Long-term outcomes of primary cardiovascular prevention: A retrospective study at a referral center in Portugal.

INTRODUCTION AND OBJECTIVES: Lifestyle changes are frequently insufficient to reduce cardiovascular (CV) risk in patients with dyslipidemia. This study aims to characterize the long-term evolution of lipid profile and CV risk of patients under primary prevention. METHODS: A retrospective study was performed of outpatients at a Portuguese cardiovascular risk clinic with ≥2 CV risk factors, followed for ≥2 years between 1995 and 2015. Statin therapy had been initiated early, in accordance with the clinic's practice. After written informed consent was obtained, sociodemographic and clinical characteristics were collected from medical charts, at baseline and last visit. Changes in lipid profile and CV risk scores were estimated. Associations between HDL-C or LDL-C changes and gender, age, observation time and treatments were assessed through bivariate analysis and multiple linear regression models. RESULTS: Out of 516 participants with mean follow-up of 11.4±4.3 years, 56.6% were female and 91.5% received statins. Lipid profile showed statistically significant improvement, including median changes in LDL-C and HDL-C of -77.0 mg/dl and +19 mg/dl, respectively. CV risk also showed statistically significant improvements according to all scores. Statin therapy resulted in a mean HDL-C increase of 7.4 mg/dl (independently of gender and other treatments) and a mean LDL-C reduction of 51.8 mg/dl (irrespective of age and other treatments). CONCLUSION: Results from this long-term real-life study indicate that primary prevention, specifically early and continuous therapy with intermediate-intensity statins as an add-on to lifestyle interventions, was important in obtaining consistent and adequate metabolic correction in patients with additional risk factors.

Lipoprotein(a) as a key target in combined therapeutic approaches for cardiovascular disease.

INTRODUCTION AND OBJECTIVE: Lipoprotein(a) [Lp(a)] is an independent cardiovascular risk factor but is closely associated with other similar risk factors that are manageable with appropriate treatment and guidance. We aimed to study the impact of using combined therapy for managing Lp(a) levels in patients at high cardiovascular risk but without major adverse cardiovascular events, in primary prevention. METHODS: We conducted a retrospective observational study in 516 patients randomly selected from a group of 1677 patients who attended cardiovascular risk and metabolism consultations between 1995 and 2015. The disorders observed and therapies used were classified into nosological and pharmacological groups, respectively. Cardiovascular risk was calculated based on the Framingham risk score, the European Society of Cardiology's SCORE and the American College of Cardiology's ASCVD Risk Estimator, and changes in patients' lifestyle were assessed. RESULTS: Significant differences (p<0.001) were found in almost all metabolic variables, except fasting insulin and C-peptide. Lp(a) levels were also significantly reduced (p<0.001). Carotid intima-media thickness improved, decreasing from 2.90 mm to 1.40 mm; however, there was no reduction in the number of cases of vascular stenosis. Of patients with hepatic steatosis (85.5%), 40.7% presented hepatomegaly, but liver function was only altered in a few patients (14.5%). Lipid-lowering therapy, especially statins, significantly decreased Lp(a), benefiting from synergy with other treatments. CONCLUSIONS: Lp(a) is a key overall indicator of vascular risk and should be considered a therapeutic target. Besides a healthy lifestyle, primary prevention should include combined drug therapies to address all cardiovascular risk factors and to delay the atherosclerotic process.

Lipoprotein(a) in the Evaluation of Cardiovascular Risk in the Portuguese Population.

INTRODUCTION: High values of lipoprotein(a), related to atherosclerosis progression, are often considered a marker of thrombosis. We assessed the lipoprotein(a) profile in a group of patients with high vascular risk and no cardiovascular events, established its correlation with other cardiovascular risk factors and inferred the results for patients with metabolic disorders and, at least, two risk factors. MATERIAL AND METHODS: This longitudinal observational study included 516 patients, who had at least two cardiovascular risk factors and regularly attended, for at least two years, the outpatient consultations at a clinic of metabolism and vascular risk for primary prevention. Sociodemographic, clinical and anthropometric parameters were obtained at the baseline visit. Hepatic morphology was assessed in 509 patients (98.6%) by ultrasonography. The 10-year vascular risk was estimated using Framingham risk score, atherosclerotic cardiovascular disease and systematic coronary risk evaluation tables. RESULTS: Significant correlations were found between lipoprotein(a) levels and the addressed vascular risk factors, as well as between lipoprotein(a), and Framingham risk score, atherosclerotic cardiovascular disease and systematic coronary risk evaluation charts. Lipoprotein(a) values were also considerably higher in patients with steatosis. DISCUSSION: Increased lipoprotein(a) values were directly associated with all markers of cardiovascular risk and with non-alcoholic hepatic steatosis. CONCLUSION: Due to its high availability and low cost, lipoprotein(a) should become part of the routine evaluation of patients at vascular risk.

Introdução: Valores elevados de lipoproteína(a), relacionados com a progressão da aterosclerose, são frequentemente considerados marcadores de trombose. O perfil de lipoproteína(a) foi avaliado num grupo de doentes sem eventos cardiovasculares mas com elevado risco vascular, estabelecendo-se a correlação com outros fatores de risco cardiovascular e inferindo-se os resultados para doentes com alterações metabólicas e, pelo menos, dois fatores de risco vascular. Material e Métodos: Este estudo observacional longitudinal incluiu 516 doentes com, pelo menos, dois fatores de risco cardiovascular e que frequentavam, regularmente e há pelo menos dois anos, a consulta ambulatória de metabolismo e risco vascular para prevenção primária. Os parâmetros sociodemográficos, clínicos e antropométricos foram recolhidos na primeira visita. A morfologia hepática foi avaliada por ultrassonografia em 509 doentes (98,6%). O risco vascular a 10 anos foi estimado através de tabelas de cálculo de risco de Framingham, doença cardiovascular e risco coronário sistemático. Resultados: Foram encontradas correlações significativas entre os níveis de lipoproteína(a) e os fatores de risco vasculares analisados, assim como entre lipoproteína(a) e as escalas de risco de Framingham, doença cardiovascular e risco coronário sistemático. Os valores de lipoproteína(a) apresentaram-se mais elevados em doentes com esteatose. Discussão: Os valores elevados de lipoproteína(a) estão diretamente associados com todos os marcadores de risco cardiovascular e com esteatose hepática não alcoólica. Conclusão: Como tal, considerando a sua elevada acessibilidade e custo reduzido, o marcador lipoproteína(a) deverá ser integrado na avaliação de rotina de doentes com risco vascular.

Cryptococcal Meningitis in a HIV-Negative Patient.

Sarcoidosis is a risk factor for the development of cryptococcal infection due to dysfunction at T-cell level. Its rarity may, however, delay diagnosis and treatment. We describe the case of a 60-year-old man, diagnosed with sarcoidosis since 1999. He had never received systemic immunomodulatory therapy, such as corticosteroid therapy. In 2012, he was diagnosed with pulmonary cryptococcosis and treated with fluconazole. In April 2013, he presented with symptoms compatible with central nervous system (CNS) infection, namely, Cryptococcus neoformans meningitis. He was treated with amphotericin B, followed by fluconazole. The clinical outcome was favourable. LEARNING POINTS: Although rare, in patients with sarcoidosis and central nervous system (CNS) symptomatology, it is important to verify the existence of cryptococcal meningitis.Antifungal treatment should be started as early as possible.Before the diagnosis of pulmonary cryptococcosis, dissemination to the CNS should be outruled due to the need for more aggressive treatment.

Autonomous electrochemical biosensors: A new vision to direct methanol fuel cells.

A new approach to biosensing devices is demonstrated aiming an easier and simpler application in routine health care systems. Our methodology considered a new concept for the biosensor transducing event that allows to obtain, simultaneously, an equipment-free, user-friendly, cheap electrical biosensor. The use of the anode triple-phase boundary (TPB) layer of a passive direct methanol fuel cell (DMFC) as biosensor transducer is herein proposed. For that, the ionomer present in the anode catalytic layer of the DMFC is partially replaced by an ionomer with molecular recognition capability working as the biorecognition element of the biosensor. In this approach, fuel cell anode catalysts are modified with a molecularly imprinted polymer (plastic antibody) capable of protein recognition (ferritin is used as model protein), inserted in a suitable membrane electrode assembly (MEA) and tested, as initial proof-of-concept, in a non-passive fuel cell operation environment. The anchoring of the ionomer-based plastic antibody on the catalyst surface follows a simple one-step grafting from approach through radical polymerization. Such modification increases fuel cell performance due to the proton conductivity and macroporosity characteristics of the polymer on the TPB. Finally, the response and selectivity of the bioreceptor inside the fuel cell showed a clear and selective signal from the biosensor. Moreover, such pioneering transducing approach allowed amplification of the electrochemical response and increased biosensor sensitivity by 2 orders of magnitude when compared to a 3-electrodes configuration system.

Acute effects of continuous positive air way pressure on pulse pressure in chronic heart failure.

BACKGROUND: Patients with heart failure (HF) have left ventricular dysfunction and reduced mean arterial pressure (MAP). Increased adrenergic drive causes vasoconstriction and vessel resistance maintaining MAP, while increasing peripheral vascular resistance and conduit vessel stiffness. Increased pulse pressure (PP) reflects a complex interaction of the heart with the arterial and venous systems. Increased PP is an important risk marker in patients with chronic HF (CHF). Non-invasive ventilation (NIV) has been used for acute decompensated HF, to improve congestion and ventilation through both respiratory and hemodynamic effects. However, none of these studies have reported the effect of NIV on PP. OBJECTIVE: The objective of this study was to determine the acute effects of NIV with CPAP on PP in outpatients with CHF. METHODS: Following a double-blind, randomized, cross-over, and placebo-controlled protocol, twenty three patients with CHF (17 males; 60±11 years; BMI 29±5 kg/cm2, NYHA class II, III) underwent CPAP via nasal mask for 30 min in a recumbent position. Mask pressure was 6 cmH2O, whereas placebo was fixed at 0-1 cmH2O. PP and other non invasive hemodynamics variables were assessed before, during and after placebo and CPAP mode. RESULTS: CPAP decreased resting heart rate (Pre: 72±9; vs. Post 5 min: 67±10 bpm; p<0.01) and MAP (CPAP: 87±11; vs. control 96±11 mmHg; p<0.05 post 5 min). CPAP decreased PP (CPAP: 47±20 pre to 38±19 mmHg post; vs. control: 42±12 mmHg, pre to 41±18 post p<0.05 post 5 min). CONCLUSION: NIV with CPAP decreased pulse pressure in patients with stable CHF. Future clinical trials should investigate whether this effect is associated with improved clinical outcome.

Efeito Agudo da Pressao Positiva Continua sobre a Pressao de Pulso na Insuficiencia Cardiaca Cronica / Acute Effects of Continuous Positive Air way Pressure on Pulse Pressure in Chronic Heart Failure

Fundamento: Pacientes com insuficiência cardíaca (IC) apresentam disfunção ventricular esquerda e redução da pressão arterial média (PAM). O aumento do estímulo adrenérgico causa vasoconstrição e resistência dos vasos, mantendo a PAM, enquanto aumenta a resistência vascular periférica e a rigidez dos vasos condutores. O aumento da pressão de pulso (PP) reflete a complexa interação do coração com os sistemas arteriais e venosos. O aumento da PP é um importante marcador de risco em pacientes com insuficiência cardíaca crônica (ICC). A ventilação não invasiva (VNI) tem sido utilizada para IC aguda descompensada para melhorar a congestão e a ventilação pelos efeitos respiratórios e hemodinâmicos. No entanto, nenhum desses estudos relatou o efeito da VNI na PP. Objetivo: O objetivo deste estudo foi determinar os efeitos agudos da VNI com CPAP (pressão positiva contínua nas vias aéreas) sobre a PP em pacientes ambulatoriais com ICC. Métodos: Seguindo um protocolo randomizado, duplo-cego, cruzado e controlado com placebo, 23 pacientes com ICC (17 homens, 60 ± 11 anos, IMC 29 ± 5 kg/cm2, classes II e III da NYHA) foram submetidos à CPAP via máscara nasal durante 30 minutos na posição reclinada. A pressão da máscara foi de 6 cmH2O, enquanto o placebo foi fixado em 0-1 cmH2O. PP e outras variáveis hemodinâmicas não invasivas foram avaliadas antes, durante e depois do placebo e do modo CPAP. Resultados: A CPAP diminuiu a frequência cardíaca de repouso (pré: 72 ± 9; pós 5 min: 67 ± 10 bpm , p < 0,01) e PAM (CPAP: 87 ± 11; controle 96 ± 11 mmHg , p < 0,05 pós 5 min). A CPAP diminuiu a PP (CPAP: 47 ± 20 pré para 38 ± 19 mmHg pós; controle: ...

Background: Patients with heart failure (HF) have left ventricular dysfunction and reduced mean arterial pressure (MAP). Increased adrenergic drive causes vasoconstriction and vessel resistance maintaining MAP, while increasing peripheral vascular resistance and conduit vessel stiffness. Increased pulse pressure (PP) reflects a complex interaction of the heart with the arterial and venous systems. Increased PP is an important risk marker in patients with chronic HF (CHF). Non-invasive ventilation (NIV) has been used for acute decompensated HF, to improve congestion and ventilation through both respiratory and hemodynamic effects. However, none of these studies have reported the effect of NIV on PP. Objective: The objective of this study was to determine the acute effects of NIV with CPAP on PP in outpatients with CHF. Methods: Following a double-blind, randomized, cross-over, and placebo-controlled protocol, twenty three patients with CHF (17 males; 60 ± 11 years; BMI 29 ± 5 kg/cm2, NYHA class II, III) underwent CPAP via nasal mask for 30 min in a recumbent position. Mask pressure was 6 cmH2O, whereas placebo was fixed at 0-1 cmH2O. PP and other non invasive hemodynamics variables were assessed before, during and after placebo and CPAP mode. Results: CPAP decreased resting heart rate (Pre: 72 ± 9; vs. Post 5 min: 67 ± 10 bpm; p < 0.01) and MAP (CPAP: 87 ± 11; vs. control 96 ± 11 mmHg; p < 0.05 post 5 min). CPAP decreased PP (CPAP: 47 ± 20 pre to 38 ± 19 mmHg post; vs. control: 42 ± 12 mmHg, pre to 41 ± 18 post p < 0.05 post 5 min). Conclusion: NIV with CPAP decreased pulse pressure in patients with stable CHF. Future clinical trials should investigate whether this effect is associated with improved clinical outcome. .

An electrochemical impedance spectroscopy study of polymer electrolyte membrane fuel cells electrocatalyst single wall carbon nanohorns-supported.

Electrochemical impedance spectroscopy (EIS) was used to study the polymer electrolyte membrane fuel cells (PEMFC) performance when using single wall carbon nanohorns (SWNH) to support Pt nanoparticles. Additionally, as-prepared and oxidized SWNH Pt-supports were compared with conventional carbon black. Two different oxidizing treatments were considered: oxygen flow at 500 degrees C and reflux in an acid solution at 85 degrees C. Both oxidizing treatments increased SWNH surface area; oxygen treatment increased surface area 4 times while acid treatment increased 2.6 times. The increase in surface area should be related to the opening access to the inner tube of SWNH. Acid treatment of SWNH increased chemical fragility and decreased electrocatalyst load in comparison with as-prepared SWNH. On the other hand, the oxygen treated SWNH sample allowed to obtain the highest electrocatalyst load. The use of as-prepared and oxygen treated SWNH showed in both cases catalytic activities 60% higher than using conventional carbon black as electrocatalyst support in PEMFC. Moreover, EIS analysis indicated that the major improvement in performance is related to the cathode kinetics in the as-prepared SWNH sample, while concerning the oxidized SWNH sample, the improvements are related to the electrokinetics in both anode and cathode electrodes. These improvements should be related with differences in the hydrophobic character between SWNH and carbon black.

Comunicação interatrial evoluindo com síndrome de Eisenmenger: revisão e apresentação de caso / Atrial communication evolving to Eisenmenger Syndrome: revision and presentation case

Os autores apresentam um caso de comunicação interatrial (CIA) tipo seio venoso em mulher de 60 anos, portadora de doença pulmonar obstrutiva crônica (DPOC) severa evoluindo com síndrome de Eisenmenger. Ressaltam a necessidade de diagnóstico prococe e tratamento adequado, capazes de evitar a evolução desfavorável, e chamar a atenção para a complementação diagnóstica com ecocardiograma transesofágico

Avaliação do uso e acondicionamento de escovas dentárias em creches / Evaluation of the usage and storage of toothbrushes on day-nurseries

O objetivo deste trabalho foi observar as formas de manipulação das escovas dentárias, verificando as condições higiênico-sanitárias. Utilizou-se o método de abordagem indutivo com procedimento estatístico e técnica de observação direta intensiva (formulário). O universo amostral contou com 524 escovas dentárias em seis creches municipais do Rio de Janeiro. Observou-se: 7 por cento das escovas não estavam identificadas e 1 por cento identificadas (ilegíveis). Quanto às condições de higiene, previamente à escovação: 56 por cento apresentavam resíduos, predominantemente creme dental. Quanto ao material utilizado no porta-escovas: predominância do plástico em 35 por cento madeira 15 por cento, pano 15 por cento, papelão 11 por cento...