Optical coherence tomography angiography findings in patients with Alport syndrome / Alterações encontradas na angiografia por tomografia de coerência óptica (OCT-A) em pacientes com síndrome de Alport

ABSTRACT Purpose: To describe the findings on optical coherence tomography angiography associated with Alport syndrome. Methods: Descriptive study from a referral ophthalmology service (Hospital Evangélico de Vila Velha, Brazil). Patients diagnosed with Alport syndrome were included. Results: The study group consisted of four patients (one female and three males) diagnosed with Alport syndrome. Visual acuity in the worst eye was between 20/40 and 20/60. All male patients had anterior lenticonus on biomicroscopy. The observed retinal findings included dots and flecks and pigmentary changes in the macula. On optical coherence tomography angiography, the inner retinal layers of all patients displayed thinning (especially in the temporal quadrant of the macula) and an increase in the foveal avascular zone. A thick choroid was observed in both eyes of the two youngest patients. Conclusions: In patients with Alport syndrome, the inner retinal layers suffer changes due to type IV collagen mutations. Optical coherence tomography angiography makes it possible to visualize and document these findings, making it a useful tool in the detection of early retinal findings associated with Alport syndrome.

RESUMO Objetivos: Descrever os achados na angiografia por tomografia de coerência óptica associada à síndrome de Alport. Métodos: Estudo descritivo de um serviço de referência em Oftalmologia (Hospital Evangélico de Vila Velha, Brasil). Os pacientes diagnosticados com síndrome de Alport, foram incluídos. Resultados: O grupo de estudo foi composto por quatro pacientes (um feminino e três homens) com diagnóstico de síndrome de Alport. A acuidade visual no pior olho estava entre 20/40 a 20/60. Todos os pacientes do sexo masculino apresentaram lenticone anterior à biomiscroscopia. Os achados da retina observados incluíram pontos e manchas e alterações pigmentares na mácula. Na angiotomografia de coerência óptica, as camadas internas da retina de todos os pacientes apresentaram afinamento (especialmente na região temporal da mácula) e aumento da zona avascular foveal. Uma coroide espessa foi observada em ambos os olhos dos dois pacientes mais jovens. Conclusões: Em pacientes com síndrome de Alport, as camadas internas da retina sofrem alterações devido à mutação do colágeno tipo IV. A angiotomografia de coerência óptica permite visualizar esses achados, tornando-o uma ferramenta útil na detecção de achados iniciais da retina associados à síndrome de Alport.

O encontro da arte com a educação: o papel do saber psicológico / The encounter between art and education: the role of psychological knowledge

RESUMO: O presente artigo é parte de uma pesquisa que problematiza o encontro da arte com a educação, no Brasil, nas últimas duas décadas e o papel da psicologia nesse processo. Realizou-se uma cartografia crítica por meio de um conjunto de artigos de revistas acadêmicas, que pautam de modo prático ou teórico essa relação entre arte e a educação. De modo concomitante buscou-se apreender as estratégias pelas quais se efetivam as práticas de pedagogização da arte e como a discursividade psicológica participa de sua constituição. Notou-se que a partir do encontro da arte com algumas formas da psicologia, promove-se um dispositivo que assume os valores éticos e estéticos do indivíduo como um processo ativo de se constituir como sujeito via uma estimulação.

Abstract This article is part of a research that problematizes the encounter between art and education in Brazil in the last two decades as well as the role of psychology in this process. A critical cartography was perfomed through an archive containing a set of articles from academic journals approaching the relationship between art and education in a practical or theoretical way. Concomitantly, there was an attempt to capture the strategies by which the practices of art pedagogization are carried out and how the psychological discourse participates in its constitution. It was noted that from the encounter of art with some forms of psychology, comes the promotion of a device that takes the ethical and aesthetic values of the individual as an active process of constituting oneself as a subject via stimulation.

O Estado, a política liberal e a biopolítica / The state, liberal politics and biopolitics

Nesse ensaio, problematizamos ações da política liberal e suas relações com oEstado. Ao considerar algumas de suas proposições, questionamos a quaisrelações de poder essa prática social responde. Em que circunstâncias ela se interessa pelo governo dos homens? A partir do estudo das práticas intituladas como filantropia empresarial podemos indicar algumas estratégias e táticas dessa política. Entre as quais destacamos: a construção do Estado Moderno, a elaboração das diversas técnicas de controle social e as mudanças de foco com relação às análises das forças produtivas do capitalismo, que passaram a intervir nas curvas de normalidade econômica imanentes aos fenômenos da população...

This essay discusses some liberal political actions and their relations with the state. Considering some of their propositions, we ask: what power relations does that social practice respond to? Under what circumstances is the liberal politics interested in the government of men? From a study of the practices called corporate philanthropy we can indicate some strategies and tactics of such politics. Among which: the construction of the modern state, the development of various techniques of social control and the focus changes regarding the analysis of capitalism productive forces that intervene within the economic normality curves inherent in the population phenomena...

As práticas de produção da saúde e a gestão das condutas humanas / The practices of health production and the management of human conducts / Las prácticas de producción de salud y la gestión de las conductas humanas / Les pratiques de production de la santé et de la gestion de la conduite humaine

Este artigo propõe trazer para a análise um conjunto de práticas que, em nossos dias, inscrevem-se nos processos de produção de saúde, no contexto do governo das populações, em que se evidenciam certos objetos para a gestão das condutas humanas. A arte, o riso e o lixo serão os campos em análise dessas práticas que dependem da existência de sujeitos livres como objeto de governamentalidade. Para tanto, a análise se encaminha no interior desses diferentes territórios de efetuação da vida. Enfocam-se as experiências de gestão do lixo na cidade, produzidas por discursos e práticas médico-sociais, nas quais se determina que, no cálculo do exercício das práticas das liberdades individuais, devem ser considerados seus custos, tanto para a normalidade das curvas econômicas quanto para a organização pública das cidades visando à efetivação do bem-estar social. No caso das práticas dos palhaços humanitários nas instituições de saúde, elas emergem como elemento capaz de oferecer novos conteúdos para os processos de subjetivação inscritos no interior de uma lógica da prática de si voltada para o desenvolvimento de capital humano e na busca da saúde e da felicidade, mesmo que em situações de experiências-limite da existência humana, como a morte, a guerra e a miséria. Por último, as práticas artísticas, ao circularem hoje por diversos âmbitos, como os da educação e da saúde, em projetos sociais e ações filantrópicas de diversos tipos, respondem a uma demanda de produção de sujeitos livres de que se necessita para se ter uma população útil, saudável e produtiva. As matérias em análise nesses três campos de intervenção e transformação dos elementos que compõem a população serão as estratégias pedagógicas que estarão em circulação na produção de uma razão de cálculo de governo para a promoção de sujeitos livres, saudáveis, felizes, criativos e, portanto, produtivos.

This article analyses a set of practices that, in our days, are inscribed in the processes of health production, in the context of the government of populations, in which certain objects are evidenced for the management of the human conducts. Art, laughter and waste will be the fields included in the analysis of these practices that depend on the existence of free individuals as objects of governmentality. For such, the analysis is heading within these different territories of effectuation of life. The experiences of waste management in the city, produced by socio-medical discourses and practices, are focused. Within these experiences, it is established, that the costs for both the normality of economic curves and for the public organization of cities for the realization of social welfare, should be consideredin the calculation of the exercise of the individual liberties practices.The humanitarian'sclownspractices in health institutions, on the other hand, emerge as an element able to offer new content for the processes of subjectification. Processes inscribed within the self-focused practiceslogic of on the development of human capital and within the pursuit of health and happiness, even in limit-experiences situationsof the human existence, such as death, war, poverty. Finally, the artistic practices, which circulate nowadays in various fields such as education and health, social projects and philanthropic deeds of various kinds, respond to a demand for production of free individuals, needed in order to have a useful, healthy and productive population. The materials under analysis in these three fields of intervention and transformation of the elements of the population will constitute the pedagogical strategies that will be in circulation in the production of a government calculation reason to promote free, healthy, happy, creative, and, therefore, productive individuals.

Este artigo propone analizar un conjunto de prácticas que, en nuestros días, se inscriben en los procesos de producción de salud en el contexto del gobierno de las populaciones en que se evidencia ciertos objetos para la gestación de las conductas humanas. El arte, la risa y la basura serán los campus en análisis de estas prácticas que dependen de la existencia de sujetos libres como objeto de gobiernamentalidad. Para eso, el análisis se encamina en el interior de estos distintos territorios de efectuación de la vida. Las experiencias de gestación de la basura en la ciudad, producidas por discursos y practicas médico-sociales en que se determina que, en cálculo del ejercicio de las prácticas de las libertades individuales, deben ser considerados sus costos tanto para la normalidad de las curvas económicas, cuanto para la efectuación del bienestar social. En el caso de las prácticas de los payasos humanitarios en las instituciones de salud, ellas emergen como elemento capaz de ofrecer nuevos contenidos para los procesos de subjetivación inscritos en el interior de una lógica de la práctica de sí, volteada para el desenvolvimiento de capital humano y humana, como la muerte, la guerra, la miseria. Por último, las prácticas artísticas al circundaren hoy, por diversos ámbitos, como los de las educación y de la salud, en proyectos sociales y acciones filantrópicas de diversos tipos, contestan a una demanda de producciones de sujetos libres de que se necesita para obtener una populación útil, saludable y productiva. Las materias en análisis en estes tres campus de intervención y transformación de los elementos que componen la populación serán las estrategias pedagógicas que estarán en circulación en la producción de una ración de cálculo de gobierno para la promoción de sujetos libres, felices, saludables, creativos y, por eso, productivos.

Cet article propose l'analyse d'un ensemble de pratiques qui est, de nos jours, inscrit dans les processus d'amélioration de la santé dont le contexte est le gouvernement des populations où certains objets pour la gestion des conduites humaines sont mis en valeur. L'art, le rire et l'ordure seront les domaines d'études de ces pratiques. Celles-ci sont dépendantes de l'existence de personnes qui sont libres en ce qui concerne l'objet de la gouvernementalité. Pour tout cela, l'analyse se déplace au sein de ces différents champs de réalisation de la vie. Les expériences de gestion de l'ordure dans une ville sont faites à partir de discours et de pratiques sociales et médicales, avec lesquelles on détermine que les coûts doivent être considérés dans le calcul de l'action des pratiques des libertés individuelles. Ces coûts servent tant pour la normalité des courbes économiques que pour l'organisation publique des villes pour la réalisation du bien-être social. Dans le cas des pratiques des clowns humanitaires, elles apparaissent dans les institutions de santé comme un élément capable d'offrir des nouveaux contenus pour les processus de subjectivation, inscrits à l'intérieur d'une logique de la pratique de lui-même tourné vers le développement du capital humain et, aussi, vers la recherche de la santé et du bonheur, voire dans des situations d'expériences à la limite de l'existence humaine, comme la mort, la guerre et la misère, par exemple. Pour conclure, les pratiques artistiques, lors de leur circulation aujourd'hui dans des divers domaines, comme celles de l'éducation et de la santé ou dans des projets sociaux et philanthropiques de toutes sortes, elles répondent à une demande de formation de personnes libres dont elles ont besoin pour avoir une population utile, saine et productive. Les matières en analyse dans ces trois champs d'intervention et de transformation des éléments qui font partie de la population seront les stratégies pédagogiques qui seront en circulation dans la production d'une raison de calcul de gouvernement pour qu'il y ait une promotion de personnes libres en bonne santé, heureuses, créatives, et donc productives.

Effect of preoperative use of topical prednisolone acetate, ketorolac tromethamine, nepafenac and placebo, on the maintenance of intraoperative mydriasis during cataract surgery: A randomized trial.

Purpose: To compare the effects of preoperative use of topical anti-inflammatory prednisolone acetate, ketorolac tromethamine, nepafenac and placebo, on the maintenance of intraoperative mydriasis during cataract surgery. Design: Randomized clinical trial. Materials and Methods: This single-center, masked, randomized clinical study comprised 140 patients scheduled for cataract surgery. Patients (35 in each group) were randomized to receive placebo, prednisolone acetate, ketorolac tromethamine 0.4% or nepafenac. These eye drops were administered three times daily for the two days prior to surgery. The pupillary diameters were measured by the surgeon using a compass prior to the corneal section and at the end of surgery. The primary outcome was the number of patients with pupil ≥ 6mm at the end of the surgery; the secondary outcome was the number of patients with pupil ≥ 6mm at the beginning of the surgery. Results: All the patients achieved pupil ≥ 6mm at the beginning of the surgery. The number of patients in the prednisolone (29/35), nepafenac (31/35) and ketorolac (30/35) groups with pupil ≥ 6mm was greater than in the placebo group in the maintenance of intraoperative mydriasis (19/35 – P =0.003). There was no statistical difference among the prednisolone, nepafenac and ketorolac groups in the maintenance of intraoperative mydriasis (P =.791). There were no complications during surgery or related to the preoperative use of the eye drops. Conclusion: Preoperative use of ketorolac, prednisolone and nepafenac was effective in maintaining intraoperative mydriasis when compared with placebo.

A política empresarial: a responsabilidade social como mecanismo de segurança / The business political: the social responsibility as security mechanism

Neste ensaio, tomamos como problema as ações da política empresarial no Brasil, em específico a política de responsabilidade social das empresas, por entender que existe nessa iniciativa um status de inovação tecnológica que precisa ser interrogado, pois se inscreve no interior de uma racionalidade que objetiva o governo das populações e tem como instrumento técnico, para realizar esse fim, uma sociedade controlada por mecanismos de segurança. Para tanto, partimos da análise de três procedimentos efetivados por alguns projetos sociais desenvolvidos por empresas brasileiras - a pesquisa científica, o protagonismo juvenil e a metodologia participativa. A referência de análise são textos de diversas naturezas, veiculados por esses projetos e disponíveis ao acesso público.

In this research we discuss some political business actions, in Brazil, in particular the politics of social responsibility of companies, understanding that there is in this initiative a technological innovation status that needs to be questioned. Therefore it refers to the rationality that aims the management of populations. It has as technical device to achieve this a society controlled by security mechanisms. We take therefore as the axis of analysis three procedures enforced by some social projects developed by Brazilian companies - the scientific research, the juvenile protagonism and the participative methodology. The reference to the analysis are texts of many kinds from these projects and available to public access.

Aspectos morfológicos e funcionais dos autoimplantes esplênicos em ratos tratados com oxigenio hiperbárico / Splenic autoimplant and hyperbaric oxygen therapy in rats

OBJETIVO: Estudar aspectos morfológicos e funcionais dos autoimplantes esplênicos de ratos submetidos ou não à oxigenioterapia hiperbárica (OHB). MÉTODOS: Foram estudados em dois períodos distintos 105 ratos Wistar. No período mediato (n= 56) os animais foram avaliados até o 11º dia de pós-operatório, e no período tardio (n= 49), até o 70º dia. Em cada período os ratos foram distribuídos nos grupos: A- Simulação, B- Autoimplante esplênico, tratados com oxigênio hiperbárico ou não. Nos animais do Grupo A realizou-se apenas manipulação do baço. Nos animais do Grupo B realizou-se esplenectomia total e a seguir quatro fragmentos do baço foram implantados no grande omento. Em todos os animais foram dosados os lípides e imunoglobulinas e contadas as plaquetas e os corpúsculos de Howell-Jolly no pré-operatório e no 11º ou 70º dia de pós-operatório. O baço dos animais do Grupo A e os autoimplantes dos animais do Grupo B foram retirados e enviados para avaliação morfológica. RESULTADOS: No grupo B11nt houve aumento do colesterol total, LDL-colesterol, VLDL-colesterol e triglicérides. No grupo B70nt houve aumento do colesterol total e LDL-colesterol. Nos grupos tratados não houve alterações lipídicas. A IgM caiu nos grupos B e não alterou nos grupos A. Os corpúsculos de Howell - Jolly foram menos freqüentes nos grupos Bt que nos grupos Bnt. As plaquetas aumentaram nos grupos B11t e B11nt e não se alteraram nos demais grupos. A viabilidade microscópica dos grupos Bt foi melhor que a dos grupos Bnt. CONCLUSÃO: Os autoimplantes esplênicos dos animais tratados com OHB apresentaram melhor função e viabilidade do que os autoimplantes dos animais não tratados.

OBJECTIVE: To study the functional and morphological features of splenic autoimplants in rats subjected, or not, to postoperative hyperbaric oxygen therapy. METHODS: One hundred and five male Wistar rats, weighing 251.6 g ± 29.5 g, were studied ot early (11th day) and late (70th day ) postoperative periods. For each period the animals were distributed in the following groups: A (n=40), splenic manipulation; B (n=65),splenic autoimplants, not treated (nt) (A11nt- n=10, B11nt- n=21, A70nt- n= 10, B70nt-n= 18) and treated with hyperbaric oxygen (t) ( A11t- n= 10, B11t- n=15, A70t - n=10, B70t- n=11). Blood was collected for measurement of lipids and immunoglobulins , platelet and Howell-Jolly body count before and after surgery. The spleen and autoimplants were removed for histologic analyses. RESULTS: There was an increase of total cholesterol (p=0.00068), LDL-cholesterol (p=0.002), VLDL-cholesterol and triglycerides (p=0.0033) in B11nt group. There was an increase of total cholesterol (p= 0.0007) and LDL-cholesterol (p=0.0000) in B70nt group, and no alterations were observed in the other groups. IgM decreased in B groups (p=0.0000) and no changes were observed in the splenic manipulation group. Number of Howell-Jolly bodies were lesser in Bt groups than in Bnt groups( p=0.03). Platelets were increased in B11t and B11nt groups (p=0.0000) and remained unchanged in the other groups. Autoimplants microscopic viability was better in Bt groups than in Bnt. CONCLUSION: The splenic autoimplants of rats treated with hyperbaric oxygen therapy showed a better functionality and viability than those subjected to other procedures.

Growth of the lower spleen pole remaining after subtotal splenectomy in rats

PURPOSE: To determine whether the lower pole of the spleen grows after subtotal splenectomy following ligature of major spleen blood vessels. METHODS: Thirty-nine Wistar rats (328.8 ± 27.8 g) submitted to subtotal splenectomy with preservation of the lower splenic pole were divided into two groups: group 1 (control, n=20), immediate removal of the lower pole; group 2 (n=19), removal of the pole on postoperative day 80. The length, width and thickness of the pole were measured. In the control group, mean percent pole weight was calculated immediately after surgery in a direct and indirect manner. In the first case, the weight of the lower pole was divided by overall spleen weight; in the second case, pole weight was divided by the ideal weight of the spleen obtained by linear regression analysis. The results of the two calculations were compared. Macro- and microscopic examinations of the pole were performed. RESULTS: In group 1, no significant difference in mean percent pole weight was observed between the direct and indirect method. In group 2, mean percent pole weight obtained by indirect calculation on day 80 was higher than in group 1 (p<0.001). In group 2, mean length, width and thickness of the pole remnant increased from the first to the 80th day (p<0.05). Histological analysis showed preserved tissue architecture and features compatible with cell hyperplasia in group 2. CONCLUSION: The lower pole splenic remnant presented statistically significant growth up to postoperative day 80 after subtotal splenectomy, even after ligature of the major spleen vessels. Light microscopy revealed changes compatible with cell hyperplasia.

OBJETIVO: Verificar se o pólo inferior do baço cresce após a esplenectomia subtotal mesmo com a ligadura dos vasos esplênicos principais. MÉTODOS: 39 ratos, Wistar, pesando 328,8g ± 27,79 foram submetidos à esplenectomia subtotal com preservação do pólo inferior e distribuídos em dois grupos de acordo com a época da retirada do referido pólo: 1- controle (n=20)-retirada imediata; 2(n=19); retirada no 80º dia de pós-operatório. Foram medidos o comprimento, largura e espessura do pólo inferior. No grupo controle, o percentual médio do pólo inferior foi calculado imediatamente após a cirurgia de forma direta e indireta, e no grupo 2 de forma indireta. No cálculo direto dividiu-se o peso do pólo inferior pelo peso global do baço. No cálculo indireto dividiu-se o peso do pólo inferior pelo peso ideal do baço obtido por análise de regressão linear. Foi realizada a comparação entre esses dois cálculos. Foi realizado o exame macro e microscópico do pólo inferior. RESULTADOS: Não houve diferença significante entre o cálculo direto e indireto do percentual médio do pólo inferior no grupo 1. No grupo 2 o percentual médio do pólo inferior, por cálculo indireto, no 80º dia foi maior que no grupo 1 (p <0,001). A média do comprimento, largura e espessura desse remanescente no grupo 2 aumentou do 1º para o 80º dia( p<0,05). A análise histológica mostrou no grupo 2 manutenção da arquitetura esplênica e sinais compatíveis com hiperplasia celular. CONCLUSÃO: O pólo inferior do baço remanescente da esplenectomia subtotal, mesmo com a ligadura dos vasos esplênicos principais, apresentou média de crescimento significante no 80º dia de pós-operatório e à microscopia óptica de luz houve sinais compatíveis com hiperplasia celular.

Acometimento intra-ocular na doença de Erdheim-Chester - primeiro relato na literatura: relato de caso / Intraocular involvement in Erdheim-Chester disease - first report in the literature: case report

A doença de Erdheim-Chester (DEC) tem causa desconhecida e se caracteriza por ser granulomatosa e infiltrativa, com proliferação de histiócitos contendo colesterol e particular acometimento ósseo. À histologia, é semelhante à histiocitose de células Langerhans, salvo na análise imuno-histoquímica. Pela primeira vez é descrito o acometimento intra-ocular nesta doença. MPSG, 46 anos, sexo feminino, apresentou-se com proptose do olho direto. Referia úlceras no palato duro, osteoesclerose bilateral e simétrica na diáfise tibial e fibular e nódulo na mama direita (biópsia: infiltrado rico em histiócitos xantomatosos e perfil imuno-histoquímico com CD68 +, S-100 e CD1a negativos, compatível com DEC). À RNM, tumoração extraconal justa-bulbar temporal superior na órbita direita, hiperintensa em T1 e próxima da glândula lacrimal. Em cada olho, visão 20/20, com numerosas drusas nas arcadas e na região macular similares às drusas laminares basais, além de duas regiões placóides elevadas com infiltrado alaranjado sub-retiniano e hiperfluorescentes na angiografia na região peridiscal inferior e justamacular temporal do olho direito. Dois anos depois, surgiram membranas neovasculares sub-retinianas em ambos os olhos. O OD manteve visão 20/20 com pequenas alterações campimétricas e o OE evoluiu com grande cicatriz disciforme e visão de vultos. Esta descrição pioneira demonstra características in vivo dos granulomas histiocíticos da DEC, e alerta para possíveis complicações intra-oculares.

Erdheim-Chester disease (ECD) is a granulomatous and infiltrative disorder of unknown etiology with proliferation of cholesterol-containing histiocytes and peculiar bone involvement. It is very similar to Langerhans cell histiocytosis (LCH) on histology but with a different immunohistochemical profile. This is the first report of intraocular involvement in this disease. MPSG, a 46 y.o. woman, presented with proptosis of the OD. She referred ulcerated lesions on the hard palate, symmetrical and bilateral osteosclerosis of the fibulae and tibiae and a nodule in the right breast (biopsy: xantomatous histiocytic infiltrate CD68+, S-100 and CD1a negative on immunohistochemistry compatible with ECD). MRI studies demonstrated an extraconal tumor in the juxta-bulbar temporal portion of the right orbit close to the lacrimal gland and hyperintense on T1. Vision was 20/20 OU, with numerous drusen in the posterior pole, similar to basal laminar drusen. Two regions of orange subretinal infiltrates that showed progressive staining on the angiogram were seen in the peripapillary region and also close to the fovea in the OD. Choroidal neovascular membranes were seen 2 years later in OU leading to severe visual loss in the OS and to a slight visual field loss in the OD, which retained 20/20 vision. This pioneer report depicts in vivo characteristics of histiocytic granulomas in ECD. Caution should be taken with patients with ECD as potentially blinding intraocular complications may arise.

Mutación G972R del gen IRS-1 en individuos chilenos con enfermedad coronaria y controles / G972R mutation of the IRS-1 gene in chilean individuals with coronary artery disease and controls

El sustrato 1 del receptor de la insulina (IRS-1) es una de las moléculas más importantes en la transducción de señales, que permiten la incorporación de glucosa a la célula. Variaciones genéticas del IRS-1 han sido relacionadas con alteraciones de su función y diversas anormalidades metabólicas. Considerando la escasa información sobre las bases genéticas de las enfermedades cardiovasculares en nuestro país, el objetivo del presente estudio fue determinar la asociación entre la mutación G972R del gen IRS-1 y enfermedad coronaria en individuos de la población de la IX Región (Chile). Estudios de casos y controles, que evaluó 111 individuos (33 a 74 años), con enfermedad coronaria comprobada por angiografía y 116 controles (20 a 68 años). La genotipificación de la mutación G972R fue realizada mediante la técnica de PCR-RFLP. La mutación G972R fue más frecuente en individuos con enfermedad coronaria que en controles (17 por ciento vs. 6 por ciento, p=0,016). La OR asociada a esta mutación fue 3,21 (I.C. 95 por ciento, 1,28 - 8,06, p<0.05). Adicionalmente, el genotipo heterocigoto GR para la mutación G972R fue asociado a niveles más bajos de HDL-C (p=0,048) y a mayores niveles de glucosa (p=0,006) en los individuos controles. La mutación G972R del gen IRS-1 fue asociada a enfermedad coronaria en la población analizada, lo que sugiere un importante rol de IRS-1 en la patogénesis de desordenes metabólicos asociados a EC.

Prevalencia de factores de riesgo de enfermedad cardiovascular en una población de empleados chilenos / Prevalence of cardiovascular risk factor among chilean employees

Cardiovascular diseases are the main causes of death in Chile and there is a high prevalence of cardiovascular risk factors in the population. Aim: To assess the prevalence of those risk factors in a group of employees. Subjects and methods: We studied 2,219 individuals, 1,378 males with a mean age of 46.2ñ10.4 years and 841 females with a median age of 41.9ñ10.3 years. Results: High blood pressure was observed in 39.7 percent of men and in 21.8 percent of women. A serum cholesterol between 200 and 239 mg/dl was observed in 38 percent of men and 31.3 percent of women. A cholesterol over this value was seen in 23.7 percent of men and 18.8 percent of women. A low proportion of those with high blood pressure, or elevated cholesterol, were under treatment. Prevalence of smoking was high in men and women: 43.5 and 48.9.2 percent, respectively. Eighty four percent of men and 61.3 percent of women over 54 years were overweight or obese. The prevalence of diabetes mellitus was 4.5 percent. Twenty percent of men and 13 percent of women exercised regularly, at least 3 times a week. Conclusions: There is a high prevalence of untreated cardiovascular risk factors in this population

Reducción de la mortalidad por infarto del miocardio en hospitales chilenos / Reduction of acute myocardial infarction mortality in Chilean hospitals

Background: The characteristics of patients with acute myocardial infarction (MI) admitted to 37 Chilean hospitals (GEMI Registry Group), have been analyzed in the periods 1993-1995 and 1997-1998. Aim: To report the changes in hospital mortality between these 2 periods, with a particular emphasis on the impact of treatment. Patients and methods: Between 1993-1995 we collected information from 2,957 patients and between 1997-1998 we registered 1,981 patients with MI. Analysis of the changes in mortality between periods was adjusted by demographic variables, coronary risk factors, MI location, Killip class on admission and the different therapeutic strategies utilized. The effects of different treatments on hospital mortality were adjusted by the previously determined mortality risk variables. Results: Hospital mortality decreased from 13.3 percent to 10.8 percent between both periods (Odds Ratio (OR) 0.78, confidence intervals (95 percent) (CI) 0.65-0.93). A significant reduction in mortality was observed among patients below 60 years of age, in men, in diabetics and in subjects with an infarction classified as Killip class over II. The use of beta blockers (OR 0.65, CI 0.42-0.99) and intravenous nitrates (OR 0.78, CI 0.61-0.99) and the lower use of calcium channel blockers (OR 0.72, CI 0.60-0.87) were significantly associated with a lower mortality. The administration of angiotensin converting enzyme inhibitors was associated with a 29.3 percent mortality reduction (OR 0.69, CI 0.47-1.02). Conclusions: There has been a significant reduction in the mortality rate for MI in Chilean hospitals during the 2 registry periods analyzed, which was significant among some high risk patients and was related to treatment changes, according to evidence based guidelines

Cambios en los patrones de prescripción de medicamentos en el infarto agudo del miocardio: comparación de dos períodos / Changes in pharmacotherapy for acute myocardial infarction: comparison of 2 periods

Background: Pharmacotherapy of Chilean patients with acute myocardial infarction has been recorded in 37 hospitals since 1993. Aim: to compare pharmacotherapy for acute myocardial infarction in the period 1993 to 1995 with the period 1997-1998. Patients and methods: Drug prescription during hospital stay was recorded in 2957 patients admitted to Chilean hospitals with an acute myocardial infarction in the period 1993-1995 and compared with that of 1981 subjects admitted in the period 1997-1998. Results: When compared with the former period, in the lapse 1997-1998 there was an increase in the frequency of prescription of aspirin (93 and 96.1 percent respectively) ß blockers (37 and 55.2 percent respectively) and angiotensin converting enzyme inhibitors (32 and 53 percent). The prescription of thrombolytic therapy did not change (33 and 33.7 percent respectively). There was a reduction in the prescription of calcium antagonists and antiarrhythmic drugs. Conclusions: During the period 1997-1998, the prescription of drugs with a potential to reduce the mortality of acute myocardial infarction, increased. The diffusion of guidelines for the management of this disease may have influenced this change

Infarto agudo del miocardio en hospitales chilenos: resultados finales del estudio GEMI / Acute myocardial infarction in chilean hospitals: results of the GEMI study

Background: Acute myocardial infarction is the leading cause of death in Chile. Aim: To report the main features, hospital evolution, complications and pharmacological treatment of patients admitted to Chilean hospitals with the diagnosis of acute myocardial infarction. Patients and methods: Between 1993 and 1995, the GEMI group registered 2,957 patients admitted to 37 hospitals with the diagnosis of acute myocardial infarction. Results: Mean age of patients was 62 ñ 2 years old and 74 percent were male. Forty six percent had a history of hypertension and 40 percent were smokers. During the first five days of admission, 93 percent of patients received aspirin, 59 percent received intravenous nitrates, 59 percent intravenous heparin, 56 percent oral nitrates, 37 percent beta blockers, 32 percent angiotensin-converting enzyme inhibitors, 33 percent thrombolytic agents, 29 percent antiarrhythmics and 23 percent calcium antagonists. Coronary angiograms were performed in 28 percent of patients, angioplasty in 9 percent and 8 percent were subjected to a coronary bypass. Global hospital mortality was 13.4 percent (19.5 percent in women and 11.1 percent in men, p <0.001). Conclusions: This work gives a picture of myocardial infarction in Chilean hospitals. Pharmacological treatment is similar to that used abroad, but certainly it can be optimized