SESARAM - CC - Cirurgia Cardiotorácica
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- Aortic Dissection Mimicking ST Elevation MyocardialPublication . RODRIGUES, Ricardo; SANTOS, Nuno; PEREIRA, Décio
- Eutanásia: Existirão vários tipos?Publication . Rijo, DiogoA eutanásia está em debate desde a Antiguidade. A eutanásia e o suicídio assistido devem ser considerados sob a mesma designação de “eutanásia” e sob a mesma definição de “morte activa e intencional, a pedido do doente, devida a administração de medicação, resultante da deliberação do médico, sendo independente do executor”, estando perante suitanásia, caso a administração da medicação fosse executada pelo doente, ou homotanásia, no caso do médico. As designações directa, activa e voluntária, actualmente relacionadas com a eutanásia devem cair em desuso, pois pressupõem vários tipos desta, o que é falso. Uma maior abertura de mentalidade e um diálogo mais alargado, baseado na evidência científica e na clarificação de definições e objectivos, são essenciais no processo de liberalização da eutanásia.
- Reclassification of the intermediate group classified according to heartscore taking in considertaion individual genetic predisposition to coronary artery diseasePublication . Mendonça, M.; Pereira, A.; Rodrigues, R.; Neto, M.; Sousa, A.C.; Freitas, S.; Freitas, C.; Freitas, A.I.; Borges, S.; Palma dos Reis, R.Introduction: Cardiovascular risk stratification has included traditional cardiovascular risk factors (TRF) including tobacco, cholesterol and blood pressure adjusted to age and sex. The utility of genetic risk scores (GRS) as predictors of cardiovascular risk remains inconclusive. Objective: We intended to evaluate the ability of a multilocus GRS within the intermediate risk subgroup, defined by the European Heart score, to add predictive power for the association with coronary artery arterial disease (CAD). Methods: After applying European SCORE (ES) stratification to a total population of 2703 Portuguese individuals, 639 individuals with 59.0 ± 4.3 years were considered to be at intermediate risk subgroup (2 Results: GRS was an independent predictor for CAD (OR=2.411; p<0.0001). Diabetes mellitus (OR=3.196;p<0.0001), arterial hypertension (OR=2.201; p=0.003) and smoking (OR=3.148; p<0.0001) were also significantly associated with CAD. AUC increased from 0.694 to 0.734 after adding GRS to TRF. When discriminated by tertiles of GRS, the AUC for TRF was maximum for the 2nd tertile GRS [AUC (TRF)=0.734] and lower for the 1st and 3rd tertiles (AUC =0.673 and AUC =0.671, respectively). NRI showed better increase in the intermediate risk subgroup with a 35.2% interpreted as the roportion of patients reclassified to a more appropriate risk category, and 29.4% on the lower risk. Conclusion: In our population, the GRS increased the predictive value of TRF in the subgroup of patients at intermediate risk by the European Score. The predictive value of TRF is lower in patients with higher GRS. In this subgroup, the inclusion of genotyping may be considered for better stratification of cardiovascular risk.
- The Hidden Dangers of Beaches: Cardiorespiratory Arrest Induced by Thermal ShockPublication . Café, HM; Santos, S; Chaves, S; Faria, P; Câmara, M; Nóbrega, J; Pereira, VThermal shock is widely recognized by modern medicine. Its pathophysiological mechanisms are known, as are its possible consequences, but scientific reports in the literature about clinical cases with severe consequences are sparse. The authors present a case of cardiorespiratory arrest after prolonged sun exposure followed by a dive in the ocean. Other aetiological causes were ruled out, by exclusion, leading to the diagnosis of cardiorespiratory arrest caused by thermal shock. It is important to inform the public in general of the risks of negligent behaviour on the beach.