Ventral medial prefrontal cortex (vMPFC) glutamatergic neurotransmission has a facilitatory role on cardiac baroreflex activity which is mediated by NMDA receptors activation. Corticotrophin releasing factor receptors type1 and 2 (CRF1 and CRF2), present in the vMPFC, are colocalized in neurons containing glutamate vesicles, suggesting that such receptors may be involved in glutamate release in this cortical area. Therefore, our hypothesis is that the CRF1 and CRF2 receptors can modulate the baroreflex bradycardic and tachycardic responses. In order to prove this assumption, male Wistar rats had bilateral stainless steel guide cannula implanted into the vMPFC, and baroreflex was activated by intravenous infusion of phenylephrine or sodium nitroprusside through a vein catheter. A second catheter was implanted into the femoral artery for cardiovascular measurements. The CRF1 receptor antagonist administration in either infralimbic cortex (IL) or prelimbic cortex (PL), vMPFC regions, was unable to change the bradycardic responses but increased the slope of the baroreflex tachycardic activity. Microinjection of the CRF2 receptor antagonist into the IL and PL did not alter ether bradycardic nor tachycardic baroreflex responses. The administration of the non-selective CRF receptors agonist, urocortin in these areas, did not modify bradycardic responses but decreased tachycardia slope of the baroreflex. CRF1 receptor antagonist administration prior to non-selective CRF agonist in vMPFC prevented the tachycardic responses reduction. However, CRF2 receptor antagonism could not prevent the effect of CRF receptors agonist. These results suggest that IL and PL CRF1 but not CRF2 receptors have an inhibitory role on the baroreflex tachycardic activity. Furthermore, they have no influence on baroreflex bradycardic activity.
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Cureus
December 2024
Internal Medicine, Hurley Medical Center, Flint, USA.
Catheter ablation procedure for symptomatic atrial fibrillation is an established treatment. Cardiac tamponade is one of the several complications associated with atrial fibrillation ablation. We present the case of a 60-year-old male with a past medical history of end-stage renal disease (ESRD) on hemodialysis, hypotension on midodrine, atrial fibrillation status post-ablation a week prior, and a cerebrovascular accident who presented to the emergency department with complaints of weakness, nausea, vomiting, confusion and some syncopal episodes for the past few days.
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December 2024
Internal Medicine, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, PRT.
Hemophagocytic lymphohistiocytosis (HLH) is a rare clinical entity characterized by fever, constitutional symptoms, and hepatosplenomegaly associated with the presence of hemophagocytosis in the bone marrow and other organs. Visceral leishmaniasis (VL) is a severe zoonotic disease hypoendemic in Portugal, particularly in the Alto Douro region. We report the case of a 21-year-old female patient with a recent diagnosis of human immunodeficiency virus (HIV) infection, stage C3, in the context of severe pneumonia, who presented to the emergency department with fever, erythematous rash on the upper limbs and trunk, choluria and jaundice, one week after starting antiretroviral therapy (ART).
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February 2025
Pharmaceutical Sciences Graduate Program, Health Sciences Centre, Federal University of Espírito Santo, Vitória, ES, Brazil; Department of Pharmaceutical Sciences, Health Science Centre, Federal University of Espírito Santo, Vitória, ES, Brazil. Electronic address:
Cureus
October 2024
Department of Cardiothoracic Surgery, Faculty of Medicine, Mansoura University, Mansoura, EGY.
Infective endocarditis (IE) is a serious cardiac infection of the endocardium, native and prosthetic valves, or cardiac device. In this case study, we report a case of an immunocompetent patient with severe aortic valve endocarditis. A 54-year-old female presented to the emergency department with progressive shortness of breath, chest pain, palpitations, and cough for a period of 20 days.
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October 2024
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Atraumatic splenic rupture (ASR) is an unfamiliar entity that is potentially life-threatening if there is a delay in the diagnosis. Due to its rarity and its non-specific presentation, it can be a challenge to diagnose early. In this report, we present a case of a 42-year-old male patient who presented to the emergency department with nonspecific abdominal pain and had no past medical history.
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