Clinical-epidemiological profile of health users who have undergone a Percutaneous Coronary Intervention / Perfil clínico-epidemiológico de usuários de saúde submetidos à Intervenção Coronária Percutânea

Background: Coronary artery disease represents the condition with the highest prevalence worldwide. The treatment of this disease is through Percutaneous Coronary Intervention (PCI). Aiming: To outline the clinical epidemiological profile of health users who have undergone PCI, in a Hospital in the state of Rio Grande do Sul. Methods: Exploratory research, with a quantitative approach carried out on 188 medical records of health users who were submitted to elective or emergency PCI, with the use of stents or not in the year 2018. Values of p <0.05 represented significant statistical differences. Results: Users with a diagnosis of unstable angina (n = 16; 17.8%), diagnostic symptoms of unstable angina (n = 61; 67.8%) and a diagnosis of angina pectoris (n = 52; 57.8%) presented significantly more likely to be submitted to the PCI in elective way (p <0.001). Users diagnosed with Acute Myocardial Infarction - AMI (n = 59; 60.2%) and symptoms with evolution greater than 24 hours (n = 30; 30.6%) and less than 24 hours (n = 24; 24.5%), with dyslipidemia (n = 38; 38.8%) and who underwent catheterization on the same day (n = 87; 88.8%) are significantly more likely to perform emergency surgery (p <0.05). In addition, the data showed that the diagnosis of unstable angina potentiates new cardiomyopathies (n = 9, 47.4%; p <0.001) and restenosis (n = 5; 26.3%; p = 0.002). Conclusion: It is necessary to create strategies to strengthen the Health Care Network (HCN) with actions for prevention, promotion and rehabilitation to health, aiming quality in diagnosis, treatment and rehabilitation.

ntrodução: A doença arterial coronariana representa a afecção de maior prevalência mundial. O tratamento desta doença se dá pela intervenção coronária percutânea (ICP). Objetivo: Delinear o perfil clínico-epidemiológico dos usuários de saúde submetidos à ICP em um Hospital do estado do Rio Grande do Sul. Métodos: Pesquisa exploratória, de abordagem quantitativa realizada em 188 prontuários de usuários de saúde submetidos à ICP eletiva ou de urgência com uso de stent ou não no ano de 2018. Valores de p< 0,05 representaram diferenças estatísticas significativas. Resultados: Usuários com diagnóstico de angina instável (n=16; 17,8%), sintomas diagnósticos de angina instável (n= 61; 67,8%) e diagnóstico de angina pectoris (n=52; 57,8%) apresentaram significativamente maior probabilidade de serem submetidos à ICP em caráter eletivo (p<0,001). Usuários com diagnóstico para infarto agudo do miocárdio (n=59; 60,2%) e sintomatologia com evolução maior que 24 horas (n=30; 30,6%) e menor que 24 horas (n=24; 24,5%), com dislipidemia (n=38; 38,8%) e que fizeram cateterismo no mesmo dia (n=87; 88,8%) são significativamente mais propensos a realizar cirurgia de urgência (p<0,05). Além disso, os dados evidenciaram que o diagnóstico de angina instável potencializa novas cardiomiopatias (n=9, 47,4%; p<0,001) e reestenose (n=5; 26,3%; p= 0,002). Conclusão: É necessário criar estratégias para fortalecer a Rede de Atenção à Saúde (RAS) com ações de prevenção, promoção e reabilitação à saúde, visando a qualidade no diagnóstico, tratamento e reabilitação.

Clinical-epidemiological profile of health users who have undergone a Percutaneous Coronary Intervention / Perfil clínico-epidemiológico de usuários de saúde submetidos à Intervenção Coronária Percutânea

ABSTRACT: Background: Coronary artery disease represents the condition with the highest prevalence worldwide. The treatment of this disease is through Percutaneous Coronary Intervention (PCI). Aiming: To outline the clinical epidemiological profile of health users who have undergone PCI, in a Hospital in the state of Rio Grande do Sul. Methods: Exploratory research, with a quantitative approach carried out on 188 medical records of health users who were submitted to elective or emergency PCI, with the use of stents or not in the year 2018. Values of p <0.05 represented significant statistical differences. Results: Users with a diagnosis of unstable angina (n = 16; 17.8%), diagnostic symptoms of unstable angina (n = 61; 67.8%) and a diagnosis of angina pectoris (n = 52; 57.8%) presented significantly more likely to be submitted to the PCI in elective way (p <0.001). Users diagnosed with Acute Myocardial Infarction - AMI (n = 59; 60.2%) and symptoms with evolution greater than 24 hours (n = 30; 30.6%) and less than 24 hours (n = 24; 24.5%), with dyslipidemia (n = 38; 38.8%) and who underwent catheterization on the same day (n = 87; 88.8%) are significantly more likely to perform emergency surgery (p <0.05). In addition, the data showed that the diagnosis of unstable angina potentiates new cardiomyopathies (n = 9, 47.4%; p <0.001) and restenosis (n = 5; 26.3%; p = 0.002). Conclusion: It is necessary to create strategies to strengthen the Health Care Network (HCN) with actions for prevention, promotion and rehabilitation to health, aiming quality in diagnosis, treatment and rehabilitation. (AU)

RESUMO: Introdução: A doença arterial coronariana representa a afecção de maior prevalência mundial. O tratamento desta doença se dá pela intervenção coronária percutânea (ICP). Objetivo: Delinear o perfil clínico-epidemiológico dos usuários de saúde submetidos à ICP em um Hospital do estado do Rio Grande do Sul. Métodos: Pesquisa exploratória, de abordagem quantitativa realizada em 188 prontuários de usuários de saúde submetidos à ICP eletiva ou de urgência com uso de stent ou não no ano de 2018. Valores de p< 0,05 representaram diferenças estatísticas significativas. Resultados: Usuários com diagnóstico de angina instável (n=16; 17,8%), sintomas diagnósticos de angina instável (n= 61; 67,8%) e diagnóstico de angina pectoris (n=52; 57,8%) apresentaram significativamente maior probabilidade de serem submetidos à ICP em caráter eletivo (p<0,001). Usuários com diagnóstico para infarto agudo do miocárdio (n=59; 60,2%) e sintomatologia com evolução maior que 24 horas (n=30; 30,6%) e menor que 24 horas (n=24; 24,5%), com dislipidemia (n=38; 38,8%) e que fizeram cateterismo no mesmo dia (n=87; 88,8%) são significativamente mais propensos a realizar cirurgia de urgência (p<0,05). Além disso, os dados evidenciaram que o diagnóstico de angina instável potencializa novas cardiomiopatias (n=9, 47,4%; p<0,001) e reestenose (n=5; 26,3%; p= 0,002). Conclusão: É necessário criar estratégias para fortalecer a Rede de Atenção à Saúde (RAS) com ações de prevenção, promoção e reabilitação à saúde, visando a qualidade no diagnóstico, tratamento e reabilitação. (AU)

Fatores sociodemográficos e de saúe associados à fragilidade em idosos / Sociodemographic and health factors associated with elderly frailty

Identificar os fatores sociodemográficos e de saúde associados à fragilidade em idosos que buscam assistência em um serviço de pronto atendimento. Estudo quantitativo e transversal desenvolvido com idosos de idade igual ou maior a 60 anos e que apresentassem condições de deambulação com ou sem auxílio. Foram coletados dados sociodemográficos e avaliado os níveis de fragilidade pela Escala de Fragilidade de Edmonton. A análise dos dados ocorreu pela estatística descritiva e analítica. Dos 163 idosos, a maioria foi classificada como frágil (81,60%), onde 79 (59,40%) idosos apresentavam fragilidade severa. Os fatores de risco para a fragilidade após a análise multivariada foram idade, estado civil, arranjo domiciliar, renda mensal, uso de medicações, doenças infecciosas, neoplasias e internação no último ano. A identificação de um percentual elevado de idosos classificados como frágeis demonstra a importância da avaliação precoce e contínua dos idosos inseridos na sociedade, garantindo uma melhor abordagem sobre o tema na prática clínica e melhores desfechos da fragilidade.(AU)

This paper aims to identify the sociodemographic and health factors associated with frailty in the elderly seeking assistance in an emergency service. A quantitative and cross-sectional study was developed with elderly between the ages of 60 years or older and who presented walking conditions with or without assistance. W collected sociodemographic data from the elderly and the frailty levels were evaluated by the Edmonton Frail Scale. The data analysis was performed using descriptive and analytical statistics. Of the 163 older adults, most were classified as frail (81.60%), where 79 (59.40%) elderly presented severe frailty. Factors associated with frailty after multivariate analyses were: age, marital status, house-hold arrangement, monthly income, use of medication, infectious diseases, neoplasms, and hospitalization in the last year. The identification of a high percentage of elderly classified as fragile demonstrates the importance of early and continuous evaluation of the elderly inserted in society, using a better approach on the subject in clinical practice and the best outcomes of frailty.(AU)

Evaluation of the treatment with resveratrol-loaded nanoparticles in intestinal injury model caused by ischemia and reperfusion.

The gastrointestinal tract is extremely sensitive to ischemia and reperfusion (I/R). Studies have reported that resveratrol (RSV) is able to combat damage caused by intestinal I/R. Because of its effectiveness in increasing the permanence and bioavailability of resveratrol in the intestinal epithelium, we investigated whether the effect of resveratrol-loaded in poly(anhydride) nanoparticles reduce oxidative stress and promote myenteric neuroprotection in the ileum of rats subjected to I/R. Physicochemical evaluations were performed on nanoparticles. The animals were divided into nine groups (n = 6/group) and treated every 48 h. Treatments with resveratrol (7 mg/kg of body weight) were applied 5 days before surgery and continued for 7 days after surgery (reperfusion period). The superior mesenteric artery was occluded to cause I/R injury. Oxidative stress, myeloperoxidase, nitrite, aspartate aminotransferase, alanine aminotransferase, immunolabeling of myenteric neurons and glial cells, and gastrointestinal transit was evaluated. Both nanoparticle formulations presented negative charge with homogeneous distribution, and the payload, showed an encapsulation efficiency of 60%. Resveratrol administered in free form prevented alterations that were caused by I/R. The results of the groups treated with RSV-loaded nanoparticles presented similar results to the group treated with free resveratrol. Treatment with empty nanoparticles showed that poly(anhydride) is not an ideal nanocarrier for application in in vivo models of intestinal I/R injury, because of hepatotoxicity that may be caused by epithelial barrier dysfunction that triggers the translocation of nanoparticles.

O efeito do uso de antioxidantes na prevenção e tratamento da neuropatia diabética no sistema nervoso entérico / The use of antioxidants in the prevention and treatment of diabetic neuropathy in the enteric nervous system

O Diabetes mellitus (DM) é um distúrbio metabólico, complexo e de etiologia múltipla. Esta doença causa prejuízos aos sistemas vasculares e nervosos que se manifestam na forma de macro e microangiopatias e neuropatias diabéticas com alta incidência e prevalência na população mundial. Entre as neuropatias existentes, a neuropatia autonômica afeta o trato gastrointestinal (TGI) e caracteriza-se por alterações degenerativas em componentes do sistema nervoso entérico, como neurônios e células gliais. Consequentemente, ocorrem modificações na secreção e motilidade do TGI que são responsáveis por sintomas comuns da doença, tais como náuseas, inchaço, dor abdominal, diarreia, entre outros. Estudos experimentais e clínicos sugerem que o estresse oxidativo esteja envolvido na patogênese e na progressão da neuropatia diabética autonômica no sistema nervoso entérico. Assim, compostos antioxidantes que previnem a formação e/ou neutralizam os radicais livres oriundos do estresse oxidativo podem ter um papel relevante no tratamento das complicações neurológicas do diabetes mellitus. Neste artigo, realizou-se uma revisão da literatura sobre os principais aspectos, quadro clínico e patogênese do DM e a ocorrência da neuropatia diabética autônoma no sistema nervoso entérico, abordando as principais pesquisas que empregaram antioxidantes para prevenir e/ou tratar os danos neurológicos que são consequências desta patologia.

Diabetes mellitus (DM) is a metabolic complex disorder of multiple etiology. This disease causes damage to the vascular and nervous systems that are seen as macro- and microangiopathies and diabetic neuropathies, with high incidence and prevalence in the world population. Among the existing neuropathies, the autonomic neuropathy affects the gastrointestinal (GI) tract and is characterized by degenerative changes in components of the enteric nervous system, such as neurons and glial cells. Accordingly, changes occur in secretion and motility of the GIT, which are responsible for common symptoms, such as nausea, bloating, abdominal pain, diarrhea, among others. Experimental and clinical studies suggest that oxidative stress is involved in the pathogenesis and progression of autonomic diabetic neuropathy in the enteric nervous system. Thus, antioxidant compounds that prevent the formation and/or neutralize free radicals derived from oxidative stress may play a role in the treatment of neurological complications of diabetes mellitus. In this article, a literature review is performed on the main aspects of the clinical presentation and the pathogenesis of diabetes and autonomous diabetic neuropathy in the enteric nervous system. It also addresses the main research employing antioxidants to prevent and/or treat neurological damages that are consequences of this disease.

Intestinal and neuronal myenteric adaptations in the small intestine induced by a high-fat diet in mice.

BACKGROUND: The prevalence of obesity has increased at alarming rates, particularly because of the increased consumption of high-fat diets (HFDs). The influence of HFDs on intrinsic innervation and the intestinal wall has not been fully characterized. The aim of this study was to investigate the morpho-quantitative aspects of myenteric neurons and the wall of the small intestine in mice fed a HFD. METHODS: Swiss mice were fed a HFD (59% kcal from fat) or standard chow (9% Kcal from fat) for 8 weeks. Segments of the duodenum, jejunum, and ileum were subjected to histological processing for morpho-quantitative examination of the intestinal wall and mucosal cells, and immunohistochemistry was performed to evaluate myenteric neurons. The data for each segment were compared between the groups using an unpaired Student's t-test or an equivalent nonparametric test. RESULTS: The HFD increased body weight and visceral fat and decreased the length of the small intestine and the circumference of the ileum. In the duodenum, the HFD increased the density of the nitrergic subpopulation and decreased the area of nitrergic neurons and vasoactive intestinal peptide (VIP) varicosities. In the jejunum, the density of the nitrergic subpopulation was increased and the neuronal areas of the general population, nitrergic subpopulation and (VIP) varicosities were reduced. In the ileum, the density of the general population and nitrergic subpopulation were increased and the neuronal areas of the general population, nitrergic subpopulation and (VIP) varicosities were reduced. The morphometric parameters of the villi, crypts, muscular layer and total wall generally increased in the duodenum and jejunum and decreased in the ileum. In the duodenum and jejunum, the HFD promoted a decreased in the proportion of intraepithelial lymphocytes. In the ileum, the proportion of intraepithelial lymphocytes and goblet cells reduced, and the enteroendocrine cells increased. CONCLUSIONS: The high-fat diet induces changes in the myenteric innervation of the small intestine, intestinal wall and mucosal cells responsible for the secretion of hormones and maintenance of the protective intestinal barrier. The morpho-quantitative data provide a basis for further studies to clarify the influence of HFD in the motility, digestive and absorptive capacity, and intestinal barrier.

Diabetic neuropathy: an evaluation of the use of quercetin in the cecum of rats.

AIM: To investigate the effect of quercetin supplementation on the myenteric neurons and glia in the cecum of diabetic rats. METHODS: Total preparations of the muscular tunic were prepared from the ceca of twenty-four rats divided into the following groups: control (C), control supplemented with quercetin (200 mg/kg quercetin body weight) (CQ), diabetic (D) and diabetic supplemented with quercetin (DQ). Immunohistochemical double staining technique was performed with HuC/D (general population)/nitric oxide synthase (nNOS), HuC-D/S-100 and VIP. Density analysis of the general neuronal population HuC/D-IR, the nNOS-IR (nitrergic subpopulation) and the enteric glial cells (S-100) was performed, and the morphometry and the reduction in varicosity population (VIP-IR) in these populations were analyzed. RESULTS: Diabetes promoted a significant reduction (25%) in the neuronal density of the HuC/D-IR (general population) and the nNOS-IR (nitrergic subpopulation) compared with the C group. Diabetes also significantly increased the areas of neurons, glial cells and VIP-IR varicosities. Supplementation with quercetin in the DQ group prevented neuronal loss in the general population and increased its area (P < 0.001) and the area of nitrergic subpopulation (P < 0.001), when compared to C group. Quercetin induced a VIP-IR and glial cells areas (P < 0.001) in DQ group when compared to C, CQ and D groups. CONCLUSION: In diabetes, quercetin exhibited a neuroprotective effect by maintaining the density of the general neuronal population but did not affect the density of the nNOS subpopulation.

Neuroprotective effect of quercetin on the duodenum enteric nervous system of streptozotocin-induced diabetic rats.

BACKGROUND: In diabetes mellitus (DM), hyperglycemia promotes changes in biochemical mechanisms that induce oxidative stress. Oxidative stress has been closely linked to adverse consequences that affect the function of the gastrointestinal tract caused by injuries to the enteric nervous system (ENS) that in turn cause neurodegeneration and enteric glial loss. Therapeutic approaches have shown that diet supplementation with antioxidants, such as quercetin, reduce oxidative stress. AIMS: This work sought to evaluate neurons and enteric glial cells in the myenteric and submucosal plexuses of the duodenum in diabetic rats supplemented with quercetin. METHODS: The duodenum of 24 rats, including a control group (C), control quercetin supplementation group (CQ), diabetic group (D), and diabetic quercetin supplementation group (DQ), were used to investigate whole mounts of muscular and submucosal layers subjected to immunohistochemistry to detect vasoactive intestinal peptide in the myenteric layer and double-staining for HuC-D/neuronal nitric oxide synthase (nNOS) and HuC-D/S100. RESULTS: A reduction of the general neuronal population (HuC/D) was found in the myenteric and submucosal plexuses (p < 0.001) in the D and DQ groups. The nitrergic subpopulation (nNOS) decreased only in the myenteric plexus (p < 0.001), and glial cells decreased in both plexuses (p < 0.001) in the D and DQ groups. In diabetic rats, quercetin supplementation reduced neuronal and glial loss. Diabetes promoted an increase in the cell body area of both the general and nitrergic populations. Quercetin supplementation only prevented neuronal hypertrophy in the general population. CONCLUSION: Supplementation with quercetin eased the damage caused by diabetes, promoting a neuroprotective effect and reducing enteric glial loss in the duodenum.