ABSTRACT
FUNDAMENTO: O diagnóstico de SCA e a estratificação de risco contemporâneos são fundamentais para o manejo apropriado e redução da mortalidade e eventos isquêmicos recorrentes, tanto na fase aguda quanto após hospitalização. A Definição Universal de Infarto do Miocárdio recomenda a detecção de curva de troponina acima do limite superior do percentil 99. OBJETIVOS: Avaliar a ocorrência de óbito e infarto agudo do miocárdio (IAM) na fase precoce em pacientes sem elevação de troponina (0,034 ng/mL e 0,12 ng/mL)]. Avaliar o impacto do percentil 99 versus ponto de corte para troponina na indicação de estratégia invasiva e revascularização miocárdica. MÉTODOS: Estudo transversal de pacientes com SCA sem elevação de ST com avaliação do pico da troponina I, escore de risco GRACE - admissão e alta, análise prospectiva de desfechos clínicos até 30 dias e testes bilaterais de significância. RESULTADOS: Em 494 pacientes, troponina > percentil 99 e abaixo do ponto de corte, assim como valores maiores (acima do ponto de corte), foram associados à maior incidência do desfecho composto (p<0,01) sem diferença significante em mortalidade até 30 dias. (Gráficos 1, 2 e 3) CONCLUSÕES: Valores de troponina acima do percentil 99 pela Definição Universal de IAM apresentam papel prognóstico e agregam informação útil ao diagnóstico clínico e escore de risco na identificação de pacientes com maior probabilidade de benefício com estratificação invasiva e procedimentos de revascularização coronária.
Subject(s)
Troponin I , Myocardial InfarctionABSTRACT
A retrospective space-time permutation model with non-Euclidean distance criteria was applied within a high-complexity hospital setting to quantitatively explore cluster patterns of 273 patients infected with or colonized by carbapenemase-producing Klebsiella pneumoniae during 4 years. Results were compared to standard nosocomial active-surveillance methods. Two clusters were identified in the period, suggesting that space-time strategies for cluster quantification within confined environments may be useful.
Subject(s)
Disease Outbreaks , Klebsiella Infections/epidemiology , Klebsiella pneumoniae/isolation & purification , Models, Statistical , Population Surveillance/methods , Bacterial Proteins/biosynthesis , Bacterial Proteins/genetics , Carrier State/diagnosis , Carrier State/epidemiology , Cluster Analysis , Cross Infection/diagnosis , Cross Infection/epidemiology , Female , Hospitals , Humans , Klebsiella Infections/diagnosis , Klebsiella pneumoniae/enzymology , Klebsiella pneumoniae/genetics , Male , Microbial Sensitivity Tests , Retrospective Studies , Spatio-Temporal Analysis , beta-Lactamases/biosynthesis , beta-Lactamases/geneticsABSTRACT
BACKGROUND: Botanical omega-3 fatty acid (alphalinolenic acid/ALA) has been shown to alleviate the prothrombotic and proinflammatory profile of metabolic syndrome, however clinical protocols are still scarce. Aiming to focus an obese population, a pilot study was designed. METHODS: Morbidly obese candidates for bariatric surgery (n = 29, age 46.3 ± 5.2 years), 82.8% females (24/29), BMI 44.9 ± 5.2 kg/m², with C-reactive protein/CRP > 5 mg/L were recruited. Twenty were randomized and after exclusions, 16 were available for analysis. Flaxseed powder (60 g/day, 10 g ALA) and isocaloric roasted cassava powder (60 g/day, fat-free) were administered in a double-blind routine for 12 weeks. RESULTS: During flaxseed consumption neutrophil count decreased and fibrinogen, complement C4, prothrombin time and carotid diameter remained stable, whereas placebo (cassava powder) was associated with further elevation of those measurements. CONCLUSIONS: Inflammatory and coagulatory markers tended to exhibit a better outlook in the flaxseed group. Also large-artery diameter stabilized whereas further increase was noticed in controls. These findings raise the hypothesis of a less deleterious cardiovascular course in seriously obese subjects receiving a flaxseed supplement.
