RESUMO
BACKGROUND: This study evaluated the association of the ankle-brachial index (ABI) and cardiovascular complications after noncardiac surgery. METHODS: We prospectively evaluated patients referred for noncardiac surgery. The ABI was performed before surgery. Patients with abnormal ABI (≤ 0.9) were included in the peripheral artery disease (PAD) group and the remaining constituted the control group. Cardiac troponin and electrocardiogram were obtained 72 hours after surgery. Patients were followed up to 30 days, and primary end point was the occurrence of any cardiovascular event: cardiovascular death, acute coronary syndrome, isolated troponin elevation (ITE), decompensated heart failure, cardiogenic shock, unstable arrhythmias, nonfatal cardiac arrest, pulmonary edema, stroke, or PAD symptoms increase. RESULTS: We evaluated 124 patients (61.3% male; mean age 65.4 years). During the study, 57.9% of patients in the PAD group had an event versus 25.7% in the control group (P = .011). The ITE was the most observed event (24.2%). After logistic regression, the odds ratio for ITE was 7.4 (95% confidence interval 2.2-25.0, P = .001). CONCLUSIONS: In patients submitted to noncardiac surgery, abnormal ABI is associated with a higher occurrence of a cardiovascular event.
Assuntos
Índice Tornozelo-Braço , Doenças Cardiovasculares/etiologia , Doença Arterial Periférica/diagnóstico , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Idoso , Biomarcadores/sangue , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/mortalidade , Eletrocardiografia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/complicações , Doença Arterial Periférica/fisiopatologia , Valor Preditivo dos Testes , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Procedimentos Cirúrgicos Operatórios/mortalidade , Fatores de Tempo , Resultado do Tratamento , Troponina/sangue , Regulação para CimaAssuntos
Anticoagulantes/uso terapêutico , Doenças Cardiovasculares/tratamento farmacológico , Inibidores da Agregação Plaquetária/uso terapêutico , Síndrome Coronariana Aguda/tratamento farmacológico , Fibrilação Atrial/tratamento farmacológico , Brasil , Doença de Chagas/tratamento farmacológico , Feminino , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Ataque Isquêmico Transitório/tratamento farmacológico , Infarto do Miocárdio/tratamento farmacológico , Período Perioperatório , Sociedades Médicas , Acidente Vascular Cerebral/tratamento farmacológico , Tromboembolia Venosa/tratamento farmacológicoAssuntos
Humanos , Doenças Cardiovasculares/cirurgia , Complicações Intraoperatórias/prevenção & controle , Assistência Perioperatória/normas , Anticoagulantes/uso terapêutico , Brasil , Doenças Cardiovasculares/diagnóstico , Eletrocardiografia/normas , Monitorização Intraoperatória/métodos , Revascularização Miocárdica/normas , Alta do Paciente/normas , Período Perioperatório/normas , Inibidores da Agregação Plaquetária/uso terapêutico , Medição de Risco , Sociedades MédicasAssuntos
Humanos , Feminino , Anticoagulantes/uso terapêutico , Doenças Cardiovasculares/tratamento farmacológico , Inibidores da Agregação Plaquetária/uso terapêutico , Síndrome Coronariana Aguda/tratamento farmacológico , Fibrilação Atrial/tratamento farmacológico , Brasil , Doença de Chagas/tratamento farmacológico , Insuficiência Cardíaca/tratamento farmacológico , Ataque Isquêmico Transitório/tratamento farmacológico , Infarto do Miocárdio/tratamento farmacológico , Período Perioperatório , Sociedades Médicas , Acidente Vascular Cerebral/tratamento farmacológico , Tromboembolia Venosa/tratamento farmacológicoRESUMO
BACKGROUND AND AIMS: HDL-cholesterol (HDL-C) and non-HDL-cholesterol (nHDL-C) are involved in atherosclerosis. The aim of this study was to determine the distribution of HDL-C and nHDL-C and its association with cardiovascular and socio-cultural variables in a pediatric Brazilian sample. METHODS AND RESULTS: Children and adolescents from Florianopolis were randomly selected and a structured questionnaire was administered, a physical examination was performed and a blood sample was collected. Enzymatic and Direct methods in vitro were used to determine the total cholesterol and HDL-cholesterol levels. The associations among HDL-C and nHDL-C and the described variables were tested by odds ratio and logistic regression. A total of 1009 individuals were examined. Based on the Brazilian criteria, 23% were classified with low levels of HDL-C and 25% with high levels of non-HDL-C. After multivariate analysis there were significant associations among low HDL-C and high C-reactive protein (OR, 3.3; 95% CI, 2.1-5.2), paternal tobacco use (OR, 1.5; 95% CI,1.1-2.1), and high triceps-to-subscapular index (OR, 1.5; 95% CI, 1.1-2.2). There were also significant associations among high nHDL-C and high waist circumference (OR, 1.95; 95% CI, 1.16-3.29), black skin color (OR, 1.78; 95% CI, 1.06-3.06), and high income (OR, 1.48; 95% CI, 1.09-2.02). CONCLUSIONS: In this sample, low levels of HDL-C were associated with other clinical variables such as a centripetal fat pattern and C-reactive protein, and n-HDL-C was associated with abdominal obesity, skin color and economic class.
Assuntos
HDL-Colesterol/sangue , Colesterol/sangue , Adolescente , Fatores Etários , Aterosclerose/epidemiologia , População Negra , Pressão Sanguínea/fisiologia , Estatura/fisiologia , Peso Corporal/fisiologia , Brasil/epidemiologia , Criança , Cultura , Etnicidade , Feminino , Humanos , Modelos Logísticos , Masculino , Modelos Estatísticos , Razão de Chances , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
The relationship between dentistry and medicine has been acknowledged throughout the history of humanity. This relationship was documented in ancient medicine accounts, and has survived until the present day, accompanied by the evolution of molecular technologies. Although we have had very important researchers' contributions in this interdisciplinary area, mainly after the 18th century, the knowledge on oral infections is still ignored by or unknown to the majority of clinical dentists and physicians. These circumstances could be changed through a broader divulgation of this complex relationship, both in the dentistry and in the medicine areas, which in turn would have a significant impact in systemic health worldwide. This movement has already started, as was observed in a World Health Assembly resolution which called for oral health to be integrated into chronic disease prevention programs in 2007. This was a significant indicator of changing perceptions of oral health over the past several decades. This brief review reports the evolution through time of the knowledge on the association between dental infections and systemic diseases, as well as the paths which we could take to consolidate this historical trend.
Assuntos
Infecções Bacterianas/complicações , Infecção Focal Dentária/complicações , História da Odontologia , Doenças da Boca/complicações , Sepse/etiologia , Infecção Focal Dentária/microbiologia , História da Medicina , História do Século XVIII , História do Século XIX , História do Século XX , Humanos , Relações Interprofissionais , Doenças da Boca/microbiologiaRESUMO
OBJECTIVES: Although effective strategies for the prevention of venous thromboembolism (VTE) are widely available, a significant number of patients still develop VTE because appropriate thromboprophylaxis is not correctly prescribed. We conducted this study to estimate the risk profile for VTE and the employment of adequate thromboprophylaxis procedures in patients admitted to hospitals in the state of São Paulo, Brazil. METHODS: Four hospitals were included in this study. Data on risk factors for VTE and prescription of pharmacological and non-pharmacological thromboprophylaxis were collected from 1454 randomly chosen patients (589 surgical and 865 clinical). Case report forms were filled according to medical and nursing records. Physicians were unaware of the survey. Three risk assessment models were used: American College of Chest Physicians (ACCP) Guidelines, Caprini score, and the International Union of Angiololy Consensus Statement (IUAS). The ACCP score classifies VTE risk in surgical patients and the others classify VTE risk in surgical and clinical patients. Contingency tables were built presenting the joined distribution of the risk score and the prescription of any pharmacological and non-pharmacological thromboprophylaxis (yes or no). RESULTS: According to the Caprini score, 29% of the patients with the highest risk for VTE were not prescribed any thromboprophylaxis. Considering the patients under moderate, high or highest risk who should be receiving prophylaxis, 37% and 29% were not prescribed thromboprophylaxis according to ACCP (surgical patients) and IUAS risk scores, respectively. In contrast, 27% and 42% of the patients at low risk of VTE, according to Caprini and IUAS scores, respectively, had thromboprophylaxis prescribed. CONCLUSION: Despite the existence of several guidelines, this study demonstrates that adequate thromboprophylaxis is not correctly prescribed: high-risk patients are under-treated and low-risk patients are over-treated. This condition must be changed to insure that patients receive adequate treatment for the prevention of thromboembolism.
Assuntos
Anticoagulantes/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Operatórios , Tromboembolia/prevenção & controle , Trombose Venosa/prevenção & controle , Brasil , Estudos Transversais , Uso de Medicamentos , Fidelidade a Diretrizes , Hospitalização , Humanos , Auditoria Médica , Complicações Pós-Operatórias/etiologia , Guias de Prática Clínica como Assunto , Padrões de Prática Médica , Medição de Risco , Tromboembolia/etiologia , Trombose Venosa/etiologiaRESUMO
This study aimed to identify the associated variables of erectile dysfunction (ED) in post myocardial infarction (MI) patients without previous sexual dysfunction (SD). Out of the 37 patients, 15 (40%) had ED. Patients significantly reduced the frequency of coitus (P<0.05). Out of nine patients with distress, eight presented ED, and of 28 patients without distress, seven presented ED (89 versus 25%, P=0.001). The two groups (distress versus without distress) were similar regarding confounding variables. We concluded that patients without SD prior the MI had a significant incidence of ED and distress was an associated variable of ED post-infarction.
Assuntos
Disfunção Erétil/psicologia , Infarto do Miocárdio/psicologia , Estresse Psicológico , Adulto , Idoso , Coito/fisiologia , Coito/psicologia , Disfunção Erétil/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Comportamento SexualRESUMO
Hyperlipidemia has been frequently recorded as a side effect of treating HIV patients with protease inhibitors (PI). This study was initiated to analyze the modifications on blood lipids in HIV-patients receiving PI and the safety and efficacy of the treatment with fenofibrate. Total (TC) and HDL-cholesterol, triglycerides (TG), and CD(4)(+) T-cell counts were measured in 30 HAART-naive patients (Group I) before and after PI introduction. In a second phase of the study, the effects of fenofibrate on lipids, CPK, CD(4)(+), and viral load were determined in 13 patients (Group II) with elevated TC or TG. In Group I, 60% of the patients showed TC or TG elevations. Average increments of 31% and 146% in TC and TG respectively (p<0.0006 and p<0.0001) were observed. In Group II, fenofibrate treatment was associated with decrements of 6.6% (TC) and 45.7% (TG) (p=0.07 and 0.0002) and no modifications on CPK, CD(4)(+), and viral load. In conclusion, hyperlipidemia is common during the treatment of HIV with protease inhibitors, and fenofibrate appears to be an effective and safe choice for its treatment.
Assuntos
Fenofibrato/uso terapêutico , Infecções por HIV/tratamento farmacológico , Inibidores da Protease de HIV/efeitos adversos , Hiperlipidemias/tratamento farmacológico , Hipolipemiantes/uso terapêutico , Adulto , Idoso , Contagem de Linfócito CD4 , Colesterol/sangue , Feminino , HIV-1/fisiologia , Humanos , Hiperlipidemias/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Triglicerídeos/sangue , Carga ViralRESUMO
OBJECTIVE: To investigate the lipoprotein profile in a group of Alzheimer's disease (AD) patients. PATIENTS AND METHODS: Twenty-four patients with AD and 32 elderly controls were evaluated. Fasting blood samples were obtained for determination of total VLDL, HDL and LDL cholesterol, lipoprotein (a), triglycerides, apolipoprotein A1 and apolipoprotein B. RESULTS: Significantly higher levels of apolipoprotein B were found in AD patients (P = 0.004), whereas the concentration of lipoprotein (a) and plasma lipids was not statistically different. Apo B levels were similar between AD patients with or without leukoaraiosis on CT scan. CONCLUSION: AD patients had high serum concentration of apolipoprotein B. This finding suggests that apolipoprotein E may not be the single factor in lipid metabolism to play a role in AD pathogenesis.
Assuntos
Doença de Alzheimer/sangue , Apolipoproteínas B/sangue , Idoso , Doença de Alzheimer/diagnóstico , Encéfalo/diagnóstico por imagem , Infarto Cerebral/diagnóstico , HDL-Colesterol/sangue , LDL-Colesterol/sangue , VLDL-Colesterol/sangue , Feminino , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
Niacin treatment (alone) was compared with etofibrate and niacin combination to treat patients with high-density lipoprotein <35 mg/dl and without hypertriglyceridemia. The niacin and etofibrate combination proved to be safe and increased high-density lipoprotein cholesterol levels to 48%, which was 3 times higher than that obtained with niacin alone.
Assuntos
Anticolesterolemiantes/uso terapêutico , HDL-Colesterol/sangue , Ácido Clofíbrico/análogos & derivados , Doença das Coronárias/tratamento farmacológico , Niacina/uso terapêutico , Anticolesterolemiantes/administração & dosagem , Ácido Clofíbrico/administração & dosagem , Ácido Clofíbrico/uso terapêutico , Doença das Coronárias/sangue , Preparações de Ação Retardada , Esquema de Medicação , Sinergismo Farmacológico , Feminino , Humanos , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Niacina/administração & dosagem , Fatores de Tempo , Resultado do TratamentoRESUMO
We report a human immunodeficiency virus (HIV)-infected man with chronic Chagas' disease who developed a congestive heart failure that could not be clinically controlled. Endomyocardial biopsy revealed severe myocarditis and the xenodiagnosis result was positive, but Trypanosoma cruzi by direct microscopic examination of the blood was found only four months after the symptoms had started. Treatment with benznidazole was effective in reducing parasitemia, stabilizing the clinical status, and controlling tissue damage related to the parasite. Although the finding of T. cruzi trypomastigotes by direct microscopic examination of the blood has been considered the mark of Chagas' reactivation in immunocompromised patients with chronic disease, in this case it was a late finding.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/complicações , Doença de Chagas/complicações , Cardiopatias/complicações , Adulto , Animais , Doença de Chagas/parasitologia , Doença Crônica , Cardiopatias/parasitologia , Cardiopatias/patologia , Insuficiência Cardíaca/complicações , Humanos , Hospedeiro Imunocomprometido , Masculino , Miocardite/complicações , Miocardite/parasitologia , Miocardite/patologia , Recidiva , Trypanosoma cruzi/isolamento & purificaçãoRESUMO
This study aimed to clarify whether smoking had any influence on platelet aggregability in coronary patients with different lipoprotein abnormalities. We studied 297 non-diabetic patients with coronary heart disease, 40 to 85 years of age, 223 (75%) male, 167 smokers and 130 never smokers. After 3 months on Step-One diet, without any regular medication, patients had fasting plasma total cholesterol levels > or = 6.2 mmol/L; low-density lipoprotein > or = 4.14 mmol/L; and different levels of high-density lipoprotein and triglycerides. Platelet aggregation was analyzed by turbidometric method of Born. Patients were classified in groups of smokers and non-smokers. Results showed that platelet hyperaggregability was more prevalent in smokers with lower levels of high-density lipoprotein (47% vs. 20%; P=0.004 for spontaneous platelet aggregation, 56% vs. 33%; P=0.02 for adenosine diphosphate induced platelet aggregation), and in smokers with hypertrygliceridemia (64% vs. 29%; P=0.004 for spontaneous, 81% vs. 43%; P<0.0001 for adenosine diphosphate induced, and 87% vs. 46%; P<0.0001 for adrenaline induced platelet aggregation). Platelet hypoaggregability was greater in non-smokers with normal high-density lipoprotein and triglycerides plasma levels when compared to non-smokers with the same lipid profile (39% vs. 12%; P=0.004). In conclusion, smoking increased platelet reactivity in hypercholesterolemic patients with low high-density lipoprotein levels or high triglycerides levels.