Operative Hysteroscopy Intravascular Absorption Syndrome - A Life-Threatening Complication.

Operative hysteroscopy intravascular absorption (OHIA) syndrome is a rare and potentially life-threatening complication related to irrigation fluid systemic absorption during hysteroscopy. It can lead to severe electrolyte disturbances, cerebral and pulmonary oedema, dysrhythmias and coagulopathy. We present the case of a 30-year-old woman who underwent a hysteroscopic myomectomy. After absorbing 2.5 l of normal saline, she experienced haemodynamic instability, respiratory distress and severe metabolic acidosis, initially mistaken for an anaphylactic or haemorrhagic shock. Insufficient monitoring of fluid deficit and irrigation fluid pressures contributed to the condition. This case underscores the importance of recognising OHIA and its risk factors to enable timely intervention and prevent adverse outcomes. Close fluid balance monitoring is vital in hysteroscopic surgeries to mitigate OHIA development. LEARNING POINTS: OHIA syndrome occurs due to the systemic absorption of the irrigation fluid used during hysteroscopic procedures.The presentation is diverse with encephalopathy, pulmonary oedema, dysrhythmias, electrolyte disturbances and coagulopathy.Fluid balance and irrigation fluid pressures should be monitored during hysteroscopic procedures to mitigate OHIA development.

Therapeutic Plasmapheresis: Seven Year Experience of an Intensive Care Unit in Portugal.

INTRODUCTION: Therapeutic plasmapheresis is a therapeutic procedure in which the patient's blood is passed through a medical device which separates out plasma from other components of blood. The plasma is removed and replaced with a replacement solution. Studies on the use of plasmapheresis in critically ill patients are scarce. The aim of this study was to review all therapeutic plasmapheresis sessions carried out in the Hospital Beatriz Ângelo intensive care unit. MATERIAL AND METHODS: An observational retrospective study was conducted between April 2012 and March 2019. All patients who underwent therapeutic plasmapheresis in the intensive care unit were included, and plasmapheresis sessions held outside the intensive care unit were excluded. RESULTS: Of 46 patients, 63% were men (n = 29), with a median age of 53 years. The most frequent diagnoses were hypertriglyceridemia-induced pancreatitis, vasculitis, autoimmune haemolytic anaemia, and atypical haemolytic-uremic syndrome. A total of 198 plasmapheresis sessions were carried out in the intensive care unit. Most of the used replacement solutions were fresh frozen plasma (34.4%), albumin/crystalloid (24.2%), and albumin/fresh frozen plasma (19.2%). The most common complications were hydroelectrolytic changes (84; 42.4%) and coagulation disorders/thrombocytopenia (65; 32.8%). There was no need to interrupt any plasmapheresis session due to complications related to the patient. DISCUSSION: Therapeutic plasmapheresis is an urgent procedure that can reduce morbidity and mortality in critically ill patients. This justifies that 37% of patients started the technique before the diagnostic confirmation. The indications for plasmapheresis and the choice of replacement solution were in agreement with the guidelines. Despite the risk of bleeding, no haemorrhagic complications were recorded. CONCLUSION: Therapeutic plasmapheresis is a complex technique that requires specific training. The indications are diverse, and some are not consensual. Complications were frequent, but they did not increase morbidity.

Introdução: A plasmaferese terapêutica é um procedimento em que o sangue passa por um circuito extracorpóreo que separa o plasma dos outros componentes do sangue. O plasma removido é substituído por soluções de reposição. Os estudos sobre a utilização de plasmaferese terapêutica no doente crítico são escassos. O objetivo do estudo foi rever todas as sessões de plasmaferese realizadas no serviço de Medicina Intensiva do Hospital Beatriz Ângelo. Material e Métodos: Estudo observacional retrospetivo de todos os doentes admitidos no serviço de Medicina Intensiva entre abril de 2012 e março de 2019. Foram selecionados os doentes submetidos a plasmaferese e excluídas as sessões realizadas fora do serviço de Medicina Intensiva. Resultados: No período de estudo foram incluídos 46 doentes. A maioria eram homens (n = 29; 63%) com uma idade mediana de 53 anos. Os diagnósticos mais frequentes foram pancreatite secundária a hipertrigliceridemia, vasculite, anemia hemolítica autoimune e síndrome hemolítica urémica atípica. Foram realizadas 198 sessões de plasmaferese no serviço de Medicina Intensiva. As soluções de substituição mais utilizadas foram plasma fresco congelado (34,4%), albumina/cristalóide (24,2%) e albumina/plasma (19,2%). As complicações mais comuns foram alterações hidroeletrolíticas (84; 42,4%), e distúrbios da coagulação/plaquetas (65; 32,8%). Em nenhum dos casos a técnica teve que ser interrompida por complicações relacionadas com o doente. Discussão: A plasmaferese terapêutica é um procedimento urgente capaz de reduzir a morbilidade e mortalidade no doente crítico. Isto justifica que 37% dos doentes tenham iniciado a técnica antes da confirmação diagnóstica. As indicações e soluto de reposição escolhido foram de acordo com as recomendações. Apesar do risco hemorrágico, nenhuma complicação desta natureza foi reportada. Conclusão: A plasmafere terapêutica é uma técnica complexa que requer treino específico. As indicações são diversas e algumas não consensuais. As complicações foram frequentes, mas não condicionaram morbilidade associada.

GlucoSTRESS - A project to optimize glycemic control in a level C (III) Portuguese intensive care unit. / GlucoSTRESS - Projeto de otimização do controle glicêmico em uma unidade de cuidados intensivos portuguesa nível C (III).

OBJECTIVE: To double the percentage of time within the 100 - 180mg/dL blood glucose range in the first three months following a phased implementation of a formal education program, and then, of an insulin therapy protocol, without entailing an increased incidence of hypoglycemia. METHODS: The pre-intervention glycemic control was assessed retrospectively. Next, were carried out the implementation of a formal education program, distribution of manual algorithms for intravenous insulin therapy - optimized by the users, based on the modified Yale protocol - and informal training of the nursing staff. The use of electronic blood glucose control systems was supported, and the results were recorded prospectively. RESULTS: The first phase of the program (formal education) lead to improvement of the time within the euglycemic interval (28% to 37%). In the second phase, euglycemia was achieved 66% of the time, and the incidence of hypoglycemia was decreased. The percentage of patients on intravenous insulin infusion at 48 hours from admission increased from 6% to 35%. CONCLUSION: The phased implementation of a formal education program, fostering the use of electronic insulin therapy protocols and dynamic manuals, received good adherence and has shown to be safe and effective for blood glucose control in critically ill patients, with a concomitant decrease in hypoglycemia.

OBJETIVO: Duplicar a percentagem de tempo no intervalo glicêmico 100 - 180mg/dL nos primeiros 3 meses após implementação faseada de um programa de educação formal e, posteriormente, de um protocolo de insulinoterapia, sem condicionar um aumento da frequência de hipoglicemia. MÉTODOS: Foi feita a avaliação retrospetiva do controle glicêmico pré-intervenção. Foram realizados: implementação de um programa formal de educação; distribuição de algoritmos manuais de insulinoterapia endovenosa - otimizados pelos utilizadores, a partir do protocolo de Yale modificado - e formação informal da equipe de enfermagem. Foi dado apoio à utilização dos sistemas eletrônicos de controle glicêmico e do registo prospetivo dos resultados. RESULTADOS: A primeira fase do programa (educação formal) melhorou o tempo no intervalo euglicêmico (28% para 37%). A segunda fase permitiu atingir 66% do tempo de euglicemia, com diminuição das hipoglicemias. A percentagem de doentes sob perfusão endovenosa de insulina às 48 horas de internamento aumentou (6% para 35%). CONCLUSÃO: A implementação faseada de um programa formal de educação que favoreceu a aplicação de protocolos de insulinoterapia eletrônicos e manuais dinâmicos demonstrou ter aderência e ser segura e eficaz no controle glicêmico no doente crítico, com diminuição concomitante das hipoglicemias.

Spontaneous Tumor Lysis Syndrome: A Rare Presentation in Plasmablastic Lymphoma.

Tumor lysis syndrome is an oncological emergency, which can ultimately lead to death if not recognized early and treated accordingly. The institution of adequate prophylactic measures can decrease its incidence and severity; but very rarely, a highly aggressive neoplasm such as acute lymphoblastic leukemia or Burkitt's lymphoma can present with spontaneous tumor lysis syndrome (sTLS). We present the case of a 58-year-old male with newly diagnosed plasmablastic lymphoma with a retroperitoneal bulky mass invading the bladder, who presented with severe sTLS and was admitted to an intensive care unit due to acute renal failure and hyperkalemia requiring emergent renal replacement therapy. With urgent chemotherapy, several hemodialysis sessions and rasburicase, all the metabolic derangements were corrected and the patient fully recovered a normal renal function. This report highlights the importance of early recognition of sTLS in any patient presenting with severe and de novo multiple metabolic derangements involving uric acid, phosphorus, calcium and creatinine, even in patients with tumors not usually presenting with this complication.

GlucoSTRESS - Projeto de otimização do controle glicêmico em uma unidade de cuidados intensivos portuguesa nível C (III) / GlucoSTRESS - A project to optimize glycemic control in a level C (III) Portuguese intensive care unit

RESUMO Objetivo: Duplicar a percentagem de tempo no intervalo glicêmico 100 - 180mg/dL nos primeiros 3 meses após implementação faseada de um programa de educação formal e, posteriormente, de um protocolo de insulinoterapia, sem condicionar um aumento da frequência de hipoglicemia. Métodos: Foi feita a avaliação retrospetiva do controle glicêmico pré-intervenção. Foram realizados: implementação de um programa formal de educação; distribuição de algoritmos manuais de insulinoterapia endovenosa - otimizados pelos utilizadores, a partir do protocolo de Yale modificado - e formação informal da equipe de enfermagem. Foi dado apoio à utilização dos sistemas eletrônicos de controle glicêmico e do registo prospetivo dos resultados. Resultados: A primeira fase do programa (educação formal) melhorou o tempo no intervalo euglicêmico (28% para 37%). A segunda fase permitiu atingir 66% do tempo de euglicemia, com diminuição das hipoglicemias. A percentagem de doentes sob perfusão endovenosa de insulina às 48 horas de internamento aumentou (6% para 35%). Conclusão: A implementação faseada de um programa formal de educação que favoreceu a aplicação de protocolos de insulinoterapia eletrônicos e manuais dinâmicos demonstrou ter aderência e ser segura e eficaz no controle glicêmico no doente crítico, com diminuição concomitante das hipoglicemias.

ABSTRACT Objective: To double the percentage of time within the 100 - 180mg/dL blood glucose range in the first three months following a phased implementation of a formal education program, and then, of an insulin therapy protocol, without entailing an increased incidence of hypoglycemia. Methods: The pre-intervention glycemic control was assessed retrospectively. Next, were carried out the implementation of a formal education program, distribution of manual algorithms for intravenous insulin therapy - optimized by the users, based on the modified Yale protocol - and informal training of the nursing staff. The use of electronic blood glucose control systems was supported, and the results were recorded prospectively. Results: The first phase of the program (formal education) lead to improvement of the time within the euglycemic interval (28% to 37%). In the second phase, euglycemia was achieved 66% of the time, and the incidence of hypoglycemia was decreased. The percentage of patients on intravenous insulin infusion at 48 hours from admission increased from 6% to 35%. Conclusion: The phased implementation of a formal education program, fostering the use of electronic insulin therapy protocols and dynamic manuals, received good adherence and has shown to be safe and effective for blood glucose control in critically ill patients, with a concomitant decrease in hypoglycemia.

Respiratory viruses in mechanically ventilated patients: a pilot study.

BACKGROUND: Respiratory virome is an integral part of the human microbiome and its characterization may contribute to a better understanding of the changes that arise in the disease and, consequently, influence the approach and treatment of patients with acute lower respiratory infections. The aim of this study was to evaluate the presence of respiratory viruses in the lower airways of individuals undergoing invasive mechanical ventilation, with and without acute lower respiratory infection (respectively WRI and WORI groups). METHODS: We studied 44 mini-bronchoalveolar lavage samples (collected with a double catheter, Combicath® kit) from patients with mean age in the seventh decade, 20 from WORI group and 24 from WRI group, who were hospitalized for acute respiratory failure in Intensive Care Units of two hospitals in the Lisbon area. Real-time PCR was applied to verify analyse the presence of 15 common respiratory viruses (adenovirus, human bocavirus, influenza virus A and B, repiratory syncytial virus, human parainfluenza virus types 1, 2, 3 and 4, human enterovirus, human rhinovirus, human metapneumovirus, human coronavirus group 1 (229E, NL63) and 2 (OC43, HKU1). RESULTS: Respiratory viruses were detected in six of the 20 patients in the WORI group: influenza AH3 (n = 2), parainfluenza virus 1/3 (n = 2), human rhinovirus (n = 2), respiratory syncytial virus (n = 1) and human metapneumovirus (n = 1). In the WRI group, respiratory viruses were detected in 12 of the 24 patients: influenza AH3 (n = 3), human rhinovirus (n = 3), respiratory syncytial virus (n = 3), human metapneumovirus (n = 3), human bocavirus (n = 2) and human enterovirus (n = 1). Simultaneous detection of two viruses was recorded in two samples in both groups. CONCLUSIONS: The results of this study suggest the presence of common respiratory viruses in the lower respiratory tract without causing symptomatic infection, even in carefully collected lower samples. This may have important implications on the interpretation of the results on the diagnostic setting.

Spindle Coma in the Intensive Care Unit: Different Aetiologies - Different Outcomes.

Spindle coma is an electroclinical entity that has been used to describe an EEG pattern of "sleep-like" activity in comatose patients. Although it has been associated with favourable prognosis, its aetiology is one of the key factors for patient outcome. The authors present three cases of spindle coma with different aetiologies (amitriptyline overdose, pontine myelinolysis and hypoxic-ischaemic encephalopathy) that culminated in different outcomes. LEARNING POINTS: Spindle coma (SC) is an electroclinical "sleep-like" pattern that appears in comatose patients.It implies the functional preservation of the cerebral hemispheres which can be associated with a good prognosis.The aetiology of SC is a key factor for outcome.

Eustachian Valve Endocarditis: Echocardiographic Diagnosis in a Critical Care Patient.

Eustachian valve endocarditis is rare. A literature review revealed that only 29 cases have been reported and, among them, there is only one mention of an intensive care unit (ICU) admission. We present an 82-year-old man without previous medical records who presented with septic shock with multiple organ dysfunction. The patient was admitted to the ICU and deteriorated with combined shock (septic + cardiogenic). A second ultrasound screen detected a prominent Eustachian valve with mobile multilobulated vegetation attached. Transesophageal echocardiography confirmed a 12 mm oscillating mass attached to a visible Eustachian valve.

[Delirium in the Intensive Care Unit]. / Delirium na Unidade de Cuidados Intensivos.

Delirium is the more common form of acute cerebral dysfunction in Intensive Care Unit (ICU), characterized by transitory and alternate changes in conscience and cognitive impairment that occur with physical disease. The incidence in ICU is high, reaching 89% of the patients. The diagnosis is exclusively clinic and could be used any one of the validated scales: Confusion Assessment Method for the ICU (CAM-ICU) or Intensive Care Delirium Screening Check-list (ICDSC), which should be applied, at least, once per shift by trained professionals. Its treatment and, more important, its prevention are known for several years. Currently there are new, safer and more effective therapeutic strategies for Haloperidol, such as Dexmedetomidine. Two new definitions of Delirium exist, besides the usual (hiperactive, hipoactive, mixed), which are: Subsyndromal Delirium and Delirium Superimposed on Dementia. Although they don't have all the same risks, the occurrence of Delirium in general leads to a decrease in cognitive function at long term and to a higher mortality. In spite of that, only 33% of the intensivists actively seek diagnoses of Delirium.

O Delirium é a forma mais comum de disfunção cerebral aguda na Unidade de Cuidados Intensivos (UCI), caracterizada por alterações da consciência transitórias e flutuantes e compromisso cognitivo que ocorrem com a doença física. Tem elevada incidência na UCI, atingindo 89% dos doentes. O seu diagnóstico é exclusivamente clínico, podendo usar-se qualquer uma das escalas validadas para este meio: Confusion Assessment Method for the ICU (CAM-ICU) ou Intensive Care Delirium Screening Check-list (ICDSC), as quais devem ser aplicadas, pelo menos, uma vez por turno, por uma equipa treinada. O seu tratamento e, principalmente, a sua prevenção, são conhecidos há vários anos. Actualmente existem novas estratégias terapêuticas mais seguras e eficazes em relação ao Haloperidol como a Dexmedetomidina. Existem duas novas definições de Delirium além das habituais (hiperativo, hipoativo, misto): o Delirium subsindromático e o Delirium sobreposto à Demência. Embora não tenham todas os mesmos riscos, a ocorrência de Delirium no geral associa-se a diminuição da função cognitiva a longo-prazo e a maior mortalidade. Apesar disso, apenas 33% dos intensivistas procura ativamente diagnosticar o Delirium.

Soluble CD40 ligand profiles in patients with septic shock.

AIM: Soluble CD40 ligand (sCD40L) has been considered as a marker of thrombosis and inflammation in several diseases, including sepsis. Recent studies challenge this view and point to a role of sCD40L in vascular and endothelial function. An indication of that association in sepsis has not been obtained so far. Therefore, herein we evaluated association between sCD40L and markers of hemorheology and inflammation on context of septic shock. METHODS: Time-changes of sCD40L levels over 72 hours of Intensive Care Unit (ICU) internment were assessed in 22 patients with septic shock and compared with 36 healthy volunteers. Association of sCD40L levels with erythrocyte deformability and aggregation (as markers of hemorheology), plasma concentrations of haemoglobin (Hb, as markers of endothelial function) and white blood cells (WBC) count (as marker of low-grade inflammation) were assessed in patients with septic shock. RESULTS: At ICU admission, sCD40L concentrations in patients with septic shock were lower (p = 0.024) than levels of healthy volunteers. However, sCD40L did not change over 72 hours of internment (F = 2.1, p = 0.137). Soluble CD40L levels in patients with septic shock at ICU admission correlate with concentrations of Hb (r = 0.61, p = 0.00) and WBC count (r = 0.63, p = 0.00), but not to erythrocyte deformability (r≥0.157, p≤0.235) and aggregation (r≥-0.109, p≤0.192). CONCLUSIONS: These results seem to highlight a possible association of sCD40L to endothelial function and inflammation in septic shock context.

Morfologia e morfometria da traqueia da preguiça (bradypus variegatus): conhecimentos para procedimentos de emergência / Morphological and morphometric trachea sloth (bradypus variegatus): knowledge for emergency procedures

Por ser uma espécie pouco estudada, principalmente do ponto de vista morfológico, objetivou-se conhecer a anatomia da traqueia da preguiça (Bradypus variegatus) a fim de fornecer informações para facilitar a eleição de tubo endotraqueal adequado, máscara laríngea ou cânula de traqueostomia para anestesia e procedimentos de emergência, uma vez que a mesma revelou-se possuidora de uma morfologia especial. Foram investigados 11animais jovens de idades diferentes, sendo quatro machos e sete fêmeas, provenientes do Museu Emilio Goeldi e doados a UFRA. Os exemplares foram perfundidos via intramuscular com solução aquosa de formol a 10% para fins de conservação e posteriormente foram dissecados em nível cervico-torácico, por meio de mesoscopia, expondo-se desde a laringe até os brônquios principais direito e esquerdo ao nível do hilo pulmonar. As traqueias foram divididas em cinco regiões (região cervical, região da primeira flexura, região da segunda flexura, região da terceira flexura e região da carina) as quais foram mensuradas altura e largura, assim como o comprimento traqueal total e parte do material foi submetido à técnicas de rotina histológica. Macroscopicamente, destacou-se a presença de sinuosidades acentuadas em porção médio caudal, contemplando a carina. O comprimento médio traqueal foi de 14,6cm. Microscopicamente, a traqueia era constituída por placas separadas de cartilagem hialina constituindo cada anel, sendo revestido por epitélio estratificado ciliado. Apesar da traqueia da preguiça comum apresentar revestimento padrão encontrado na traqueia de outros animais, na literatura não há registros de outras espécies que tenham morfologia macroscópica nas condições descritas, o que nos leva a sugerir, quando necessário acesso para ventilação de emergência, a prática da IOT e não a de traqueostomia.

As the sloth (Bradypus variegatus) is a little studied species, especially from a morphological point of view, this research aimed to define the anatomy of its trachea. The information would facilitate the selection of a proper endotracheal tube, laryngeal mask or tracheostomy tube for anesthesia and emergency procedures, since it appeared to have a special morphology. Eleven young animals of different ages were investigated, four males and seven females, obtained from the Emilio Goeldi Museum and donated to UFRA. The specimens were infused intramuscularly with 10% aqueous formaldehyde for preservation and were later dissected at the cervico-thoracic level, by mesoscopia, exposing the area from the larynx to the right and left primary bronchi at the hilum. The tracheae were divided into five regions (cervical, first flexure, second flexure, third flexure, and carina) for which length and width were measured, as well as the total tracheal length. Sharp windings were seen in the middle caudal portion, including the carina. The average tracheal length was 14.6 cm. Microscopically, the trachea was made up of separate plates of hyaline cartilage forming each ring, lined with ciliated epithelium. Despite the trachea of the common sloth displaying the same lining pattern found in other animals, there are no reports in the literature of other species having a macroscopic morphology as described here, which leads us to suggest, where appropriate access to emergency ventilation, the practice of IOT and not tracheostomy.

Genotypic interactions of renin-angiotensin system genes in myocardial infarction.

BACKGROUND: Three-gene interactions among the genetic polymorphisms of the renin-angiotensin system (RAS) associated with acute myocardial infarction (AMI) have not been examined in a single population. We hypothesized that all types of gene-to-gene associations may occur in AMI, but that some will have a higher risk, depending on the gene frequencies. METHODS: Polymorphisms of the AGT (M235T), ACE (I/D) and AGTR1 (A1166C) genes in AMI patients and controls were analyzed using the polymerase chain reaction. Classic coronary risk factors were analyzed in all individuals. RESULTS: Logistic regression analysis of these factors and the genetic polymorphisms demonstrated that smoking, family history of CAD, arterial hypertension and total cholesterol were the most significant contributors to AMI. The genotypic frequencies for all three genes alone were similar between the infarction and control groups, with no increased risk of developing AMI. Double homozygous combinations for normal alleles (MM of AGT, II of ACE and AA of AGTR1) had a lower risk of AMI (odds ratio<0.38), indicating a protective effect in these individuals. In genotypic combinations that included at least one unfavorable allele, the risk (odds ratio) of developing AMI was 2.92, 2.63 and 2.68 for AGT vs. ACE, AGT vs. ATR1 and ACE vs. AGTR1, respectively. The positive interaction among the three genes and the risk of AMI had an odds ratio of 3.78 with a 95% CI of 0.88-12.85. CONCLUSIONS: The risk of developing AMI is higher whenever there are unfavorable alleles in gene-to-gene associations in the RAS.

[The angiotensinogen gene (M235T) and the acute myocardial infarction]. / O gene do angiotensinogênio (M235T) e o infarto agudo do miocárdio.

OBJECTIVE: To study the effect of the angiotensinogen gene M235T polymorphism on coronary artery disease and its severity in patients with and without acute myocardial infarction. METHODS: A cross sectional study was carried out with 305 Caucasians who were divided into two groups. One group with 201 patients with coronary artery disease proven by coronary angiography (obstructive lesion > 50%) was further divided into two subgroups; 110 patients with acute myocardial infarction and 91 without it. The control group consisted of 104 individuals with normal coronary arteries. Three angiographic criteria were evaluated to determine severity of the coronary artery disease: number of diseased vessels, morphology of the atherosclerosis plaque and jeopardy score. Risk factors were also analyzed. Gene polymorphism was evaluated by the polymerase chain reaction followed by restriction endonuclease digestion. RESULTS: The angiotensinogen gene TT, MT and MM genotypic frequencies were neither statistically different between coronary artery disease patients and controls (chi-square = 0.123; p = 0.939) nor between the acute myocardial infarction subgroup (chi-square = 2.171; p = 0.338). The coronary artery disease and acute myocardial infarction risk analyzed between TT vs. MM, MT vs. MM and TT+MT vs. MM genotypes were not significant. The severity of atherosclerotic disease analysis within the group of patients with coronary artery disease showed no correlation with the genotypes. Similar results were found between groups with and without acute myocardial infarction. CONCLUSIONS: No association was found between the angiotensinogen gene M235T polymorphism and coronary artery disease, neither with its severity nor with acute myocardial infarction.

O gene do angiotensinogênio (M235T) e o infarto agudo do miocárdio / The angiotensinogen gene (M235T) and the acute myocardial infarction

OBJETIVO: Estudar o efeito do polimorfismo M235T do gene do angiotensinogênio na doença arterial coronariana e na sua gravidade em pacientes com e sem infarto agudo do miocárdio. MÉTODOS: Estudo transversal com 305 indivíduos de raça branca que foram alocados em 2 grupos. O primeiro com 201 pacientes com doença arterial coronariana comprovada pela angiografia (lesão obstrutiva > 50 por cento), sendo 110 com infarto agudo do miocárdio e 91 sem infarto. O segundo, 104 indivíduos controles com artérias coronárias normais. O polimorfismo M235T do angiotensinogênio foi analisado através da genotipagem pela reação em cadeia da polimerase seguida da digestão pela enzima de restrição. RESULTADOS: A freqüência dos genótipos TT, MT e MM do angiotensinogênio não foi estatisticamente diferente entre os pacientes com doença arterial coronariana e os controles (chi2 = 0,123; p = 0,939) bem como nos grupos de infartados e não infartados (chi2 = 2,171; p = 0,338). O risco relativo de desenvolver doença arterial coronariana e de apresentar infarto analisado entre os genótipos TT vs MM, MT vs MM e TT+MT vs MM não foi significante. A análise da gravidade da doença aterosclerótica no grupo de pacientes com doença arterial coronariana mostrou não haver correlação com os genótipos; resultado semelhante foi encontrado na comparação entre os grupos com e sem infarto. CONCLUSÕES: Não há associação entre o polimorfismo M235T do gene do angiotensinogênio com a doença arterial coronariana, com a sua gravidade e nem com o infarto agudo do miocárdio.

The A1166C polymorphism of the angiotensin II type-1 receptor in acute myocardial infarction.

OBJECTIVE: To assess the association of the A1166C polymorphism of the angiotensin II type-1 receptor (AT1R) gene with acute myocardial infarction and also with the severity of coronary artery disease. METHODS: A prospective, cross-sectional study was carried out with 110 patients with acute myocardial infarction, who, on coronary angiography, had significant lesions (> 50%) assessed according to 3 criteria of severity: number of vessels affected, morphology of the atherosclerotic plaque, and coronary risk score. The control group comprised 104 individuals with no coronary lesions. The A1166C polymorphism of AT1R gene was determined by polymerase chain reaction in the DNA of leukocytes in peripheral blood. The classic coronary risk factors were analyzed in all individuals. RESULTS: When stratifying the genotypes in regard to risk factors, only smoking predominated in the AC heterozygous patients (P = 0.02). The genotypic frequency in the infarcted patients was as follows: AA = 54.5%; AC = 35.5%; and CC = 10%, which was similar and nonsignificant in regard to that in the control group (P = 0.83). No risk increase occurred for acute myocardial infarction when comparing the genotypes as follows: CC vs AA (OR = 1.35; 95% CI = 0.50 - 3.59); AC vs AA (OR = 1.03; 95% CI = 0.58 - 1.84); and AA+AC vs AA (OR = 1.33; 95% CI = 0.51 - 3.45). None of the severity criteria showed a significant correlation with the genotypes. CONCLUSION: According to our results, no correlation exists between the A1166C polymorphism of the angiotensin II type-1 receptor (AT1R) gene and acute myocardial infarction or the severity of coronary artery disease.

O polimorfismo A1166C do receptor tipo 1 da angiotensina II no infarto agudo do miocárdio / The A1166C polymorphism of the angiotensin II type-1 receptor in acute myocardial infarction

RESUMO OBJETIVO:Avaliar a associação do polimorfismo A1166C do gene do receptor AT1 da angiotensina II (AT1R) com o infarto agudo do miocárdio e a severidade da doença arterial coronariana. MÉTODOS: Estudo prospectivo, transversal de 110 pacientes com infarto agudo do miocárdio submetidos à angiografia coronariana com lesão significante (> 50 por cento) avaliada por três critérios de severidade: número de vasos lesados, morfologia da placa aterosclerótica e escore de risco coronariano. Sem lesões coronarianas 104 indivíduos controles. O polimorfismo A1166C do gene do AT1R foi determinado pela reação em cadeia da polimerase no DNA dos leucócitos do sangue periférico. Os fatores de risco coronariano clássicos foram analisados em todos os indivíduos. RESULTADOS: Na estratificação dos genótipos em relação aos fatores de risco apenas o tabagismo teve predominância nos heterozigotos AC (p = 0,02). A freqüência dos genótipos nos pacientes infartados foi de AA = 54,5 por cento; AC = 35,5 por cento e CC = 10 por cento, sendo similar e não significativa em relação aos controles (p = 0,83). Não houve aumento do risco de infarto agudo do miocárdio nas comparações dos genótipos CC vs AA (OR = 1,35; IC-95 por cento = 0,50 - 3,59), AC vs AA (OR = 1,03; IC-95 por cento = 0,58 - 1,84 e AA+AC vs AA (OR = 1,33; IC-95 por cento = 0,51 - 3,45). Nenhum dos critérios de severidade teve associação significativa com os genótipos. CONCLUSAO: Os nossos resultados indicam não haver associação do polimorfismo A1166C do AT1R com o infarto agudo do miocárdio e nem com a severidade da doença arterial coronariana segundo nossos resultados.