Ácidos grasos omega-3 y función endotelial en pacientes con síndrome coronario agudo / Omega-3 fatty acids and endothelial function in patients with acute coronary syndrome

Las enfermedades cardiovasculares son la principal causa de muerte a nivel mundial, manifestándose principalmente como enfermedad isquémica coronaria. El pronóstico y desenlace del Síndrome Coronario Agudo (SCA) depende en gran proporción de la disfunción endotelial asociado a este cuadro. Objetivo:Evaluar el efecto de los ácidos grasos omega­3, sobre la función endotelial en el Síndrome Coronario Agudo (SCA). Métodos: Se realizó estudio con 16 pacientes con síndrome coronario agudo (SCA) tratados con Omega-3 a dosis de 3 gramos/día+Terapia Convencional (O3+Tc) durante 30 días. Se les realizó a las 12 horas del ingreso y los a 30 días, perfil lipídico, proteína C reactiva ultrasensible (PCRus), Endotelina 1 (ET-1), y Péptido Natriurético cerebral (NTproBNP). Resultados: Durante 4 semanas de seguimiento, el uso de 3 gramos/día de ácidos grasos omega-3, añadido a la terapia convencional en el Síndrome Coronario Agudo, mostró una reducción significativa de la concentración plasmática de NTproBNP (p = 0,000), PCRus (p =0,000) y triglicéridos (p = 0,004). Conclusión: Tres gramos al día de ácidos grasos omega-3 contribuye a la reducción de la concentración plasmática de Triglicéridos y NTproBNP en pacientes con síndrome coronario agudo(AU)

Mainly as coronary ischemic disease. the prognosis and outcome of Acute Coronary Syndrome (ACS) depend largely on the endothelial dysfunction associated with this condition. Objective: To evaluate the effect of omega-3 fatty acids on endothelial function in Acute Coronary Syndrome (ACS). Method: A study was conducted with 16 patients with acute coronary syndrome (ACS) treated with Omega-3 at a dose of 3 grams/day+Conventional erapy (O3+Tc) for 30 days. Lipid profile, ultrasensitive C-reactive protein (usCRP), Endothelin 1 (ET-1), and Brain Natriuretic Peptide (NTproBNP) were performed 12 hours aer admission and 30 days later. Results: During 4 weeks of follow-up, the use of 3 grams/day of omega-3 fatty acids, added to conventional therapy in Acute Coronary Syndrome, showed a significant reduction in the plasma concentration of NTproBNP (p = 0.000), hsCRP (p =0.000) and Triglycerides (p = 0.004). Conclusion: three grams a day of omega-3 fatty acids contributes to the reduction of the plasmatic concentration of Triglycerides and NTproBNP in patients with acute coronary syndrome(AU)

Avaliação de incidência de eventos cardiovasculares de pacientes hipertensos resistentes: análise de coorte retrospectiva em ambulatórios especializados / Incidence evaluation of cardiovascular event of resistant hypertensive patients: retrospective cohort analysis in specialized outpatient clinics

Resumo: Introdução: Sabe-se que o risco cardiovascular (CV) aumenta com a falta de controle pressórico, além de outros fatores como diabetes mellitus, lesão em órgãos-alvo, obesidade, altas taxas de ingestão de sódio, sexo feminino e raça negra. Além disso, as doenças CV são causa de morte de 17,5 milhões de pessoas no mundo todos os anos, sendo a hipertensão arterial responsável por 14% das mortes no Brasil. Objetivos: O presente estudo avaliou (1) a ocorrência de eventos cardiovasculares ¿ acidente vascular cerebral (AVC), infarto do miocárdio (IM) e morte ¿ assim como, (2) os fatores associados à ocorrência de tais eventos, na população de hipertensos resistentes em ambulatórios especializados entre os anos de 1998 e 2017. Desenho de estudo e Métodos: Este estudo de coorte retrospectiva incluiu 156 pacientes com hipertensão arterial resistente (HAR) regularmente atendidos e acompanhados em ambulatórios especializados a partir de 1998 - Hospitais de Clínicas da Universidade Estadual de Campinas (UNICAMP) e Faculdade de Medicina de São José do Rio Preto (FAMERP). Foram avaliadas características gerais (idade, raça, gênero), exames bioquímicos, parâmetros antropométricos (índice de massa corporal), clínicos (pressão arterial ambulatorial e de consultório, hipertrofia cardíaca, microalbuminúria) e medicações em uso em dois períodos distintos, sendo a primeira e última consultas dos pacientes em seguimento. Resultados: Observou-se que, após a média de cinco anos de seguimento em ambulatórios especializados, 9% dos pacientes HAR apresentaram evento CV: AVC (6%); IM (3%) e morte (0,6%). Os pacientes HAR, ao final do seguimento, apresentaram um perfil clínico mais favorável em comparação ao momento inicial, quando foram observadas: (1) melhora do perfil pressórico de consultório (PAS: -18mmHg; PAD: -12mmHg) e 24h ( PAS 24h: -9mmHg; PAD 24h: -7mmHg) e (2) dos níveis de LDL-colesterol (-9,03mg/dL). A redução dos parâmetros pressóricos foi decorrente de alterações na conduta terapêutica, com aumento da prescrição de diferentes classes de anti-hipertensivos. De maneira interessante, o diabetes e uso de betabloqueadores no início do seguimento, foram associados, de maneira independente, à redução da pressão arterial sistólica no final do seguimento, assim como as estatinas. Por outro lado, a presença de obesidade foi associada inversamente à redução desses níveis. Os pacientes HAR que apresentaram algum evento CV tinham, tanto o nível pressórico de 24h quanto o de triglicérides, mais elevados em relação aos pacientes HAR que não apresentaram nenhum evento. Conclusão: Através do tratamento farmacológico otimizado, a redução dos parâmetros pressóricos e do perfil lipídico, pode ter sido favorável à baixa ocorrência de eventos CV na população estudada. Esses dados sugerem a importância de se prestar atendimento individualizado aos pacientes de alto risco CV. Além disso, o conhecimento dos fatores de risco CV pode contribuir para melhor se guiar a terapia farmacológica e, consequentemente, proporcionar maior sobrevida a grupos de alto risco CV, como o de pacientes HAR(AU)

Abstract: Background: It is known that cardiovascular (CV) risk increases with lack of blood pressure (BP) control, in addition to other factors such as diabetes mellitus, target organ damage, obesity, high sodium intake, female sex and black race. In addition, CV diseases are responsible for the deaths of 17.5 million people worldwide, it being known that hypertension accounts for 14% of deaths in Brazil. Objectives: This study evaluated (1) the occurrence of CV events - stroke, myocardial infarction (MI) and death - as well as (2) factors associated with the occurrence of such events in the population of hypertensive specialized outpatient clinics between 1998 and 2017. Design and Methods: This retrospective cohort study included 156 patients with resistant hypertension (RH) regularly attended and followed up in specialized outpatient clinics from 1998 ¿ in Clinical Hospital of the State University of Campinas (UNICAMP) and Medical School of São José do Rio Preto (FAMERP). General characteristics (age, race, gender), biochemical tests, anthropometric parameters (body mass index), clinical parameters (ambulatory and office BP, cardiac hypertrophy, microalbuminuria) and medications in use were evaluated in two distinct periods: at the beginning and at the end of this follow-up. Results: It was observed that, after a follow-up in specialized outpatient clinics that lasted, in average, five years, 9% of RH patients presented CV event: stroke (6%); MI (3%) and death (0.6%). At the end of the follow-up, the RH patients presented a more favorable clinical profile compared to the initial moment, when: (1) improvement of the office BP profile (SBP: -18mmHg; DBP: -12mmHg) and 24h: -9mmHg, DBP 24h: -7mmHg) and (2) LDL-cholesterol levels (-9.03mg/dL). The reduction in BP parameters was due to changes in therapeutic management, with an increase in the prescription of different classes of antihypertensives. Interestingly, diabetes and the use of beta-blockers at the beginning of follow-up were associated with a reduction in systolic BP in an independent way at the end of follow-up, as well as statins. On the other hand, the presence of obesity was inversely associated with the reduction of these levels. The RH patients who had a CV event had the 24h BP and the triglyceride levels higher than the RH patients who did not present any events. Conclusion: Through optimized pharmacological treatment the reduction of pressure parameters and lipid profile could have been favorable to the low occurrence of CV events in the study population. These data suggest the importance of providing individualized care to patients at high risk CV. In addition, knowledge of CV risk factors may contribute to better guiding pharmacological therapy and, consequently, providing greater survival rates to high-risk CV groups, such as in RH patients(AU)

Intensive insulin therapy in severe acute pancreatitis: a meta-analysis and systematic review / Terapia intensiva de insulina en la pancreatitis aguda severa: meta-análisis y revisión sistemática

OBJECTIVE: To assess the effect of intensive insulin therapy on outcomes of patients with severe acute pancreatitis. METHODS: Relevant literatures cited in these electronic databases: Medline, Chinese Biomedical Literature Database, China National Knowledge Infrastructure (CNKI) database, and Excerpta Medical database (Embase) were systematically searched for randomized controlled trials (RCTs) in which intensive insulin therapy was used in severe acute pancreatitis. Length of hospitalization, acute physiology and chronic health evaluation II (APACHE II) score, incidence of complications, and adverse effects were recorded for statistical analysis. The methodological quality of the eligible studies was assessed by Jadad scale. The results were analysed by Revman 4.3 software. RESULTS: Three studies, which included a total of 118 cases, were finally reviewed. The methodological quality of the trials varied substantially. In patients with severe acute pancreatitis, intensive insulin therapy was associated with shorter length of hospitalization (weighted mean difference (WMD) = -12.13, 95% confidence interval (CI) [-15.48,8.78], p > 0.00001) and lower APACHE II score after 72 hours treatment (WMD = -3.80, 95% CI [-4.88,2.72], p> 0.00001). One study reported insulin-related adverse event. CONCLUSION: In patients with severe acute pancreatitis, intensive insulin therapy could relieve the patient's condition earlier and shorten the length of hospitalization without serious adverse effect.

OBJETIVO: Evaluar el efecto de la terapia intensiva de insulina en la evolución clínica de los pacientes afligidos de pancreatitis aguda severa. MÉTODOS: La literatura pertinente citada a partir de las siguientes bases electrónicas de datos: Medline, Base de datos de literatura biomédica china, Base de datos de la infraestructura nacional china de conocimientos (CNKI), y la Excerpta Medical Database (Embase). Todas estas bases de datos fueron investigadas sistemáticamente en busca ensayos controlados aleatorios (RCT), en los cuales la terapia de insulina intensiva se usó en la pancreatitis aguda severa. El tiempo de hospitalización, la fisiología aguda, y la puntuación de la evaluación de salud crónica II (APACHE II), la incidencia de complicaciones, así como los efectos adversos, fueron registrados para el análisis estadístico. La calidad metodológica de los estudios elegibles fue evaluada mediante la escala de Jadad. Los resultados se analizaron mediante el software Revman 4.3. RESULTADOS: Finalmente se examinaron tres estudios que incluyeron un total de 118 casos. La calidad metodológica de los ensayos varió sustancialmente. En los pacientes con pancreatitis aguda severa, la terapia de insulina intensiva estuvo asociada con una estadía hospitalaria más corta (diferencia media ponderada WMD = -12.13, 95% intervalo de confianza (CI) [-15.48, 8.78], p < 0.00001) y una puntuación APACHE II más baja después de 72 horas de tratamiento (WMD = -3.80, 95% CI [-4.88, 2.72], p < 0.00001). Un estudio reportó eventos adversos relacionados con la insulina. CONCLUSIÓN: En los pacientes con pancreatitis aguda severa, la terapia intensiva de insulina podría aliviar la condición del paciente más rápidamente, y acortar el tiempo de hospitalización sin serios efectos adversos.

Asma casi fatal

El Asma Casi Fatal (ACF) es la condición de un paciente en falla respiratoria progresiva debido a asma, en quien la terapéutica convencional ha fallado. La mortalidad se asocia típicamente a la falla en reconocer la severidad del episodio y al retardo en el tratamiento oportuno. Existen poblaciones que presentan mayor riesgo de morir durante las exacerbaciones de asma: una de ellas son los lactantes, debido a las características anatómicas y fisiológicas de sus pulmones. En los niños menores de 5 años la valoración del grado de severidad, depende más del examen físico. Se considera crisis severa a un valor en el Puntaje Pulmonar (Pulmonary Score) mayor o igual a 7 y/o una StcO2 < 91%. Los parámetros paraclínicos a tomar en cuenta en ACF son: los gases arteriales, la StcO2 y las pruebas de función pulmonar que pueden realizarse en mayores de 5 años. En esta revisión se hace énfasis en el tratamiento del ACF, especialmente en terapia convencional con nivel de evidencia y en el uso de las medidas terapéuticas no convencionales que han demostrado los mejores resultados, incluyendo las medidas de soporte de la vía aérea.

Almost Fatal Asthma (AFA) is the condition of a patient in progressive respiratory failure due to asthma, in whom conventional treatment has failed. Mortality is associated typically to failure in recognizing the severity of the episode and to retardation in opportune treatment. There are populations that present greater mortality risk during asthma episodes. One of these is the infant population, due to the anatomical and physiological characteristics of their lungs. In children under 5 years of age, the assessment of the severity of the episode depends more on physical examination. An asthma crisis is considered to be severe when the Pulmonary Score is greater or equal to 7 and/or the StcO2 is less than 91%. Laboratory parameters to be considered in AFA are: arterial gases, StcO2 and pulmonary function tests that can be performed in children over 5 years of age. In this review emphasis is focussed on treatment of AFA, specially on conventional therapy with level of evidence and on non conventional therapeutic measures that have demonstrated best results, including support measures for the respiratory airway.