A male patient with flu-like symptoms and tomography and laboratory diagnosis of severe acute respiratory syndrome. He developed acute cardiac dysfunction during admission and was submitted to a cardiac magnetic resonance imaging examination, which confirmed acute myocarditis, indicating cardiac involvement by coronavirus disease 2019. A review and discussion about coronavirus disease 2019-related cardiac manifestations are reported, focusing on the imaging findings to make diagnosis.

A síndrome do aprisionamento da artéria poplítea caracteriza-se pela compressão desta artéria sendo a principal causa de claudicação intermitente em jovens. Homem, 18 anos, branco, apresentava parestesia, frialdade e palidez do pé direito, iniciada 24 horas após exercício físico. Em membro inferior direito, ausência de pulsos tibial posterior e dorsal do pé. À flexão dorsal e flexão plantar forçadas, houve diminuição dos pulsos tibial posterior e dorsal do pé à esquerda. Tratado cirurgicamente, o paciente apresentou pulso em ambas as artérias. A síndrome é mais frequente em homens e a prevalência varia entre 0,16 e 3,5%. O aprisionamento da artéria poplítea tipo III é mais comum. A falta de tratamento pode levar à embolia, trombose e aneurismas pós-estenóticos. Esta síndrome deve ser lembrada como causa de dor na perna, especialmente em homens jovens e de prática esportiva intensa.

Fundamentos: A síndrome de Heyde é a associação de estenose aórtica importante com episódio de sangramento gastrointestinal por lesões angiodisplásicas. Pouco é conhecido sobre os fatores associados a novos sangramentos e desfechos em longo prazo. Além disso, a maioria dos dados é restrita a relatos de casos e pequenas séries. Objetivo: Avaliar o perfil clínico, laboratorial e ecocardiográfico de pacientes com síndrome de Heyde submetidos a intervenção valvar ou tratamento medicamentoso. Métodos: Coorte prospectiva de 24 pacientes consecutivos entre 2005 e 2018. Foram avaliados dados clínicos, laboratoriais, ecocardiográficos e relacionados à intervenção valvar e a desfechos após o diagnóstico. Valor de p<0,05 foi considerado estatisticamente significante. Resultados: Metade dos 24 pacientes apresentou sangramento com necessidade de transfusão sanguínea na admissão. Angiodisplasias foram encontradas mais frequentemente no cólon ascendente (62%). Intervenção valvar (cirúrgica ou transcateter) foi realizada em 70,8% dos pacientes, e 29,2% foram mantidos em tratamento clínico. Novos episódios de sangramento ocorreram em 25% dos casos, e não houve diferença entre os grupos clínico e intervenção (28,6 vs. 23,5%, p=1,00; respectivamente). A mortalidade no seguimento de 2 e 5 anos foi de 16% e 25%, sem diferença entre os grupos (log-rank p = 0,185 e 0,737, respectivamente). Conclusões: Pacientes com síndrome de Heyde tiveram alta taxa de sangramento com necessidade de transfusão sanguínea na admissão, sugerindo ser uma doença grave e com risco elevado de mortalidade. Não encontramos diferenças entre os grupos submetidos ao tratamento clínico e à intervenção valvar em relação a taxas de ressangramento e mortalidade tardia.

Positive predictive values of each of the symptoms assessed as well as physical findings will be detailed. Conclusion:Clinical guidelines can play an important role in directing the radiologic investigation for paranasal sinus disease, decreasing radiation exposure, and economic burden on healthcare. Rhinology/AllergyDo Nasal Muscles Really Work during Nasal Breathing? Silvio Bettega, MD (presenter); Marcelo BettegaObjective: Determine the role of nasal muscle function in healthy patients and patients with nasal septum deviation who underwent surgical treatment.Method: Forty-five patients were divided into 2 groups: Group A (n = 16), with no septum deviation and no nasal obstruction; Group B (n = 29), with both. Electromyographic (EMG) activities of nasal muscles were evaluated. Group A was the control, and Group B underwent surgery. Patients were evaluated before and after surgery. Results:No abnormal finding was found in any of the nasal muscles of the control group. There was less EMG activity during normal breathing compared with forced breathing in both groups. In group B, there was a decrease in EMG activity 30 days after surgery (33.17% on normal breathing and 49.04% on forced breathing) as well as 90 days after surgery (27.21% on normal breathing and 36.14% on forced breathing). Conclusion:The decrease in electromyographic activities of nasal muscles after removal of an obstructive factor as septum deviation, correlates with the hypothesis that nasal muscles are important during nasal breathing. Rhinology/AllergyEffect of Berberine on Nasal Polyp-derived Fibroblast Il-Ho Park, MD (presenter); Hyuk Choi; Heung-Man Lee; Yong-Dae Kim, MD Objective: Berberine is a compound isolated from medicinal herbs such as coptidis rhizoma. Berberine has been reported with diverse pharmacological effects. Nasal polyps are a common chronic inflammatory disease of nasal mucosa. In this study, we investigated the effect of berberine on myofibroblast differentiation in nasal polyp-derived fibroblast (NPDF).Method: NPDFs were prepared with and without berberine before TGF-beta1 treatment. The mRNA expressions of alpha-SMA was determined by RT-PCR. The expression of alpha-SMA protein and Phosphorylation of Smad2/3, ERK, p38, JNK, c-fos was determined by western blotting and or immunocytochemistry. The amount of total collagen production was analyzed by SirCol assay. Results:We observed that berberine inhibited the expression of alpha-SMA and total soluble collagen in a dose dependent manner. The TGF-β1-induced expression of pERK, p38, and AP-1 were decreased by berberine. Conclusion:Berberine abrogates TGF-beta1-induced myofibroblast differentiation by inhibition of Akt, MAPK phosphorylation, and AP-1 activation. These findings offer a mechanism for the antifibrotic effects of berberine and a therapeutic point in the treatment for nasal polyps. Rhinology/AllergyEffects of Anatomy and Particle Size on Nasal Sprays Dennis Frank, PhD (presenter); Sachin Pawar, MD; John S. Rhee, MD, MPH; Julia S. Kimbell, PhDObjective: Compare spr...

Introduction Degenerative aortic valve presents distinct patterns according to gender. Inappropriate myocardial hypertrophy in response to severe aortic stenosis (AS) and their clinical repercussions is of recent interest. Purpose To evaluate the influence of gender on the pattern of ventricular remodelling in patients with AS and inappropriate ventricular hypertrophy. Methods Retrospective study, analysing clinical and echocardiographic characteristics of 145 patients, between 2008 and 2018, with severe aortic stenosis and inappropriate ventricular hypertrophy, defined as septal wall thickness greater than 14 mm. Results Women were 42% of the patients, with higher mean age compared to men (75.23±12.78 vs 70.01±12.59 years, p=0.01), lower body surface (1.68±0.17 vs 1.94±0.68 m2, p=0.004), lower ventricular volumes (94.33±32.88x3856±23.81 vs 122.68±43.24x50.34±28.10 ml/m2, p<0.001), increased LV wall thickness (0.65±0.19 vs 0.58±0.10, p<0.001). There were no differences in LV mass (163.22±37.92 vs 170.51±39.08g, p=0.26), septal wall thickness (16.08±1.63 vs 15.71±1.02mm, p=0.24), posterior wall thickness (13.35±1.63 vs 13.67±1.58mm, p=0.23), left ventricular ejection fraction (61.31±10.36 vs 58.92±10.33%, p=0.17), indexed aortic valve area (0.41±0.10 x 0.39±0.08 cm/m2, p=0.23), medium transaortic gradient (57.50±16.42 x 55.08±17.11mmHg, p=0.39), BNP (896.28±1432.44 x 591.09±1007.71pg/ml, p=0.365) and troponin I (7.17±26.36 x 1.01±2.64 mcg/L, p=0.29). The difference between the septum and posterior wall indexed to the body surface was significantly higher in women (1.60±1.06 x 1.10±0.83 mm/m2, p=0.02), as well as the septal wall thickness indexed by the body surface (9.60±1.40 x 8.48±1.30 mm/m2, p<0.001). Conclusions Septal wall thickness indexed by body surface and difference between septum and the posterior wall in ventricles with smaller volumes suggest that myocardial hypertrophy in response to severe AS is more severe in women than in men. Since inappropriate myocardial hypertrophy is a predictor of outcomes in AS, it is possible that the optimal timing for valve replacement should be earlier in women.