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1.
Bol. méd. postgrado ; 37(1): 27-33, Ene-Jun 2021. tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1147875

ABSTRACT

Se realizó una investigación descriptiva transversal retrospectiva con el fin de determinar el perfil clínico y epidemiológico de la enfermedad de Kawasaki (EK) en 95 niños egresados del Hospital Pediátrico Dr. Agustín Zubillaga durante el período 2014-2017. El promedio de edad de los pacientes se ubicó en 3,9 ± 3,3 años, siendo 69,5% del sexo masculino. El tiempo de evolución de la enfermedad fue menor de 10 días en el 68,4% de los casos. Las manifestaciones clínicas predominantes fueron fiebre (100%), edema y/o descamación de palmas y plantas (85,3%), alteración de la mucosa oral (65,3%), inyección conjuntival (59%) y eritema polimorfo (55,8%). El tratamiento recibido consistió en aspirina (100%) e inmunoglobulina (96,8%). La respuesta al tratamiento fue satisfactoria en el 95,8% de los pacientes. Los hallazgos de laboratorio evidenciaron una PCR elevada (51,6%) y trombocitosis (97,9%) con hemoglobina normal en 62,1% de los casos. 41% de los pacientes presentaron ecocardiograma anormal y 97,9% presentaron ultrasonido abdominal normal. El diagnóstico de ingreso de la EK fue incompleto en 53,7% de los pacientes y el diagnóstico de egreso de la EK fue completo en 51,6%. Los resultados de este estudio brindan datos epidemiológicos recientes sobre la enfermedad de Kawasaki en nuestra institución prestadora de salud(AU)


A descriptive cross-sectional retrospective investigation was carried out to evaluate the clinical and epidemiological profile of Kawasaki disease (KD) in 95 children discharged from the Pediatric Hospital Dr. Agustín Zubillaga during the period 2014-2017. Mean age of children was 3.9 ± 3.3 years and 69.5% were male. Time of symptom onset was less than ten days in 68.4% patients. Predominant clinical manifestations were fever (100%), edema and/or desquamation of palms and soles (85.3%), alteration of the oral mucosa (65.3%), conjunctival injection (59%) and polymorphic erythema (55.8%). Treatment received included aspirin (100%) and immunoglobulin (96.8%). Response to treatment was satisfactory in 95.8% of cases. Laboratory findings showed elevated CRP (51.6%), thrombocytosis (97.9%) and normal hemoglobin in 62.1% patients. 41% had an abnormal echocardiogram and 97.9% showed a normal abdominal ultrasound. The diagnosis of CHD admission was incomplete in 53.7% of cases and the diagnosis of EK was complete in 51.6%. Results of this study show recent epidemiological data about Kawasaki disease in our healthcare institution(AU)


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Immunoglobulins/therapeutic use , Aspirin/therapeutic use , Clinical Laboratory Techniques , Coronary Disease/etiology , Mucocutaneous Lymph Node Syndrome/epidemiology , Signs and Symptoms , Vasculitis , Edema , Fever
2.
Rev. chil. infectol ; 36(5): 636-641, oct. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1058090

ABSTRACT

Resumen Introducción: La enfermedad de Kawasaki (EK) es una vasculitis sistémica aguda con riesgo de desarrollar aneurismas coronarios. Objetivos: Describir características clínico-epidemiológicas en niños con diagnóstico de EK en Argentina. Analizar factores de riesgo para el desarrollo de complicaciones coronarias (CC). Población y Métodos: Estudio multicéntrico, retrospectivo, transversal, observacional y analítico. Incluyó pacientes bajo 18 años de edad, con diagnóstico de EK en hospitales de Argentina, entre el 1 de enero de 2010 y el 31 de diciembre de 2013. Resultados: N = 193 sujetos. Edad: mediana: 29 meses. Tasa promedio total país 5 casos/10.000 egresos hospitalarios. Presentaron CC 15,5%. Mayor riesgo de CC: Mayor cantidad de días de fiebre al momento de colocación del tratamiento (p = 0,0033); Aumento de: frecuencia cardíaca (p = 0,0021), eritrosedimentación (VSG) (p = 0,005), proteína C reactiva (PCR) (p < 0,0001), leucocitosis (p = 0,0006), neutrofilia (p = 0,0021); Disminución de hematocrito (p = 0,0007) y hemoglobina (p < 0,0001). Asociación con CC: alteraciones cardiológicas no coronarias (ORv10.818); PCR mayor de 68 mg/L (OR = 11.596); leucocitos mayores a 20.000/mm3 (OR= 4.316); y VSG mayor de 64 mm/1° hora (OR = 4.267). Conclusión: La forma de presentación más frecuente fue EK completa, el riesgo de CC fue mayor en varones, menores de 5 años de edad, los factores de riesgo (clínicos y de laboratorio) fueron semejantes a los descritos en la bibliografía.


Background: Kawasaki disease (EK) is an acute systemic vasculitis with a risk of developing coronary aneurysms. Aim: To describe the clinical and epidemiological characteristics of children with EK in Argentina and to analyse the risk factors for the development of coronary's complications (CC). Methods: Multicenter, retrospective, cross-sectional, observational and analytical study. It included patients younger than 18 years of age diagnosed with EK in hospitals in Argentina, between January the 1st, 2010 and December the 31th, 2013. Results: N = 193 subjects. Age: medium: 29 months. Total incidence 5 cases / 10,000 hospital discharges. CC was observed in 15.5% of patients. Increased risk factors for CC: Elevated number of days with fever at the time of treatment placement (p = 0.0033); Increased of: heart frequency (p = 0.0021), erythrosedimentation (ESR) (p = 0.005), C-reactive protein (CRP) (p < 0.0001), leukocytes (p = 0.0006), neutrophils (p = 0.0021); Decreased of hematocrit (p = 0.0007) and hemoglobin (p < 0.0001).Association with CC: non-coronary cardiological alterations (OR = 10,818); PCR greater than 68 mg /L (OR = 11,596); leukocytes greater than 20,000 / mm3 (OR = 4.316); and ESR greater than 64 mm / 1 hour (OR = 4.267). Conclusion: The most frequent form of presentation was complete EK, the risk of CC was higher in males, younger than 5 years old, the risk factors (clinical and laboratory) were similar to those described in the literature.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Coronary Disease/etiology , Coronary Disease/epidemiology , Mucocutaneous Lymph Node Syndrome/complications , Mucocutaneous Lymph Node Syndrome/epidemiology , Argentina/epidemiology , Seasons , Blood Sedimentation , C-Reactive Protein/analysis , Incidence , Cross-Sectional Studies , Retrospective Studies , Risk Factors , Immunoglobulins, Intravenous/therapeutic use , Statistics, Nonparametric , Risk Assessment , Mucocutaneous Lymph Node Syndrome/therapy
3.
In. Consolim-Colombo, Fernanda M; Saraiva, José Francisco Kerr; Izar, Maria Cristina de Oliveira. Tratado de Cardiologia: SOCESP / Cardiology Treaty: SOCESP. São Paulo, Manole, 4ª; 2019. p.652-655.
Monography in Portuguese | LILACS | ID: biblio-1009187
6.
Braz. j. med. biol. res ; 51(9): e7239, 2018. tab, graf
Article in English | LILACS | ID: biblio-951762

ABSTRACT

Previous studies have reported increased prevalence of coronary heart disease (CHD) in Indians and South Asian settlers in North America. This increased burden of CHD among South Asians is mainly caused by dyslipidemia. To the best of our knowledge, none of the previous works has studied the patterns and prevalence of dyslipidemia in the Pakistani population. The present work aimed to study the plasma lipid trends and abnormalities in a population-based sample of urban and rural Pakistanis. The study included 238 participants (108 males,130 females). Plasma lipid profiles of the participants were determined using standard protocols. We observed that 63% of the study population displayed irregularities in at least one major lipid-fraction including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), or triglycerides (TG). The most common form of isolated-dyslipidemia was low HDL-C (17.3%) followed by high TG (11.2%). Several overlaps between high TC, LDL-C, TG and low HDL-C were also noted. Gender, urbanization, and occupational class were all observed to have an impact on lipid profiles. Briefly, male, urban, and blue-collar participants displayed higher prevalence of dyslipidemia compared to female, rural, and white-collar participants, respectively. In comparison to normal subjects, dyslipidemic subjects displayed significantly higher values for different anthropometric variables including body mass index (BMI), body fat percentage, and waist circumference. The present work provides a comprehensive estimation of the prevalence of dyslipidemia and CHD risk in the Pakistani population. This information will be helpful for better healthcare planning and resource allocation in Pakistan.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Coronary Disease/etiology , Dyslipidemias/epidemiology , Lipids/blood , Pakistan/ethnology , Rural Population , Triglycerides/blood , Case-Control Studies , Anthropometry , Cholesterol/blood , Prevalence , Cross-Sectional Studies , Risk Factors , Sex Distribution , Coronary Disease/blood , Dyslipidemias/complications , Dyslipidemias/blood , Cholesterol, HDL/blood , Cholesterol, LDL/blood
7.
MedicalExpress (São Paulo, Online) ; 4(4)July-Aug. 2017. tab, graf
Article in English | LILACS | ID: biblio-894360

ABSTRACT

In the history of medicine, only recently has obesity been recognized as a disease. We know now that it is a pandemic condition, partly explained by the so-called Western lifestyle and related to multiple other comorbidities in various systems. This lyfestyle includes eating large portions, rich in saturated fats and refined sugar, all coupled with sedentary habits. In recent years, the gut microbiota has been indited as a new culprit in pathophysiological aspects involved in obesity. From studies with animals free of bacteria in the digestive tract, known as "germ-free animals", the relevance of intestinal microbiota in the regulation of body fat became evident and its importance has also been extended to the pathophysiology of diseases such as diabetes mellitus and coronary heart disease. Characterization of Toll-like receptors led to the discovery of mechanisms that link the immune system with some metabolic pathways and opened new avenues of a previously unknown world to biological sciences. Increased knowledge about interactions between gut microbiota and the host can certainly reveal, in a not too distant future, new therapeutic perspectives for obesity and its related diseases.


Na história da medicina apenas recentemente a obesidade foi reconhecida como uma doença. Sabemos agora que é uma doença pandêmica, explicada em parte pelo chamado estilo de vida ocidental e relacionado a múltiplas outras comorbidades em vários sistemas. O referido estilo de vida inclui comer grandes porções, ricas em gorduras saturadas e açúcares refinados, e hábitos sedentários. Nos últimos anos, a microbiota intestinal foi associada aos aspectos fisiopatológicos envolvidos na obesidade. De estudos com animais livres de bactérias no trato digestivo, conhecidos como "animais sem germes", a relevância da microbiota intestinal na regulação da gordura corporal tornou-se evidente e sua importância também se estendeu à fisiopatologia de doenças como diabetes mellitus e doença cardíaca coronária. A caracterização dos receptores "Toll-like" levou à descoberta de mecanismos que ligam o sistema imunológico a algumas vias metabólicas e abriram novas avenidas de um mundo anteriormente desconhecido para as ciências biológicas. O aumento do conhecimento sobre as interações entre a microbiota intestinal e o hospedeiro certamente pode revelar, em um futuro não muito distante, novas perspectivas terapêuticas para a obesidade e suas doenças relacionadas.


Subject(s)
Humans , Bacterial Physiological Phenomena , Gastrointestinal Microbiome/physiology , Intestines/microbiology , Obesity/physiopathology , Coronary Disease/etiology , Diabetes Mellitus/etiology
8.
Arq. bras. cardiol ; 106(1): 56-61, Jan. 2016. tab
Article in Portuguese | LILACS | ID: lil-771052

ABSTRACT

Abstract Background: Hemorheological and glycemic parameters and high density lipoprotein (HDL) cholesterol are used as biomarkers of atherosclerosis and thrombosis. Objective: To investigate the association and clinical relevance of erythrocyte sedimentation rate (ESR), fibrinogen, fasting glucose, glycated hemoglobin (HbA1c), and HDL cholesterol in the prediction of major adverse cardiovascular events (MACE) and coronary heart disease (CHD) in an outpatient population. Methods: 708 stable patients who visited the outpatient department were enrolled and followed for a mean period of 28.5 months. Patients were divided into two groups, patients without MACE and patients with MACE, which included cardiac death, acute myocardial infarction, newly diagnosed CHD, and cerebral vascular accident. We compared hemorheological and glycemic parameters and lipid profiles between the groups. Results: Patients with MACE had significantly higher ESR, fibrinogen, fasting glucose, and HbA1c, while lower HDL cholesterol compared with patients without MACE. High ESR and fibrinogen and low HDL cholesterol significantly increased the risk of MACE in multivariate regression analysis. In patients with MACE, high fibrinogen and HbA1c levels increased the risk of multivessel CHD. Furthermore, ESR and fibrinogen were significantly positively correlated with HbA1c and negatively correlated with HDL cholesterol, however not correlated with fasting glucose. Conclusion: Hemorheological abnormalities, poor glycemic control, and low HDL cholesterol are correlated with each other and could serve as simple and useful surrogate markers and predictors for MACE and CHD in outpatients.


Resumo Fundamento: Parâmetros hemorreológicos e glicêmicos e o HDL-colesterol são utilizados como biomarcadores da aterosclerose e trombose. Objetivo: Investigar a associação e a relevância clínica da velocidade de hemossedimentação (VHS), fibrinogênio, glicose de jejum, hemoglobina glicada (HbA1c) e HDL-colesterol na predição de eventos adversos cardiovasculares (EAC) importantes em pacientes ambulatoriais. Métodos: 708 pacientes estáveis ambulatoriais foram incluídos no estudo e acompanhados por um período médio de 28,5 meses. Os pacientes foram subdivididos em pacientes sem EAC e pacientes com EAC, que incluíram morte súbita cardíaca, infarto agudo do miocárdio, doença coronariana recém-diagnosticada, e acidente vascular cerebral. Comparamos os parâmetros hemorreológicos, glicêmicos, e perfis lipídicos entre os grupos. Resultados: Pacientes com EAC apresentaram níveis significativamente mais elevados de VHS, fibrinogênio, glicose de jejum, e HbA1c, e níveis mais baixos de HDL-colesterol em comparação a pacientes sem EAC. VHS e níveis de fibrinogênio elevados, e baixos níveis de HDL-colesterol aumentaram significativamente o risco de EAC em análise de regressão multivariada. Além disso, VHS e fibrinogênio correlacionaram-se positivamente com HbA1c e negativamente com HDL-colesterol, mas não se correlacionaram com glicose de jejum. Conclusão: Distúrbios hemorreológicos, baixo controle glicêmico e baixo nível de HDL-colesterol correlacionam-se entre si e podem ser usados como marcadores substitutos simples, úteis, e como preditores de EAC e doença coronariana em pacientes ambulatoriais.


Subject(s)
Aged , Female , Humans , Male , Middle Aged , Blood Glucose/analysis , Cardiovascular Diseases/blood , Cholesterol, HDL/blood , Coronary Disease/blood , Fibrinogen/analysis , Glycated Hemoglobin A/analysis , Blood Sedimentation , Biomarkers/blood , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/etiology , Coronary Disease/diagnosis , Coronary Disease/etiology , Glycemic Index , Hemorheology , Outpatients , Predictive Value of Tests , Reproducibility of Results , Risk Factors , Statistics, Nonparametric
9.
In. Pastore, Alberto Carlos; Samesima, Nelson; Tobias, Nancy Maria Martins de Oliveira; Pereira Filho, Horacio Gomes. Eletrocardiografia atual: curso do serviço de eletrocardiografia do InCor. São Paulo, Atheneu, 3º; 2016. p.265-278.
Monography in Portuguese | LILACS | ID: biblio-833693
10.
Rev. mex. enferm. cardiol ; 23(3): 103-109, sep-dic. 2015.
Article in Spanish | LILACS, BDENF | ID: biblio-1035506

ABSTRACT

Antecedentes: las enfermedades cardiovasculares constituyen la primera causa de morbimortalidad a nivel mundial y nacional; sobresale la enfermedad coronaria. Esto ha contribuido para que el tratamiento quirúrgico de revascularización miocárdica sea considerado como un procedimiento de rutina. Éste es uno de los avances más importantes de la medicina durante el siglo XX. En Bogotá, los registros estadísticos muestran que más del 50% del total de cirugías cardiovasculares corresponde a ella. Objetivo: realizar la caracterización de pacientes que se encuentran en posoperatorio temprano de revascularización miocárdica, quienes presentan cambios fisiológicos en su esfera biológica, secundarios al procedimiento, a nivel neurológico, cardiovascular, respiratorio, gastrointestinal, de eliminación y de la piel. Metodología: se realizó un estudio descriptivo, de seguimiento prospectivo. Se observaron y revisaron las historias clínicas de 151 pacientes en posoperatorio de 48 a 96 horas. La revisión de la historia clínica se realizó por el investigador. Se consignó la información en una hoja de registro de información y se procesó mediante métodos de análisis exploratorio multidimensional: análisis factorial de correspondencias múltiples combinado con el Método Cluster de Clasificación. Resultados: estuvieron relacionados con clases de pacientes de acuerdo con los eventos clínicos presentes en cada uno de los sistemas estudiados donde se evidencia que presentan alteración de los sistemas neurológico, cardiovascular, respiratorio y de la piel. Conclusión: la caracterización de los pacientes en posoperatorio de una revascularización miocárdica permite que el cuidado de enfermería sea enfocado hacia la solución de problemas de los sistemas antes mencionados.


Background: cardiovascular diseases are the leading cause of morbidity and mortality at global and national level; stands out coronary disease. This has contributed to make the surgical treatment of coronary artery bypass grafting being considered a routine procedure. This is one of the most important advances in medicine during the twentieth century. In Bogota, statistical records show that more than 50% of all cardiovascular surgeries corresponds to it. Objective: to characterize patients who are in early postoperative myocardial revascularization, who present physiological changes secondary to procedure, in the biological area at neurological, cardiovascular, respiratory, and gastrointestinal level, elimination system and skin. Methodology: a descriptive study was performed and followed prospectively. The medical records of 151 patients in postoperative 48 to 96 hours were seen and reviewed. The review of the medical history was performed by the researcher. The information was collected on a recording sheet and then recorded and processed by methods of multidimensional exploratory analysis: Multiple correspondence analysis combined with Cluster Classification Method. Results: they were related to the kind of patient according to clinical events present in each of the studied systems where there is evidence of alteration of the neurological, cardiovascular and respiratory systems, and skin. Conclusion: the characterization of patients in postoperative of myocardial revascularization allows nursing care to be focused on solving problems of the aforementioned systems.


Subject(s)
Humans , Myocardial Revascularization/education , Myocardial Revascularization/adverse effects , Myocardial Revascularization/nursing , Myocardial Revascularization/statistics & numerical data , Myocardial Revascularization/methods , Myocardial Revascularization/mortality , Myocardial Revascularization/rehabilitation , Coronary Disease/surgery , Coronary Disease/complications , Coronary Disease/nursing , Coronary Disease/epidemiology , Coronary Disease/etiology , Coronary Disease/physiopathology , Coronary Disease/history , Coronary Disease/mortality , Coronary Disease/pathology , Coronary Disease/rehabilitation
11.
Colomb. med ; 46(1): 41-46, Jan.-Mar. 2015. tab
Article in English | LILACS | ID: lil-753534

ABSTRACT

Coronary heart disease (CHD) is highly prevalent in patients with diabetes mellitus (DM), and remains the single most common cause of death among this population. Regrettably, a significant percentage of diabetics fail to perceive the classic symptoms associated with myocardial ischemia. Among asymptomatic diabetics, the prevalence of abnormal cardiac testing appears to be high, raging between 10% and 62%, and mortality is significantly higher in those with abnormal scans. Hence, the potential use of screening for CHD detection among asymptomatic DM individuals is appealing and has been recommended in certain circumstances. However, it was not until recently, that this question was addressed in clinical trials. Two studies randomized a total of 2,023 asymptomatic diabetics to screening or not using cardiac imaging with a mean follow up of 4.4 ±1.4 yrs. In combination, both trials showed lower than expected annual event rates, and failed to reduce major cardiovascular events in the screened group compared to the standard of care alone. The results of these trials do not currently support the use of screening tools for CHD detection in asymptomatic DM individuals. However, these studies have important limitations, and potential explanations for their negative results that are discussed in this manuscript.


La enfermedad de la arterias coronarias (EAC) es muy prevalente en pacientes con diabetes mellitus (DM), y continúa siendo la principal causa de muerte en estos pacientes. Desafortunadamente, muchos diabéticos pueden carecer de síntomas de alerta en la presencia de isquemia miocárdica, por lo cual el diagnóstico de EAC puede ocurrir de manera tardía. Estudios observacionales han sugerido que la prevalencia de isquemia miocárdica puede ser alta en diabéticos asintomáticos (10 al 62% según la serie) y la mortalidad es mayor en esos pacientes. Por esto, el uso de pruebas para detección de EAC en el paciente diabético asintomático parece atractivo y es recomendado en ciertas circunstancias. Sin embargo, no fue si no hasta hace poco que dos estudios investigaron el verdadero rol de estas pruebas de manera randomizada. En conjunto, 2,023 pacientes diabéticos asintomáticos fueron aleatorizados a recibir o no una prueba para detección de EAC y fueron seguidos en promedio por 4.4 ±1.4 años. Al final de seguimiento, ambos estudios mostraron menos eventos cardiovasculares de los esperados, y el uso de pruebas para detección de EAC no redujo la tasa de eventos cardiovasculares comparado al no uso de estas pruebas. Los resultados de estos ensayos clínicos no soportan actualmente el uso de estas pruebas en el paciente diabético asintomático. Sin embargo, estos estudios tienen limitaciones importantes, y posibles hipótesis para explicar los resultados que son discutidas en el artículo.


Subject(s)
Humans , Coronary Disease/diagnosis , Diabetic Angiopathies/diagnosis , Mass Screening/methods , Coronary Disease/epidemiology , Coronary Disease/etiology , Diabetic Angiopathies/epidemiology , Myocardial Ischemia/diagnosis , Myocardial Ischemia/epidemiology , Myocardial Ischemia/etiology , Randomized Controlled Trials as Topic
12.
Arch. cardiol. Méx ; 84(2): 71-78, abr.-jun. 2014. ilus, tab
Article in English | LILACS | ID: lil-732008

ABSTRACT

Objective: The Framingham Coronary Heart Disease Risk Score is an important clinical tool. The aim of this cross-sectional study was to compare plasma homocysteine levels and polymorphism 677CT MTHFR with this score to determine the utility of these new biomarkers in clinical practice. Methods: Plasma homocysteine levels determined by chemiluminescence and polymorphism 677CT MTHFR, detected by PCR-RFLP, were compared with Framingham coronary risk score in a cross-sectional survey on 68 men and 165 women. Results: Coronary heart disease risk augmented with an increase in the quartile of plasma homocysteine. In the 2nd, 3rd and 4th quartile of plasma homocysteine, men showed significantly (P < 0.001) higher risk than women. For the highest quartile of plasma homocysteine, OR of high-risk (10-year risk ≥ 20%) compared with the lowest quartile was 17.45 (95% CI: 5.79-52.01). Frequencies of CT and TT genotype and T allele were not over-represented in the individuals with score ≥ 10%. The higher plasma homocysteine concentrations in individuals with score ≥ 10% with respect to those with low risk (P < 0.005 and P < 0.001) were not due to the presence of T allele. The T allele (CT + TT genotypes) of the MTHFR C677T polymorphism was not significantly associated with an increased risk of coronary disease (OR = 1.09, 95% CI = 0.50-2.39, P = 0.844). Conclusions: The present study demonstrated an association between plasma homocysteine levels and the severity of coronary heart disease estimated with the Framingham coronary risk score, and this association appeared to be independent on the genotype of MTHFR. We postulate that plasma homocysteine is effective enough, considered even in isolation.


Objetivo: La puntuación del riesgo coronario de Framingham es una importante herramienta clínica. El objetivo del presente estudio transversal fue comparar los niveles plasmáticos de homocisteína plasmática y el polimorfismo 677CT de la MTHFR con esta herramienta para determinar la utilidad de estos nuevos biomarcadores en la práctica clínica. Métodos: Los niveles de homocisteína plasmática determinados por quimioluminiscencia y el polimorfismo 677CT MTHFR por PCR-RFLP fueron comparados con la puntuación del riesgo coronario de Framingham en un estudio transversal sobre 68 hombres y 165 mujeres. Resultados: El riesgo de enfermedad coronaria aumentó con el incremento en los cuartiles de homocisteína plasmática. En el segundo, tercero y cuarto cuartil de homocisteína plasmática los hombres mostraron significativamente (p < 0.001) mayor riesgo que las mujeres. Para el cuartil más alto de homocisteína plasmática, la OR de riesgo alto (riesgo a 10 años ≥ 20%) comparado con el cuartil más bajo fue 17,45 (IC 95%: 5,79-52,01; p < 0.001). Las frecuencias de los genotipos CT y TT y del alelo T no estuvieron aumentados en los individuos con una puntuación ≥ 10%. Las mayores concentraciones de homocisteína plasmática en los individuos con una puntuación ≥ 10% respecto a los de bajo riesgo (p < 0.005 y p < 0.001) no se debieron a la presencia del alelo T. El alelo T (genotipos CT + TT) del polimorfismo MTHFR C677T no estuvo significativamente asociado con mayor riesgo de enfermedad coronaria (OR = 1.09, IC 95% = 0.50-2.39, p = 0.844). Conclusiones: El presente estudio mostró una asociación entre los niveles de homocisteína plasmática y la severidad de la enfermedad coronaria estimada con el algoritmo de puntuación de riesgo coronario de Framingham y esta asociación resultó ser independiente del genotipo de MTHFR. Postulamos que la homocisteína plasmática es lo suficientemente eficaz, estudiada incluso aisladamente.


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Coronary Disease/blood , Coronary Disease/enzymology , Homocysteine/blood , /genetics , Polymorphism, Genetic , Alleles , Biomarkers/blood , Cross-Sectional Studies , Coronary Disease/etiology , Hyperhomocysteinemia/blood , Hyperhomocysteinemia/complications , Odds Ratio , Risk , Sex Factors
13.
Journal of the Egyptian Society of Parasitology. 2014; 44 (1): 187-195
in English | IMEMR | ID: emr-154441

ABSTRACT

Non-alcoholic fatty liver disease [NAFLD] is currently the most common cause of abnormal liver biochemistry and cryptogenic cirrhosis. Those with NAFLD have a higher prevalence of atherosclerosis, as shown by increased carotid artery intimal media thickness [CIMT]. The aim of this study is to assess the co-incidence and prevalence between NAFLD and carotid atherosclerosis. In this study seventy-two subjects were categorized into 2 groups. QL 52 patients diagnosed as NAFLD with diabetes mellitus type 2 or obesity or hyperlipedemia. Gil: 20 diseased controls diagnosed as NAFLD without other predisposing factor. CIMT and plaque prevalence were estimated by carotid ultrasonography as a single trained operator who was blind to clinical characteristics of participants. The results showed that CIMT by carotid duplex ultrasonography was significantly higher in group A than group B but CIMT did not reveal any significant difference as regards to the etiology of NAFLD. CIMT was significantly higher in cases with bright liver than those with homogenous liver [by abdominal US] in group I and II. CIMT was significantly higher in those with moderate steatosis than those with mild steatosis [in GI and Gil]


Subject(s)
Humans , Male , Female , Coronary Disease/etiology , /pathology , Carotid Artery Diseases/complications , Risk Factors , Obesity/complications , Hyperlipidemias/complications , Ultrasonography/statistics & numerical data , Cross-Sectional Studies , Diabetes Mellitus, Type 2 , Hypertension/complications
14.
Article in English | IMSEAR | ID: sea-157524

ABSTRACT

Background: Several studies have investigated the relationships of lipid levels with psychiatric patients and their results revealed an association between lipid derangement and psychiatric disorders. The aim of our study is to evaluate the lipid profile alteration in psychiatric disorder and compare with normal control. Materials and Methods: This study was conducted at People’s College of Medical Sciences and Research Centre, Bhopal. Sixty newly diagnosed psychiatric patients were included in this study and compare with 40 normal subjects. In both the groups we have measured lipid profile which includes serum total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (LDL), very low density lipoprotein cholesterol (VLDL), and cardiovascular risk factors (R-1and R2). Results: The levels of serum TC, TG, LDL-C and VLDL-C and risk factors in psychiatric patients was significantly increased as compared to control group (p<0.05). While serum HDL-C level was significantly decreased in test group (p > 0.05). Conclusion: In our study it is clearly evident that psychiatric disorders are associated with significantly higher levels of lipids (constituents of lipid profile) and risk factors for coronary heart disease.


Subject(s)
Adult , Coronary Disease/epidemiology , Coronary Disease/etiology , Female , Humans , India , Lipids/analysis , Lipids/blood , Male , Mental Disorders/epidemiology , Mental Disorders/etiology , Middle Aged , Risk Factors , Schizophrenia/epidemiology , Schizophrenia/etiology , Young Adult
15.
Rev. bras. cir. cardiovasc ; 28(2): 238-247, abr.-jun. 2013. tab
Article in Portuguese | SES-SP, LILACS, SES-SP | ID: lil-682435

ABSTRACT

OBJETIVO: Demonstrar a eficácia de um programa de otimização da prática clínica em pacientes com doença arterial coronária para prescrição de medicamentos e documentar a prática clínica vigente quanto aos medicamentos e medidas para a mudança do estilo de vida. MÉTODOS: Estudo de corte transversal, seguido de componente longitudinal. Foram incluídos 710 pacientes consecutivos (Fase 1). Após aplicação de ferramentas para melhoria da prática clínica, foram incluídos, após seis meses, 705 pacientes com coleta dos mesmos dados (Fase 2). Foram selecionados aleatoriamente, a partir do primeiro grupo, 318 prontuários para comparação desses mesmos pacientes (Fase 3). RESULTADOS: Comparação entre as Fases 1 e 2: melhora em relação a tabagismo (P=0,019), dislipidemia (P<0,001), hipertensão arterial e atividade física regular (P<0,001). Diferença significativa para inibidores da enzima de conversão da angiotensina - IECA (67,2% vs. 56,8%, P<0,001); antagonistas do receptor da angiotensina II - ARA II (25,4% vs. 32,9%, P=0,002) e betabloqueador (88,7% vs. 91,9%, P=0,047). Comparação entre as Fases 1 e 3: houve redução do peso (P=0,044) e pressão arterial (P<0,001). Em relação à prescrição de medicamentos recomendados, diferença para IECA (64,8% vs. 61,6%, P=0,011) e ARA II (27,0% vs. 31,3%, P=0,035). CONCLUSÃO: Não houve mudança significativa na utilização de medicamentos; entretanto, observou-se melhora significativa em relação ao tabagismo e atividade física na Fase 2; melhora substancial nos níveis de pressão arterial, na comparação tanto entre as Fases 1 e 2 como entre as Fases 1 e 3. A inclusão de enfermeiro treinado para gerenciar o processo foi fundamental. Programas abrangentes de melhoria de qualidade assistencial, provavelmente, devem ser continuados por período de seguimento maior.


OBJECTIVE: To demonstrate the utilization of a clinical improvement program in stable coronary artery disease patients to increase the evidence-proven treatment utilization, and to describe the ongoing clinical practice and lifestyle change counseling. METHODS: Cross-sectional study followed by a longitudinal component in which the tools utilization to improve clinical practice was assessed by means of additional cross-sectional data collection. 710 consecutive patients were included (Phase 1). After tools implementation, within 6 months period, 705 patients were included (Phase 2) for comparative analysis. Randomly, 318 patients from Phase 1 were selected, 6-12 months after the first evaluation (Phase 3). RESULTS: Phase 1 to Phase 2: there were improvement on smoking cessation (P=0.019), dyslipidemia (P<0.001), hypertension and physical activity (P<0.001). There was significant difference on angiotensin converting enzyme inhibitors - ACEI (67.2% vs. 56.8%, P<0.001); angiotensin II receptor blockers - ARB II (25.4% vs. 32.9%, P=0.002) and beta-blocker (88.7% vs. 91.9%, P=0.047). Phase 1 to Phase 3: there was both weight (P=0.044), and blood pressure reduction (P<0.001). There was statistical significant difference on ACEI (64.8% vs. 61.6%, P=0.011) and ARB II (27.0% vs. 31.3%, P=0.035). CONCLUSION: There was no significant change on the evidence-based pharmacological treatment utilization between pre and post-intervention phases; there was significant improvement concerning smoking and physical activity in phase 2; substantial improvement on blood pressure levels in both comparisons (Phase 1 to 2 and Phase 1 to 3). The inclusion of a case-manager for the process management was crucial for program efficacy. Comprehensive programs for clinical practice should be pursued for longer follow-up period.


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Coronary Disease/prevention & control , Guideline Adherence , Life Style , Secondary Prevention/methods , Cardiovascular Agents/therapeutic use , Coronary Disease/etiology , Cross-Sectional Studies , Dyslipidemias/therapy , Hypertension/drug therapy , Reproducibility of Results , Risk Factors , Smoking Cessation , Time Factors , Treatment Outcome
16.
Arq. neuropsiquiatr ; 71(5): 320-326, maio 2013. tab
Article in English | LILACS | ID: lil-674215

ABSTRACT

Coronary heart disease and ischemic stroke are frequent coexistent conditions that share risk factors and pose major burdens to global health. Even though a clear relation has been established between extracranial internal carotid artery atherosclerosis and symptomatic or asymptomatic coronary heart disease, there is a gap in knowledge about the association between intracranial atherosclerosis and coronary heart disease. Intracranial atherosclerosis is associated with high risks of stroke recurrence and vascular death. More research and clinical trials are needed to answer whether early diagnosis of asymptomatic coronary heart disease and aggressive treatment can decrease the risk of vascular death in patients with ischemic stroke caused by intracranial atherosclerosis.


A doença coronária e o acidente vascular cerebral isquêmico são condições frequentemente associadas, que compartilham fatores de risco e representam grande sobrecarga à saúde mundial. Embora seja claramente reconhecida a relação entre a doença coronária sintomática ou assintomática e a aterosclerose da artéria carótida interna em sua porção extracraniana, há uma lacuna no conhecimento sobre a associação entre doença coronária e aterosclerose intracraniana, que por sua vez é associada a alto risco de recorrência de acidente vascular cerebral isquêmico e de morte por causas vasculares. é necessário avaliar se o diagnóstico precoce da doença coronária assintomática e seu tratamento agressivo podem diminuir o risco de morte por causas vasculares em pacientes com acidente vascular cerebral isquêmico ocasionado por aterosclerose intracraniana.


Subject(s)
Humans , Coronary Disease/etiology , Intracranial Arteriosclerosis/complications , Stroke/etiology , Carotid Artery Diseases/physiopathology , Coronary Disease/diagnosis , Risk Factors , Stroke/diagnosis
17.
Rev. bras. epidemiol ; 16(1): 49-57, mar. 2013. tab
Article in Portuguese | LILACS | ID: lil-674810

ABSTRACT

OBJETIVOS: Examinar a associação entre consumo de álcool e risco para doença coronariana em amostra populacional. MÉTODOS: Estudo transversal, de base populacional, conduzido de janeiro/2006 a junho/2007, na região metropolitana de São Paulo, como parte do estudo internacional (Gender, Alcohol, and Culture: an International Study). Os sujeitos (1.501, sendo 609 homens e 892 mulheres) eram residentes da região metropolitana de São Paulo, tinham 30 anos ou mais de idade e foram selecionados aleatoriamente, a partir de amostragem complexa por conglomerados. Todos os indivíduos consentiram em participar da pesquisa. A variável dependente foi risco cardíaco avaliado através do WHO Rose Angina Questionnaire. A análise multivariada consistiu em regressão logística, tendo sido realizado ajuste para uso de tabaco e índice de massa corpórea. RESULTADOS: A taxa de resposta foi 75%. Ser mulher, ter mais idade, ser negro, fumante e ter um índice de massa corpórea elevado, foram associados a maior risco para doença coronariana. Indivíduos que nunca beberam na vida (OR = 2,22) e ex-bebedores (OR = 2,42) tiveram maior risco de doença cardíaca do que aqueles que informaram beber até 19 g de álcool por dia, sem episódios de beber excessivo. Entre os que tiveram episódios de embriaguês observou-se uma tendência a maior risco (OR = 3,95, p = 0,09). CONCLUSÕES: Nossos achados sugerem um menor risco para doença coronariana entre os bebedores moderados. Destaca-se que os estudos que avaliam o impacto do álcool sobre doença cardíaca precisam identificar o padrão de uso de álcool dos sujeitos, visto que este aspecto pode modificar o risco. Políticas públicas são necessárias para reduzir ...


OBJECTIVES: To examine the association between patterns of drinking and coronary heart disease (CHD) risk in a populational sample. METHODS: A population-based cross-sectional study carried out from January 2006 to June 2007, in Metropolitan São Paulo, Brazil, in conjunction with the international collaborative GENACIS project (Gender, Alcohol, and Culture: an International Study), with PAHO support. The subjects (1,501; 609 men, 892 women) of this study were residents of randomly chosen households aged 30 years and above who consented to provide information. The dependent variable was cardiac risk as assessed by the WHO Rose Angina Questionnaire. Logistic Regression analysis was used and the data were adjusted for Body Mass Index (BMI) and smoking. RESULTS: The response rate was 75%. Being female, older, African-American, a current smoker, and having a greater BMI were associated with higher risk of coronary heart disease. Lifetime abstainers (OR = 2.22) and former drinkers (OR = 2.42) had greater CHD risk than those who consumed up to 19g pure alcohol per day, with no binge. Among those who had binged weekly or more there was a tendency toward higher risk (OR = 3.95, p = .09). CONCLUSIONS: Our findings suggest a lower risk for CHD among moderate drinkers. It is important, in studies which were investigating cardiac risk, assess heavy alcohol use, since it can change that risk. Also, effective public policies are needed to reduce harmful drinking and related morbidity in Brazil. .


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Alcohol Drinking/epidemiology , Coronary Disease/epidemiology , Alcohol Drinking/adverse effects , Brazil/epidemiology , Cross-Sectional Studies , Cultural Characteristics , Coronary Disease/etiology , Risk Assessment , Risk Factors , Urban Health
18.
Arch. latinoam. nutr ; 62(3): 267-274, Sept. 2012. ilus, tab
Article in English | LILACS | ID: lil-710631

ABSTRACT

The objective of this study was to analyze whether obese women with no metabolic syndrome (MetS) have increased cardiometabolic risk compared to non-obese women and to observe the correlations between adiposity and coronary heart disease (CHD) risk factors in metabolically healthy women. 20-40 year old non-obese (n=41), obese with no MetS (n=30) and obese with MetS (n=28) women were studied. Lipid profile, blood pressure, CHD family history, physical inactivity, high-sensitivity C-reactive protein (hs-CRP), fibrinogen, interleukin-1β and tumor necrosis factor-alpha were analyzed. A subset of obese (13) and non-obese (33) women with no major components of MetS (except waist circumference) were further compared. Obese women with no MetS and non-obese women presented a similar metabolic profile that was statistically different from those seen in obese women with MetS. The number of obese women with no MetS and non-obese women presenting two or more risk factors (23.3 and 19.5%, respectively) or presenting high Framingham Risk Score (6.7 and 2.4%, respectively) were also similar. The only pro inflammatory protein correlated to waist circumference was hs-CRP. These data suggest that obesity with no MetS induce a CHD risk comparable to the risk seen in non-obese women. However, when women with no major components of MetS alone were considered, adiposity was positively correlated to blood pressure and hs-CRP. Although CHD risk of obese women with no MetS is closer to non-obese women, adipose tissue expansion was positively correlated to blood pressure and hs-CRP that are important risk factors for CHD.


Obesidad sin síndrome metabólico y expansión del tejido lipidio basado exclusivamente en factores de riesgo e marcador inflamatorio de la enfermedad coronaria em mujeres en la pré-menopausia. El objetivo de esta investigación fue analizar si las mujeres obesas que no tienen el síndrome metabólico (MetS), tienen riesgo cardiometabólico aumentado comparado con mujeres no obesas y observar las correlaciones entre factores de riesgo de la adiposidad y la enfermedad coronaria del corazón (CHD) en mujeres metabólicamente saludables. Fueron estudiadas mujeres de 20-40 años de edad no-obesas (n=41), obesas sin MetS (n=30) y obesas con MetS (n=28). Se analizaron también factores tradicionales de riesgo y marcadores inflamatorios. Un sub conjunto de mujeres obesas (13) y no obesas (33) sin componentes mayores de MetS fueron comparados adicionalmente. Mujeres obesas sin MetS y mujeres no obesas evidenciaron un perfil metabólico semejante, estadísticamente diferente de lo visto en mujeres obesas con MetS. El número de mujeres obesas sin MetS y no obesas que presentaban dos ó más factores de riesgo (23.3 y 19.5%, respectivamente) ó presentaban riesgo alto con Framingham (6.7 y 2.4%, respectivamente) también fueron semejantes. Estos datos sugieren que la obesidad sin MetS induce un riesgo de CHD comparable al riesgo observado en mujeres no obesas. Sin embargo, cuando las mujeres sin componentes importantes del MetS únicamente fueron llevadas en cuenta, la adiposidad fue correlacionada a la presión sanguínea y a la hs-CRP. Aunque el riesgo de la CHD de mujeres obesas sin MetS sea más próximo al de mujeres no obesas, la expansión del tejido adiposo fue positivamente correlacionado a la presión sanguínea y a la hs-CRP, ambos importantes factores de riesgo para la CHD.


Subject(s)
Adult , Female , Humans , Young Adult , Adipose Tissue , Coronary Disease/etiology , Obesity/complications , Body Mass Index , Biomarkers/analysis , C-Reactive Protein/analysis , Cross-Sectional Studies , Inflammation/diagnosis , Metabolic Syndrome/complications , Pilot Projects , Risk Factors , Waist Circumference
19.
Article in English | IMSEAR | ID: sea-157423

ABSTRACT

Present study was carried out in a view to studing the effect of Risperidone used for treatment of Schizophrenia on Lipid Profile and, its related risk for coronary heart disease, in 30 patients on Risperidone and compared with 30 age and sex matched healthy controls. We found that this drug significantly does not increase the risk for coronary heart disease in patients with respect to lipid profile and other parameters as described by Framingham study group by estimating Framingham Point Scores. Nor it has much effect on lipid profile, except that triglyceride shows significantly higher levels (187.1 ± 24.73) as compared to controls (135.9 ± 25.05) with p value <0.001. Altogether, this drug is safe for these patients, but long-term implications of these findings need to be studied, as prevalence of CHD is increasing day-by-day due to the globalization.


Subject(s)
Adult , Coronary Disease/epidemiology , Coronary Disease/etiology , Humans , Lipids/analysis , Lipids/blood
20.
Pakistan Oral and Dental Journal. 2012; 32 (2): 267-270
in English | IMEMR | ID: emr-146066

ABSTRACT

This cross sectional study was done to find out the association of periodontal disease, smoking and diabetes in Coronary Heart Disease [CHD] patients. Sixty eligible coronary heart disease male patients with periodontitis visiting the University College of Dentistry between October 2011 to April 2012 were divided into 4 groups i.e. A [smoker-diabetic], B [nonsmoker-diabetic], C [smoker-non diabetic] and D [non smoker - non diabetic]. Bleeding on probing, periodonetal pocket depth and clinical attachment loss were noted as measures of periodontal status. Differences of periodontal parameters between groups A, B, C and D were analyzed using K-test of proportions and one-way ANOVA. Levels of bleeding on probing, periodontal pocket depth and clinical attachment loss were comparatively higher in group A [smoker - diabetic]. Mean levels of bleeding on probing, periodontal pocket depth and clinical attachment loss were significant [<0.05] between groups. Forty five percent subjects of group A [smoker-diabetic] had periodontal pocket depth >4 mm and clinical attachment loss >3mm at more than 30% sites [p=0.01]. This study showed that periodontal disease is significantly associated with coronary heart disease patients and the levels of periodontal parameters were higher in smoker-diabetic coronary heart disease patients suggesting an association between periodontal disease, smoking, diabetes and coronary heart disease


Subject(s)
Humans , Male , Smoking/adverse effects , Coronary Disease/etiology , Diabetes Complications , Risk Factors , Cross-Sectional Studies
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