Atherosclerosis risk factor management - what's new for the neurologist? / Controle dos fatores de risco cardiovascular - o que há de novo para o neurologista?

ABSTRACT Stroke is the second leading cause of death worldwide and the vast majority can be attributed to modifiable risk factors, mainly behavioral and metabolic. The top six risk factors responsible for cardiovascular mortality in Brazil in 2019 were high systolic blood pressure, inadequate dietary exposure, high body mass index, high LDL cholesterol, high fasting blood glucose levels, and tobacco. We intend to discuss in this paper the evidence and recommendations in the approach of three essential risk factors for patients with a history of stroke: dyslipidemia, hypertension and diabetes.

RESUMO O acidente vascular cerebral (AVC) é a segunda causa de morte no mundo e, em grande parte, pode ser atribuído a fatores de risco modificáveis, principalmente comportamentais e metabólicos. Os seis principais fatores de risco responsáveis pela mortalidade cardiovascular no Brasil em 2019 foram pressão arterial sistólica elevada, exposição alimentar inadequada, índice de massa corporal elevado, LDL -colesterol elevado, níveis alterados de glicemia e tabagismo. Pretendemos discutir neste artigo as evidências e recomendações na abordagem de três fatores de risco essenciais para pacientes com histórico de AVC: dislipidemia, hipertensão e diabetes.

Hemodynamic depression after carotid surgery: Incidence, risk factors and outcomes

Abstract Introduction: Hemodynamic Depression (HD) characterized by hypotension and bradycardia is a complication of carotid surgery due to direct autonomic stimulation in the carotid sinus. The authors believe the incidence of HD is high and possibly related to major cardiac complications. Methods: Analysis of patient records during admissions for carotid surgery between January 2014 and December 2018 in two hospitals. HD was defined as bradycardia or hypotension in the first 24 postoperative hours. Bradycardia was defined as heart rate < 50bpm; hypotension as systolic blood pressure < 90 mmHg, continuous use of vasopressors, or a drop in SBP > 20% compared to preoperative values. Myocardial infarction, stroke, and cardiovascular death were defined as adverse events. Results: Overall, 237 carotid surgeries (178 endarterectomies, 59 angioplasties) were studied, and the global incidence of HD was 54.4% (hypotension in 50.2%, bradycardia in 11.0%, and hypotension and bradycardia in 6.8%). The independent predictors of HD were asymptomatic carotid stenosis (OR = 1.824; 95% CI 1.014 −3.280; p = 0.045), endovascular surgery (OR = 3.319; 95% CI 1.675−6.576; p = 0.001) and intraoperative hypotension or bradycardia (OR = 2.144; 95% CI 1.222−3.762; p = 0.008). Hypotension requiring continuous vasopressor infusion was the only factor independently associated with adverse cardiovascular events (OR = 5.504; 95% CI 1.729-17.529; p = 0.004). Discussion/conclusion: Incidence of Hemodynamic Depression after carotid surgery is high and independently associated with surgical technique, symptomatic repercussion of the carotid stenosis, and intraoperative hypotension or bradycardia. Hypotension requiring the continuous infusion of vasopressors was independently associated with the occurrence of MACE.

Cardiology referral during the COVID-19 pandemic

OBJECTIVES: This study presents the cardiology referral model adopted at the University of São Paulo-Hospital das Clínicas complex during the initial period of the coronavirus disease (COVID-19) pandemic, main reasons for requesting a cardiologic evaluation, and clinical profile of and prognostic predictors in patients with COVID-19. METHODS: In this observational study, data of all cardiology referral requests between March 30, 2020 and July 6, 2020 were collected prospectively. A descriptive analysis of the reasons for cardiologic evaluation requests and the most common cardiologic diagnoses was performed. A multivariable model was used to identify independent predictors of in-hospital mortality among patients with COVID-19. RESULTS: Cardiologic evaluation was requested for 206 patients admitted to the ICHC-COVID. A diagnosis of COVID-19 was confirmed for 180 patients. Cardiologic complications occurred in 77.7% of the patients. Among these, decompensated heart failure was the most common complication (38.8%), followed by myocardial injury (35%), and arrhythmias, especially high ventricular response atrial fibrillation (17.7%). Advanced age, greater need of ventilatory support on admission, and pre-existing heart failure were independently associated with in-hospital mortality. CONCLUSIONS: A hybrid model combining in-person referral with remote discussion and teaching is a viable alternative to overcome COVID-19 limitations. Cardiologic evaluation remains important during the pandemic, as patients with COVID-19 frequently develop cardiovascular complications or decompensation of the underlying heart disease.

Effectiveness of a Brief Intervention based on Motivational Interviewing in Colombian Adolescents / Efetividade de uma intervenção Breve baseada na Entrevista Motivacional com Adolescentes Colombianos

ABSTRACT Prevention science has identified evidence-based strategies for reducing alcohol and other drug use among adolescents, such as Brief Interventions (BI) and Motivational Interviewing (MI). However, there is little evidence about the effectiveness of these practices in Colombia. This study aimed to analyze the effectiveness of the preventive program Brief Intervention based on Motivational Interviewing (BIMI) in reducing alcohol use in adolescents. The program was administered to 3,159 secondary students through a within-subjects design. The results showed that BIMI is a preventive strategy that diminishes the frequency and quantity of alcohol consumption. The study examines how the elapsed time between sessions influences the results. Implications for prevention and evaluation methodologies are discussed.

RESUMO A ciência preventiva tem identificado estratégias baseadas em evidências voltadas à redução do uso de álcool e outras drogas entre adolescentes, tais como as Intervenções Breves (BI) e a Entrevista Motivacional (MI). No entanto, existe pouca evidência quanto à efetividade dessas práticas na Colômbia. Este estudo buscou analisar a eficácia do programa preventivo Intervenção Breve Baseada na Entrevista Motivacional (BIMI) em reduzir o uso de álcool em adolescentes. O programa foi conduzido junto a 3159 estudantes secundários por meio de um delineamento intra-sujeitos. Os resultados demonstraram que a BIMI constitui uma estratégia preventiva que diminui a frequência e a quantidade de uso de álcool. O estudo examina como o tempo transcorrido entre as sessões influencia os resultados. Implicações para a prevenção e métodos de avaliação são discutidos.

Sand flies (Diptera: Psychodidae) in a cerrado area of the Maranhão state, Brazil

The present paper aims to increase the knowledge on the sand fly fauna in the cerrado areas of Maranhão state in urban, rural and forest environments. The research was carried out from October 2007 to September 2008, between 18:00h and 06:00h, in the municipality of Chapadinha, northeast Maranhão. For insect sampling, CDC light traps were set up in peridomicile and domicile areas of urban and rural zones as well as in Cerrado and Gallery forests. The total of 1,401 specimens belonging to 17 species were sampled, all within the genus Lutzomyia. Lutzomyia longipalpis (Lutz & Neiva) (52.5 percent), Lu. evandroi (Costa Lima & Antunes) (18.3 percent), Lu. whitmani (Antunes & Coutinho) (12.1 percent), Lu. lenti (Mangabeira) (4.7 percent) and Lu. termitophila (Martins, Falcão & Silva) (4.0 percent) were the most frequently collected. From an epidemiological viewpoint, five from all of the collected species are vectors of leishmaniasis: Lu. longipalpis, Lu. whitmani, Lu. flaviscutellata (Mangabeira), Lu. gomezi (Nitzulescu) and Lu. chagasi (Costa Lima). Lutzomyia chagasi was registered for the first time in Maranhão state and Lu. saulensis (Floch & Abonnenc), Lu. monstruosa (Floch & Abonnenc) and Lu. gomezi were found for the first time in the eastern part of the state, since they had been reported only in the Amazonian region of Maranhão. Regarding to the studied environments, the urban chicken house had the highest number of specimens collected (801), while the Gallery Forest was the most diverse (15 species). This study demonstrates that the northeast cerrado exhibits a mixed sand fly fauna characterized by an extremely important species vectors assortment involved in the epidemiological cycle of leishmaniasis in Maranhão state.