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1.
Arq. bras. cardiol ; 115(6): 1063-1069, dez. 2020. tab, graf
Article in Portuguese | LILACS | ID: biblio-1152946

ABSTRACT

Resumo Fundamento Estudos revelam que pacientes com insuficiência cardíaca (IC) e frequência cardíaca (FC) <70 batimentos por minuto (bpm) evoluem melhor e têm menor morbimortalidade em comparação com FC >70. Entretanto, muitos pacientes com IC mantêm FC elevada. Objetivo Avaliar se os pacientes acompanhados em ambulatório de cardiologia têm sua FC controlada e como estava a prescrição dos medicamentos que reduzem a mortalidade na IC. Métodos Foram analisados de forma consecutiva pacientes que passaram em consulta e que já acompanhavam em ambulatório de cardiologia, idade > 18 anos e com diagnóstico de IC e fração de ejeção do ventrículo esquerdo (FEVE) <45%. Os pacientes em ritmo sinusal foram divididos em dois grupos: FC ≤70 bpm (G1) e FC >70 bpm (G2). Na análise estatística, foram utilizados os testes t de Student, Qui-quadrado. Foi considerado significante p <0,05. Utilizamos o programa Statistical Package for the Social Sciences (SPSS) para análise. Resultados Foram avaliados 212 pacientes de forma consecutiva. Destes, 41 (19,3%) apresentavam fibrilação atrial ou eram portadores de marca-passo e foram excluídos desta análise; assim, 171 pacientes foram analisados. Os pacientes em ritmo sinusal tinham idade média de 63,80 anos (±11,77), sendo 59,6% homens e FEVE média de 36,64% (±7,79). Com relação à etiologia, a isquêmica estava presente em 102 pacientes (59,65%), enquanto a cardiopatia chagásica em 17 pacientes (9,9%); 131 pacientes eram hipertensos (76,6%), enquanto 63 pacientes (36,84%) eram diabéticos. Quanto à FC, 101 pacientes apresentaram FC ≤70 bpm (59,06%) G1 e 70 pacientes (40,93%) FC >70 bpm (G2). A FC média no G1 foi de 61,53 bpm (±5,26) e no G2, 81,76 bpm (±9,52), p <0,001. A quase totalidade dos pacientes (98,8%) estava sendo tratada com carvedilol prescrito na dose média de 42,14 mg/dia (±18,55) no G1 versus 42,48 mg/dia (±21,14) no G2, p=0,911. A digoxina foi utilizada em 5,9% dos pacientes no G1 versus 8,5% no G2, p=0,510. A dose média de digoxina no G1 foi de 0,19 mg/dia (±0,06) e no G2 foi de 0,19 mg/dia (±0,06), p=0,999. A maioria dos pacientes (87,72%) utilizou o inibidor da enzima de conversão da angiotensina (IECA) ou bloqueador do receptor da angiotensina (BRA), e 56,72% utilizaram espironolactona. A dose média de enalapril foi de 28,86 mg/dia (±12,68) e de BRA foi de 87,80 mg/dia (±29,80). A maioria dos pacientes utilizou IECA ou BRA e com doses adequadas. Conclusão O estudo revelou que 40,93% dos pacientes estavam com FC acima de 70 bpm, apesar de o betabloqueador ter sido prescrito para praticamente todos os pacientes e em doses elevadas. Outras medidas precisam ser adotadas para manter a FC mais controlada nesse grupo de frequência mais elevada. (Arq Bras Cardiol. 2020; 115(6):1063-1069)


Abstract Background Studies have shown that heart failure (HF) patients with heart rate (HR) < 70 bpm have had a better clinical outcome and lower morbidity and mortality compared with those with HR > 70 bpm. However, many HF patients maintain an elevated HR. Objective To evaluate HR and the prescription of medications known to reduce mortality in HF patients attending an outpatient cardiology clinic. Methods We consecutively evaluated patients seen in an outpatient cardiology clinic, aged older than 18 years, with diagnosis of HF and left ventricular ejection fraction (LVEF) < 45%. Patients with sinus rhythm were divided into two groups - HR ≤ 70 bpm (G1) and HR > 70 bpm (G2). The Student's t-test and the chi-square test were used in the statistical analysis, and a p-value < 0.05 was considered statistically significant. The SPSS software was used for the analyses. Results A total of 212 consecutive patients were studied; 41 (19.3%) had atrial fibrillation or had a pacemaker implanted and were excluded from the analysis, yielding 171 patients. Mean age of patients was 63.80 ± 11.77 years, 59.6% were men, and mean LVEF 36.64±7.79%. The most prevalent HF etiology was ischemic (n=102; 59.6%), followed by Chagasic (n=17; 9.9%). One-hundred thirty-one patients (76.6%) were hypertensive and 63 (36.8%) diabetic. Regarding HR, 101 patients had a HR ≤70 bpm (59.1%) and 70 patients (40.93%) had a HR >70 bpm (G2). Mean HR of G1 and G2 was 61.5±5.3 bpm and 81.8±9.5 bpm, respectively (p<0.001). Almost all patients (98.8%) were receiving carvedilol, prescribed at a mean dose of 42.1±18.5 mg/day in G1 and 42.5±21.1mg/day in G2 (p=0.911). Digoxin was used in 5.9% of patients of G1 and 8.5% of G2 (p=0.510). Mean dose of digoxin in G1 and G2 was 0.19±0.1 mg/day and 0.19±0.06 mg/day, respectively (p=0,999). Most patients (87.7%) used angiotensin converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB), and 56.7% used spironolactone. Mean dose of enalapril was 28.9±12.7 mg/day and mean dose of ARB was 87.8±29.8 mg/day. The doses of ACEI and ARB were adequate in most of patients. Conclusion The study revealed that HR of 40.9% of patients with HF was above 70 bpm, despite treatment with high doses of beta blockers. Further measures should be applied for HR control in HF patients who maintain an elevated rate despite adequate treatment with beta blocker. (Arq Bras Cardiol. 2020; 115(6):1063-1069)


Subject(s)
Humans , Male , Female , Adolescent , Aged , Angiotensin Receptor Antagonists , Heart Failure/drug therapy , Stroke Volume , Angiotensin-Converting Enzyme Inhibitors , Ventricular Function, Left , Treatment Outcome , Adrenergic beta-Antagonists/therapeutic use , Heart Rate , Middle Aged
3.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(3): 392-395, July-Sept. 2019. graf
Article in English | LILACS | ID: biblio-1041337

ABSTRACT

ABSTRACT Objective: To present the outcomes of fixed doses of propranolol tablets for the treatment of hemangiomas. Case description: Two illustrative cases of hemangioma in infant patients younger than six months old are described. Treatments were started in 2010 and 2011 and were monitored until August 2017. Patients were treated with fixed doses, initially calculated based on the upper limit of 3 mg/kg/day and administrated in two daily doses rounded down to the nearest multiple of five milligrams. Dosage was not adjusted to patients' weight gain. The tablets were crushed and then diluted in a maximum amount of 3 mL of water. This procedure was necessary because propranolol was not available in oral solution in 2009, when dosages available in the Brazilian market were 10, 40 and 80 mg. Both patients presented significative improvement in the first 60 days and were in complete remission by the end of the treatment. Comments: It is possible to treat patients with Propranolol 10 mg tablets, even though the dosage is not as precise as when calculated according to patients' weight. The maintenance of a fixed dose, ignoring the patient's progressive weight gains, helps avoiding the rebound effect and decreases complications.


RESUMO Objetivo: Apresentar a experiência com a utilização de propranolol em doses fixas, em forma de comprimido, para o tratamento de hemangiomas. Descrição do caso: Dois casos ilustrativos de portadores de hemangiomas com menos de seis meses de idade são descritos. O início de tratamento ocorreu nos anos de 2010 e 2011 com seguimento até agosto de 2017. Os pacientes foram tratados com doses fixas iniciais calculadas com limite máximo de 3 mg/kg/dia, divididas em duas doses diárias, sempre com quantidades múltiplas de 5 mg. Os comprimidos de 10 mg ou a sua metade eram macerados e diluídos em 3 mL de água. As doses não foram mais alteradas. Esse uso foi decorrente da ausência da forma líquida de propranolol em 2009, quando começamos a utilizar esse tratamento, sendo então apenas disponíveis comprimidos de 10, 40 e 80 mg. Os pacientes obtiveram melhora acentuada nos primeiros 60 dias e remissão completa posteriormente. Comentários: É possível o uso de comprimidos de 10 mg, apesar de resultar numa dose não exata, como a calculada por kg/peso. A manutenção da mesma dose, mesmo com aumento progressivo de peso, pode evitar o efeito rebote e diminuir o índice de complicações.


Subject(s)
Humans , Female , Child , Propranolol/therapeutic use , Skin Neoplasms/drug therapy , Adrenergic beta-Antagonists/therapeutic use , Hemangioma/drug therapy , Propranolol/pharmacology , Skin Neoplasms/pathology , Weight Gain , Treatment Outcome , Adrenergic beta-Antagonists/pharmacology , Dose-Response Relationship, Drug , Hemangioma/pathology
4.
Arq. bras. oftalmol ; 81(6): 490-493, Nov.-Dec. 2018. tab
Article in English | LILACS | ID: biblio-973846

ABSTRACT

ABSTRACT Purpose: To evaluate whether any topical anti-glaucoma medications increase the risk of lacrimal drainage system obstruction or whether the presence of preservatives alone is sufficient to generate obstruction. Methods: This nested case-control study compared a group of patients with lacrimal duct obstruction who received topical anti-glaucoma medications to a control group of patients without obstruction. Results: The medical records of 255 patients with glaucoma who consulted the Oculoplastic Section with complaints of watery eyes were reviewed. Among these patients, 59 exhibited lacrimal drainage obstruction. Ninety-four percent of patients with lacrimal drainage obstruction used beta-blockers, and 41% used prostaglandin analogs. A logistic regression model was used to adjust for age, sex, and the use of other medications. No significant differences were observed regarding the topical anti-glaucoma medications used between groups. Conclusion: No single topical anti-glaucoma medication demonstrated a stronger association with the development of lacrimal duct obstruction.


RESUMO Objetivo: Avaliar se algum medicamento tópico anti-glaucoma aumenta o risco de obstrução do sistema de drenagem lacrimal ou se a presença de conservantes é su fi cien te para gerar obstrução. Métodos: Este estudo de caso-controle aninhado comparou um grupo de pacientes com obstrução do ducto lacrimal que receberam medicações tópicas anti-glaucoma contra um grupo controle de pacientes sem obstrução. Resultados: Foram revistos os prontuários de 255 pacientes com glaucoma que consultaram a Seção de Oculoplástica com queixas de olhos lacrimejantes. Dentre esses pacientes, 59 apresentavam obstrução da via lacrimal de drenagem. Noventa e quatro por cento dos pacientes com obstrução usaram betabloqueadores e 41% usaram análogos de prostaglandinas. Um modelo de regressão logística foi utilizado para ajustar a idade, sexo e o uso de outros medicamentos. Não foram observadas diferenças significativas em relação às medicações tópicas anti-glaucoma usadas entre os grupos. Conclusão: Nenhum medicamento anti-glaucoma tópico único demonstrou uma associação mais forte com o desenvolvimento de obstrução do ducto lacrimal.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Ophthalmic Solutions/therapeutic use , Glaucoma/drug therapy , Lacrimal Duct Obstruction/complications , Preservatives, Pharmaceutical/therapeutic use , Prostaglandins, Synthetic/therapeutic use , Carbonic Anhydrase Inhibitors/therapeutic use , Case-Control Studies , Glaucoma/complications , Retrospective Studies , Adrenergic beta-Antagonists/therapeutic use , Administration, Ophthalmic
5.
Rev. Assoc. Med. Bras. (1992) ; 64(8): 745-754, Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-976841

ABSTRACT

SUMMARY OBJECTIVES This study aimed at assessing the role of beta-blockers on preventing anthracycline-induced cardiotoxicity in adults. METHODS A systematic review was performed on electronic databases, including relevant studies that analysed beta-blockers as cardioprotective agents before the use of anthracyclines by adult oncologic patients. RESULTS After application of eligibility and selection criteria, eight articles were considered as high quality, complying with the proposed theme; all eight clinical trials, four of them placebo-controlled, with a total number of 655 patients included. From this sample, 281 (42.9%) used beta-blocker as intervention, and carvedilol was the most frequent (167 patients - 25.5%). Six studies were considered positive regarding the cardioprotection role played by beta-blockers, although only four demonstrated significant difference on left ventricle ejection fraction after chemotherapy on groups that used beta-blockers compared to control groups. Carvedilol and nebivolol, but not metoprolol, had positive results regarding cardioprotection. Other beta-blockers were not analysed in the selected studies. CONCLUSIONS Despite the potential cardioprotective effect of beta-blockers, as demonstrated in small and unicentric clinical trials, its routine use on prevention of anthracycline-associated cardiotoxicity demands greater scientific evidence.


RESUMO OBJETIVO Este estudo teve como objetivo analisar o papel dos betabloqueadores na prevenção da cardiotoxicidade induzida pelas antraciclinas em adultos. MÉTODOS Foi realizada uma revisão sistemática em bases de dados eletrônicos, incluindo os estudos relevantes que analisaram fármacos betabloqueadores como agentes cardioprotetores antes do início do uso de antraciclinas por pacientes oncológicos adultos. RESULTADOS Após aplicação dos critérios de elegibilidade e seleção, foram obtidos oito artigos considerados de boa qualidade, que se adequavam à temática proposta, sendo todos ensaios clínicos, quatro placebo-controlados, totalizando 655 pacientes incluídos. Destes, 281 (42,9%) fizeram uso de algum betabloqueador como intervenção, sendo o carvedilol o mais utilizado (167 pacientes - 25,5%). Seis estudos foram considerados positivos quanto à cardioproteção exercida pelos betabloqueadores, porém apenas quatro demonstraram diferença na fração de ejeção do ventrículo esquerdo após a quimioterapia nos grupos que usaram betabloqueadores em relação aos grupos controle. O carvedilol e o nebivolol, mas não o metoprolol, tiveram resultados positivos quanto à cardioproteção. Outros betabloqueadores não foram avaliados nos estudos incluídos. CONCLUSÕES Apesar de haver um potencial efeito cardioprotetor dos betabloqueadores, conforme demonstrado em ensaios clínicos pequenos e unicêntricos, sua utilização rotineira na prevenção da cardiotoxicidade associada às antraciclinas requer maiores comprovações científicas.


Subject(s)
Humans , Adult , Cardiotonic Agents/pharmacology , Adrenergic beta-Antagonists/pharmacology , Anthracyclines/adverse effects , Heart Diseases/chemically induced , Heart Diseases/prevention & control , Stroke Volume , Cardiotonic Agents/therapeutic use , Reproducibility of Results , Adrenergic beta-Antagonists/therapeutic use , Cardiotoxicity/prevention & control , Carvedilol/therapeutic use , Carvedilol/pharmacology
6.
Article in Portuguese | LILACS | ID: biblio-913926

ABSTRACT

A fibrilação atrial é a arritmia mais frequentemente encontrada após cirurgia cardíaca. Embora geralmente autolimitada, representa um importante preditor de aumento de morbimortalidade e de custos aos sistemas de saúde. Numerosos estudos tentaram determinar os mecanismos associados à fibrilação atrial no pós-operatório com resultados variados. Uma fisiopatologia multifatorial é sugerida, sendo o processo inflamatório e a ativação simpática adrenérgica do período pós-operatório reconhecidos como importantes fatores de contribuição. O tratamento é dificultado pela escassez de dados relativos aos resultados de diferentes intervenções terapêuticas nessa população. Este artigo analisa a literatura cujo foco sejam as intervenções para prevenir a fibrilação atrial no pós-operatório


Atrial fibrillation is the most commonly found arrhythmia after cardiac surgery. Although usually self-limiting, it represents an important predictor of increased patient morbidity, mortality, and health care costs. Numerous studies have attempted to determine the underlying mechanisms of postoperative atrial fibrillation with different results. A multifactorial pathophysiology is suggested, with inflammation and postoperative adrenergic activation recognized as important contributing factors. The management is complicated by a lack of data on the outcomes of different therapeutic interventions in this population. This article reviews the literature focusing on interventions to prevent postoperative atrial fibrillation


Subject(s)
Humans , Male , Female , Atrial Fibrillation/physiopathology , Disease Prevention , Postoperative Period , Thoracic Surgery/methods , Adrenergic beta-Antagonists/therapeutic use , Anti-Arrhythmia Agents/therapeutic use , Arrhythmias, Cardiac , Indicators of Morbidity and Mortality , Oxidative Stress , Risk Factors , Sotalol/therapeutic use
7.
Pakistan Journal of Medical Sciences. 2018; 34 (1): 135-138
in English | IMEMR | ID: emr-130075

ABSTRACT

Objective: To investigate the characteristics of clinical therapeutic drugs in elderly chronic heart failure [CHF] patients complicated with different degrees of renal insufficiency


Methods: The elderly patients who were hospitalized from October 2010 to October 2015 in our hospital due to CHF for the first time were selected by means of retrospective case collection. The glomerular filtration rate was estimated by using the Modification of Diet in Renal Disease [MDRD] Study equation. The patients were divided into a group with normal renal function, a group with slight decrease in renal function, and a group with moderate and severe decrease in renal function. Statistical analysis was made to compare the characteristics of clinical drugs for the three groups


Results: Compared with the normal renal function group and the slight decrease group, ACEIs and beta-blockers were less used in the moderate and severe decrease group, but diuretics and spironolactone were more used [P<0.05]. Compared with the normal renal function group, the use rate of ACEIs was low whereas that of diuretics was high [P<0.05]


Conclusion: ACEIs and beta-blockers were barely employed to treat elderly CHF patients complicated with renal insufficiency, but diuretics and spironolactone were frequently utilized


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Heart Failure/complications , Renal Insufficiency , Aged , Diuretics/therapeutic use , Adrenergic beta-Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Chronic Disease
9.
Rev. Assoc. Med. Bras. (1992) ; 63(3): 242-247, Mar. 2017. tab, graf
Article in English | LILACS | ID: biblio-956438

ABSTRACT

Summary Introduction: The mortality rate attributed to ST-segment elevation myocardial infarction (STEMI) has decreased in the world. However, this disease is still responsible for high costs for health systems. Several factors could decrease mortality in these patients, including implementation of cardiac intensive care units (CICU). The aim of this study was to evaluate the effect of CICU implementation on prescribed recommended treatments and mortality 30 days after STEMI. Method: We performed a retrospective study with patients admitted to CICU between 2005 and 2006 (after group) and between 2000 and 2002, before CICU implementation (before group). Results: The after group had 101 patients, while the before group had 143 patients. There were no differences in general characteristics between groups. We observed an increase in angiotensin-converting enzyme inhibitors, clopidogrel and statin prescriptions after CICU implementation. We did not find differences regarding number of patients submitted to reperfusion therapy; however, there was an increase in primary percutaneous angioplasty compared with thrombolytic therapy in the after group. There was no difference in 30-day mortality (before: 10.5%; after: 8.9%; p=0.850), but prescription of recommended treatments was high in both groups. Prescription of angiotensin-converting enzyme inhibitors and beta-blocker decreased mortality risk by 4.4 and 4.9 times, respectively. Conclusion: CICU implementation did not reduce mortality after 30 days in patients with STEMI; however, it increased the prescription of standard treatment for these patients.


Resumo Introdução: Apesar da diminuição da mortalidade por infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAM-ST) no mundo, a doença ainda acarreta elevados custos e morbidade. Muitas medidas contribuem para a redução da mortalidade, dentre elas a criação de unidades intensivas coronarianas (UCO). Objetivo: Avaliar o impacto da criação de uma UCO na prescrição de tratamentos preconizados e na mortalidade em 30 dias em pacientes com IAM-ST. Método: Foi realizado estudo retrospectivo e foram coletados dados de prontuários de pacientes internados na UCO de 2005 a 2006 (grupo depois). Esses dados foram comparados com dados do serviço de 2000 a 2002, previamente à criação da UCO (grupo antes). Resultados: Havia 101 e 143 pacientes nos grupos depois e antes, respectivamente. Não houve diferenças em relação às características populacionais e às características do infarto entre os períodos. Observamos aumento na prescrição de iECA, clopidogrel e estatinas. Apesar da ausência de mudanças no número de pacientes que receberam terapia de reperfusão, houve aumento de angioplastias primárias em detrimento ao uso de trombolíticos no período posterior à criação da UCO. Não observamos diminuição da mortalidade em 30 dias após IAM-ST (antes: 10,5%; depois: 8,9%; p=0,850), mas a prescrição de tratamentos preconizados foi alta em ambos os períodos. O uso de iECA e de betabloqueador diminuiu o risco de morte em 4,4 e 4,9 vezes, respectivamente. Conclusão: Em pacientes com IAM-ST, a criação da UCO não reduziu a mortalidade em 30 dias, mas houve aumento na prescrição de tratamentos preconizados.


Subject(s)
Humans , Male , Female , Aged , Coronary Care Units/statistics & numerical data , ST Elevation Myocardial Infarction/mortality , ST Elevation Myocardial Infarction/therapy , Drug Prescriptions/statistics & numerical data , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Logistic Models , Multivariate Analysis , Retrospective Studies , Risk Factors , Treatment Outcome , Hospital Mortality , Adrenergic beta-Antagonists/therapeutic use , Middle Aged
12.
Porto Alegre; Universidade Federal do Rio Grande do Sul. Telessaúde; 2017.
Non-conventional in Portuguese | LILACS | ID: biblio-995608

ABSTRACT

Cardiopatia isquêmica é uma causa importante de morbimortalidade no Brasil. Visto sua importante prevalência, seus casos estáveis devem ser manejados na Atenção Primária à Saúde (APS). A principal etiologia é a aterosclerose, porém podem ocorrer eventos por espasmo coronariano, alteração da relação da oferta de oxigênio e demanda miocárdica ou trombose coronariana. A manifestação clínica mais comum é a angina pectoris (desconforto torácico em aperto, retroesternal, relacionado com esforços físicos ou emocionais e que alivia com repouso ou nitratos), mas podem ocorrer outras situações, como: infarto agudo do miocárdio, arritmia, insuficiência cardíaca, isquemia silenciosa e morte súbita. O papel do médico na APS é avaliar a probabilidade clínica da dor ser de origem cardíaca e iniciar investigação diagnóstica apropriada, continuar ou otimizar tratamento farmacológico em pacientes com diagnóstico confirmado, trabalhar no controle dos fatores de risco e coordenar o cuidado de pacientes que necessitam encaminhamento para o cardiologista ou serviço de emergência. Esta guia apresenta informação que orienta a conduta para casos de cardiopatia isquêmica no contexto da Atenção Primária à Saúde, incluindo: Classificação clínica da dor torácica, Probabilidade pré-teste na dor torácica, Classificação da angina, Exames complementares, Acompanhamento na APS, Tratamento farmacológico, Tabela com medicamentos, Manejo na APS da doença arterial aguda, Encaminhamento para serviço especializado.


Subject(s)
Humans , Telemedicine/methods , Myocardial Ischemia/diagnosis , Myocardial Ischemia/therapy , Education, Distance/methods , Primary Health Care , Calcium Channel Blockers/therapeutic use , Adrenergic beta-Antagonists/therapeutic use , Nitrates/therapeutic use
15.
Braz. j. med. biol. res ; 48(10): 886-894, Oct. 2015. tab, ilus
Article in English | LILACS | ID: lil-761604

ABSTRACT

This study aimed to evaluate the effects of carvedilol treatment and a regimen of supervised aerobic exercise training on quality of life and other clinical, echocardiographic, and biochemical variables in a group of client-owned dogs with chronic mitral valve disease (CMVD). Ten healthy dogs (control) and 36 CMVD dogs were studied, with the latter group divided into 3 subgroups. In addition to conventional treatment (benazepril, 0.3-0.5 mg/kg once a day, and digoxin, 0.0055 mg/kg twice daily), 13 dogs received exercise training (subgroup I; 10.3±2.1 years), 10 dogs received carvedilol (0.3 mg/kg twice daily) and exercise training (subgroup II; 10.8±1.7 years), and 13 dogs received only carvedilol (subgroup III; 10.9±2.1 years). All drugs were administered orally. Clinical, laboratory, and Doppler echocardiographic variables were evaluated at baseline and after 3 and 6 months. Exercise training was conducted from months 3-6. The mean speed rate during training increased for both subgroups I and II (ANOVA, P>0.001), indicating improvement in physical conditioning at the end of the exercise period. Quality of life and functional class was improved for all subgroups at the end of the study. The N-terminal pro-brain natriuretic peptide (NT-proBNP) level increased in subgroup I from baseline to 3 months, but remained stable after training introduction (from 3 to 6 months). For subgroups II and III, NT-proBNP levels remained stable during the entire study. No difference was observed for the other variables between the three evaluation periods. The combination of carvedilol or exercise training with conventional treatment in CMVD dogs led to improvements in quality of life and functional class. Therefore, light walking in CMVD dogs must be encouraged.


Subject(s)
Animals , Dogs , Female , Male , Adrenergic beta-Antagonists/therapeutic use , Carbazoles/therapeutic use , Mitral Valve Insufficiency/veterinary , Physical Conditioning, Animal/statistics & numerical data , Propanolamines/therapeutic use , Quality of Life , Analysis of Variance , Echocardiography, Doppler/veterinary , Follow-Up Studies , Heart Rate , Lactic Acid/blood , Mitral Valve Insufficiency/therapy , Natriuretic Peptide, Brain/blood , Prospective Studies , Peptide Fragments/blood , Statistics, Nonparametric
16.
Rev. bras. reumatol ; 55(2): 103-112, Mar-Apr/2015. tab, graf
Article in Portuguese | LILACS | ID: lil-746141

ABSTRACT

Objetivos: Este estudo foi desenvolvido para investigar a eficácia e a segurança do ácidozoledrônico (ZOL) e do propranolol (PRO) como monoterapia e terapia combinada em ummodelo de rato com osteoporose pós-menopáusica. Métodos: Ratas Wistar fêmeas foram ovariectomizadas (OVX) ou submetidas à cirurgia simulada (placebo) aos três meses de idade. Doze semanas depois da cirurgia, as ratas foram divididas em seis grupos: (1) placebo + veículo; (2) OVX + veículo; (3) OVX + ZOL (100 µg/kg, dose única intravenosa); (4) OVX + ZOL (50 µg/kg, dose única intravenosa); (5) OVX + PRO (0,1 mg/kg, via subcutânea, cinco dias por semana); (6) OVX + ZOL (50 µg/kg, dose única intravenosa) + PRO (0,1 mg/kg, via subcutânea, cinco dias por semana) durante 12 semanas. Depois do tratamento, testou-se a densidade óssea, a porosidade e a microarquitetura tra-becular dos fêmures. Também foram avaliados marcadores bioquímicos séricos e urinários. Resultados: A terapia combinada com ZOL mais PRO foi mais eficaz em corrigir a diminuição do cálcio sérico e o aumento do nível sérico de fosfatase alcalina e fosfatase ácida resistenteao tartarato do que a monoterapia com ZOL ou PRO. Além disso, a terapia combinada comZOL mais PRO foi mais eficaz em corrigir o aumento dos níveis urinários de cálcio, fósforo ecreatinina do que a monoterapia com ZOL ou PRO. A terapia combinada com ZOL mais PRO também preservou a microarquitetura trabecular e a porosidade do osso cortical. Conclusão: Os resultados sugerem que a terapia combinada com ZOL mais PRO pode ser aabordagem mais eficaz para o tratamento da osteoporose grave em humanos. .


Objectives: The present study was designed to investigate further the efficacy and safety of zoledronic acid (ZOL) and propranolol (PRO) as monotherapy and combination therapy in a rat model of postmenopausal osteoporosis. Methods: Female Wistar rats were ovariectomized (OVX) or sham-operated at 3 months ofage. Twelve weeks post-surgery, rats were randomized into six groups: (1) sham + vehicle; (2) OVX + vehicle; (3) OVX + ZOL (100 뀅g/kg, i.v. single dose); (4) OVX + ZOL (50 뀅g/kg, i.v. single dose); (5) OVX + PRO (0.1 mg/kg, s.c. 5 days per week); (6) OVX + ZOL (50 뀅g/kg, i.v. single dose) + PRO (0.1 mg/kg, s.c. 5 days per week) for 12 weeks. After treatment, femurs were tested for bone density, porosity and trabecular micro-architecture. Biochemical markers in serum and urine were also determined. Results: Combined treatment with ZOL plus PRO corrected the decrease in serum calcium and increase in serum alkaline phosphatase and tartarate resistant acid phosphatase level better than single-drug therapy using ZOL or PRO. Moreover, combined treatment with ZOL plus PRO corrected the increase in urine calcium, phosphorous and creatinine level better than single-drug therapy using ZOL or PRO. Combination therapy using ZOL plus PRO also preserved the trabecular micro-architecture and cortical bone porosity. Conclusion: These data suggest that combined treatment with ZOL plus PRO could be a more effective approach for treating severe osteoporosis in humans. .


Subject(s)
Humans , Animals , Female , Rats , Adrenergic beta-Antagonists/pharmacology , Adrenergic beta-Antagonists/therapeutic use , Bone Density Conservation Agents/pharmacology , Bone Density Conservation Agents/therapeutic use , Bone Density/drug effects , Bone Diseases, Metabolic/drug therapy , Bone Remodeling/drug effects , Diphosphonates/pharmacology , Diphosphonates/therapeutic use , Imidazoles/pharmacology , Imidazoles/therapeutic use , Osteoporosis, Postmenopausal/drug therapy , Propranolol/pharmacology , Propranolol/therapeutic use , Biomarkers , Drug Synergism , Drug Therapy, Combination , Ovariectomy , Random Allocation
17.
Acta cir. bras ; 30(1): 24-33, 01/2015. tab, graf
Article in English | LILACS | ID: lil-735711

ABSTRACT

PURPOSE: To evaluate the effect of propranolol on capsular architecture around silicone implants by measuring the inflammation, capsular thickness, and collagen fiber density, using a guinea pig experimental model. METHODS: Thirty six adult male guinea pigs randomly divided into two groups (n=18) were used. Each one received a silicone implant with textured-surface. The capsular tissue around implants from untreated or treated animals with the beta-adrenoceptor antagonist propranolol (10 mg/kg, dissolved in daily water) were analyzed for inflammation by histological scoring, capsular thickness by computerized histometry, and collagen fibers type I and Type III density by picrosirius polarization at different time points (7, 14 or 21 days after silicone implantation). RESULTS: Propranolol treatment reduced inflammation and impaired capsular thickness and delayed collagen maturation around the textured implant. CONCLUSION: Propranolol reduces the risk of developing capsular contracture around silicone implants with textured surface. .


Subject(s)
Animals , Guinea Pigs , Humans , Male , Adrenergic beta-Antagonists/pharmacology , Implant Capsular Contracture/prevention & control , Propranolol/pharmacology , Silicone Gels/adverse effects , Adrenergic beta-Antagonists/therapeutic use , Breast Implants/adverse effects , Collagen Type I/analysis , Collagen Type I/drug effects , Collagen Type III/analysis , Collagen Type III/drug effects , Disease Models, Animal , Implant Capsular Contracture/pathology , Implants, Experimental/adverse effects , Propranolol/therapeutic use , Random Allocation , Reproducibility of Results , Subcutaneous Tissue/drug effects , Subcutaneous Tissue/pathology , Time Factors , Treatment Outcome
18.
Article in English | WPRIM | ID: wpr-164155

ABSTRACT

We aimed to assess one-year persistence with antihypertensive therapy (AHT) among newly treated uncomplicated hypertensive patients in Korea and to evaluate the effect of initial therapeutic classes on persistence. We retrospectively analyzed a random sample of 20% of newly treated uncomplicated hypertensive patients (n = 45,787) in 2012 from the National Health Insurance claims database. This group was classified into six cohorts based on initial AHT class. We then measured treatment persistence, allowing a prescription gap of 60 days. Adherence to AHT was assessed with the medication possession ratio. Calcium channel blockers (CCB, 43.7%) and angiotensin receptor blockers (ARB, 40.3%) were most commonly prescribed as initial monotherapy. Overall, 62.1% and 42.0% were persistent with any AHT and initial class at one year, respectively, and 64.2% were adherent to antihypertensive treatment. Compared with ARBs, the risk of AHT discontinuation was significantly increased with initial use of thiazide diuretics (hazard ratio [HR], 3.16; 95% confidence interval [CI] 2.96-3.74) and beta blockers (HR, 1.86; CI, 1.77-1.95) and was minimally increased with CCBs (HR, 1.12; CI, 1.08-1.15). In conclusion, persistence and adherence to AHT are suboptimal, but the differences are meaningful in persistence and adherence between initial AHT classes.


Subject(s)
Adolescent , Adrenergic beta-Antagonists/therapeutic use , Adult , Aged , Aged, 80 and over , Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Antihypertensive Agents/classification , Calcium Channel Blockers/therapeutic use , Cohort Studies , Female , Humans , Hypertension/drug therapy , Male , Medication Adherence , Middle Aged , Republic of Korea , Retrospective Studies , Sodium Chloride Symporter Inhibitors/therapeutic use , Young Adult
20.
Säo Paulo med. j ; 132(6): 359-363, Nov-Dec/2014. tab, graf
Article in English | LILACS | ID: lil-726374

ABSTRACT

CONTEXT AND OBJECTIVE: Occurrences of asymptomatic atrial fibrillation (AF) are common. It is important to identify AF because it increases morbidity and mortality. 24-hour Holter has been used to detect paroxysmal AF (PAF). The objective of this study was to investigate the relationship between occurrence of PAF in 24-hour Holter and the symptoms of the population studied. DESIGN AND SETTING: Cross-sectional study conducted at a cardiology hospital. METHODS: 11,321 consecutive 24-hour Holter tests performed at a referral service were analyzed. Patients with pacemakers or with AF throughout the recording were excluded. RESULTS: There were 75 tests (0.67%) with PAF. The mean age was 67 ± 13 years and 45% were female. The heart rate (HR) over the 24 hours was a minimum of 45 ± 8 bpm, mean of 74 ± 17 bpm and maximum of 151 ± 32 bpm. Among the tests showing PAF, only 26% had symptoms. The only factor tested that showed a correlation with symptomatic AF was maximum HR (165 ± 34 versus 147 ± 30 bpm) (P = 0.03). Use of beta blockers had a protective effect against occurrence of PAF symptoms (odds ratio: 0.24, P = 0.031). CONCLUSIONS: PAF is a rare event in 24-hour Holter. The maximum HR during the 24 hours was the only factor correlated with symptomatic AF, and use of beta blockers had a protective effect against AF symptom occurrence. .


CONTEXTO E OBJETIVO: A ocorrência de fibrilação atrial (FA) assintomática é comum. A identificação da FA é importante e está associada com maior morbimortalidade. O Holter de 24 horas vem sendo utilizado para a detecção de FA paroxística (FAP). O objetivo desse estudo é investigar a relação entre a ocorrência de FAP no Holter de 24 horas e os sintomas na população estudada. TIPO DE ESTUDO E LOCAL: Estudo transversal realizado em um hospital de cardiologia. MÉTODOS: Análise de 11.321 exames consecutivos de Holter de 24 horas realizados em serviço de referência. Foram excluídos pacientes com marcapasso e aqueles com FA durante toda a gravação. RESULTADOS: Foram identificados 75 (0,67%) exames apresentando FAP. A idade média foi de 67 ± 13 anos e 45% eram do sexo feminino. A frequência cardíaca (FC) encontrada nas 24 horas foi mínima de 45 ± 8 bpm, média de 74 ± 17 bpm e máxima de 151 ± 32 bpm. Entre os exames apresentando FAP, apenas 26% apresentaram sintomas. O único fator testado que evidenciou correlação com FA sintomática foi a FC máxima (165 ± 34 versus 147 ± 30 bpm) (P = 0,03). O uso de betabloqueadores teve efeito protetor para ocorrência de sintomas na FA (odds ratio: 0.24, P = 0.031). CONCLUSÕES: A FAP é um evento raro em Holter de 24 horas. A FC máxima nas 24 horas foi o único fator relacionado com FA sintomática e o uso de betabloqueadores teve efeito protetor para ocorrência de sintomas na FA. .


Subject(s)
Aged , Female , Humans , Male , Middle Aged , Asymptomatic Diseases , Atrial Fibrillation/diagnosis , Electrocardiography, Ambulatory/methods , Heart Rate/physiology , Adrenergic beta-Antagonists/therapeutic use , Atrial Fibrillation/drug therapy , Atrial Fibrillation/physiopathology , Brazil , Cross-Sectional Studies
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