Objective: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the elderly and a major cause of stroke. Compared to standard care procedures, prolonged Holter electrocardiogram (ECG) monitoring might increase detection of AF. We aim to determine the prevalence of paroxysmal AF (PAF) in elderly patients with increased stroke risk and without known AF, using prolonged Holter ECG monitoring in a primary healthcare setting.Methods: Prospective study with a community convenience sample. Inclusion criteria: age ≥ 65 years, no known AF and at least one additional risk factor for stroke according to the CHA 2 DS 2 VASc score. Heart rhythm was determined by continuous 4 day Holter monitoring. The primary endpoint was the detection of AF (lasting ≥ 30 seconds and ≥ 10 seconds).Results: Fifty patients, mean (SD) age was 72,9 (±5.2) years, were included. Thirty-six (72%) were female.Forty patients (80%) had at least two additional risk factors for stroke. Mean duration of monitoring was 93 hours. Atrial fibrillation was detected in 7 out of 50

The diagnosis and management of blood culture-negative endocarditis constitute a real clinical challenge and a systemic approach is necessary for a successful outcome. The authors report a case of a female patient aged 26, with previous clinical history of valve disease and heart failure NYHA class II, with decompensation of co-morbidities associated with fever, productive cough, nonselective anorexia and unquantified weight loss with one month of evolution with negative blood cultures. Transesophageal echocardiography revealed the presence of severe pulmonary hypertension and mitral valve vegetations in the context of positive serology for Q fever. Herein, the authors report a case of blood culture-negative endocarditis and present a brief review on the management of this medical condition. We highlighted the diagnostic difficulties of blood culturenegative endocarditis and subacute clinical presentation, which sometimes present with fever of unknown origin and complaints of deterioration of cardiac function, thus creating a challenging differential diagnosis.

Thymoma is the most common neoplasm of the anterior mediastinum and accounts for one quarter of all mediastinal tumours and half of all anterior mediastinal masses. Pericardial effusion may be present in approximately 20% of cases. This report presents a patient with a previously diagnosed thymoma without surgical indication and with poor response to chemotherapy and radiotherapy who had a pericardial effusion that likely resulted from the malignancy dissemination to pericardium.

Lung cancer is a leading cause of death due to malignancy worldwide. Diaphragmatic metastasis secondary to primary lung cancer is rare. In the literature, only a few cases have been described as the majority of cases of diaphragmatic metastasis which are secondary to gastrointestinal neoplasia. The authors report a rare case of diaphragmmatic metastasis from a primary adenocarcinoma of the lung in a 76-year-old female patient with no history of active or passive smoking with progressive worsening fatigue, asthenia, malaise, and unquantified weight loss with three months of evolution, associated with pleuritic chest pain and edema of the lower limbs for fifteen days previous to hospital admission. Chest X-ray showed elevation of the right hemi-diaphragm and thoracic-abdominal-pelvic computed tomography revealed a complex multilobuled mass with neoformative characteristics intersecting the diaphragm and invading the dome liver and the right lung region. Biopsy of the mass was performed whose histological examination was consistent with moderately differentiated adenocarcinoma. Immunohistochemical examination was positive for cytokeratin 7 and negative forcytokeratin 20, suggesting primary lung tumor. A positron emission tomography was performed without uptake in other locations. Diagnosis of adenocarcinoma with diaphragmatic metastasis was then admitted and the patient started chemotherapy with carboplatin and gemcitabine. The patient died six months after the diagnosis. The authors also present a brief theoretical discussion based on the current and scarce literature on this rare entity.