Análise do perfil lipídico e glicêmico de pacientes em ambulatório de dislipidemia de hospital terciário / Analysis of the lipid and glycemic profile of patients in a dyslipidemia outpatient clinic of a tertiary hospital

INTRODUÇÃO: Diabetes mellitus (DM) e dislipidemia (DLP) são as principais causas de morbimortalidade no mundo, além de ocasionarem mortes prematuras, incapacidades e altos custos e encargos financeiros para indivíduos, sociedades e sistemas de saúde. O DM apresentou aumento da prevalência nos últimos anos, o que demonstra a necessidade dos serviços estarem bem preparados para atender a essa demanda. O objetivo deste trabalho é verificar a obtenção de metas glicêmicas e lipídicas em indivíduos do ambulatório de DLP e DM de hospital terciário. MÉTODOS: Estudo descritivo, quantitativo e retrospectivo utilizando banco de dados de pacientes atendidos em ambulatório de DLP e DM de hospital terciário de março a outubro de 2020 de forma sequencial. Foram analisados sexo, idade, presença de comorbidades (DM, doença arterial coronariana, acidente vascular encefálico), antidiabéticos e hipolipemiantes em uso, exames laboratoriais (colesterol total, LDL, triglicerídeos, hemoglobina glicada (HbA1c) e glicemia de jejum), e alcance de metas de HbA1c (para pacientes com ≥60 anos, meta ≤8,0% e, para os demais, ≤7,0%). Além disso, foram categorizados em relação ao risco cardiovascular em intermediário (meta LDL RESULTADOS: Dos 2052 pacientes, 1521 tinham DM e após aplicados os critérios de exclusão foram analisados 1418 pacientes com idade entre 32 e 91 anos e média de 66 anos. Destes, 53% foram do sexo feminino. Em relação ao risco cardiovascular 58,5% eram de muito alto risco, 41,3% alto risco e apenas 0,2% risco intermediário. Apenas 21,9% da amostra apresentava LDL dentro da meta, 22,1% tinham meta de não-HDL atingida e 56,7% triglicérides controlados. Do total, 70,2% usavam estatina de alta potência (principalmente atorvastatina 40 e 80 mg) 5,4% ezetimiba e 3,2% ciprofibrato. Avaliando o perfil glicêmico, 40,8% tinham HbA1c ≤7%. Destes, 57,3% usavam apenas um hipoglicemiante; 23,5% usavam dois; 10,4% usavam três; e 1,7% usavam quatro. Insulina NPH foi utilizada por 51,3%. Em relação aos >60 anos, 62,7% apresentavam HbA1c ≤8. CONCLUSÃO: Apesar da maioria dos pacientes estarem usando estatinas de alta potência em altas doses, as metas lipídicas não foram atingidas. O DM também é um desafio para seu controle e a falta de opção de medicamentos orais que aumentariam a aderência chama a atenção para a necessidade de novos medicamentos serem incorporados ao SUS.

Are we being able to meet current guidelines LDLcholesterol goals in very high risk patients? How many of them could benefit of PSCK9 inhibition by the FOURIER/ODYSSEY and NICE criteria?

BACKGROUND/INTRODUCTION: With increasing evidence of LDLcholesterol (LDLc) lowering and a subsequente reduction in cardiovascular events, guidelines of different parts of the world aim for lower LDLc goals by risk stratification. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition has been able to reduce up to 60% LDLc levels, with further reduction in cardiovascular outcomes. Purpose: Our aim was to evaluate the proportion of very high risk patients in a tertiary cardiology center that met LDLc goal of less than 50mg/dL proposed by the Brazilian Society of Cardiology (BSC) guidelines. Furthermore, we assessed the number of patients that were receiving adequate statin intensity therapy and could benefit from PCSK9 inhibition by the FOURIER/ODYSSEY and by the National Institute for Health and Care Excellence (NICE) criteria. METHODS: We screened 2180 consecutive patients from March, 2018 to February, 2019 for cardiovascular risk factors, cholesterol and glycemic levels, and current medical therapy at use. Patients were stratified by level of risk, and compliance to recommended statin therapy was evaluated. We then analyzed how many of the very high risk patients, that were in use of high intensity statin therapy, met the inclusion LDLc levels of the FOURIER/ODYSSEY trials (= 70mg/dL) and the NICE recommendations (= 140mg/dL) for the introduction of PCSK9 inhibitors. RESULTS: Of the 2180 patients enrolled to our study, 1225 (56.2%) patients were at very high cardiovascular risk level. Of these patients, 136 (11.1%) met LDLc BSC guideline levels. Using the LDLc target of 70mg/dL, an additional 320 (26.1%) patients were below target range. When analyzing statin therapy at use, 913 (74,5%) were receiving adequate statin therapy. Of the very high risk patients in adequate statin treatment, 617 (65.9%) by the FOURIER/ODYSSEY criteria and 88 (9.4%) patients by the NICE criteria would benefit from PCSK9 inhibitors. CONCLUSIONS: With lower LDLc goals, achievement of optimal LDLc levels is now a challenge for current clinical practice. Even though many patients are receiving adequate guidelinebased statin therapy, difficultyb remains in achieving optimal treatment, especially in the higher risk stratum. These patients would benefit from PCSK9 inhibition, being the NICE criteria, a more costeffective strategy, still applicable in a substantial portion of our patients. (AU)

Influence of the copepod Mesocyclops longisetus (Crustacea: Cyclopidae) on the survival of Vibrio cholerae O1 in fresh water.

In an experimental microcosm, an analysis was performed of the influence exerted by freshwater Mesocyclops longisetus copepods on the survival of Vibrio cholerae O1 serovar Inaba. In the State of Ceará, copepods are used in the control of Aedes aegypti larvae. The system consisted of water with a salinity of 0.27 per 10,000 habitants and pH 7.5, which after sterilizing filtration was distributed into seven flasks with a volume of 400 ml; in each of six flasks, 10 live copepods were inoculated along with 1 ml of an 8-hour culture of Vibrio cholerae O1 at 37oC in Alkaline Peptone Water, resulting in a concentration of 3.80x10(4) colony-forming units. The control flask contained only the water with the same bacterial suspension. The system was maintained for six days at room temperature (25-28oC), and daily duplicate counts were performed in TCBS Agar. Results confirmed a clear association between Vibrio cholerae O1 and the live copepods, based on survival of the bacteria at compatible levels with the initial inoculation until the sixth day of the analysis.