Moderate Exertion Research Articles

Fit club: Outcomes from 35-minute daily exercise program for autistic adolescents

BackgroundAutistic children and adolescents have academic performance challenges and are often reluctant to participate in physical activities. Executive function (EF) abilities generally remain stable or worsen as autistic children get older and obesity and lack of physical fitness are frequent concerns experienced by these individuals. Finding ways to address these concerns has the potential to improve outcomes in autistic youth. MethodWe conducted a 12-month, repeated-measures study to examine the effectiveness of a mandatory 35-minute daily school physical activity intervention involving low to moderate exertion for autistic adolescents (n = 29). Changes in fitness, EF, social responsiveness, and restrictive and repetitive behaviors were examined. ResultsSignificant improvements were seen in fitness, EF areas (specifically cognitive flexibility and planning/organizing), restrictive and repetitive behaviors and social responsiveness. ConclusionFindings suggest that participation in a mandatory daily 35-minute physical activity program with low to moderate exertion is feasible and may contribute to improved EF, fitness, restricted and repetitive behavior, and social responsiveness in autistic adolescents.

Pharmaceutical Care in Patients with Side Effects to Oral Antineoplastic Agents: A Case Report

Background Chronic myeloid leukaemia (CML) is a haematopoietic stem cell disease characterised by the proliferation of granulocytes and their immature myeloid precursors. The treatments recommended are oral treatments dispensed in the outpatient unit (OU) of the hospital’s pharmacy service (PS), where patient-centred pharmaceutical care (PC) is essential to enhance therapeutic adherence, detect drug interactions and create a pharmacist-patient relationship to educate the patient on the main potential toxicities derived from the treatment and warning signs or symptoms requiring immediate attention. Methodology We present the case of a 55-year-old woman, followed up in consultation by the Haematology Service (HS) since October 2021 for CML in the chronic phase. Results She started treatment on nilotinib 300 mg every 12 hours. The patient attended OU and was offered PC. After 12 months, nilotinib was well tolerated, but our patient experienced a loss of effectiveness, so HS decided to switch to dasatinib 100 mg daily. After one year of treatment, our patient was presented with symptoms of swelling and dyspnoea on moderate exertion. In January 2024, following a joint Haematology-Pharmacy session, a switch to bosutinib 400 mg daily was decided. After 15 days of treatment, the patient presented without an appointment due to a pruritic generalised rash on the torso, face, and extremities, being diagnosed with leukocytoclastic vasculitis. Conclusion In conclusion, we describe case reports of a patient who has a lack of effectiveness and ARs in several TKIs and the importance of identifying side effects, through early and close PC, in order for the patient’s evolution to be favourable.

Change in Femoral Cartilage Cross-Sectional Area After Aerobic and Resistance Exercise.

We compared the immediate response and recovery of femoral cartilage morphology following aerobic or resistance exercise to a control condition. Fifteen healthy young males (23.9 years; 170.1 cm; 69.7 kg) visited the laboratory three separate days and randomly performed one of the 30-min exercise aerobic exercises (treadmill running), resistance exercises (leg presses, back squats, and knee extensions), or seated rest as the control, each followed by the 50-min recovery. Ultrasonographic images of the femoral cartilage cross-sectional area (CSA) were obtained before and after exercise and every 5 min thereafter. To test exercise effects over time, a mixed model analysis of variance and Tukey-Kramer post-hoc tests were performed (p<0.05). The femoral cartilage CSA was different (condition×time: F34,742=4.30, p<0.0001) and the femoral cartilage CSA was decreased after the aerobic (-5.8%, p<0.0001) and the resistance (-3.4%, p=0.04) exercises compared to the pre-exercise levels. Deformed femoral cartilage CSA took 35 and 10 min to return to the pre-exercise levels after aerobic and resistance exercises (p+>+0.09), respectively. Thirty minutes of moderate exertion performing aerobic or resistance exercises immediately reduced the femoral cartilage CSA. A rest period ranging from 10 to 35 min was required for cartilage recovery after weight-bearing exercises.

Effectiveness of dynamic atrioventricular optimization during patient exercise in cardiac resynchronization therapy

Abstract Background Cardiac resynchronization therapy (CRT) is considered the standard treatment for patients with heart failure and prolonged QRS duration. Recent studies suggest that atrioventricular delay (AVD) optimization can play a key role in QRS narrowing, thus improving CRT outcomes. For this purpose, device-based algorithms have been developed. In particular, the SyncAV algorithm continuously monitors the patient’s intrinsic AVD and dynamically adjusts the pacing AVD to allow fusion of the left ventricle pacing with intrinsic right ventricle depolarization. SyncAV optimization is usually performed in a single patient condition, i.e. at rest, and in a single operating scenario of the device, i.e. during atrial sensing. Purpose This study aims to compare QRS narrowing after AVD optimization using SyncAV in CRT-treated patients at rest, during moderate exertion, and during an increase in the atrial pacing rate. Methods This is a prospective, non-randomized, non-blinded, multicenter study. The study population consisted of patients in sinus rhythm, PR interval &amp;lt; 350 ms, and rest ventricular rate &amp;lt; 100 bpm. Within one month from the implant, patients were assessed for AVD optimization with SyncAV, selecting the offset (i.e. 10 to 40% AVD) that resulted in the shortest QRS duration (QRSd). Subsequently, patients performed moderate physical activity using a bicycle ergo-meter while a surface ECG was collected. QRSd was assessed once patients achieved a heart rate over 20 bpm to baseline heart rate, up to 100 bpm. Finally, QRSd narrowing was evaluated during a programmed increase in atrial pacing (i.e. &amp;gt;20 bpm of baseline atrial rate). Results Nine patients were treated with CRT and enrolled (age 67,3 ± 13,2 years; 66% male; LV ejection fraction 33,7±2,9 %; intrinsic QRSd 155,6 ± 12,7 ms) with intact atrioventricular conduction (PR interval 170,6±25,8 ms). The median SyncAV offset that provided the best QRSd reduction was 20 % (10 - 35%). Intrinsic QRSd was reduced to 132,7 ± 10,0 ms (-14,2±9,4%) with standard biventricular pacing and to 122,0 ± 11,2 ms (-21,2±8,5%) with SyncAV optimization. During exercise the mean heart rate was 88,1 bpm, the QRSd was reduced to 132,7 ± 10,0 ms (-14,2±9,4%) with standard biventricular pacing and to 124,9 ± 14,9 ms (-19,3±10,8 %) with SyncAV optimization. The mean heart rate during atrial pacing was 90 bpm with paced QRSd of 126,0 ±13,9 ms (-18,9±7,3% from baseline) with SyncAV optimization and paced PR interval of 198,2±22,7ms. Conclusion We evaluated the effectiveness of SyncAV for AVD optimization in out-of-clinic. This study demonstrates the possibility of narrowing the QRSd using SyncAV at several activity levels. Nevertheless, a deeper evaluation is needed to confirm our findings, investigating the SyncAV role in a larger population of patients.

A TAVI VALV IN VALV AT ALMOST 90 YEARS

Abstract Degeneration of the biologic aortic valve prosthesis represents an increasingly important issue. This process often affects frail elderly patients who are not candidates for cardiac re–intervention. TAVI valve–in–valve implantation therefore probably remains the only viable option in such patients.We report the clinical case of Mrs. Luciana F., currently 94 years old, who underwent biological aortic valve replacement in 2016. In charge of the Elderly Patient‘s Heart Failure Outpatient Clinic (SOD Geriatrics–UTIG) since January 2023.At first evaluation,89 years old, widowed, living alone; MMSE 29/30. SPPB 7/12. Totally autonomous in BADL, and partially in IADL.She complained of decreased exercise tolerance (NYHA Class III). No alterations in left ventricular kinetics. Calcified and degenerated aortic valve prosthesis with markedly reduced box opening and severe stenosis (Vel 4.7 m/s; Grad max/med (86/55 mmHg) mild insufficiency. May 2023 access to DEA for syncopal episode, complicated by fall down stairs and head injury; on echocardiogram relief of further degeneration of aortic bioprosthesis (moderate–grade intra–prosthetic insufficiency at 2 jets with PTH 300 msec and severe stenosis, Gmax/Gmed 88/55 mmHg, DVI 0.20 June 2023 worsening of dyspnea that appeared even at rest NYHA IV. At echocolordoppler confirmed severe aortic stenosis severe bioprosthesis degeneration. She was evaluated in Heart Team: low overall risk (MPI 0.31) therefore percutaneous implantation of Medtronic Evolut R aortic bioprosthesis has been performed. At discharge asymptomatic, eupnoic, walking independently without aids for short stretches. At subsequent follow–up.–1 month: substantial clinical well–being in the absence of dyspnea on ordinary exertion (NYHA II), no orthopnea or paroxysmal nocturnal dyspnea; denies angor, heart palp or syncopal episodes. She has resumed household chores and leaves the house almost every day –6 months: clinical stability. She walks long distances every day in the absence of symptomatology. –1 years (turned 90 years old): clinical stability with dyspnea for moderate exertion continues active life. Trans prosthetic gradient max/medium 22/12 mmHg, VD–AD 30 mmHg. In conclusion TAVI procedure on degenerated biological prosthesis should be an option to be considered in the elderly patient selected and evaluated by a multidisciplinary Heart Team to achieve improvement of cardiovascular symptoms and concomitantly recovery of functional autonomy.

Granulomatous Slack Skin With Lung and Esophagus Involvement: A Case Report and Molecular Analysis.

Granulomatous slack skin (GSS) is a rare subtype of mycosis fungoides, and few cases have been known to spread to the blood, lymph nodes, or viscera. We present a case with early dissemination to the lung. A 27-year-old woman, previously healthy, presented with scattered disseminated scaly patches, associated with vulvar and intergluteal firm swelling and groin-skin induration for 1 year. She also reported mild fatigue and breathlessness on moderate exertion. The patient underwent blood tests, skin biopsies, and computed tomography scan. The skin biopsy showed a mildly atypical T-cell lymphoid infiltrate involving the dermis/hypodermis, with focal epidermotropism, associated with a granulomatous infiltrate and elastophagocytosis. The computed tomography scan revealed bilateral ground-glass lung nodular opacities. Positron emission tomography showed an increased signal in the skin and subcutis around the buttocks, inguinal and mediastinal lymph nodes, and lungs. The lung biopsy confirmed a dense T-cell infiltrate with numerous multinucleated giant cells. Subsequently, esophageal involvement was also observed following biopsy. Molecular analyses demonstrated identical T-cell clones in the skin and lung. After 6 cycles of chemotherapy/localized external radiotherapy, the patient had a partial skin response and stable lung disease. A preferred diagnosis of GSS with systemic spread was made based on clinical/histologic/molecular findings, after considering granulomatous mycosis fungoides and peripheral T-cell lymphoma, not otherwise specified. This case highlights the frequent diagnostic difficulty in distinguishing GSS from an inflammatory granulomatous dermatitis. Pulmonary and esophageal involvements are rare in GSS, and the simultaneous presentation of characteristic cutaneous GSS with systemic disease poses an additional classification challenge.

Development of adventure tourism in the Republic of Sakha (Yakutia)

The article examines the trends in the development of adventure tourism in the Republic of Sakha (Yakutia), where nature-oriented forms of tourism are the most promising. The object of the study is adventure tourism, the subject is the peculiarities of its development in the regions of new development on the example of the Republic of Sakha (Yakutia). The concept and characteristics of adventure tourism are briefly analysed. It is determined that adventure tourism is one of the types of nature–oriented tourism, including visits to unique natural sites (mainly in areas untouched by economic activity) through active forms of movement combined with moderate physical exertion, overcoming difficulties and obtaining unforgettable experiences, impressions and new knowledge about the world around. The specifics of the organization and trends in the development of tourism in the Republic of Sakha (Yakutia) are analysed. The analysis of the natural and recreational potential showed high attractive properties of the studied territory and the possibility of developing various types of active tourism. Despite the rich natural resource potential, the development of adventure tourism in the region is hampered by a number of negative factors. The main problems of the development of adventure tourism are considered and measures to intensify the development of adventure tourism in the region are proposed.

Moderate Mitral Regurgitation Secondary to Hammock Congenital Mitral Valve Disease

A 30-year-old woman with a history of systemic lupus erythematosus and hypothyroidism . She started with dyspnea on moderate exertion, orthopnea, and a sensation of palpitations an early systolic murmur of mitral regurgitation was found. Transthoracic and transesophageal echocardiography reported hammock congenital mitral valve disease as a cause of mitral regurgitation with impaired functional class, requiring surgical valve replacement. The mitral arcade, or hammock mitral valve, is a very rare entity, even more so in the adult population, with a reported prevalence of 0.5%. It is characterized by abnormal papillary muscles connected directly to the anterior mitral.

Early Human Pathophysiological Responses to Exertional Hypobaric Decompression Stress.

INTRODUCTION: Consistent blood biomarkers of hypobaric (altitude) decompression stress remain elusive. Recent laboratory investigation of decompression sickness risk at 25,000 ft (7620 m) enabled evaluation of early pathophysiological responses to exertional decompression stress.METHODS: In this study, 15 healthy men, aged 20-50 yr, undertook 2 consecutive (same-day) ascents to 25,000 ft (7620 m) for 60 and 90 min, breathing 100% oxygen, each following 1 h of prior denitrogenation. Venous blood was sampled at baseline (T0), immediately after the second ascent (T8), and next morning (T24). Analyses encompassed whole blood hematology, endothelial microparticles, and soluble markers of cytokine response, endothelial function, inflammation, coagulopathy, oxidative stress, and brain insult, plus cortisol and creatine kinase.RESULTS: Acute hematological effects on neutrophils (mean 72% increase), eosinophils (40% decrease), monocytes (37% increase), and platelets (7% increase) normalized by T24. Consistent elevation (mean five-fold) of the cytokine interleukin-6 (IL-6) at T8 was proinflammatory and associated with venous gas emboli (microbubble) load. Levels of C-reactive protein and complement peptide C5a were persistently elevated at T24, the former by 100% over baseline. Additionally, glial fibrillary acidic protein, a sensitive marker of traumatic brain injury, increased by a mean 10% at T24.CONCLUSIONS: This complex composite environmental stress, comprising the triad of hyperoxia, decompression, and moderate exertion at altitude, provoked pathophysiological changes consistent with an IL-6 cytokine-mediated inflammatory response. Multiple persistent biomarker disturbances at T24 imply incomplete recovery the day after exposure. The elevation of glial fibrillary acidic protein similarly implies incomplete resolution following recent neurological insult.Connolly DM, Madden LA, Edwards VC, D'Oyly TJ, Harridge SDR, Smith TG, Lee VM. Early human pathophysiological responses to exertional hypobaric decompression stress. Aerosp Med Hum Perform. 2023; 94(10):738-749.

Cardiac masses and the role of imaging in their diagnostic

Abstract Objectives Myxomas are the most common primary tumors of the adult heart and should be considered in the differential diagnosis of intracavitary cardiac masses, along with thrombi and vegetations. Methods We report a case of a 64-year-old obese, hypertensive woman, who presented with dyspnea on moderate exertion as well as fatigue. The patient was admitted to our hospital after the discovery on transthoracic echocardiography of an intracardiac mass, which was highly suggestive for a left atrial myxoma. Results On admission, the patient presents no abnormalities on physical exam, with blood tests showing only slight deviations in the lipid profile. The ECG presents a normal sinus rhythm of 80/min with two premature ventricular contractions and a premature atrial contraction. Transthoracic echocardiography revealed the presence of a well-defined, pediculated, left atrial mass attached to the interatrial septum, measuring 25/17 mm, with no apparent interference in mitral valve motion. We supplemented our investigations with the use of transesophageal echocardiography which further defined the dimensions and location of the tumor, while also showing the presence of an atrial septal aneurysm associated to two small atrial septal defects measuring 6 mm and 7 mm respectively, with a left to right shunt. Cardiac CT examination confirmed the benign aspect of the mass and offered important anatomical elements, useful in preoperative planning. The patient was, therefore, admitted to our Cardiovascular Surgery department, where a successful surgical resection of the tumor was performed, without any local or systemic complications. The differential diagnosis of this mass included intracavitary thrombi, vegetations, as well as other histological subtypes of benign or malignant tumors, while the presence of an atrial septal defect, which represents a possible source of paradoxical emboli, provided an additional challenge. Conclusions This complicated case stands out due to its particular echocardiographic appearance and emphasizes the importance of a comprehensive evaluation in both the differential diagnosis and preoperative assessment.

Pregnancy risk and contraception among reproductive-age women with rheumatic heart disease attending care at a tertiary cardiac center in Tanzania: a hospital-based cross-sectional study

BackgroundRheumatic heart disease (RHD) remains prevalent in the developing world and reproductive-age women are disproportionately affected. It is among the common est cardiac diseases during pregnancy and is associated with poor pregnancy outcomes. Despite its importance among reproductive-age women, there are no local studies that characterize the clinical characteristics, risk of poor pregnancy outcomes and contraception which represents one effective way to prevent unplanned pregnancies in this population.MethodsThis was a hospital-based descriptive cross-sectional study. Non-pregnant reproductive-age women with echocardiographically diagnosed RHD were consecutively recruited from in- and out-patients units of the Jakaya Kikwete Cardiac Institute (JKCI). A clinical research form was used to gather socio-demographic, clinical characteristics, contraception status and echocardiographic information. The maternal/pregnancy risk class was determined using the modified World Health Organization (WHO) classification of maternal risk.ResultsTwo hundred thirty-eight women of reproductive age with RHD were recruited. The median age (range) was 36 years (15–49). Two-thirds were dyspneic on moderate exertion and 17.2% had New York Heart Association class IV heart failure. A quarter had atrial fibrillation/flutter. On echocardiography, mitral regurgitation was the most common valvular lesion (68.1%), followed by mitral stenosis (66.8%), and 12.2% of participants had reduced left ventricular ejection fraction. Two-thirds (66%) had a high pregnancy risk (class IV) based on the modified WHO classification system. The proportion of participants using contraception was 7.1% and common methods were: bilateral tubal ligation 5 of 17 (29.4%) and hormonal implant (4 of 17). The most common reason for the choice of a method was safety, 10 out of 17 (58.8%).ConclusionThe majority of women of reproductive age with RHD in our hospital cohort are at the highest pregnancy risk based on the modified WHO classification and a very small proportion of them are on contraception. These results call for action among clinicians to offer counselling to these patients, educating them on their risk and offering appropriate contraception advice while waiting for definitive interventions.

Surgical Treatment of Aortic Valve Papillary Fibroelastoma in Combination With Coronary Artery Bypass Grafting

Objective: To describe a rare case of surgical treatment of aortic valve papillary fibroelastoma in combination with coronary artery bypass grafting. Clinical case: The patient was hospitalized with a suspected mass on the left coronary cusp of the aortic valve and complained of retrosternal pain that appeared during moderate exertion and brisk walking and went away with rest. The patient history revealed that these clinical manifestations began in February 2022 and were treated by coronary stenting. Since May 2022 the patient noticed symptoms of recurrent angina. Transthoracic echocardiogram dated June 14, 2022 revealed a 13 × 12 mm additional mobile mass on the left coronary cusp. On June 30, 2022 the patient had an open surgery: mass removal, coronary artery bypass grafting of the anterior descending artery, and coronary artery bypass grafting of the circumflex artery. During the aortic valve exploration, the mass was visualized on the left coronary cusp on the side of the left ventricle. The mass was removed by precision marginal excision. Conclusions: To timely examine patients, refer them for surgical treatment, preserve and prolong their life, and improve its quality, clinical practitioners should know clinical manifestations and challenges in screening for aortic valve papillary fibroelastoma.

Rhabdomyolysis of rare etiology

A40-year-old Syrian man presented to the emergency department with a5-day history of anuria. He had previously excreted dark urine. Major rhabdomyolysis and crush kidney were found, meaning that hemodialysis was immediately initiated. Adetailed patient history in the patient's mother tongue revealed indications of metabolic myopathy. The PYGM-associated glycogen storage disease typeV (McArdle disease) was confirmed by next generation sequencing panel diagnostics. The most important treatment approach is to avoid rhabdomyolysis through only moderate physical exertion.

P155 CT EVIDENCE OF PARTIAL ISCHEMIC PAPILLARY MUSCLE RUPTURE

Abstract A 77–year–old man was referred for coronary CT following an episode of prolonged chest pain that occurred about 30 days earlier, with subsequent onset of dyspnea on moderate exertion. Coronary CT demonstrated right dominance, occlusion of the right coronary artery, as well as severe stenosis of the distal segment of the left anterior descending artery and of the first obtuse marginal branch. CT scan also showed an intraventricular image consistent with partial rupture of the posteromedial papillary muscle (Figure 1). The patient was transferred to the emergency department. An ECG showed signs of inferolateral necrosis. Transthoracic echocardiography confirmed akinesia of the inferior and inferolateral walls and of the basal segment of the inferior septum, with severe mitral valve insufficiency from anterior leaflet prolapse (A3 scallop) from partial rupture of the posteromedial papillary muscle (Figure 2). Transesophageal echocardiography confirmed the diagnosis (Figure 3). The patient was admitted to the CCU and underwent coronarography, which confirmed the severe triple vessel coronary artery disease with occlusion of the right coronary artery, and then urgent mitral valve replacement with bioprosthesis and aortocoronary bypass with saphenous vein grafting to the posterior descending artery. The postoperative course was uneventful. Ischemic papillary muscle rupture is a rare cause of mitral insufficiency. Papillary rupture typically occurs within 5 days of an acute myocardial infarction, and causes mitral insufficiency by prolapse and flail of one or, more rarely, both mitral valve leaflets. The posteromedial papillary muscle is most commonly affected, since the anterolateral papillary muscle has dual supply from the anterior interventricular artery and the circumflex artery. Papillary muscle rupture can be total or partial; however, most cases of partial rupture progress to complete rupture and therefore require urgent surgical treatment. The peculiarity of this case lies in the fact that it is the first case described in the literature of a papillary muscle rupture documented on CT.

C83 BEHIND MYOCARDITIS DIAGNOSIS

Abstract Background Myocarditis is an inflammatory disease of myocardium, with a wide range of clinical presentation. Myocarditis may mimic acute coronary syndrome (ACS), but it is also possible an overlap between these two different syndromes, as we considered the close relationship between wide inflammatory systemic condition and coronary atherosclerotic plaque instability Case report: We report the case of 29 years old man admitted to emergency department for burning chest pain changed with breathing and in different positions of the body, associated to dyspnea on mild–moderate exertion. Symptoms had begun to arise a week earlier, with flu–like symptoms, and got worse in the last 48 hours. In his clinical history the patient reports: previous myocarditis, dyslipidemia, hyperhomocysteinemia, overweight, family history of cardiovascular disease and a previous COVID infection. Blood tests found a rise of Troponin I HS. Electrocardiogram showed diphasic T wave in antero–lateral leads. An echocardiogram showed left ventricle with normal cavitary dimensions and preserved global systolic function, apical segment of interventricular septum and inferior wall hypokinetic; minimal pericardial detachment with leaflet hyperecogenicity. The patient was admitted to Cardiology ward, and he was given a medical therapy with colchicina 0.5 mg 1 cp x 2/die and AcetylSalicilic Acid 1000 mg x 3 /die. Cardiac Magnetic Resonance showed epi–mesocardial LGE in inferior and lateral distal segments, compatible with myocarditis. CT coronary angiography exhibited a calcified plaque determining partial caliber reduction in anterior descending coronary proximal segment, the coronary in its apical portion appeared ectatic, hypodense and poorly dulled likely for steno–occlusion. Therefore, it was performed a coronary angiography that revealed an anterior descending coronary artery occluded at the apical tract, the OCT showed plaque erosion with thrombotic apposition at the mid–proximal tract of the vessel. Finally, considered results of instrumental exams, a second antiplatelet agent, a hypolipidemic drug were added Discussion According to the cardiac MRI findings and the coronary angiography, it was hypothesized a picture of acute coronary syndrome triggered by erosion of the unstable coronary plaque, induced by the massive myocardial inflammation related to the myocarditis. The relationship between acute infections and myocardial infarction has been already established in COVID–19 patients

P168 FOLLOW–UP IN A PATIENT WITH LYMPHOMA UNDERGOING CHEMOTHERAPY TREATMENT

Abstract We present the case of a 55–year–old hypertensive patient, with no other cardiovascular risk factors and no noteworthy cardiovascular history. Suffering from lymphoma, derived from grade I/II peripheral B lymphocytes, diagnosed in January 2018, underwent chemotherapy according to the R–CHOP scheme and continued until September 2021 with immunotherapy (Rituximab). The follow–up cardiological evaluation in September 2022 refers to dyspnoea for moderate exertion and some episodes of stinging chest pain, of short duration, not associated with neurovegetative symptoms. The Echocardiogram documented a left ventricular global systolic function at the lower limits of the norm evaluated with Eco3D (FE 53%). GLS –17.6%. ECG normal. A Coro–Tc was recommended and scheduled which documented the presence on the middle part of the anterior descending artery of partially calcified atheromatous plaque which extends for about 5 mm and which determines the reduction of the area by 67% and of the diameter of 70% therefore the patient underwent a coronary angiography with angioplasty with implantation of a medicated stent on IVA. This case demonstrates how important it is to perform a careful follow–up in cancer patients and how properly used imaging methods can help us in diagnosis and treatment.

Wet-Bulb Temperature or Heat Index: Which Better Predicts Fatal Heat in a Warming Climate?

The wet-bulb temperature of 35 °C has been widely used as the threshold for human survivability in the field of climate science. However, recent experiments have shown that a person's core temperature starts to rise at a range of critical wet-bulb temperatures well below this threshold. It is shown here why this state of severe heat stress cannot be predicted using the wet-bulb temperature. Instead, it is shown that the recently extended heat index can explain nearly all of the variance in the observed critical combinations of temperature and humidity in those heat-stress experiments. For light and moderate exertion in an indoor setting, the heat index predicts that the critical wet-bulb temperature ranges from 20 to 32 °C, depending on the relative humidity, consistent with experimental results. For the same setting and exertion, the heat index predicts fatal wet-bulb temperatures ranging from 24 to 37 °C. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Undiagnosed sub-valvular aortic stenosis with an associated Ventricular Septal Defect (VSD) presenting late in a multi-parous woman

BackgroundSub-valvular aortic stenosis is a rare disorder that has a prevalence of 6.5% of all adult congenital heart diseases. The hemodynamic changes that occur in pregnancy with the resultant increase in cardiac output may not well be tolerated by a pregnant woman with sub-valvular aortic stenosis.Case presentationWe report the case of a 34-year-old para 7 (6 alive + 1 dead) who has been experiencing intermittent episodes of easy fatigability on moderate exertion since childhood and had survived 6 prior pregnancies. During her last pregnancy, she started experiencing chest pain, palpitations, dyspnea, orthopnea, and pre-syncope at 36 weeks and had a caesarean section at 37 weeks on account of fetal distress. The post-delivery cardiac evaluation showed severe sub-valvular Aortic stenosis and a ventricular septal defect.ConclusionSub-valvular Aortic stenosis may progress slowly in adults and may be tolerated during pregnancy. Despite the rare presentation and contraindication of pregnancy in such a patient, she extraordinarily survived the pregnancy with a healthy baby. Routine cardiovascular assessment during prenatal, ante-natal and post-natal care is highly advocated particularly so in resource-poor settings.

The effect of physical activity on electrophysiological processes in the ventricular myocardium in child-athletes

Maladaptation processes in the cardiovascular system in child athletes are associated with changes in electrophysiological processes in the myocardium. To identify risk groups for the development of the cardiovascular system pathology among this contingent, it is possible to use a non-invasive technique: ECG dispersion mapping.Purpose. To identify changes in electrophysiological processes in the myocardium of the left and right ventricles in child athletes in response to physical activity.Material and methods. 279 healthy children without chronic disease aged from 12 to 18 years were under observation. A group of 209 children involved in sports has been identified. The gender distribution is as follows: 153 boys (73%) and 56 girls (27%). The reference group included 70 children not involved in sports. All child athletes had access to the training and competition process. Within the study group, 4 subgroups were allocated in accordance with sports: A subgroup — children attending the football section (51 boys); B — basketball (37 boys and 22 girls); C — volleyball (29 boys and 27 girls); D — martial arts (36 boys and 7 girls). All children underwent dispersion mapping of the electrocardiogram using the Cardiovisor software and hardware complex before and after the exercise test. The processes of depolarization and repolarization in the myocardium of the left and right ventricles were analyzed on the basis of G3–G6 indices. Statistical processing of the results was carried out using MS Excel, Stata.Results. The analysis of electrophysiological processes in the myocardium of the left and right ventricles in child athletes showed statistically significant differences in comparison with the reference group. In all G3-G6 indicators in the main group, a moderate deviation was noted, while all values in the reference group were within normal limits in more than 92%. Moderate physical exertion led to the registration of both moderate and pronounced electrophysiological disturbances in the myocardium, especially in children engaged in highly dynamic sports, namely basketball.

Flexor-Pronator Mass Training Exercises Selectively Activate Forearm Musculature.

The flexor-pronator mass of the forearm contributes dynamic stability to the medial elbow. Training this muscle group is essential for overhead athletes, however, there is lack of evidence supporting use of training exercises. The purpose of this study was to measure the extent of EMG activity of the flexor pronator musculature during two distinct forearm strengthening exercises using resistance bands. It was hypothesized that two exercises would elicit at least moderate level of muscle activity, but the activation would be different in the pronator versus the flexor muscles. 10 healthy subjects (all males, age 36±12 years) were included. Surface EMG activity was measured on three muscles of the dominant-side forearm: flexor carpi ulnaris (FCP), flexor digitorum superficialis (FDS), and pronator teres (PT). After measurement of maximal voluntary contraction (MVC) for each muscle, subjects performed wrist ulnar deviation and forearm pronation exercises using elastic band resistance. Resistance was set to elicit moderate exertion (5/10 on the Borg CR10 scale). Order of exercise was randomized and three repetitions of each exercise were performed. Mean peak EMG activity in each muscle across repetitions during the eccentric phase of each exercise was calculated and expressed as a percentage of MVC. Moderate level of activity was defined as 21% of MVC or higher. Peak normalized EMG activity in each muscle was compared using two-way (exercise x muscle) repeated-measures ANOVA with post-hoc pairwise comparisons if a significant interaction was found. There was an exercise by muscle interaction effect (p<0.001). The ulnar deviation exercise selectively activated FCU (40.3%) versus FDS (19.5%, p=0.009) and PT (21.5%, p=0.022). Conversely, the pronation exercise selectively activated FDS (63.8%, p=0.002) and PT (73.0%, p=0.001) versus FDS (27.4%). The ulnar deviation and pronation exercises using elastic band resistance studied targeted and activated the flexor-pronator mass musculature. The ulnar deviation and pronation exercises using elastic band resistance are practical and effective means of training the flexor-pronator mass. These exercises can be readily prescribed to athletes and patients as part of their arm care program.