Irisin and troponin I expression in dialysis patients submitted to remote ischemic preconditioning: a pilot study / Expressão de irisina e troponina I em pacientes em diálise submetidos a pré-condicionamento isquêmico remoto: um estudo piloto

ABSTRACT Background: Renal replacement therapy continues to be related to high hospitalization rates and poor quality of life. All-cause morbidity and mortality in renal replacement therapy in greater than 20% per year, being 44 times greater when diabetes is present, and over 10 times that of the general population. Regardless of treatment, the 5-year survival is 40%, surpassing many types of cancers. Irisin is a hormone that converts white adipose tissue into beige adipose tissue, aggregating positive effects like fat mass control, glucose tolerance, insulin resistance, prevention of muscle loss, and reduction in systemic inflammation. Objectives: To determine the serum levels of troponin I in hemodialysis patients submitted to remote ischemic preconditioning (RIPC) associated with irisin expression. Methods: This was a prospective, randomized, double-blind clinical trial with patients with chronic kidney disease submitted to hemodialysis for a 6-month period. Troponin I, IL-6, urea, TNF-α, and creatinine levels were determined from blood samples. The expressions of irisin, thioredoxin, Nf-kb, GPX4, selenoprotein and GADPH were also evaluated by RT-PCR. Results: Samples from 14 hypertensive patients were analyzed, 9 (64.3%) of whom were type 2 diabetics, aged 44-64 years, and 50% of each sex. The difference between pre- and post-intervention levels of troponin I was not significant. No differences were verified between the RIPC and control groups, except for IL-6, although a significant correlation was observed between irisin and troponin I. Conclusion: Remote ischemic preconditioning did not modify irisin or troponin I expression, independent of the time of collection.

RESUMO Introdução: A terapia de substituição renal continua associada a altas taxas de hospitalização e baixa qualidade de vida. A morbimortalidade por todas as causas na terapia de substituição renal é superior a 20% ao ano, sendo 44 vezes maior quando a diabetes está presente e mais de 10 vezes a da população em geral. Independentemente do tratamento, a sobrevida em 5 anos é de 40%, superando muitos tipos de câncer. A irisina é um hormônio que converte tecido adiposo branco em tecido adiposo bege, agregando efeitos positivos como o controle de massa gorda, tolerância à glicose, resistência à insulina, prevenção de perda muscular e redução da inflamação sistêmica. Objetivos: Determinar os níveis séricos de troponina I em pacientes em hemodiálise submetidos ao pré-condicionamento isquêmico remoto (PCIR) associado à expressão da irisina. Métodos: Estudo clínico prospectivo, randomizado, duplo-cego, com pacientes com doença renal crônica submetidos à hemodiálise por um período de 6 meses. Os níveis de troponina I, IL-6, uréia, TNF-α e creatinina foram determinados a partir de amostras de sangue. As expressões de irisina, tioredoxina, Nf-kb, GPX4, selenoproteína e GADPH foram também avaliadas por RT-PCR. Resultados: Foram analisadas amostras de 14 pacientes hipertensos, 9 (64,3%) dos quais eram diabéticos tipo 2, com idades entre 44 e 64 anos e 50% de cada gênero. A diferença entre os níveis pré e pós-intervenção de troponina I não foi significativa. Não houve diferenças entre os grupos PCIR e controle, exceto pela IL-6, embora tenha sido observada correlação significativa entre irisina e troponina I. Conclusão: O pré-condicionamento isquêmico remoto não modificou a expressão de irisina ou troponina I, independentemente do tempo de coleta.

Irisin and troponin I expression in dialysis patients submitted to remote ischemic preconditioning: a pilot study.

BACKGROUND: Renal replacement therapy continues to be related to high hospitalization rates and poor quality of life. All-cause morbidity and mortality in renal replacement therapy in greater than 20% per year, being 44 times greater when diabetes is present, and over 10 times that of the general population. Regardless of treatment, the 5-year survival is 40%, surpassing many types of cancers. Irisin is a hormone that converts white adipose tissue into beige adipose tissue, aggregating positive effects like fat mass control, glucose tolerance, insulin resistance, prevention of muscle loss, and reduction in systemic inflammation. OBJECTIVES: To determine the serum levels of troponin I in hemodialysis patients submitted to remote ischemic preconditioning (RIPC) associated with irisin expression. METHODS: This was a prospective, randomized, double-blind clinical trial with patients with chronic kidney disease submitted to hemodialysis for a 6-month period. Troponin I, IL-6, urea, TNF-α, and creatinine levels were determined from blood samples. The expressions of irisin, thioredoxin, Nf-kb, GPX4, selenoprotein and GADPH were also evaluated by RT-PCR. RESULTS: Samples from 14 hypertensive patients were analyzed, 9 (64.3%) of whom were type 2 diabetics, aged 44-64 years, and 50% of each sex. The difference between pre- and post-intervention levels of troponin I was not significant. No differences were verified between the RIPC and control groups, except for IL-6, although a significant correlation was observed between irisin and troponin I. CONCLUSION: Remote ischemic preconditioning did not modify irisin or troponin I expression, independent of the time of collection.

Role of hypoxia-inducible factor 1α as a potential biomarker for renal diseases-A systematic review.

Renal cells need oxygen for homeostasis; it is known for adjusting cellular functioning and the energy obtainment have a broad relationship with cellular respiration, through the O2 bioavailability. O2 homeostasis regulation in the kidney is mediated by hypoxia-inducible factors (HIFs). HIF is divided into three α isoforms, represented by HIF-1α, HIF-2α, and HIF-3α in addition to three paralogs of HIF-1ß; these are involved in some metabolic processes, as well as in the pathogenesis of several diseases. Renal biopsy analyses of patients and experimental animal models aim to understand the relationship between HIF and protection against developing renal diseases or the induction of their onset, being thus this molecule can be considered a potential biomarker of renal disease. We carried out a systematic review to which we included studies on HIF-1α and renal disease in the last 5 years (2013-2018) in researches with humans and/or animal model through searches in three databases: LILACS, PubMed, and SciELO by two researchers. We obtained 22 articles that discussed the relationship with HIF as inductor or protector against renal disease and no relation between HIF and renal. We observed controversies remain regarding the relation between of HIF with renal diseases; this may be related to the different intracellular pathways mediated by HIF-1α, thereby determining differentiated cellular responses.

Evaluation of Beta 2-Microglobulin, Cystatin C, and Lipocalin-2 as Renal Biomarkers for Patients with Fabry Disease.

BACKGROUND: Since renal failure is one of the main causes of death in patients with Fabry disease (FD), renal follow-up is an important part of clinical monitoring in these patients. Despite its known limitations, serum creatinine is still the most widely used biomarker. While new renal biomarkers are described, their effectiveness has not yet been fully evaluated in relation to FD. OBJECTIVES: This study aimed to compare renal biomarkers commonly and rarely used in the evaluation of FD patients. METHOD: The usual biomarkers for renal monitoring (microalbuminuria, proteinuria, and creatinine) and some more rarely used (cystatin C, beta 2-microglobulin [ß2M], neutrophil gelatinase-associated lipocalin/lipocalin-2) were quantified in the blood and/or urine samples of 40 FD patients, 39 controls without chronic kidney disease (CKD) paired by age and sex and 38 controls with CKD undergoing hemodialysis. RESULTS: Significant statistical differences (p < 0.05) were observed for cystatin C and lipocalin-2 in plasma levels, for ß2M and serum creatinine levels and by estimated glomerular filtration rate when compared FD patients and control group with CKD and for proteinuria and microalbuminuria in urine samples and for lipocalin-2 in plasma levels when compared FD patients and control group without CKD. Urine creatinine (UCreat), pH, and urine specific gravity did not present a significant statistical difference between groups. CONCLUSION: Considering serum creatinine as gold standard, all renal parameters evaluated, including receiver operating characteristic curve, indicated ß2M as the best biomarker, followed by cystatin C, proteinuria and microalbuminuria, while the results for lipocalin-2 and UCreat do not indicate good predictors of renal impairment. It suggests that at least 2 altered biomarkers should be considered to characterize a renal alteration, thereby establishing a better therapeutic course for FD patients. If possible, along with serum creatinine, measurement of ß2M or cystatin C for renal evaluation of Fabry's patients should be considered.

Urinary beta-trace protein gene expression analysis in type 2 diabetes mellitus patients / Análise da expressão do gene da proteína beta-traço na urina de pacientes com diabetes mellitus tipo 2

ABSTRACT Objective: To evaluate the gene expression of beta-trace protein in urine of diabetic patients, with no reduction in glomerular filtration rate, which was defined as below 60mL/min/1.73m2. Methods: Type 2 diabetes mellitus patients were recruited, and a group of non-diabetic individuals served as control. Beta-trace protein gene expression was analyzed by quantitative PCR. Blood samples were collected to establish glucose levels and baseline kidney function. Accuracy was analyzed using ROC curves. Results: Ninety type 2 diabetes mellitus patients and 20 non-diabetic individuals were recruited. The area under the curve was 0.601, sensitivity of 20% and specificity of 89.47%. Among diabetic participants, 18% showed an expression above the cutoff point. Conclusion: These results of accuracy of beta-trace protein gene expression in urine of diabetic patients are promising, although they did not achieve a higher area under the curve level.

RESUMO Objetivo: Avaliar a expressão do gene da proteína beta-traço na urina de pacientes diabéticos, sem redução na taxa de filtração glomerular, definida como abaixo de 60mL/min/1,73m2. Métodos: Foram recrutados pacientes com diabetes mellitus tipo 2, e um grupo de indivíduos não diabéticos serviu como controle. A expressão do gene da proteína beta-traço foi analisada por PCR quantitativa. Amostras de sangue foram coletadas para estabelecer níveis de glicemia e função renal inicial. A acurácia foi analisada utilizando curvas ROC. Resultados: Foram recrutados 90 pacientes com diabetes mellitus tipo 2 e 20 não diabéticos. A área sob a curva foi de 0,601, com sensibilidade de 20% e especificidade de 89,47%. Entre os diabéticos, 18% apresentaram expressão acima do ponto de corte. Conclusão: Estes resultados de acurácia da expressão do gene da proteína beta-traço na urina de pacientes diabéticos são promissores, apesar de não terem atingido um nível alto na área sob a curva.

Obstructive sleep apnea syndrome and sleep quality in hypertensive patients / Síndrome da apneia obstrutiva do sono e qualidade do sono em hipertensos

Summary Introduction: Obstructive sleep apnea and hypopnea syndrome (OSAHS) is one of the developmental factors of high blood pressure (HBP), a relevant global public health problem. OSAHS is characterized by the reduction or complete cessation of respiratory airflow due to intermittent airway collapse. Additionally, significant changes in sleep rhythm and pattern are observed in these patients. Objective: To evaluate the association between OSAHS and sleep quality in essential and resistant hypertensives. Method: A cross-sectional, observational study evaluated 43 hypertensive patients treated at the outpatient clinics of the Faculdade de Medicina do ABC (FMABC) who were medicated with two or more antihypertensive drugs and divided into nonresistant or resistant to treatment. Results: Group I (using up to two antihypertensive agents - 60.47% of the sample) presented mean systolic blood pressure (SBP) of 127.5±6.4 mmHg, mean diastolic blood pressure (DBP) of 79.6±5.2 mmHg, mean body mass index (BMI) of 27.2±5.3 kg/m2 and mean age of 51.2±15.1 years. Group II (using more than two antihypertensive drugs - 37.2% of the sample) presented mean SBP of 132.1±9.3 mmHg, mean DBP of 84.5±5.8 mmHg, mean BMI of 27.2±7.2 kg/m2 and mean age of 55.5±13.4 years. The patients presented low quality of sleep/sleep disorder evaluated by the Pittsburgh Sleep Quality Index (PSQI), which represents a preponderant factor for OSAHS. Conclusion: Patients at high risk for OSAHS had poor sleep quality and high levels of DBP, suggesting a causal relation between these parameters. However, they did not present a higher prevalence of resistant high blood pressure (RHBP).

Resumo Introdução: A síndrome da apneia e a hipopneia obstrutiva do sono (SAHOS) estão inseridas entre os fatores de desenvolvimento da hipertensão arterial sistêmica (HAS), um relevante problema de saúde pública mundial. A SAHOS é caracterizada pela redução ou cessação completa do fluxo aéreo respiratório, decorrente do colapso intermitente das vias respiratórias. Adicionalmente, observam-se nos pacientes importantes alterações no ritmo e padrão do sono. Objetivo: Avaliar a associação entre SAHOS e qualidade de sono em hipertensos essenciais e resistentes. Método: Estudo observacional, transversal avaliou 43 pacientes hipertensos provenientes dos ambulatórios da Faculdade de Medicina do ABC (FMABC) medicados com dois ou mais anti-hipertensivos, divididos em não resistentes ou resistentes ao tratamento. Resultados: Grupo I (que utilizava até dois anti-hipertensivos - 60,47% da amostra) apresentou pressão arterial sistêmica (PAS) média de 127,5±6,4 mmHg, pressão arterial diastólica (PAD) média de 79,6±5,2 mmHg, índice de massa corpórea (IMC) médio de 27,2± 5,3 kg/m2 e idade média de 51,2±15,1 anos. Grupo II (que utilizava mais que dois anti-hipertensivos - 37,2% da amostra) apresentou PAS média de 132,1±9,3 mmHg, PAD média de 84,5±5,8 mmHg, IMC médio de 27,2±7,2 kg/m2 e idade média de 55,5±13,4 anos. Os pacientes apresentaram baixa qualidade de sono/distúrbio do sono avaliada pelo PSQI, o que representa um fator preponderante para SAHOS. Conclusão: Os pacientes com alto risco para SAHOS tiveram pior qualidade de sono e elevados níveis de PAD, sugerindo uma relação causal entre esses parâmetros. Contudo, não apresentaram maior prevalência de hipertensão arterial resistente.

Obstructive sleep apnea syndrome and sleep quality in hypertensive patients.

INTRODUCTION: Obstructive sleep apnea and hypopnea syndrome (OSAHS) is one of the developmental factors of high blood pressure (HBP), a relevant global public health problem. OSAHS is characterized by the reduction or complete cessation of respiratory airflow due to intermittent airway collapse. Additionally, significant changes in sleep rhythm and pattern are observed in these patients. OBJECTIVE: To evaluate the association between OSAHS and sleep quality in essential and resistant hypertensives. METHOD: A cross-sectional, observational study evaluated 43 hypertensive patients treated at the outpatient clinics of the Faculdade de Medicina do ABC (FMABC) who were medicated with two or more antihypertensive drugs and divided into nonresistant or resistant to treatment. RESULTS: Group I (using up to two antihypertensive agents - 60.47% of the sample) presented mean systolic blood pressure (SBP) of 127.5±6.4 mmHg, mean diastolic blood pressure (DBP) of 79.6±5.2 mmHg, mean body mass index (BMI) of 27.2±5.3 kg/m2 and mean age of 51.2±15.1 years. Group II (using more than two antihypertensive drugs - 37.2% of the sample) presented mean SBP of 132.1±9.3 mmHg, mean DBP of 84.5±5.8 mmHg, mean BMI of 27.2±7.2 kg/m2 and mean age of 55.5±13.4 years. The patients presented low quality of sleep/sleep disorder evaluated by the Pittsburgh Sleep Quality Index (PSQI), which represents a preponderant factor for OSAHS. CONCLUSION: Patients at high risk for OSAHS had poor sleep quality and high levels of DBP, suggesting a causal relation between these parameters. However, they did not present a higher prevalence of resistant high blood pressure (RHBP).

Urinary beta-trace protein gene expression analysis in type 2 diabetes mellitus patients.

OBJECTIVE: To evaluate the gene expression of beta-trace protein in urine of diabetic patients, with no reduction in glomerular filtration rate, which was defined as below 60mL/min/1.73m2. METHODS: Type 2 diabetes mellitus patients were recruited, and a group of non-diabetic individuals served as control. Beta-trace protein gene expression was analyzed by quantitative PCR. Blood samples were collected to establish glucose levels and baseline kidney function. Accuracy was analyzed using ROC curves. RESULTS: Ninety type 2 diabetes mellitus patients and 20 non-diabetic individuals were recruited. The area under the curve was 0.601, sensitivity of 20% and specificity of 89.47%. Among diabetic participants, 18% showed an expression above the cutoff point. CONCLUSION: These results of accuracy of beta-trace protein gene expression in urine of diabetic patients are promising, although they did not achieve a higher area under the curve level.

Predominance of STEMI and severity of coronary artery disease in a cohort of patients hospitalized with acute coronary syndrome: a report from ABC Medical School.

INTRODUCTION: acute coronary syndromes (ACS) represent a widely prevalent health issue with high mortality in Brazil and worldwide. The severity of ACS is not known in patients in the city of São Bernardo do Campo a municipality contiguous and adjacent to the city of São Paulo. OBJECTIVES: to study the profile of coronary disease in patients hospitalized with ACS who underwent coronary angiography in the emergency room between 2012 and 2013. METHODS: this is an observational study that included consecutive patients with ACS admitted to the emergency room of a hospital. Data collection was performed using medical records with the following variables: sex, age, risk factors for cardiovascular disease, coronary angiography. RESULTS: the sample in this period included 131 patients, of which 64.8% were men. The most prevalent diagnosis was ST-elevation myocardial infarction (STEMI) (57.2%) followed by non-ST-elevation myocardial infarction (NSTEMI) (22.1%) and unstable angina (UA) (20.6%). There were no significant differences in the epidemiology and risk factors between the diagnoses, except that heart failure was more prevalent in patients with UA. DISCUSSION: there were no differences between groups regarding the coronaries involved; however, STEMI patients showed similar numbers of multi- and singlevessel lesions, NSTEMI patients showed more multivessel lesions, and UA patients showed more multivessel lesions or lesion-free arteries. Although multivessel lesions were prevalent in all groups, STEMI patients showed a significantly higher number of single-vessel lesions compared with the other acute coronary syndromes. CONCLUSION: the study demonstrated a predominance of STEMI in the studied population, which differs from the usual results in ACS.

The impact of lipocalin-type-prostaglandin-D-synthase as a predictor of kidney disease in patients with type 2 diabetes.

Hypertension and diabetes are clinical conditions which contribute to the development of chronic kidney disease as well as risk factors for cardiovascular events. In recent years, lipocalin-type-prostaglandin-D-synthase (beta trace protein; BTP) has increasingly been studied as an alternative to creatinine for the evaluation of renal function as well as for being a possible biomarker for cardiovascular disease. It is expected that the levels of BTP in patients with cardiovascular disease are elevated, as is the case with patients with renal dysfunction. The objective of this study is to realize a systematic review of the pertinent literature in respect to BTP as a biomarker of renal dysfunction in diabetic patients. Using the database MEDLINE, a search up to year 2014 was conducted using the follow descriptors: "lipocalin type prostaglandin d synthase" AND "diabetes"; "lipocalin type prostaglandin d synthase" and "diabetic nephropathy"; "beta trace protein" AND "diabetes"; "beta trace protein" AND "diabetic nephropathy". The criteria used for inclusion were the presence of the referring to terms in title or abstract and study conducted in humans. About 17 articles were selected, of which six articles were duplicates, and of which six articles did not investigate any possible relationship between the protein (BTP) and either diabetes or nephropathy. The final result yielded five articles to be analyzed. This review found BTP is not influenced by race, by body mass index nor by patient's sex. BTP can be considered as a reliable early biomarker of renal dysfunction in diabetics. BTP is associated with metabolic syndrome and is also associated with greater cardiovascular risk. Prospective data establishing a correlation between BTP and mortality would have been of great interest, but such articles were not found in this review.

Predominance of STEMI and severity of coronary artery disease in a cohort of patients hospitalized with acute coronary syndrome: a report from ABC Medical School / Predomínio de infarto agudo do miocárdio com supra ST e gravidade da doença arterial coronariana em uma coorte de pacientes internados com síndrome coronariana aguda: relato da Faculdade de Medicina do ABC.

Summary Introduction: acute coronary syndromes (ACS) represent a widely prevalent health issue with high mortality in Brazil and worldwide. The severity of ACS is not known in patients in the city of São Bernardo do Campo a municipality contiguous and adjacent to the city of São Paulo. Objectives: to study the profile of coronary disease in patients hospitalized with ACS who underwent coronary angiography in the emergency room between 2012 and 2013. Methods: this is an observational study that included consecutive patients with ACS admitted to the emergency room of a hospital. Data collection was performed using medical records with the following variables: sex, age, risk factors for cardiovascular disease, coronary angiography. Results: the sample in this period included 131 patients, of which 64.8% were men. The most prevalent diagnosis was ST-elevation myocardial infarction (STEMI) (57.2%) followed by non-ST-elevation myocardial infarction (NSTEMI) (22.1%) and unstable angina (UA) (20.6%). There were no significant differences in the epidemiology and risk factors between the diagnoses, except that heart failure was more prevalent in patients with UA. Discussion: there were no differences between groups regarding the coronaries involved; however, STEMI patients showed similar numbers of multi- and singlevessel lesions, NSTEMI patients showed more multivessel lesions, and UA patients showed more multivessel lesions or lesion-free arteries. Although multivessel lesions were prevalent in all groups, STEMI patients showed a significantly higher number of single-vessel lesions compared with the other acute coronary syndromes. Conclusion: the study demonstrated a predominance of STEMI in the studied population, which differs from the usual results in ACS. .

Resumo Introdução: a síndrome coronariana aguda (SCA) é uma das principais causas de morbidade e mortalidade no Brasil e no mundo. A gravidade da coronariopatia em pacientes atendidos na cidade de São Bernardo do Campo não é conhecida. Objetivo: estudar o perfil da doença coronariana em pacientes internados com SCA e submetidos à cineangiocoronariografia entre 2012 e 2013. Métodos trata-se de estudo descritivo no qual se incluíram pacientes com SCA admitidos no setor de emergência do hospital. Houve consulta aos prontuários das seguintes variáveis: sexo, idade, fatores de risco para doença cardiovascular, diagnóstico e lesões coronárias. O erro alfa estabelecido foi de 5%. Resultados: a amostra neste período foi de 131 pacientes, sendo 64,8% homens. O diagnóstico mais prevalente foi o infarto agudo do miocárdio com supradesnível do segmento ST (IAMCST) (57,2%), seguido de infarto agudo do miocárdio sem supradesnível do segmento ST (IAMSST) (22,1%) e angina instável (AI) (20,6%). Não houve diferenças significativas quanto ao perfil epidemiológico e a fatores de risco entre os diagnósticos, com exceção da presença de insuficiência cardíaca, mais prevalente nos pacientes com AI. Discussão: as coronárias acometidas não diferiram entre os grupos; porém, enquanto o grupo IAMCST apresentou proporção de lesões multi e uniarteriais similares, o grupo IAMSST apresentou mais lesões multiarteriais, e o grupo AI, mais lesões multiarteriais ou artérias livres de lesões. Apesar das lesões multiarteriais serem prevalentes em todos os grupos, os pacientes com IAMCST apresentaram um número significativamente maior de lesões uniarteriais em comparação a pacientes com outras síndromes coronárias agudas. Conclusão: o estudo demonstrou um predomínio de IAMCST na população estudada, o que difere dos resultados habituais na SCA. .

Inflammatory biomarker kinetics after mechanical and bioprosthetic valve replacement.

INTRODUCTION: valve disease is an important cause of heart failure. There is a direct relationship between valve deterioration and the patient's inflammatory status and cytokines: interleukin-6, interleukin-1, tumor necrosis factor, and C-reactive protein, involved in this major state of inflammation. OBJECTIVE: to report a series of cases of valve replacement, using a bioprosthetic or mechanical valve, and the inflammatory profile of them. METHODS: patients older than 18 years and with bioprosthetic or mechanical valve placed for a minimum of 6 months and maximum of 2 years were included. In addition to the demographic characteristics of each patient, inflammatory markers were measured and a comparison was made of echocardiographic results before (based on medical records) and after surgery. A total of 46 patients were enrolled, 23 with mechanical valve and 23 with bioprosthetic valve. RESULTS: of the 46 patients, 20 presented complete data were included, 12 with bioprosthetic and 8 with mechanical valve. There was no difference between types of prosthesis or implant site for the values of inflammatory markers although they were all above reference range. DISCUSSION: patients undergoing aortic mechanical valve implant benefited more than those undergoing bioprosthetic implant and both with much better results than those of valve replacements performed on mitral valve. In short, there was no difference in relation to inflammatory biomarkers.

Inflammatory biomarker kinetics after mechanical and bioprosthetic valve replacement / Cinética dos marcadores inflamatórios após troca valvar protética mecânica e bioprótese: série de casos

Introduction: valve disease is an important cause of heart failure. There is a direct relationship between valve deterioration and the patient’s inflammatory status and cytokines: interleukin-6, interleukin-1, tumor necrosis factor, and C-reactive protein, involved in this major state of inflammation. Objective: to report a series of cases of valve replacement, using a bioprosthetic or mechanical valve, and the inflammatory profile of them. Methods: patients older than 18 years and with bioprosthetic or mechanical valve placed for a minimum of 6 months and maximum of 2 years were included. In addition to the demographic characteristics of each patient, inflammatory markers were measured and a comparison was made of echocardiographic results before (based on medical records) and after surgery. A total of 46 patients were enrolled, 23 with mechanical valve and 23 with bioprosthetic valve. Results: of the 46 patients, 20 presented complete data were included, 12 with bioprosthetic and 8 with mechanical valve. There was no difference between types of prosthesis or implant site for the values of inflammatory markers although they were all above reference range. Discussion: patients undergoing aortic mechanical valve implant benefited more than those undergoing bioprosthetic implant and both with much better results than those of valve replacements performed on mitral valve. In short, there was no difference in relation to inflammatory biomarkers. .

Introdução: doença valvar é importante causa de insuficiência cardíaca. Existe relação direta entre a deterioração valvar e o estado inflamatório do paciente, sendo as citocinas interleucina-6, interleucina-1, fator de necrose tumoral e a proteína C reativa as principais envolvidas nesse estado de estimulação. Objetivo: relatar uma série de casos de troca valvar, bioprótese ou mecânica e seu perfil inflamatório. Métodos: pacientes maiores de 18 anos e portadores de bioprótese ou protética mecânica, com período mínimo de 6 meses e máximo de 2 anos, foram incluídos. Além das características demográficas de cada paciente, colheram-se os marcadores inflamatórios e comparou-se o ecocardiograma conforme registro de prontuário antes e depois da cirurgia. Um total de 46 pacientes foi incluído, tendo sido 23 com valva mecânica e 23 de bioprótese. Resultados: dos 46 pacientes, chegamos ao total de 20 pacientes com dados completos, sendo 12 com bioprótese e 8 com protética mecânica. Não houve diferença entre tipo de prótese ou local de implante para os valores dos marcadores inflamatórios, contudo, na média, seus valores estavam aumentados. Discussão: pacientes submetidos ao implante de valva protética mecânica aórtica beneficiaram-se mais do que os submetidos ao implante de bioprótese e ambos com resultado bem superior às trocas realizadas na valva mitral. Não houve diferença em relação aos biomarcadores inflamatórios. .

Hemodialysis and hepatitis B vaccination: a challenge to physicians.

Hepatitis B is responsible for the development of half of hepatocellular carcinoma cases and is a major cause of hepatic insufficiency. The vaccine against hepatitis B virus does not exhibit the same high efficacy in patients on hemodialysis as it does in immunocompetent individuals. The medical literature recommends vaccination with four doses (40 mg each) of the hepatitis B virus vaccine before beginning hemodialysis; however, approximately one-third of hemodialysis patients do not respond to this vaccination schedule. A new serologic test should be performed each year for individuals who respond adequately, whereas a booster dose should be offered to those with antibody titers below 10 mIU/mL. In this study, we followed 83 hemodialysis patients and collected quantitative serologic measurements every 2 months over a 1-year period. We made the measurements 1 month after the vaccination period. We found that 41% of the patients had antibody titers below 10 mIU/mL (nonresponders), 21.7% had antibody titers between 10 mIU/mL and 100 mIU/mL (poor responders), and 37.3% had antibody titers higher than 100 mIU/mL (good responders). Patients with diabetes and/or hypertension exhibited worse response to vaccination. All subjects displayed decreasing antibody titers during the observation period. The group of poorly responsive patients had antibody titers below 10 mIU/mL at the 6-month follow-up period.

Dyspepsia among patients with chronic kidney disease: a cross sectional study.

BACKGROUNDS: Dyspepsia is a condition that affects 25% of the U.S. population, and, when associated with pyrosis, its prevalence reaches 40%. Patients with chronic renal insufficiency not only present higher circulating levels of gastrin and gastric dysmotilty, but also make use of a great amount of drugs for the treatment of their comorbidities. This situation increases the chances of developing gastrointestinal symptoms. The aim of the current study is to evaluate the dyspeptic disease profile in patients undergoing hemodialysis, comparing them with chronic renal disease patients in conservative treatment and non-renal injury patients. METHODS: This is a cross sectional study performed at the Gastroenterology department at Faculdade de Medicina do ABC in São Paulo, Brazil. Three groups were set aside according to the renal function levels calculated using the simplified MDRD formula. They answered three questionnaires that evaluated the presence of dyspepsia, functional dyspepsia and gastroesophageal reflux disease (GERD) associated with the performance of high digestive endoscopy. RESULTS: A significant difference between the groups was observed concerning the renal function evaluated by the rates of creatinine clearance, creatinine and urea (p < 0.001). The rate of dyspepsia in the control group was higher than in patients with renal function alterations (p = 0.014). There was no difference between groups when it came to the presence of functional dyspepsia and GERD. However, there was a higher use of proton pump inhibitors in the hemodialysis group than in the other groups (p < 0.001). CONCLUSION: In the proposed model, there was no positive correlation between the worsening of the renal function and the presence of dyspepsia, functional dyspepsia and GERD. The longitudinal evaluation of hemodialysis patients is hampered by the high mortality rates in this group. There was a higher use of proton pump inhibitors, and it is believed that the dyspeptic symptoms are not acid-related.

Acute lymphocitic leukaemia and AIDS.

Patients with AIDS have become more and more prevalent. Therefore, the onset of diseases that coexist with this condition must be studied in order to establish proper diagnosis and treatment. We report a case of a patient who reported with loss of strength in the lower limbs and a progressive worsening in his clinical picture. He was diagnosed with acute lymphocytic leukaemia, an unusual form of association with the AIDS condition. Despite the diagnosis, he evolved into pulmonary sepsis and so staging and chemotherapy treatment could not be performed.

Fever of unknown origin and the role of Plasmodium vivax in Sao Paulo.

Malaria is a disease that hits the northern part of Brazil in an endemic form. Recorded cases outside this region are unusual and, in most cases, limited to travellers. The southeast of Brazil has an extensive wilderness area with a type of vegetation similar to the one found in the equatorial rainforest. We present the case of a patient living in the southeast, with no reported travel history, who evolved to periodic fever, associated with myalgia and chills. With the positive test result for Plasmodium, the treatment for malaria was started. This case enabled the study in the Anopheles mosquito affected area, where the patient reported infection, outside the Amazon region.

Coronary stent stenosis in acute myocardial infarction.

Acute myocardial infarction (AMI) represents one of the major mortality causes in the world. Treatment of AMI is widely known; however, in developing countries some medications are not so easily available yet. We present a case of a 49-year-old black male patient who suffered an AMI and 2 weeks after stent angioplasty evolved to a new ischaemic episode with a stent thrombosis. The patient did not use the prescribed medications.