular diameter in patients with hypertension: A cross-sectional study

OBJECTIVEnAbnormalities in retinal vessels are frequent, but its association with findings in other vascular sites has been scarcely investigated. This study aimed to examine the association between ultrasound-measured carotid intima-media thickness (IMT) and retinal arteriolar and venular diameters, in hypertensive patients.nnnMETHODSnIn this cross-section study, 173 hypertensive patients had both retinography taken and digitized to determine vessel diameters by an edge-detecting computerized method and carotid ultrasound for semi-automated carotid IMT measurement. The association between the mean common carotid IMT and retinal arterioles and venules diameters was assessed by using multiple linear regression models.nnnRESULTSnThe mean (±SD) arteriolar and venular diameters were 102. 8 (±11.6) μm and 128.9 (±15.5) μm, respectively, and common carotid IMT was 0.87 (±0.19) mm. A significant and independent association was demonstrated for carotid IMT and retinal arteriolar caliber (adjusted β -0.245, p = 0.001) and for carotid IMT and retinal venular caliber (adjusted β 0.191, p = 0.009) after controlling for age, gender, systolic blood pressure, total cholesterol and HDL (high-density lipoprotein) cholesterol, prior cardiovascular disease, carotid plaque and the retinal fellow vessel.nnnCONCLUSIONnIn patients with hypertension, carotid intima-media thickness, a marker of macrovascular damage, is significantly and independently associated with microvascular damage, determined by retinal arteriolar and venular calibers.

Unilateral pulmonary veins atresia: evaluation by computed tomography

Unilateral pulmonary vein atresia is a rare congenital condition. In addition to cardiac malformations or pulmonary hypertension, patients may present with recurrent pulmonary infections or hemoptysis in childhood or adolescence. The authors report a case where the typical findings of such condition were observed at computed tomography in an adult patient.

Association of adult mastocytosis with M541L in the transmembrane domain of KIT

Editor Mastocytosis is a disorder characterized by mast cell (MC) proliferation and accumulation within various organs, most commonly the skin. Multiple KIT mutations have been reported in patients with adult mastocytosis, but the potential association of specific KIT mutations with specific subtypes of mastocytosis remains to be clarified. We present the case of a 32-year-old caucasian woman who came to the Dermatology Department complaining of a 12-year history of multiple, generalized and reddish-brown macules and papules with positive Darier’s sign. These lesions were more numerous in the trunk and limbs, and absent from face, palms and soles. She had no systemic symptoms and physical examination was unremarkable. Skin biopsy showed MC infiltrates in the dermis (Fig. 1), confirming the diagnosis of cutaneous mastocytosis. Full blood count, white blood cell differential and routine serum biochemistry tests were within normal range. Serum tryptase level was 17.9 ng ⁄ mL (normal: 0.1–11.4 ng ⁄ mL). The patient had a 46,XX karyotype. Abdominal ultrasound, PET scan and bone densitometry were all normal. Complete bone marrow study showed normal percentage of bone marrow MCs (BMMCs) (0.04%) which showed aberrant coexpression of CD25+, CD2+ and also CD33+, CD35+, CD45+, CD63+, CD69+ and CD59+. Analysis of coding exons 8, 9, 10, 11 and 17 of the KIT gene revealed the presence of a heterozygous substitution in exon 10, resulting in the substitution of leucine for methionine at codon 541 (M541L) (Fig. 2). The sequencing of KIT exon 10, using DNA extracted from oral mucosa cells, confirmed that this was a germline mutation. Human KIT is a protooncogene located at chromosome 4q12 that contains 21 exons, which encode a transmembrane receptor (kit) with tyrosine kinase (TK) activity. Binding of kit ligand stem cell factor (SCF) to kit receptor is known to activate kit TK, which results in different biological effects depending on the activated cell. In MCs, these effects include, among others, cell proliferation and suppression of apoptosis. Mutations of KIT are considered to play a key role in the pathogenesis of mastocytosis. Most frequently, KIT mutations occur at exon 11 and 17, resulting in aminoacid changes at the juxtamembrane and TK domain of kit respectively. Furitsu et al. showed that point mutations in KIT (Asp816Val and Val560Asp) are capable of inducing constitutive activation of kit. Multiple other activating KIT mutations have been reported in patients with adult mastocytosis, but few are described in the transmembrane domain of KIT, encoded by exon 10. In our patient, we detected a heterozygous substitution (germline mutation) in exon 10, resulting in the substitution of leucine for methionine at codon 541 (M541L). This mutation was described in general population, in a family with piebaldism and in two unrelated pairs of apparently identical twin children with mastocytosis. To the best of our knowledge, however, this is the first time it is reported in an adult patient with mastocytosis. According to Foster et al., cells expressing M541L displayed a significantly heightened response to low levels of SCF, suggesting that these cells may have a proliferative and ⁄ or survival advantage. Although our patient had elevated serum tryptase levels, coexpression of both CD2 and CD25 by BMMCs and a KIT Figure 2 Analysis of coding exons 8, 9, 10, 11 and 17 of the KIT gene revealed the presence of a heterozygous substitution in exon 10, resulting in the substitution of leucine for methionine at codon 541 (M541L).

Right aortic arch with aberrant left innominate artery arising from Kommerell's diverticulum

We report a case of an uncommon thoracic aorta anomaly-right aortic arch with aberrant left innominate artery arising from Kommerells diverticulum-that went undiagnosed until adulthood.

Does coronary CT angiography improve risk stratification over coronary artery calcium scoring in symptomatic patients with a low pre-test probability of coronary artery disease and a CAC of zero?

I read with great interest the article entitled ‘Does coronary CT angiography improve risk stratification over coronary calcium scoring in symptomatic patients with suspected coronary artery disease? Results from the prospective multicenter international CONFIRM registry’ from Al-Mallah et al. 1 published in European Heart Journal Cardiovascular Imaging . Perhaps, an unanswered question that could be addressed by the same group would be: Does coronary computed tomography angiography (CCTA) improve risk stratification over coronary artery calcium (CAC) scoring in symptomatic patients …

Cardiovascular risk and bipolar disorder: factors associated with a positive coronary calcium score in patients with bipolar disorder type 1

Objective: Cardiovascular disease is the leading cause of death in patients with bipolar disorder. The aim of this study was to evaluate the factors associated with positive coronary calcium score (CCS) in individuals with bipolar disorder type 1. Methods: Patients from the Bipolar Disorder Program at Hospital de Clínicas de Porto Alegre, Brazil, underwent computed tomography scanning for calcium score measurement. Clinical and sociodemographic variables were compared between patients according to their CCS status: negative (CCS = 0) or positive (CCS > 0). Poisson regression analysis was used to examine the association of CCS with number of psychiatric hospitalizations. Results: Out of 41 patients evaluated, only 10 had a positive CCS. Individuals in the CCS-positive group were older (55.2±4.2 vs. 43.1±10.0 years; p = 0.001) and had more psychiatric hospitalizations (4.7±3.0 vs. 2.6±2.5; p = 0.04) when compared with CCS- negative subjects. The number of previous psychiatric hospitalizations correlated positively with CCS (p < 0.001). Conclusion: Age and number of psychiatric hospitalizations were significantly associated with higher CCS, which might be a potential method for diagnosis and stratification of cardiovascular disease in bipolar patients. There is a need for increased awareness of risk assessment in this population.

Systematic Layout Planning of a Radiology Reporting Area to Optimize Radiologists’ Performance

Optimizing radiologists’ performance is a major priority for managers of health services/systems, since the radiologists’ reporting activity imposes a severe constraint on radiology productivity. Despite that, methods to optimize radiologists’ reporting workplace layout are scarce in the literature. This study was performed in the Radiology Division (RD) of an 850-bed University-based general hospital. The analysis of the reporting workplace layout was carried out using the systematic layout planning (SLP) method, in association with cluster analysis as a complementary tool in early stages of SLP. Radiologists, architects, and hospital managers were the stakeholders consulted for the completion of different stages of the layout planning process. A step-by-step description of the proposed methodology to plan an RD reporting layout is presented. Clusters of radiologists were defined using types of exams reported and their frequency of occurrence as clustering variables. Sectors with high degree of interaction were placed in proximity in the new RD layout, with separation of noisy and quiet areas. Four reporting cells were positioned in the quiet area, grouping radiologists by subspecialty, as follows: cluster 1-abdomen; cluster 2-musculoskeletal; cluster 3-neurological, vascular and head & neck; cluster 4-thoracic and cardiac. The creation of reporting cells has the potential to limit unplanned interruptions and enhance the exchange of knowledge and information within cells, joining radiologists with the same expertise. That should lead to improvements in productivity, allowing managers to more easily monitor radiologists’ performance.

Tumorlike Cardiac Fungal Mycetoma Caused by Scedosporium apiospermum Presenting as Symptomatic Ventricular Tachycardia

A 35-year-old man comes to the emergency department reporting dizziness, palpitations, and chest pain. A physical examination revealed a blood pressure of 70/50 mm Hg, faint peripheral pulses, and a regular cardiac rhythm. The ECG showed a regular widened QRS tachycardia (Figure 1A) that was electrically cardioverted with successful sinus rhythm reversion. He had no previous known cardiovascular pathologies, but was HIV-positive on antiretroviral therapy, with a history of cryptococcal and tuberculous meningitis (4 years before presentation). Viral load quantification was undetectable, and CD4 counting was 254 cells/μL. Impregnation with intravenous amiodarone was initiated. On transthoracic echocardiography, a tumorlike mass involving the right ventricle free wall and lateral tricuspid annulus was identified (Figure 1B). Initial cardiac MRI confirmed a large mass in the right ventricular free wall (Figure 1C, Movie I in the online-only Data Supplement) that demonstrated intense first-pass perfusion (Movie II in the online-only Data Supplement) and contrast uptake (Figure 1D …