Hepatitis D virus (HDV) infection poses a serious global health burden due to its rapid progression to cirrhosis, hepatic decompensation, and hepatocellular carcinoma

Introduction: Left ventricular dysfunction in an independent predictor of mortality in Chagas disease. Global longitudinal strain (GLS) is an emerging echocardiographic modality with possible incremental value in early detection of cardiac involvement. Objective: Compare left ventricular function with multiple echocardiographic parameters between patients with the indeterminate and chronic forms of Chagas and perform a literature review. Methods: In this observational study, 11 patients with a confirmed diagnosis of Chagas disease were evaluated. Individuals were distributed as follows: 5 with the indeterminate and 6 with the chronic forms. Conventional echocardiographic evaluation was followed by GLS measurement. Results: The mean left ventricle ejection fraction LVEF was 33 ± 2.88 and the mean GLS of the left ventricle was - 10.76 ± 2.20 in the chronic form as compared to 57.80 ± 6.49 and - 17.34 ± 3.82, respectively in the indeterminate group. Contractility was reduced in segments of the inferior, inferoseptal and anteroseptal walls in both groups. Conclusion: Analysis of longitudinal strain in the indeterminate form has potential incremental value to the conventional analysis of ejection fraction when compared to patients with chronic Chagas cardiomyopathy, especially with individual segmental analysis but the impact and clinical significance of these techniques is still unknown.

Introdução: Disfunção ventricular esquerda como preditor independente de mortalidade na doença de Chagas. A deformação longitudinal global (DLG) é uma modalidade ecocardiográfica emergente com possível valor incremental na detecção precoce de envolvimento cardíaco. Objetivo: Comparar a função ventricular esquerda com múltiplos parâmetros ecocardiográficos entre pacientes com formas indeterminadas e crônicas de Chagas, e realizar uma revisão da literatura. Metodologia: Neste estudo observacional, 11 pacientes com diagnóstico confirmado de doença de Chagas foram avaliados. Os indivíduos foram distribuídos da seguinte forma: cinco com as formas indeterminadas e com as formas crônicas. A avaliação ecocardiográfica convencional foi acompanhada pela medida da DLG. Resultados: A média da fração de ejeção do ventrículo esquerdo (FEVE) foi de 33 ± 2,88 e a DLG média do ventrículo esquerdo foi de -10,76 ± 2,20 na forma crônica, em comparação com 57,80 ± 6,49 e -17,34 ± 3,82, respectivamente no grupo indeterminado. A contratilidade foi reduzida em segmentos das paredes inferior, inferoseptal e ântero-septal em ambos os grupos. Essas alterações segmentares no grupo indeterminado podem ser atribuídas ao dano miocárdico precoce por inflamação e fibrose, mesmo antes de uma disfunção ventricular esquerda significativa se tornar evidente. Conclusão: A análise da deformação longitudinal na forma indeterminada tem potencial valor incremental à análise convencional da fração de ejeção quando comparada a pacientes com cardiomiopatia chagásica crônica, principalmente com a análise segmentar individual, mas o impacto e o significado clínico dessas técnicas ainda são desconhecidos.

Background: Venous vascular lesions in the lower extremities pose a significant clinical challenge due to their varied etiology and complexity. Practical assessment and management of these lesions require a thorough understanding of their underlying causes and appropriate treatment modalities. Objective: Using a simulated case study approach, this research paper will comprehensively analyze assessment and management strategies for venous vascular lesions in the lower extremities. By employing this method, the paper seeks to enhance healthcare professionals' knowledge and decision-making capabilities in diagnosing and treating venous vascular issues. Methods: The paper utilizes a simulated case study format to explore assessment and management strategies for venous vascular lesions in the lower extremities. Through an in-depth analysis of a representative case, various diagnostic techniques, treatment options, and therapeutic interventions are discussed and evaluated. Results: The simulated case study highlights the diverse etiology and complexity of venous vascular lesions in the lower extremities. Assessment strategies encompass clinical examination, imaging studies, and diagnostic procedures tailored to identify the underlying pathology. Management approaches, including conservative measures, minimally invasive interventions, and surgical techniques, are discussed in detail, considering the individual patient's needs and preferences. Conclusion: By employing a simulated case study approach, this paper provides valuable insights into assessing and managing venous vascular lesions in the lower extremities. Healthcare professionals can utilize the knowledge gained from this analysis to improve their diagnostic accuracy and optimize treatment outcomes for patients with venous vascular issues. Background: Venous vascular lesions in the lower extremities pose a significant clinical challenge due to their varied etiology and complexity. Practical assessment and management of these lesions require a thorough understanding of their underlying causes and appropriate treatment modalities. Objective: Using a simulated case study approach, this research paper will comprehensively analyze assessment and management strategies for venous vascular lesions in the lower extremities. By employing this method, the paper seeks to enhance healthcare professionals' knowledge and decision-making capabilities in diagnosing and treating venous vascular issues. Methods: The paper utilizes a simulated case study format to explore assessment and management strategies for venous vascular lesions in the lower extremities. Through an in-depth analysis of a representative case, various diagnostic techniques, treatment options, and therapeutic interventions are discussed and evaluated. Results: The simulated case study highlights the diverse etiology and complexity of venous vascular lesions in the lower extremities. Assessment strategies encompass clinical examination, imaging studies, and diagnostic procedures tailored to identify the underlying pathology. Management approaches, including conservative measures, minimally invasive interventions, and surgical techniques, are discussed in detail, considering the individual patient's needs and preferences. Conclusion: By employing a simulated case study approach, this paper provides valuable insights into assessing and managing venous vascular lesions in the lower extremities. Healthcare professionals can utilize the knowledge gained from this analysis to improve their diagnostic accuracy and optimize treatment outcomes for patients with venous vascular issues.

Introduction: The disease caused by Coronavirus-2019 (COVID-19) was initially described in December 2019. Severe acute respiratory syndrome type 2 (Sars-Cov-2) is responsible for an important multisystem inflammatory spectrum. Cardiovascular conditions have been reported with an estimated frequency of 8-28%. In this context, transthoracic echocardiography associated with the analysis of the two-dimensional Global Longitudinal Strain (GLS) of the left ventricle derived from Speckle Tracking emerges as a promising modality. Objective: This study aims to evaluate the applicability of GLS and segmental deformity assessment in detecting subclinical myocardial dysfunction in patients that recovered from COVID-19 infection. Methods: The observational study involved 18 patients (mean age 52 years) with recent evidence of COVID-19 infection that underwent detailed echocardiographic evaluation with GLS, and cardiac magnetic resonance (CMR) according to segmental assessment results. The degree of correlation between the methods was analyzed and a systematic literature review was also conducted. Results: The mean left ventricular ejection fraction (LVEF) was 57.50 ± 9.98%. Only 16.6% of patients had reduced LVEF. The average GLS was – 18.70 ± 3.54% and in 44% of cases only one myocardial segment was affected, particularly the inferolateral basal. CMR revealed inflammatory cardiomyopathy. Discussion: Subclinical myocardial involvement is associated with major adverse cardiac events. Literature review supports the use of GLS for detecting early cardiac involvement. Conclusion: Speckle-tracking echocardiography has been shown to have clinical utility in a variety of settings and to offer superior prognostic value with a potential to enhance subclinical detection of myocardial changes in patients after COVID-19 infection.

Objective: To compare the efficacy and safety of bulevirtide (BLV) monotherapy versus BLV plus pegylated interferon alfa-2a (Peg-IFNα-2a) in adults with chronic hepatitis D. Methods: We conducted a systematic review and meta-analysis in accordance with PRISMA 2020 (PROSPERO: CRD420251137112). Randomized controlled trials (RCTs) directly comparing BLV plus Peg-IFNα-2a with BLV monotherapy were identified through PubMed/MEDLINE, Embase, Scopus, the Cochrane Library, Google Scholar, and ClinicalTrials.gov. The original searches were completed in August 2025. All information sources were searched again on September 21, 2026, to identify any newly published eligible trials. Trial-defined virological, biochemical, and combined responses and changes in HDV RNA and ALT were synthesized using random-effects models. The primary analyses used restricted maximum likelihood estimation with the Hartung–Knapp–Sidik–Jonkman (REML-HKSJ) adjustment. DerSimonian–Laird (DL) random-effects analyses with conventional normal-approximation confidence intervals were performed as sensitivity analyses. Results: Three RCTs comprising 225 patients were included. At week 24, virological response was numerically higher with BLV plus Peg-IFNα-2a, although the difference was not statistically significant (RR 2.07, 95% CI 0.38–11.40), while no difference was observed in combined response (RR 1.01, 95% CI 0.12–8.48). Combination therapy produced a greater reduction in HDV RNA (Hedges’ g − 0.96, 95% CI − 1.75 to − 0.18). In contrast, biochemical response favored BLV monotherapy (RR 0.36, 95% CI 0.17–0.78), as did ALT change (MD 45.58 U/L, 95% CI 33.51–57.65). At week 48, virological response favored combination therapy (RR 5.33, 95% CI 1.57–18.12), whereas biochemical and combined responses did not differ significantly between groups. At 24 weeks post-EOT, combined response favored combination therapy (RR 4.15, 95% CI 1.05–16.40), while the virological and biochemical response estimates remained imprecise. Peg-IFNα-2a containing combination regimens were associated with higher rates of neutropenia and thrombocytopenia. DL sensitivity analyses yielded narrower confidence intervals for several outcomes and changed the statistical significance of some longer-term estimates. Conclusions: BLV plus Peg-IFNα-2a was associated with greater virological suppression, whereas BLV monotherapy showed more favorable on-treatment biochemical responses. Follow-up estimates were based on only two randomized trials, with wide confidence intervals for several outcomes under the primary REML-HKSJ analysis. The available randomized evidence should therefore be interpreted cautiously, particularly for longer-term and post-treatment outcomes. Clinical trial number: Not applicable.