Luis Miguel

Introduction: Hypertrophic cardiomyopathy (HCM) is a common myocardial disease worldwide and is associated with heart failure symptoms and sudden cardiac death. In a subset of patients, it may produce dynamic left ventricular outflow tract obstruction (LVOTO) and systolic anterior motion (SAM)-related mitral valve dysfunction through drag forces and altered mitral–septal geometry. In contrast, subaortic stenosis caused by a subaortic membrane is an uncommon congenital lesion that may lead to fixed subvalvular LVOTO in adulthood. The coexistence of these entities is rare and can substantially complicate diagnosis and management. Case presentation: A 51-year-old woman with HCM, paroxysmal atrial fibrillation, and heart failure presented with acute decompensation and cardiogenic shock. After initial hemodynamic stabilization and cardioversion for atrial fibrillation with rapid ventricular response, multimodality imaging with transthoracic and transesophageal echocardiography, coronary computed tomography angiography, and cardiac magnetic resonance demonstrated dual LVOTO, with a dynamic component related to HCM/SAM physiology and a fixed component caused by an elongated subaortic membrane, accompanied by severe SAM-related mitral regurgitation. Echocardiography showed a resting peak LVOT gradient of 49 mmHg, increasing to 85 mmHg with the Valsalva maneuver. After exclusion of obstructive coronary artery disease and evaluation for selected phenocopies, the patient underwent septal myectomy, subaortic membrane resection, and adjunctive mitral valve plication. Early postoperative echocardiography showed reduction in the maximum provoked LVOT gradient to 38 mmHg and improvement of mitral regurgitation from severe to mild. At 3-month follow-up, she remained in sinus rhythm, improved to New York Heart Association functional class II, and had no documented readmissions for heart failure. Conclusions: Combined fixed and dynamic LVOTO due to concomitant subaortic membrane and HCM is exceedingly rare. Accurate diagnosis requires a high index of suspicion and a multimodality imaging strategy to define the obstructive mechanisms and support mechanism-based surgical management and avoid incomplete treatment when a coexisting fixed lesion is present.

The immunosuppression inherent to chronic lymphocytic leukemia (CLL) is the most frequent cause of morbidity and mortality associated with this pathology. Both the innate and adaptive immune responses exhibit marked functional alterations, with a bias towards a tolerant environment that favors the spread of the disease. This condition is reflected in increased risk of infections, immune-mediated cytopenias, and associated second malignancies. Knowledge of these alterations, both in the molecular pathways that modulate T cell activity in CLL (the T lymphocyte cytotoxic antigen-4 (CTLA-4) axis and programmed cell death 1 (PD-1)) and at the T cell immunoreceptor level, could be of interest as therapeutic targets in CLL. In this review, we will analyze the main consequences of this dysfunction and its management strategies.

Introduction: This systematic review examines the association between ultraprocessed food (UPF) intake and cognitive and executive function in adults. Given the global rise in overweight and obesity and the increasing consumption of UPFs, understanding their potential impact on brain health is of growing importance. Method: A comprehensive literature search was conducted in PubMed, EBSCO, and Scopus databases following PRISMA guidelines. Fourteen studies met inclusion criteria, encompassing cross-sectional, longitudinal, and experimental designs. Risk of bias was assessed using the National Institutes of Health Quality Assessment Tool. Results: The majority of studies (78.5%) reported a significant association between higher UPF consumption and poorer cognitive outcomes, including deficits in memory, executive function, and global cognition. Longitudinal studies consistently demonstrated that increased UPF intake is linked to accelerated cognitive decline and a higher risk of mild cognitive impairment and dementia, particularly in middle-aged and older adults. In contrast, cross-sectional findings were more heterogeneous, and evidence in younger populations remains limited and inconclusive. Conclusions: Overall, the findings suggest that high UPF consumption may be a modifiable risk factor for cognitive decline. However, methodological variability and the predominance of observational studies highlight the need for further longitudinal and experimental research to clarify causal mechanisms.

Technologies and Engineering School (EET), Instituto Politécnico da Lusofonia (IPLuso), 1700-098 Lisbon, Portugal

Background/Objectives: Hyperkalemia is common in patients with chronic kidney disease (CKD). However, its epidemiology may be evolving due to population aging, new therapeutic developments and novel estimated glomerular filtration rate (eGFR) equations. We have re-evaluated the epidemiology of hyperkalemia in a contemporary cohort in which eGFR was assessed using the EKFC equation recommended by the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM). Methods: We analyzed 190,579 laboratory tests with serum potassium values corresponding to individual outpatients in Primary or Specialty Care from a single laboratory in 2023, representing 42% of the catchment area population. Results: Hypokalemia (<3.5 mmol/L) was present in 0.3% patients, hyperkalemia (≥5.0 mmol/L) in 10.5% (11.5% of men, 9.7% of women). Hyperkalemia was mostly mild (9.4%) but was severe in 0.1% overall and in 10.5% of CKD G5. One in four patients with hyperkalemia had CKD. Hyperkalemia was more common among patients with CKD G3–G5 defined using the CKD-EPI2009 equation than defined using the EKFC equation (20.5 vs. 18.6%, p < 0.0001). Using EKFC, hyperkalemia prevalence increased with decreasing eGFR from G1 (6.6%) to G2 (10.8%) and, especially in CKD G3–G5 (G3 17.2% to G5 47.5%). In multivariate logistic analysis, worse renal function, worse diabetes control, older age, and surrogates for release of intracellular potassium during sample processing (red blood cell counts or size, platelet counts, elevated calcium levels) were independently associated with hyperkalemia. This multivariate model yielded an area under the curve (AUC) of the Receiver Operating Characteristic (ROC) curve for hyperkalemia of 0.678 (95% CI 0.674–0.682). Random forest also identified GFR as the most important feature associated with hyperkalemia and generally concurred with logistic analysis findings. Conclusions: Hyperkalemia remains common, especially in CKD G5. While hyperkalemia is mainly associated with low eGFR, sample processing should be optimized.

Developing eco-friendly metal oxide nanoparticles (NPs) with plant-based reducing and stabilizing agents offers a sustainable alternative to traditional chemical methods. Nonetheless, the detailed mechanisms by which phytochemicals influence NPs formation, antimicrobial properties, and cytocompatibility remain poorly understood, especially in systems mediated by Vaccinium. This study aimed to synthesize TiO2 NPs and ZnO NPs using Vaccinium corymbosum (blueberry) extract, analyze their structural and surface characteristics, assess their antimicrobial effectiveness and cytotoxicity, and explore potential molecular mechanisms through computational docking. ZnO NPs were produced via alkaline precipitation (pH 12) from ZnCl2, while food-grade TiO2 was mixed with blueberry extract. A comprehensive characterization was carried out using techniques like X-ray diffraction (XRD), Fourier-transform infrared spectroscopy (FTIR), X-ray photoelectron spectroscopy (XPS), Raman spectroscopy, transmission and scanning electron microscopy (TEM/SEM), dynamic light scattering (DLS), and high-performance liquid chromatography (HPLC) for polyphenol profiling. The antimicrobial activity was tested against Escherichia coli and Salmonella Typhimurium, and the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were determined. Cytotoxicity was assessed using Gallus gallus domesticus leukocytes and Artemia salina bioassays, and molecular docking simulations were performed to examine polyphenol interactions with the bacterial DNA gyrase subunit B (GyrB). XRD analysis confirmed the presence of wurtzite ZnO (with a crystallite size of 18.2 nm) and anatase TiO2 (12.8 nm after functionalization). HPLC identified key polyphenols, including quercetin, cyanidin, malvidin, and cyanidin-3-glucoside, with patterns indicating stronger adsorption onto TiO2 NPs surfaces. ZnO NPs showed higher antimicrobial effectiveness (>90% inhibition at 2 mg/mL; MIC 0.5–1 mg/mL) compared to TiO2 (72% inhibition at 16 mg/mL; MIC 8–16 mg/mL). Cytotoxicity results indicated concentration-dependent effects. Molecular docking simulations revealed favorable binding energies (−6.2 to −8.4 kcal/mol) for blueberry polyphenols with GyrB, suggesting potential synergistic antimicrobial effects and ROS production. The study highlights a successful green synthesis of bioactive TiO2 NPs and ZnO NPs using Vaccinium corymbosum extract, where polyphenol surface functionalization enhances both colloidal stability and biological activity. This comparative research offers mechanistic insights into how polyphenol-coated NPs work and supports the development of eco-friendly antimicrobial oxide nanomaterials.

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